IF.... your PN underlying cause was heavy alcohol use. It appears that, for me, tramadol was the reason my PN symptoms worsened. I had stopped all alcohol use last year because I was aware that it could be the reason for my PN (24 years of heavy drinking). I was showing less and less symptoms of PN, and was improving. It became apparent that alcohol use was the underlying cause. I was feeling great. Some time later, I started using tramadol for arthritis and muscle pain (66 years old and remodeling my home) and over a period of time the PN symptoms started returning, tingling, burning, et. al. It all became very much worse. I did not put the two things together...... then. Over a period of time, PN symptoms increased to the point that I began to have to use neurontin for pain, also WITH tramadol. Three days ago, I stopped using tramadol (I was using 300 mg per day) and ALL tingling and burning stopped within 24 hours. It remains so until now and getting better. I stopped neurontin yesterday and no pain whatsoever. All symptoms stopped. Tramadol and alcohol must trigger the same symptoms of PN for me, maybe for all alcohol users with PN. I don't know. I am telling you what happened to me. I feel great. I felt I had to tell you in case this might help PN suffers with alcohol abuse as the underlying cause. Tramadol will not help those type PN sufferers. I will keep you posted. T. Bear