Another opioid (or is it an opioid?) is Ultram (tramadol). This medication is frequently used for various types of pain and may or may not be a controlled substance based upon your location. It definitely has opioid activity so common side effects are the usual constipation, sedation etc. as other opioids. One of the unique and maybe unfortunate side effects of this medications is that it can lower seizure threshold. I’ve certainly had a case or two where the patient had a seizure and was on this medication…now how much of a role it played in their seizure, it is certainly difficult to tell. If there are other analgesic options for patients that have a seizure history, I guess why would you take that chance?