Tramadol is a good non-narcotic pain reliever. It's roughly equivalent in pain relief to propoxyphene (Darvon), which is no longer on the market. It's considerably less potent than hydrocodone or codeine, but as others have pointed out it's much less likely to cause habituation than narcotic pain meds.
I've found tramadol pretty effective, both in my personal experience (knees) and in my professional practice. If it won't cut the pain, a narcotic may be needed. I usually try tramadol first, then ramp up to hydrocodone (Vicodin) if necessary. Oxycodone (percocet, percodan) is reserved for severe pain, as it's the most potent oral pain reliever short of morphine. I do not prescribe codeine often at all.. lots of side effects with codeine.
If tramadol isn't cutting your back pain down, you probably need to escalate to hydrocodone.
