Hello, I am new to the forum but not new to the pain management system. Just a quick and brief over view of my history. I have had both shoulders operated on, nose reconstructed, I have broke my neck and lower back, after 2 surgeries on each end of my spine, my neck-cervical spine and lumbar spine are now constructed with titanium rods and screws, each section contains approximately 8 inches of hardware and cause severe chronic pain. I have been on pain meds starting back in 1999. After each work related injury surgery would follow and medications. My point to all of this that I have been to good PM Drs and to very poor PM Drs, I wa s recently changed from ER meds to methadone with 30mg of IR oxycodone 1-2 every 4-6 hours as needed for break through pain, I have been on the meds for so long that my body has built up a tolerance to the meds and they are no longer effective, I by know means want to increase the amount and/or strength of the medication. Anyone in a similar situation, successful changes, etc???