Okay, I have a problem. My PM doc is not a PM specialist. I had to explain to him that MS Contin is available in generic and I believe it was news to him that methodane is prescribed for pain. I also had to explain that morphine poorly metabolized" which expains why the oral dosage appears to be so high.

Even thought the 60x2 I'm at noe doesn't really give the relief I need I want to keep my dose as low as I can. That way I have more options for when my pain increases. Already I can't use codiene. . . 400mg and *nothing*

It (MS Contin)definitely doesn't last 12 hours. And I have to wait 3 hours to starting feeling relief after I take it. And on bad days, it's still close to nothing. Do these situations constitute breakthrough pain?

People talk about it all the time, but I still don't understand what it is or how it works. How many tablets/,pmth does a doctor give you for breakthrough pain? Does it have to be just the instant release form of the time-release med you are taking? (I asked because I cannot fathom 15 mg MSIR helping to bring me through this. The breakthrough meds seem like they would HAVE to be a stronger med. than the SR med, or it wouldn't work.

I really need to get some concrete info on the use of break through pain and links, if possible. This is a doctor who is willing to listen. He made me sign a contract last week when he upped me from 30mg Morphine to 60mg. Like when they brought me up to 30 from 15 I felt woozy for a day or two but that went away. The 30mg were knocking out maybe 10-15 % of my pain. When I first started on the 60mg twice a day I felt great but maybe I was just having a run of good days. Imean, it's only been 2 weeks on the 60's but I am definitely hurting again. Don't get me wrong, it's better than the 30mg but not the miracle I thought they were at first.

So, I got my doctor to raise my MSContin a bit by telling him I had educated myself about it. Perhaps if I can tell him I have also educated myself about "breakthrough pain medication," I can get some if that, too. 60mg 3 times a day would defeat my point, as would raising me to 100x2.

Please, tell me everything you know about breakthrough pain and how the meds are prescribed.
I sure would appreciate it.