Hi JoanB,
Have your doctor check heart and you should maybe start at 5mg twice a day. In Virginia you have to see a Dr. to get a refill, the VA is not very high on Tramadol usage (was on it with Lyrica) and at max dosage fell a lot and cut off a finger in my wood shop. Quit neurotin when on high dosage 3600 didn't work that well. I'm only taking amitriptyline 12mg at night its great for sleeping, but might go back to 5mg Methadone in am as the pain is in the 4 to 5 range. Thought about dying a lot when on Tramadol-Lyrica and had breathing problems. One does sweat more while taking Methadone. Also take Mythl B-12, R-lipoic acid, L-Carnitine, Benfotiamine, plus other basic vitiams. There is a web site Askapatient.com that patients comment on the meds they take, I suggest this site for those seeking info on medicines. Just type in the name and read the reviews. Methadone is rated very high for pain. Tramadol gets a poor rating. Hope this helps.