Do all your doctors know about the other meds you are taking? That's a lot of NSAID meds (Ibuprofen, APAP, Naproxen) with some being high doses. I'm not jealous of your liver with all those and I would think you can only get so much relief from NSAIDs and you have far exceeded a therapeutic amount. I'm not sure what winter has to do with taking ibuprofen but I think I would drop it and the APAP. The Naproxen should help with a migraine, though if it is a true migraine and not a headache, a vasoconstrictor would probably be more effective. I don't get migraines but they are supposedly opposite of the normal headache which a vasodialator is helpful. Quite a few things are vasoconstrictors so you can probably find a list with a search and see if it helps.
Tramadol did not work well for me for pain even when I wasn't opiate tolerant. You shouldn't have to take crazy high dangerous doses to get pain relief. You need either a true opiate or a muscle relaxer might help ease the pain instead of trying to mask it and work better.
Also should see a Dr and see what it is causing it. Do you know what you did to hurt it? Sometimes rest and time are the best things for a hurt back, especially if it's a tight muscle/spasm. And do everything you can to not stress it, lift heavy objects, or bend where it hurts. If the Dr recommends physical therapy do it. Or go the first time and learn the exercises they want you to do and ask if there will be others and what they are and how long you will be doing it for and then just do it on your own if you can't afford it.
40 mg of ativan is pretty crazy. I take 4 and I'm sleeping even with taking 2 every day. But tolerance is a bitch. Luckily I've always been able to taper down easily and not have any withdrawals, though stopping completely is a different story as I start having an almost constant panic attack after a day or 2.
