A friend of mine started having back issues in 2009. He was referred to a pain management doctor. He was started on Tramadol and then shortly switched to Tylenol with Codeine #4. The Tylenol with Codeine became ineffective after about 6 months, so was switched to percocet 7.5mg x 2 per day. As the pain increased the doesage was increased to 10mg x 2 per day.
He was steady with this for years. Between wear and tear from his job and a car accident, his condition had worsen and the pain level increased. He went to a 50mcg/hr Fentanyl Patch and 2 Percocet 5mg x 2 per day. The patch was giving him rashes, He then switched to oxycontin 30mg x3 per day. As his pain increased and tolerance built up, his percocet increased to 10mg x 5 per day.
So he was on oxycontin 30mg x 3 per day and oxycodone 10mg x 5 per day. He was steady with this plan for about a year. His tolerance had built up and was switched to oxycodone 15mg x 5 per day, still on the same oxycontin doseage. It wasnt working. He was then switched to oxycodone 30mg pills x4 per day. He was still having minimal luck due to his tolerance and pain level.
The doctor had decided to change his plan. He was started on Methadone 10mg x2 per day and 15mg oxycodone x4 per day. Now, increased to 20mg Methadone x3 per day. The methadone supposedly plays a special role in reducing opiate tolerance. This is the current plan and it is working for him finally.