Q) I took Tramadol for years for osteoarthritis pain and found if I were late for a dose, I would start getting flu-like symptoms.

I was taking three 50-milligram doses a day. Finally, with my doctor’s help, I tapered off totally but began having awful nasal allergies and constant water running out of my head.

One night, because I was sick and hurting, I took two of the leftover Tramadols and, lo and behold, by morning I felt terrific. I’m 66 years old and started taking one Tramadol a day to try to keep the allergies away, but I feel better if I take two of them.

My doctor doesn’t seem concerned one way or the other, but I want to know why I cannot stop taking the drug. I cannot find anything on the subject anywhere. it doesn’t seem to help the pain much, but I cannot stop taking it. help!

A) Tramadol is an opiate agonist, a narcotic-like pain reliever used to treat moderate-to-severe pain.

In the United States, it is marketed as Ultram, Rybix, Ultracet containing acetaminophen or Ryzolt; in Canada, Ralivia; in Mexico, Durodor Retard and Trexol. The regular tablet is generally taken every four to six hours. The extended-release tablet should be taken once daily.

Side effects can include blurred vision, lightheadedness, dizziness, uncontrollable shaking, drowsiness, headache, nausea, vomiting and constipation. Overdose may include chest tightness, wheezing, fever, itching, cough, swelling of the face, tongue, lips or throat and cough. it can be habit-forming.

Dosing should be under the strict guidance of the prescribing physician. when discontinued, the Tramadol should be decreased gradually. Sudden withdrawal can lead to insomnia, runny nose, paresthesias of the hands or feet, chills, nausea, hallucinations and more.

Before beginning this medication, a physician should be advised if the user consumes alcohol or takes any medications containing alcohol, or has a drug addiction. should this be the case, he or she will likely recommend another drug for pain control.

The flu-like symptoms you experienced were not flu — they were from withdrawal. The water running out of your head is likely because you didn’t taper the dosage downward but attempted sudden withdrawal.

Osteoarthritis is a chronic disease of the joints that results from a breakdown of cartilage. it causes pain and stiffness of joints. The problem should be addressed for what it is.

You might consider rubbing castor oil onto your affected joints, using over-the-counter Castiva, liquid pectin and purple grape juice, or glucosamine/chondroitin.

Therapeutic exercise is important, too. consider yoga, tai chi or water aerobics, which will keep your joints flexible while reducing your pain.

Perhaps a visit to the physical-therapy department of your local hospital will be beneficial.

Then, despite the fact that your doctor isn’t concerned, I recommend you make appointments with a rheumatologist to discuss treatment of your arthritis and a drug counselor for help with your addiction to Tramadol.

To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “Understanding Osteoarthritis.”

Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167.

Write to Peter Gott, c/o United Media, 200 Madison Ave., Fourth Floor, new York, NY 10016.

“They’re really just catching a lot of colds from kids,” he says.

But there’s another possibility, one that many people have never heard of. It’s called nonallergic rhinitis. People with nonallergic rhinitis have many of the same symptoms as people with nasal allergies — the runny noses, congestion and annoying post-nasal drip. Some sneeze, too. But “when we do allergy testing on them, we don’t find anything,” Shulan says.

These patients often have no personal or family history of allergy, are older than the usual new allergy patient, averaging about age 35, and are more often women than men, says Dr. Jonathan Bernstein, an allergy researcher at the University of Cincinnati.

Patients often say they have symptoms year-round or are bothered by irritants that are not known to cause the immune system responses associated with a true allergy, says Dr. Michael Blaiss, an allergist at the University of Tennessee Health Science Center in Memphis. The possible triggers include:

? Perfumes and other substances with strong odors.

? Cigarette smoke and car exhaust.

? cold air, wind and humidity.

? Foods — and not just the spicy ones. This variation is called gustatory rhinitis.

? just lying down triggers symptoms in some people, Blaiss says. Though these people don’t have allergies, “this is a real condition,” he says.

Says Bernstein: “It can have an impact on sleep and concentration, cause headaches and lead to sinus infections.”

The underlying causes aren’t well understood. with some, the problem seems related to changes in the nose that occur with aging, says Dr. Stanley Fineman, vice president of the American College of Allergy, Asthma & Immunology. Older noses tend to be drier, Fineman says, so sometimes simple saline nose sprays can help.

Doctors also often recommend certain antihistamines, decongestants, steroid nasal sprays and drying agents. But the popular non-sedating antihistamines that are sold in drugstores often don’t work, Blaiss says. Patients also won’t benefit from allergy shots — unless they also have allergies, which is still also possible, he adds.

It should be noted that adults can, at any age, develop allergies, says Dr. Jacqueline Eghrari-Sabet, an allergist in Gaithersburg, Md.

Gannett News Service