I'm a 48 year-old fibro patient, and have been taking 60mg duloxetine daily for approximately four years now. Up to this year, it was producing extremely good improvments in my pain, energy and mood levels. Without it, everything hurt, I was tired all the time, and that made me pessimistic and mildly depressed. With it, I felt great, had clearer thinking and brighter mood, and it allowed me to return to college and breeze through my classes.

This year, I started working as an ICU nurse which I LOVE; however I believe the increase physical demands, stress and long hours have caused me to lose ground in the pain and fatigue areas. On my days off, my feet hurt terribly, so much so that I find myself "sparing" them by avoiding taking long walks or exercising in ways that exacerbate their pain.  I am generally sore all over, too, like I DID work out the day before, with neck, shoulder and other pain. Not to mention I pretty much am too wiped out to do anything anymore. 

On top of it all, my weight has crept up over the past few years from 155 (which is great for me, as I am large boned) to now 177. I just can't do the amount of physical working out anymore that it takes for me to lose weight--at least 5-6 days a week of 30-60 minutes, weights and aerobic.

All I want is to feel relatively pain free, lose 20lbs, and still have the mental and physical energy to perform in my new career.  Any suggestions?