Leah, I was so interested in your question on tramadol. That was one of the earliest pain medications I was prescribed. I thought it was wonderful in managing my pain and wasn't a narcotic as some of the other medications I had tried. Unfortunately I Experience severe hives with the medication and my rheumatologist was concerned that I'd actually experience anaphylactic shock. So one of the few medications that has so helped to manage my pain, I can't take. Many of the medications particularly Barbiturates and other medications affecting the central nervous system, while managing the symptom they were prescribed for, so affect my cognition, that I too had to limit my activity when taking them. I finally learned that asI got older my brain and nervous system didn't seem as able to manage these meds. So muscle relaxers, sleep medications like Ambien, many of the anesthetic meds used during surgery, and narcotics other than codeine, canactually so alter my perceptions because I develop a delirium and in severe situations can hallucinate. I'm well aware of these side effects occurring but I can't intervene until the medications out of my system. Consequently, when I have major surgery in two weeks, my daughter will be staying in the hospital with me including overnight. Then I have other adult children and a sibling assisting me along with my husband, while I have these strong mediciin my system. I should write an article on all the clinical experiences I have went under the influence of these medications. it is really kind of scary in retrospect. During periods of severe flares when the codeine alone doesn't assist, I will very carefully use the Fentanyl patches. But, my husband and adult children know when I need to use this medication . That's a major reason why I was so sorry I couldn't take the tramadol it did not affect me the way the other medications do. Just thought I'd give you my experience with that specific med.