I take a combination of tramadol and paracetamol which helps really well. It's 37.5 mg of tramadol, and I can take up to 8 of those per day, but usually have enough with 4. It's called Zaldiar over here, I'm not sure what the name is in the US.

I asked both my neuro and my GP repeatedly if this was dangerous long term, and they assured me it wasn't, provided there are no kidney or liver problems.

Nausea is pretty typical at first but that goes away completely.

Also, tramadol has recently been found as a natural molecule in tree bark in Africa - I posted about this a couple of weeks ago.