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.