Comparing Tramadol vs Vicodin for Treating Pain?

Summary: Tramadol and Vicodin are both considered opioid pain killers. They are both considered first line agents for the treatment of mild to moderate pain. Some doctors may be more comfortable with tramadol because it’s not a controlled substance and has less risk (theoretically) for abuse or developing dependency. I think this will change in a couple of years.

Dear Curtis: I had been prescribed Vicodin in the past for my back pain but my doctor said he doesn’t want me to be on that long term so he said he wanted to try Tramadol. How effective is Tramadol in treating pain compared to Vicodin?

Some resources (I use that term lightly) claim that a certain amount of tramadol is as effective as a certain amount of Vicodin or other pain killer. But, in my experience that isn’t fair to folks who are taking the drugs because everyone responds differently.

What I can tell you is that there are certain guidelines in the medical community when it comes to treating different types of pain. There are also different guidelines on how some doctors, pharmacies and even states treat tramadol and Vicodin.

Technically, tramadol (just like Vicodin) is an opioid pain killer. Meaning it’s in the top couple of tier’s of pain medications that your doctor has at his disposal. Also, because it is an opioid it also has the risk of dependency and abuse. But, because (as of the time of this writing) it’s not a controlled substance it’s easier for some doctor’s to write for.

I mention all this because judging how effective tramadol is at treating pain versus Vicodin is not only hard – it’s very subjective. So keep that in mind.

General Pain Killing Potential

To put things in perspective for you, let’s put yourself in your doctor’s shoes.

You have back pain. Your doctor has a number of different medications that he can put you on. Most likely, he will start with the safest drug that can hopefully treat your pain or, at the very least, make you more comfortable. This would be a step 1 medication. In this list of medications is things like ibuprofen, Tylenol and diclofenac.

If that doesn’t control it your doctor is then faced with moving up to step 2 drugs. Now this is where Vicodin and tramadol are introduced. Both are opioid pain killers. But, and this is the important part, in most references and clinical studies Vicodin is generally considered stronger than tramadol and more effective as a pain killer. But, it also depends on the type of pain being treated.

For example, Vicodin is notoriously ineffective at treating neuropathic pain. But tramadol (combined with drugs like amitriptyline) can often provide relief. However, when it comes to serious pain, like that associated with cancer or severe arthritis, both tramadol and Vicodin are lumped into step 2 drugs.

However, from a practical standpoint and feedback from lots of folks who’ve taken both drugs, I would have to say Vicodin is likely the more potent pain killer.

Why The Switch To Tramadol?

With that being said, why would your doctor take a ‘step back’ to tramadol? It could be any number of things but here are some likely scenario’s that you could discuss with him:

  1. He may be concerned about dependency developing with Vicodin. It’s a real possibility. I’ve seen it many times before. However, I’ve also seen it with tramadol. Remember, both drugs are considered opiates. While tramadol isn’t considered a controlled substance in the eyes of the DEA (Drug Enforcement Agency) I personally believe it will be there in the next couple of years.
  2. Your doctor may be concerned about your taking Tylenol. Vicodin is a combination of hydrocodone (the opioid pain killer in Vicodin) and Tylenol. That is the only way to get hydrocodone in this country is in combination with Tylenol. If you have any sort of concerns about liver damage then getting off Vicodin is a prudent thing to do.

Irregardless of why the switch was made it’s up to you to discuss it with your doctor and be honest with each other.

Too Long, Didn’t Read?

  • Tramadol and Vicodin are both opioid pain killers and, generally speaking, are both considered first line agents for the treatment of mild to moderate pain.
  • Vicodin is a controlled substance which means it is considered to have a higher potential for dependency and abuse. However, tramadol can produce the same sort of effects in my experience and I think within a couple of years it will be reclassified as a controlled substance.
  • Personally, I would consider Vicodin to be a more effective pain killer. But it also contains high amounts of Tylenol which can muddy the waters side effect wise – especially if you have any sort of liver conditions.


  1. Jost L, Roila F; ESMO Guidelines Working Group. Management of cancer pain: ESMO Clinical Practice Guidelines. Department of Oncology, Kantonsspital, Bruderholz, Switzerland. Ann Oncol. 2010 May;21 Suppl 5:v257-60.