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I used the pain patches for four years and my body became very dependent on those patches to function.  After my Rheumatologist took me off the patches I began to take Ultram.  My doctor started me off on a relatively low dose and has worked me up to 100 mg. four times a day.  While it has not taken away 100% of the pain it has changed my life for the better in more ways than I can name.  I take my first dose upon rising each day and sit down to my computer to wait for it to kick in.  I am then able to begin my day and every four hours I take another dose.  The Ultram allows me to accomplish things I would never be able to without it and I am so thankful my doctor put me on it.  Good Luck and God Bless. Terrie