What do we know about tramadol?

Mr. Novák, suffering from chronic pain due to grade III osteoarthritis of the left hip joint, is visiting your pain management clinic for the first time.

He was referred by his general practitioner, who prescribed a fixed combination of tramadol/paracetamol 75 mg/650 mg, 1 tablet as needed, up to 3 times a day.
The patient takes all three doses, yet the treatment is not sufficiently effective. In addition to the tramadol/paracetamol combination, he is chronically using aceclofenac 100 mg, 1-0-1 and tramadol SR 100 mg, 1-0-1.

Let's focus on the tramadol/paracetamol combination, specifically on the active substance tramadol, which is the most commonly prescribed opioid in Czechia.

What is the pharmacodynamic profile of tramadol?
Would it be possible to increase its dosage
(currently 425 mg/day) in order to enhance its analgesic effect?
70
years
185
cm
85
kg
man
Examination
Personal history
Coxarthrosis l. sin.
Hypertension
Hypercholesterolemia
Anemia
Benign prostatic hyperplasia
Chronic kidney disease (CKD G3a)

Pharmacological history
aceclofenac 100 mg 1-0-1
tramadol SR 100 mg 1-0-1
tramadol/paracetamol 75 mg/650 mg 1-1-1
perindopril/amlodipine 4 mg/10 mg 1-0-0
simvastatin 20 mg 0-0-1
ferrous sulfate 247.25 mg 0-1-0
tamsulosin 0.4 mg 1-0-0