Tramadol Hydrochloride, Back Pain

Patient: Hi I was wondering if you could help with some information about Tramadol Hydrochloride (50mg cap) and its daily dosages in direction to severe back pain.Also I would like to ask a question also regarding the above.I have had severe back pain now for the past 6 or so years localising around the TH7 area. In this time I have had numerous occasions of physiotherapy and even an x-ray to check for Scheuermann’s Kyphosis from which nothing was found.Over the years I have took med’s from paracetamol, ibprofen, co-codamol, diclofenac and now tramadol for the past couple of years on and off as my pain feels to be getting more and more severe.I also have damage to my right rotary cuff with weakening of the teres minor, infraspinatus, supraspinatus and subscapularis, with it also sitting slightly forwards, due to an old injury in which the shoulder dislocated from a hard impact. According to my GP will not be helping my thoracic back pain by pulling across the upper thoracic and lower cervical.Is there any advice you could give with regards to further diagnosis or treatment to this back pain, suck as an MRI or cortisone injections in the erector spinae?Any help or advice would be extremely grateful.Thank you.

Doctor: