Hello, Thanks for your query on HCM As per your clinical history is concerned you may follow like this - 1)Meet your rheumatologist today and discuss these medications [tramadol, Duloxetine and pregabalin] 2)Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax.But do not try not to change your routine completely.Try stress management techniques, such as deep-breathing exercises or meditation. 3)Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping. 4)Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. 5)Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day. Take one multivitamin caps at bedtime regularly. Hope that helps