Tramadol is a centrally acting analgesic for the treatment of moderate to severe pain. It appears to have actions on the opioid receptor as well the noradrenergic and serotonergic systems(24, 25). In a double blind comparative trial tramadol caused weakness, a higher incidence of nausea, dizziness, loss of appetite compared with other opiates in patients with cancer(26). Seizures associated with intoxication and abuse of Tramadol have been reported(27). Tramadol is associated with the development of a physical dependence and withdrawal syndrome(28).