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The statement, published in the journal Circulation, suggested that doctors urge patients to try exercise, orthotics, weight loss, physical therapy and hot or cold packs before turning to medication, especially nonsteroidal anti-inflammatory drugs, or NSAIDs such as naproxen and ibuprofen, and COX-2 inhibitors Celebrex to treat chronic pain. Ultram opioid activity derives from low affinity binding of the parent compound to opioid receptors and higher affinity binding of the M1 metabolite. The new guidelines follow several years of debate about the value, and potential danger, of such medications. Ultram is a narcotic-like pain reliever.

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