Daycamp,
That's a good post. I'm brand new to this board and I commend you on your fortitude in seeking one on one medical attention. You are ultimately going to save a ton of money by seeing your PCP and going to receive better treatment. Don't get me wrong, the OPs are a lifesavers for some, but a good percentage of the users are just plain hooked.

Anyway, when your doctor referred to "breakthrough pain", he was addressing that pain that exceeded the Bextra's efacacy. I'm sure you read the literature on the Bextra and saw that it is a NSAID, non-steroidal anti-inflamatory drug. If the Bextra is insufficient to relieve your pain, then take the Vicoden, however, give the Bextra a chance to work. Your blood serum levels of the Bextra is rising and so will the pain relief. I'm assuming you're taking it for neck, back or joint pain and it isn't initially doing the job. Unfortunately it doesn't provide that immediate relief like Vicoden. However, your doctor did prescribe #90 of the Vicoden ES and he probably expects you to take it as prescribed if needed. If you need the Vicoden because the pain is not suppressed sufficiently by the NSAID, then take the Vicoden, as per Dr,s instructions. I don't know how many narcotic pain meds you were taking before, but this is one way to "take that down a notch".

I hope you feel better!