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The FDA approves the drug for the treatment of moderate to moderately severe chronic pain in adults such as back pain, fibromyalgia, and so on, which is the most well-known of the Tramadol uses. The drug itself has no activity on opioid receptors but instead works through the actions of one of its major metabolites O-desmethyl Tramadol. This activity at opioid receptors is the primary mechanism behind the analgesic properties of the medication. The parent drug also inhibits the reuptake of norepinephrine and serotonin, contributing to its analgesic properties.

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A woman banned from providing any sort of health service to the public faces a further 11-month wait for a trial over a death she's accused of causing - as a key witness in the case goes missing. 

Jie Shao was charged with manslaughter and using poison to endanger life after allegedly injecting tramadol, lidocaine and hyaluronic acid breast fillers to another woman.

Shao met Jean Huang through a mutual friend and allegedly performed the injections at Ms Huang's Medi Beauty Clinic at Chippendale in Sydney.

The 35-year-old went into cardiac arrest and was rushed to hospital, but died two days later in September 2017.

Shao is on bail while her trial has been beset by delays.

Jean Huang (pictured) after receiving breast filler injections

Shao (pictured) was charged with manslaughter and using poison to endanger life after allegedly injecting tramadol, lidocaine and hyaluronic acid breast fillers to Ms Huang

Key witnesses have left the country, and overseas authorities were not co-operative in having them give evidence via audiovisual link.

Almost two years ago, Shao's barrister Winston Terracini KC confirmed the defence case was 'ready to rock 'n' roll'.

Multiple dates for a trial have been set and passed, and Shao received another date on Wednesday.

Her three-week trial is scheduled to start on February 19, 2024.

A readiness hearing in December will make sure the trial is finally ready to proceed.

'For the moment that's a long way away and the matter has been around for a long time,' Judge Timothy Gartelmann said in the Downing Centre District Court on Wednesday.

'We need to have some real certainty about who will be available,' he said.

The Crown indicated it had lost contact with a witness.

'He's gone overseas. We'll be seeking his return to the state,' the crown prosecutor told the court.

Multiple dates for a trial have been set and passed as Shao's three-week trial is scheduled to start on February 19, 2024 (Shao with barrister Winston Terracini at the Downing Centre District Court in Sydney)

Shao did not have Australian medical qualifications when she allegedly performed the procedure.

The NSW Health Care Complaints Commission has made interim prohibition orders against her.

'Shao must not, under any circumstances provide health services, either in paid employment or voluntarily, to any member of the public,' the commission warns.

It has consecutively renewed the eight-week interim orders since March 2021.

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