I have been on the Butrans patch and Tramadol for alamost a year. I recently tried to stop the Butrans, but had 2 very bad pain episodes, and so resumed. It just works so well for me.
The only side effect that is difficult to deal with is the extreme exhaustion, especially after taking the Tramadol for breakthrough pain. The combination is just debilitating, and has never improved. I have to work full time, and I hate coming home from work and going straight to bed.
I am just barely making it now taking some 5 hour energy (about 1/3 of a bottle in the am, noon, and dinner time). Anybody out there have a better idea? I just restarted thyroid meds about 5 weeks ago also, and no change.