Hello notborntoburn, first of all I love your Mayo name! I am very heavy hearted to hear about your pain. I was put on Tramadol back in the day. My understanding is (which could be wrong) that it is an opiate with an epinephrine in it. The thinking was that the epi would keep patients from getting high while on the Tramadol. It made me clench my teeth and have insomnia. I think it may have helped my pain somewhat but very minimally. I can't recall the dose I was on but don't think it was as much as you are on. Today 2 of my doctors met and increased my Morphine. I about fainted! I didn't ask for that and in fact had tapered myself down a lot over the past couple of years. That and the Gabapentin has helped my tolerate my pain but I have almost all the unwanted side-effects of Gabapentin so I'm thinking that I may be able to decrease my dose when I begin my new Morphine regime on Wednesday. I believe there was Divine intervention for these two docs to talk and have this compassion. I'm stunned! I don't like to feel any drug so don't know if I will take the extra mg. but we'll see. I definitely won't take it if I don't need it. I hope you can find just the right doctor. It's so hard now b/c there is opiophobia out there now and patients are receiving substandard care. You practically have to have cancer for a doctor to validate your pain and be willing to prescribe opiate pain medicine. You build up a tolerance after being on meds like this which isn't something you want either. I will pray that you find just the right doctor for you and your needs. And that your pain goes away!!!!!!!! Take care, many blessings, Sunnyflower