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Tramadol exerts its analgesic effect mainly through complementary mechanisms. First, it acts on opioid receptors in the central nervous system, modulating pain perception. This effect is enhanced by the formation of its active metabolite, (+)-M1, catalyzed by the enzyme CYP2D6. In addition, tramadol inhibits the reuptake of neurotransmitters such as serotonin and noradrenaline, increasing their availability in neuronal synapses.