Imagine a safe and non-addictive pain medicine that is as good as morphine for mild to moderate pain. Sounds too good to be true, right? This is how tramadol is marketed and perceived—as a better opioid due to its excellent pain-relieving qualities coupled with a reduced risk of respiratory depression and low addictive potential. On paper, this sounds wonderful and should be a staple in any podiatrist’s post-operative pain course. However, digging deeper into the pharmacology of tramadol reveals something far more concerning.