Toe;

Im sorry to hear that you are having so much pain. I just went through the same thing, trying to find a BT med. I was on 20mgs per day of methadone, a really low dose. I also got Norco for breakthrough. At a certain point I was taking up to 12 per day for pain, which is not acceptable for breakthrough. My methadone wasn't a high enough dose, and didn't work. I was overcompensating with the Norco and I was really scaring myself about how much I was taking and how tolerant I got. When I finally saw the PM doctor, he solved the problem by increasing my methadone by three times and cutting out the Norco. While I like to have them on hand as a safety net, I have to admit that I really don't think I need them now. For me, that is just as well as I feel like my use of Norco was starting to get out of control. That means a little holiday is in order. I find that just going from 5mgs to 15mgs four times a day works just as well as taking 2 different narcotics. I also find that I am not so tolerant now to the methadone. With the norco on board, I couldn't "feel" the methadone at all, normally I get kinda dizzy from it.

I guess it just depends on the person. I thought that having a BT med was necessary if you took long-acting meds, just to have a back up plan. But if the doctor gets it right the first time, you might not need them. It also depends on your condition. If you have RA, I am really suprised that you are having luck getting narcotics at all. I used to work for a rheumatologist and I thought RA looked very painful and crippling. I was so suprised that she almost never gave out narcotics for this. She used things like methotrexate and Enbrel instead. I could never understand this reasoning. She was willing to use drugs that could potentially cause real harm to the patient. I mean methotrexate is used for early abortions and to as a neoplastic drug (cancer) Enbrel is expensive and has to be injected. They also overuse Vioxx and other things like gold salts, sulfathalazine and other NSAIDS that people generally couldn't tolerate. In fact the doctor was once frustrated how so many people couldn't take methotrexate or Vioxx, that it made them sicker. She also sarcastically mentioned that these same people could, however, take "massive amounts" of narcotics. My God!! A whole 30 vicoden only lasted a week for people whos' fingers were slowly turining into claws!! Sadly her attitude is so common. And among doctors who specialize in treating painful conditions like RA or fibromyalgia or arthritis ets. Pathetic.

Sarah