The thing a lot of folks don't know about opiates is that most people don't get full pain relief from them, and some people (about 20%) get absolutely none - I get some relief from Tramadol, but only if I layer it with ibuprofen and paracetamol, and it does work on my fatigue ( I understand a lot of people are sedated by tramadol, not me, I'm the opposite, which is annoying when pain stops sleep, because then I have to choose insomnia ) .I've swerved gabapentin(pregabalin) - I've seen what it did to my mum and I'm already dizzy, forgetful and nauseous enough from the POTS and Fibro TVM, taking it for epilepsy turned my daughter into amnesiac rip van winkle, so I'm not going to poke that particular bear - SNRIs and SRIs raise my intraocular pressure which isn't good when you've got a parent with glaucoma, and also they don't play nice with POTs (taking something that can make your blood pressure drop when you stand up isn't a good move when you've got low blood pressure and postural tachycardia). I wish there were better options than messing with your brain chemistry for NP and fatigue disorders, because it's exhausting careering from one flare up to the next