I have used tramadol for over 10 years and it is the only thing that helps. I have crest syndrome and it damages my joints and bones. I don't have side effects, I have not developed a tolerance , and needed more and if I don't have the medication I don't go thru withdrawal. Once I couldn't get the med renewed for 4 days due to Dr out of town etc and all that happened is that all my pain returned and I had difficulty walking. I am also a retired nurse and have alot of knowledge about medications. I was able to get tramadol extended release from my pain Dr and that stopped the peaks and valleys I would have with my pain. I hate that tramadol is put in the same category that other narcotics are placed. Thank the Lord something works for me.