I think Tramadol is useful for some. I use 1/2 tablet (25mg) only at night for tough days. (this is to avoid tolerance).

I also get nausea sometimes with it...so I use it carefully.

You cannot really use it with SSRIs or SNRIs safely, as the risk of seizures increases and also serotonin syndrome.

Tramadol needs to be activated by the liver to its active metabolites, so there is a delay in onset from when you swallow your dose. Some people mistake this delay for it not working and up doses when that is not necessary. And some people lack the liver enzyme to activate it at all ...so it won't work well for them.

I personally like it because the next day, I am virtually pain free..so a very little goes a LONG WAY for me.

But response is all very personal depending on your genetics and particulars.