ive been taking tramal for 12 years 50 mg instant for 2 to 3 times aweek for 5years then every day for the last 7 years 2 years ago the 50 mg started wearing off earlier then it used to the dr gave me 50 mg slow release then 100mg they are wearing off now to .the slow release tablets keep me awake all night i dont eat and i smoke more now i look like a skeleton in the last 6-8 months ive lost about 20 kg and have just been told i have emphysema the Dr wants me to stop taking my tramal right now and put a denpax patch on i really dont know if this is a good idea or not .does any one have any suggestions.