Are there any pain killers as strong as tramadol?

Unsure if you mean: Over the counter or just generally? There are no otc meds as strong as tramadol. As for generally, it is a moderately strong pain medication but most of the narcotics are stepwise stronger than tramadol, but this does not mean they are more effective. Tramadol is a fairly safe and very effective pain medication. If you are noticing any side effects, speak with your physician. Hope that helps!