I'm going to take the max dose today, see if that helps at all. Its not having absolutely no effect, as I've had nightmares that have woken me up every night this week, which is apparently a common side effect. So if I'm getting the side effects, I cant be completely devoid of opioid receptors 
I've been wary of taking the max dose because my mum (who is the hypermobile one of my parents too) says tramadol made her hallucinate, and I've been home alone with the kids. But DH is off work for the next four days, so will give it a go :)
And I seem to be used to the increased AD dose now, so can't attribute any weird side effects to that.
I'm irrationally irritated by the (possible, not yet confirmed, but quite likely to be it) POTS not being diagnosed when I was in and out of hospital every time I fainted. I know it has only become well known recently, but it still existed, so why did noone think to test. Before my arthritis came on, my hypermobility was way more obvious too, so now I find myself trying to convince people that I used to be really flexible, while getting the
look probably just in my head