This is my first post on this forum, so I feel a longer post is necessary. This is to introduce myself, give a back-story for my issues, and then delve into my pain management as well as my concerns. About 5 years ago, I experienced severe pain in my throat accompanied by a huge lump. This pain also referred to nearly every part of my back, hips, ribs, and buttocks. Doctors did a few tests, but nothing conclusive showed. It was Native hospital so it was an 'in/out' thing with no real care for discovering the problem. After the lump went away, my back hurt so bad I couldn't walk. My ribs would hurt when breathing and the joints where my femur meets the acetabulum, ischium, and pelvis would hurt when moving, standing, sitting, or anything really. After numerous trips to doc, they discovered I tested positive for the Eppstein-Barr virus (mono). They told me that mono can cause all those symptoms, and from then on, that's what they would say if I went back in for any check up due to worsening symptoms. They said it can last up to two years. So, two years pass and this is still happening. And worsening. They would give me 5-10, 2.5mg hydrocodones and send me out the door. Eventually, they stopped doing that. Fast-forward to 5 years after first symptoms. Native doctor finally has me tested for HLA-B27 (Gene associated with Ankylosing Spondylitis). Sure enough, it's there. Not a definitive diagnostic thing, but given the symptoms, it's more than likely the case. I get real health insurance and see a real doctor (private sector). He sends me to rheumatologist who does MRIs. They found a lot of edema in my sacroilliac joint and along my spine. They tell me it's Ankylosing Spondylitis and Osteoarthrosis. The Rheumatologist tells me the only thing for it are biologic shots. He told me there's no cure and that the shots may not help, but that's all there is. Price tag for me: $1500 - 3000 per month. Um, no. So I have my doc refer me to pain management. I started out on hydrocodon 10/325's BID for about 3 months. I then requested an increase to TID, to which they did. About 10 months after that, I informed the pain doc that the 3 were not sufficient anymore as they generally only give relief for 2-3 hours and that by the end of the day, I would be out and then waking up in horribly excruciating pain sucks. He asked if q.i.d. would be enough - I said yes. Then he suggested a long-lasting medication. Since I do whatever they ask, I did not complain. He gave me 15mg MS-Contin ER to take twice a day. He said it would be used as my main pain relief and he would continue giving me 3 - 10/325 hydros per day for breakthrough. I tried getting him to explain at what point it's safe for me to take my breakthrough after he stated that in 6 hours, the MS-Contin will kick in and at that point I shouldn't have taken my breakthrough as it will compound the effects of the morphine. But, he wouldn't really answer my question because he just kept saying: "take it only when you're in pain." Well, I have dropped my hydro use down to just once in the morning for while I wait for MS-Contin to kick in (6 hours is about right). But, the MS-Contin makes me EXTREMELY tired and has done absolutely NOTHING for my pain. I am thankful for the all-day relief from withdrawal symptoms. I think taking it is fantastic because I had been running out of my t.i.d hydros before my next appt. and would go through nasty detox every month. I know I'm not going to crush this or chew it just because I'm not going to be stupid and try to kill myself. However, the pain relief I get from the MS-Contin is pretty much 0. I do not feel any elation or euphoria from it. I do not get that highly-sought-after rush of pain relief I enjoy in the mornings when my hydro kicks in. I KNOW when the hydro is working because my pain level goes from 8 - 3 within moments. I only know the MS-Contin has kicked in once I start wanting to fall asleep. But, I cannot live like that. Does this mean that I need a higher dose of MS-Contin? Or, might this drug not help me just because I'm not susceptible enough to it. Mind you, I typically have a very low tolerance for drugs, but my tolerance for hydros has risen considerably. Also, will taking two of the MS-Contin be the exact same as if I were to take 1 30mg MS-Contin? Like, would the two pills release the morphine in the same manner as the 15mg, just at a higher, extended dose. When is it safe for me to take my breakthrough medication?