Rather than upping the dosage of the breakthrough med, (I would like to cut back on those, quit all together) I have heard horror stories about rapid release pain meds. I know the damage they do, and have been on them too long already, but I need a stronger ER pain med before I can cut back/quit the RR meds. I know there are lots out there,appreciate your input and what meds may have worked for you. Currently taking 30mg MS Contin 2 X daily. I'm having additional surgery after vertebrates heal. They're about half way there. I know each person has different levels of tolerance and reactions. I'm awake at 1am, 4am, 7am. with so much pain. End up in tears most nights. I'm usually a strong person, but this I can not handle! The only doctor I see is my surgeon. Is he able to prescribe any type of pain med?