I am disabled with serious RA, and have recently moved from Colorado (which I loved) to Vermont, because Vermont has great health care, and here I can get the extensive care I need for free. So it was a necessary move. But now I am having a problem with my new doctor, and I wonder if anyone can advise me on this. She's a wonderful person, generous and kind, a good doctor. But we are struggling about my pain meds, always (in my experience) such a contested and difficult area. I am really discouraged and depressed, and honestly scared about it. I have been on pain meds now for 6 years. I take them daily. I cannot begin to imagine life without them. My pain is extremely high. I can't walk much, and the pain wakes me up every night. It drains all my energy, and controls everything I can or can't (more can't) do. The meds make it possible for my daily life to be closer to normal. It makes the pain more maneagable (doesn't take it completely away and I wouldn't expect it to). After six years, I get absoutely no feeling of being drugged or even sleepy. In fact, I have more energy and my mind is clearer, because I can think of things other than surviving the pain. But also, after 6 years, my tolerance has gone up, and it seems reasonable to me that I should need slightly more now, not less. Isn't this called titration? But my new doctor keeps cutting my dose, forcing me lower and lower, just as the pain gets worse as I wait to schedule a hip replacement surgery. She recently cut me back to 4 pills a day, which is just not enough, without discussing it with me first, and not responding to my request to talk to her about it. Is there some way to make her understand that needing slightly more after 6 years, enough to get through the day (I take them on a schedule, but 4 doesn't make it, and doesn't leave me one for night when the pain wakes me up), does not mean I am doing anything wrong? I am exhausted from struggling with this, and being made to feel that I am somehow a problem patient, when I'm just asking for adequate pain treatment so I can live my life. I would be so grateful for any help, perhaps reference to something I could show my doctor -- or word from one of the doctors on this site? Thank you so much. Susan Noel.