I am taking 50 mg of tramadol 4x a day with no relief. i've been on it 4 yrs. have i built up a tolerance? if so what are my options for pain relief?

This question can: be answered best by the doctor that cares for you regularly. The options for treatment are many but they depend on the diagnosis. They also have to be tailored to your specific medical history. Typically people do very well with tramadol and toerance is less of an issue with this medication than with others. All things considered though, you should call your MD and make an appointment to discuss.

Tolerance is likely: I don't know the location or causes of your pain, so it is very hard to recommend a specific relief. You might try to find a chronic pain specialist or clinic and be evaluated for a programatic approach w/ a variety of additive (not addictive) elements that might include: exercise, diet, hypnosis/meditation, psychotherapy, massage, etc + other meds. Best wishes!