Sorry to post 2 times in a row, but, I am also one of those 'rare' cases who had a hideous reaction to Zofran (an SSRI type drug to stop nausea) and boy was this a doozy....movement disorder for days....and to make matters worse, the usual treatment is Benadryl, which does the same thing to me.

When I see some one not getting the prescribed effect from a drug, I wonder if they are not metabolizing or metabolizing too fast. That is when I look at what else they are one, to see if there is any one enzymatic pathway 'plugged' up, ala 'drug interaction'. More often than not, when it comes to pain treatment, an SSRI is involved.

There has been talk of how much tramadol is to much and the effects on the liver. My average is 150-200mg per day and really helps with the burning.

My thoughts are no point spending years in Pain and checking out with a pink super healthy liver, you cant use it when your gone!

As a matter of interest check out this tramadol abuse forum. keep in mind a vast number abusers are middle class . some of the doses are scary

http://www.medhelp.org/user_journals...y-Room-Part-14

I've been taking Tramadol for over 10 years, along with Lyrica
(previously with neurontin).
I take 100-150 per dose for a max of 300-400mg/day.
It sure helps me & I haven't seen a tolerance issue.

I would eat raw yak liver if it would cure this.

When researching Tramadol I found evidence that it also has anti depressant properties. This is a side effect as tramadol is not prescribed for depression that I am aware of

This may explain why its so abused, simply pop a few and get the lift you need. also explains why its so difficult to wean off.

Great for us that are genuine as it effectively gives 2 for the price 1.

Certainly I dont think about much when Im taking it and Im usually a big thinker.

It binds to opiate receptors, much like hydrocodone and all opiates. Tolerance to the drug occurs the same as with opiates. Abrupt withdrawal of tramadol causes flu like symptoms. This can be found on the PDR site and other reliable sources. Although not classified as a controlled substance, do not be surprised if it goes on the list.

I'm not a chemist, and there are definitions, and there are definitions.

Using the Medical dictionary above, "opiate" is defined as:
As a derivative of codeine, tramadol fits that definition, and has many/most of the same characteristics: an opioid analgesic that can produce euphoria, dependency, tolerance, (opiate-like) withdrawal, and the potential for abuse/addiction.

Not trying to start a debate - just explaining my statement.

Doc

Not a debate, but important info to share. It is frightening for one to think their condition is deteriorating because more pain med is needed to control symptoms. In most cases also, esp in high dose control, stopping this med without another opioid on board will induce withdrawal symptoms similar to the heavier controlled pain meds. If one understands tolerance, it helps relieve some of the concern about worsening of PN. The use of any of this class of drugs causes the body's own endorphin production to slow down, thus less of nature's protective system is working, and over time more breakthrough pain. It only takes 3 days use to start reducing endorphins.

In addition to my critical care and ED work, I spent 6 year working in a medical detox, mostly teens and mostly opioids. Sorry to say, tramadol was a frequent flyer.

Some other opiates have a serotonin stimulating component too. Oxycodone is one. The itching some people get from synthetic opiates is thought to be serotonin triggered.

The mu receptor does cross react with stimulating serotonin receptors. Some drugs like tramadol have this mixed action more than other opiates.

If you google oxycodone serotonin you can read about it in more detail.

Tramadol mixed with Flexeril increases seizure risk as well as both have mixed serotonin weak agonism.

Tramadol in high doses can trigger seizures in some patients.

This accounts for the "cocktail" effect.