"took severe pain away. hand and neck arthritis. take with 2 tylenol or ibuprofen  every other dose for best relief. brand name ultram 50 mg every 5-6 hrs if needed. for me, took most pain away! better than vicodin and not sure why but so happy i have it. cons: occasional nausea and big time constipation-take with laxative or colace. i started pill slowly- two 25mg per day over period of a week and worked up to 50 3 x per day over 3 weeks."