I have had an IT pump with Dilaudid and Bupivicaine for over ten years.  I just had it replaced and it was at about 8mg/day.  I was also taking the long-acting drug methadone, and Actiq (fentanyl) for breakthrough pain.  When I went in to have it replaced, the doctor discovered the catheter was leaking.  He started me all over again.  He put my pump at 1mg/day, and took me off both opiods, so I had no pain control whatsoever.  He is raising my pump very slowly every week (about 20% every week).  He started me back on the Actiq for breakthrough, but not the methadone. One month later, my pump is at 2.8, and I am in severe pain all the time and bedridden.  He refuses to put me on a long-acting pain reliever.  He told me to choose between the two- Actiq or methadone.  How do I make that choice?  I know to use Actiq, one must be opioid tolerant, so I thought if the pump doesn't qualify, I can talk him into putting me back on the pain relievers that, in conjunction, will make the pain somewhat tolerable while my pump is being increased ever so slowly.   I know he is afraid I was on too many meds, and he's excited to start at square one, hoping I, being in intolerable pain, will settle for less meds, so he will get less flack for the amount of meds it takes for me, my individual body, to be able to participate in my life again.  I just thought since Actiq is normally prescribed in conjunction with another opioid, and the patient has to be "opioid tolerant" to take Actiq, if my pump doesn't count, I could persuade him to prescribe methadone, which, besides breakthrough pain, helps my pain so much.  And yes, after 34 days of unendurable pain, I am getting desperate.