I too was on Tramadol for quite some time - 8 tablets a day (2 x 4 times a day) combined with Co-codomol 8 tablets a day and Diazepam 3 times a day (to help with the spasms). I didn't find the Tramadol worked either but it did turn me into somewhat of a space cadet. I couldn't really function (at the time I couldn't walk and was housebound with a zimmer frame for ages).
The problem with these painkillers is that they 'deaden' the nerves, supposedly stopping the pain. But as a result instead of dealing with the problem, you create more nerve endings therefore the need to increase the dose of painkillers or add another one to the mix.
When I saw the President of the British Orthoaedics Association, he was appalled at the drugs I was taking - in the end they cause more harm than good and suggested I stop - cold turkey. I was very concerned about 'just stopping' and asked if a gradual decrease would be better. He said No. So I took Professor Clarke's advice and just stopped. After 3 days I started to feel more normal and now I accept the fact I am always going to experience a little bit of pain.
However, I do use DLPA (DL-Phenylalanine) to help with the pain - the D helps the pain and the L helps the mood. However, I have heard that those who just want to use it for pain the D-phenylalanine is more effective). These are to be taken on an empty stomach ie first thing in the morning and mid-late afternoon. However if you suffer from high blood pressure it is not recommended you use DLPA
This may be of interest to some of you, just thought I'd share with you what I have found to help with pain.