I just use Ultram er 200m one time in my life, last night for my back pain ,I am very happy because the severe back pain I had getaway, but now since this morning went I wake up I fell to bad with nausea, dizziness , itching, vomiting I can't drink even water because i need to go and throwout. I do not think I will continue with this medication. Just one pill was an off for me to discontinue the medication.