Rebound pain after reducing pramiprexole

[Dustylee22]

I had been taking 3 tabs of .125 mg of pramiprexole for a couple of years, but I have been on dopamine agonists for about a decade (ropinerole to pramiprexole). I also take hydrocodone 10 mgs 2-3x day for both back & leg pain. Finally, I take 300-600 mg of gabapentin as needed. About reducing the pramiprexole, I was probably having one night per week of leg pain/agitation. About two months back, I reduced the pramiprexole to 2 tabs at night rather than three & all seemed to be going okay. However, in the past 10 days or so, my leg pain has significantly increased, so much that my legs have been sore almost all the time. I've been taking both the gabapentin & hydrocodone at night with hot baths, stretching, etc., but nothing has seemed to help. Finally, last night I went back to 3 tabs of .125 pramiprexole, and I had the first good sleep in quite a while. In addition to the leg pain, I have been so sleepy during the day that I frequently returned from a 4-mile walk & just fell asleep. This will not work with my life. I am still working (part-time), and it does not work for me to not get decent sleep night after night. I don't know if I have ever experienced augmentation from the pramiprexole: I just thought I should reduce it based on everything I've been reading. Now I am not so sure. Does it make sense that I should start having increased let pain (day & night) after about two months of successful reduction of the pramiprexole? Right now, I am sure that I am not about to reduce it any further unless something changes dramatically. My PCP has been pretty open to my suggestions, but the only thing I can think might work is a longer acting opiate. I really hate the gabapentin because I frequently feel sort of hung-over in the morning when I take the full 600 mg. I'm really at my wits end & thinking maybe I will just stay on the pramiprexole unless I start having more problems. I took it for years without any augmentation & now, with the reduction, it has started screwing with my quality of life. Open (sort of) to ideas. Thanks-

[SueJohnson]

I would ask for a stronger long lasting opioid like buprenorphine or methadone and when everything settles try reducing the pramipexole again.