Mrs D,
I've been taking Tramadol for many years, 100mg 4x/day (400mg/day).
It takes a week or so, with daily use, for the side effects to subside.
If they don't, stop the med & try another.
I do have to say that Tramadol has made my life much more livable, I really am
thankful that it works for me. The high doses are to be expected- I have a very high drug tolerance and am on the max of just about every med that has ever been Rx'd for me.
My Lyrica, same - 600mg/day.