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Tramadol works by binding to opioid receptors in the brain and spinal cord, inhibiting the reuptake of norepinephrine and serotonin. Its dual mechanism of action contributes to its pain-relieving effects. Tramadol works by binding to opioid receptors in the brain and spinal cord, inhibiting the reuptake of norepinephrine and serotonin. Its dual mechanism of action contributes to its pain-relieving effects.