Hi, I am a 64 yo woman with a history of gastroparesis, GERD, and degenerative L4-L5 disc with back pain and bilateral weakness in thighs and tingling and numbness in feet. Also have sleep apnea. A fantastic GI Doc put me on Celexa at a very low dose - 15-20 mg/d - to increase GI motility for the gastroparesis, and it has worked like a charm. An Ortho Doc put me on Tramadol at a very low dose - 50 mg/d - for the back pain (also getting steroid injections for the back pain). I ve only needed 25 mg of the Tramadol to help with the pain, and it has helped me sleep and even helps with GERD pain. Have been on both for about two months with no problem. I needed my Celexa refilled, and the nurse practitioner has refused on the basis of the interaction between the two drugs and concerns of seizures. I have no history of sz disorder, and the Ortho Doc has no problem with the combo. Do you feel this combination at these doses is of concern; and, if not, how can I work around the script problem. The nurse practiioner has in the past been a fantastic assist with the GI practice, but I feel in this instance that she is being a bit over zealous. This combo is the only thing that has made me feel like myself in a long time.