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Long-term use of high doses of tramadol will cause physical dependence and withdrawal syndrome.[27] These include both symptoms typical of opioid withdrawal and those associated with SNRI withdrawal; symptoms include numbness, tingling, paresthesia, and tinnitus.[28] Psychiatric symptoms may include hallucinations, paranoia, extreme anxiety, panic attacks, and confusion.[29] In most cases, tramadol withdrawal will set in 12–20 hours after the last dose, but this can vary.[28] Tramadol withdrawal typically lasts longer than that of other opioids. Seven days or more of acute withdrawal symptoms can occur as opposed to typically three or four days for other codeine analogues.[28]
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