Thanks Sallymander,Dolfinz and Shelley for your replies. I am on the slow release form of tramadol. I take 200 to 300 mg's a day depending on my pain levels. I have been using fast release tylenol for breakthrough pain. As with many medications I have taken, they all seem to work well for awhile and then all at once I seem to need more and more. It seems 300 mg of the slow release is the maximum dosage with tramadol. Thanks again, for responding.