Just a caution on a medication combo. I was prescribed Effexor (antidepressant)twice a day to help the pain. It does help a little, but still needed pain meds. The doctor wanted me to use Ultram which seemed to be ok for mild-moderate days. I started to have myoclonic jerking when drifting off to sleep, which sure does not help your sleep pattern. I thought it was just being FM until I used a drug interaction checker and found there is a moderate caution that the combo of Effexor and Ultram will lower seizure threshold! Even though I do not have epilepsy, I stopped the Ultram and immediatly the jerking at night stopped. I would think that this combo would be very problematic for people with epilepsy.