Also, be very careful about what other meds you are taking it with - do not take it with any tri-cyclic antidepressants (Elavil, etc) or any medicines that speed up the heart rate.... Ultram/Ultracet are known to reduce the seizure threshold - many patients have had seizures while taking this medication.... Many people do take it, and have never experienced a seizure or even close to one - but if you already have a low seizure threshold, or are taking other meds that ALSO lower the seizure threshold, you are at a much greater risk. Be careful..... I think it is a totally useless pain reliever..... But like I said, it can come in handy when you are trying to conserve your intake of opioids - because it seems to have enough action on the opioid receptors to keep the worst of the w/d's away from regular opioids.... But if you have a migraine or bad back pain - and your body chemistry is anything like mine - you can forget Tramadol doing anything at all for it.... I have had backaches and taken 2-3 Ultram and felt NO difference, at all whatsoever.... Then I will take 800mg's Advil and feel the difference.... Go figure... It is a WEIRD medication.