Idk if there’s a better comm for this, but.
Let’s say, purely for the sake of argument 
that I am currently on a super-cool prescription painkiller that works great. Let’s also say for the sake of argument that the bone/sinew structure that’s supposed to hold my ribs together is trying to kill me constantly by conspiring with the base of my skull to cause me unbearable chronic pain. If I skip more than like one day of the cool prescription painkillers, then even just walking around becomes challenging. But also, if I just keep taking the cool prescription painkillers, I’ll build up a tolerance. I’m on like 75mg a day right now and even that could be playing with fire.
I need something cool that’s gonna dummy out my pain receptors long term. What’s a good painkilling solution? I’ve tried cymbalta, taking way too much paracetamol and ibuprofen, and this cool highly addictive prescription thing. I’m game for any suggestions.
Everyone always says tramadol is shit. I’ve been on 150mg/day for 3 years with no tolerance increase. It sucks when the pharmacy fucks something up and I’m out for a couple of days, but it’s not nearly as bad as missing a dose of gabapentin was.
I’m sure it works fine for you, but drugs are judged based on their efficacy and safety across 10s of thousands of people.
https://rebelem.com/tramadol-or-tramadont/
“The big issue is that CYP2D6 activity varies among patients and this is important because you don’t know how much opiate the patient is actually receiving (i.e. the same dose of tramadol will have widely different effects from patient to patient). Not only is tramadol potentially not giving pain relief, but patients often return to the ED for common side effects of tramadol including nausea/vomiting, dizziness, constipation, etc. Because of it’s multiple mechanisms of action, potential drug-drug interactions, and lowering of the seizure threshold, the safety of tramadol has been brought to question.”
That is really interesting. Thank you. I hadn’t seen that chart.