I have been recently been given Duloxetine by consultant Anaesthetist. 30mg a day working up to 120mg a day. He told me to come off the 30mg Amytriptoline an evening that I have been taking for three years, fo RA and Mixed Connective Tissue Diseas also CRPS. He knows I also take 100mg of Tramadol on an "as required" basis which is usually once every three days as I am being careful not to become tolerant of it. Can I still take the Tramadol? He didn't mention not to but I see MAJOR warnings. I also have an injection of 25mg Methotrexate once a week, plus 200mg of Hydroxycloroquine Sulphate every twelve hours, 5mg Folic acid per day, (except the day of the methotrexate), plus 200mg of Pregabalin every twelve hours. I am constantly on paracetamol, (not more than eight in 24 hours). Tonight is my second night of Duloxetine. I feel "glowing" on my chest, face and arms. Which is a kind of neuropathic pain that I don't usually get. I feel on fire. I have diarrhoea. I am in my usual pain of joints, pain in my arms. I am debating whether to take 100mg of Tramadol. My consultant Anaesthetist knew about it so why didn't he give me anyw arnings of it when he knew to tell me to stop the Amytriptoline before beginning the Duloxetine. Sorry. I know this is a complicated long question. I have been symptomatic for four years. I've been on Methotrexate for fourteen months and eight months at top dose of 25mg per day. I see a consultant rheumatologist for this and the Anaesthetist for pain management. I am ANA positive 1/640. Thank you for your time. YYYY@YYYY