Ultram / Serotonin Syndrom(syndrome) Question

Hey there, I am new here... short story, I am 29, good shape other than chronic pain, professional model, two kids (2 and 4). Arthritis, hypermobility, 2 degenerative discs in my neck and possible fybromyalgia.

Anyways, for the past few years I have been really struggling with pain more so even though I have had pain since I was a kid, and started Ultram about a year and a half ago. I did 3 epidurals on my neck but no real help. 800 mgs of ibuprofen takes the edge barely off but not much. Teamed the Ultram up with Tylenol and I didn't notice a huge difference either.

I have tried Celebrex (nothing), Flexeril (knocks me out), Soma (works ok, but off and on), Zanaflex (horrible reaction, seeing black, similar to low blood pressure). Methocarbamol (sp?) worked out, not so much help with the muscle, but did help a little with sleep.

My Ultram ranges from 2 to 6 tabs a day. I am 100 lbs so if I take 2 too late in the afternoon I get "buzzed". I found Rozarem to help once with sleep, the other time I tried it, not so much, but leaves me too tired in the AM. A muscle relaxer will help me sleep but I don't take them all the time. Rozarem left me so tired I was horrible depressed feeling -- which I have enough of! LOL

Prior to having my kids and for a while after my second one, I was on Paxil CR 12.5 for anxiety leading to depression. Got off it the first pregnance with HORRIBLE withdrawals. Zaps in the head, the whole nine yards. Vowed I would never go on it again -- but of course, stress and postpartum = Paxil after my second son.

Got off it successfully again but drank heavily for a while. I have been not drinking at all for the past 6 months. I only take Ultram with OTC stuff... but I think the Ultram modified my chemicals enough so that I got by without a SSRI.  Have gone cold turkey with the Ultram when I have had the flu and taken OTC Sudafed etc... but now that I think about it, I do think I had side effects. No energy, tired, restless arms and legs, palpitations.

Problem is, I am starting Paxil CR 12.5 again. I am having a lot of stress in my marriage and getting severe Panic Attacks. So, I decided, I need to go back on the Paxil for my kids' well being as well as mine. About 7 years ago I had severe attacks and depression and did just Xanax; then switched to Paxil with Ativan for panic attacks. I have not decided if I need Ativan. Trying to do without.

However, I see you shouldn't take Ultram and Paxil together due to Serotonin Syndrome. My question is, how frequently does that actually happen? And what can I take instead of Ultram -- no Vicodin, I hope, as that makes me really cranky? My pain dr doesn't seem to want to give me anything but Ultram -- but I think that Ultram is not as innocent as everyone thinks.

I have noticed if the Ultram wears off I do get cranky, and by the end of the day, unless I up the dosage and risk not sleeping, the pain is back to unbearable.

Any thoughts on combining pain meds and SSRI's safely? Or alternatives?

Thanks so much, I really appreciate you taking the time to read this!
LK