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Ultram or tramadol is commonly used for back pain. General recommendations for Ultram are 1-2 50 mg. tablets every 4-6 hours for severe pain with no more than 8 pills a day.   Drugs.com suggestion that Ultram's effects can wane after 'a few weeks' in some people suggests that it should take effect fairly quickly but I was unable to get a good answer on that. There is generally a phase-in period if you're going to be taking higher doses of the drug so if you're in the beginning of that you won't be seeing all the effects of the drug.     http://www.spine-health.com/treatment/pain-medication/ultram-pain-reliever   Good luck!