I have stage 4 endometriosis with chronic abdominal pain. I am 40. I have had multiple operations, the most recent a couple of months ago. I am on fentanyl 25mcg/hr patches and nefopam 30mg tablets 2 tablets 3x daily ( I was on 3 tablets 3x daily but had to reduce due to side effects ). I am also on paracetamol 1000mg 3 to 4 times daily cyclizine and lofepramine 70mg 2 tablets twice daily. I have tramadol 50mg for breakthrough pain ( none taken since I suspected I may be pregnant ), and i get acupuncture. I have previously tried the codine based medications such as dihydrocodine and strong paracetamol/codine mixtures and found no effect, so it appears I am one of the peopln who are unable to metabolise codine into an active form. I have just found out I am pregnant. I am concerned as I cannot find much info on atipam ( nefopam ) in pregnancy and my dr wants me to continue this and stop the fentany as he says it is higher risk. When I am just on paracetamol I am unable to do anything. I need help to stand. I cannot walk and I certainly cannot work or look after my older children. I am worried about using the nefopam , and feel that despite it s known risks the fentanyl may be safer ( especially as my pain is not adequately controlled on the nefopam ) What would you advise your patient? Do you think the nefopam is safer than fentanyl? Thanks for your help.