<s>[INST] I live in Houston, TX. I have 4 severe disc herniations in my lumbar region, 2 of which are pressing on the nerves on the left side. As well as several in my neck. The laws in Texas for pain medicine are extremely limiting . I understand why but that only makes it harder for someone like me to get proper treatment. My pain doctor recently switched me from percocet to ultracet, which didn t work, so then put me on tramadol 50mg. Still unable to function normally, but after 11 years on opiates, and now being 9 days without opiates, my head is clearer, which makes me happy. I detoxed at home which was horrible. My questions are: Is tramadol an opiate or a narcotic? Will I need to detox from tramadol like I did the opiates, because if so, I think rehab is in my future? Finally, how can I handle the chronic pain without these medicines? [/INST] Hi, Okay. Several treatments / approaches. Acupuncture probably would pass FDA scrutiny if it was required to get it. Physical therapy is advised as a standard, but there is whether the back is stable enough for it. If it is possible to do physical therapy, then there are a few reasons why it is one of the most effective non-medication interventions: it builds up the support muscles of the back. It increases pain tolerance, it changes emotional and psychological state, and cognitive therapy approaches seem to be non-zero in their effect on pain. Hope I have answered your query. Let me know if I can assist you further., Addiction Medicine Specialist </s>