Tramadol is on a different 'list' than the usual opioids, at least according to how my insurance handles it. I've been on it over a year and my pain specialist is not concerned about long term effects for me. She has a whole diatribe about long term NSAIDS, so if there were effects to be strongly concerned about, she would definitely have given me all the information and options. I would talk to your doctor about it before going off if you still need them.