Tramadol is a centrally acting analgesic that plays a unique role in chronic pain management due to its dual mechanism of action. Tramadol possesses weak μ-opioid receptor agonism and inhibition of norepinephrine and serotonin reuptake. This chapter provides an overview of tramadol’s pharmacology, clinical efficacy, dosing strategies, and safety considerations in the treatment of chronic pain conditions. It examines the drug’s role across a spectrum of pain types, including nociceptive and neuropathic pain, and highlights its utility in conditions such as osteoarthritis, fibromyalgia, and low back pain. The chapter also reviews tramadol’s pharmacokinetics, metabolism, as well as important considerations in special populations, including the elderly, individuals with hepatic or renal impairment, and pregnant or breastfeeding patients. By outlining both the therapeutic potential and limitations of tramadol, this chapter looks to equip clinicians with evidence-based knowledge to appropriately integrate tramadol into multimodal chronic pain treatment plans.