First, you may need to ask for methylprednisone or an NSAID (or a change in dose / med if you are already taking those).  I've been on methylpred for over a year now, and at times, it was the only thing keeping me sane.  I seem to have a choice of moderately high doses of methylpred, or PRN pain medications.  For a while, I took 28-32mg of methylpred per day, but didn't need pain meds, except for really bad days.  Recently, I needed to drop the dose significantly due to related sides, and had to add daily pain meds.

Both of the meds you are on can be effective, but you need full coverage at least, a may need a stronger medication.  I took Vicodin (hydrocodone with tylenol added) for a while, but eventually needed something stronger and switched to percocet (oxycodone with the tylenol).  Because I'm somewhat MXT toxic and have to monitor my LFTs closely, when I needed to drop the methylpred dose  and knew I'd be taking the pain meds 3x per day, I rasked my Rheumy to switch me to straight oxycodone 5mg (getting rid of the tylenol, and hopefully avoiding LFT spikes from the pain meds).

For comparison's sake:

Tramadol is 1/10th the strength of morphine (oral).

Meperidol (Demerol) is 3.6/10ths the strength of morhpine (oral).

Hydrocodone (Vicodin) is 6/10ths the strength of morphine (oral).

Oxycodone (Percocet/Percodan) is 1.5-2x the strength of morphine (oral).

Hydromorphone (Dilaudid) is 5x the strength of morphine (oral).

My best advice is to know what you need and to calmly explain the deficit between what your GP prescribes and your needs to your Rheumy.  Your Rheumy may actively resist writing pain med scripts -- at which point you should think long and hard about whether you need a different Rheumy (my first refused to write pain meds, and even my current Rheumy was content to let my GP do it until I had a talk with him).  If he resists, ask him if you should see a pain management physician -- my rheumy would rather write me the scripts than add a third MD to the treatment.  Also, tell your MD that you don't want the drugs but feel you have to have something so you can live.  Ask for alternatives.   Also, ask for the bare minimum you think you can survive with -- its easier to get an increase in dose after you have the script in your treatment history than it is to get a big dose, super strong drug right out of the gate.  If you can stand it, go to your appointment unmedicated -- especially if it is a new MD and let him see the level of your pain.

I'm willing to bet you are taking  Vicodin 5/325 or 5/500 (which translates to 5mg of hydrocodone and either 325 or 500 of tylenol).  You might start by asking your MD to give you 5mg of hydrocodone, but 3x per day (e.g. 6 hours apart), unless you can't sleep through the night due to pain -- in which case, ask for 4x per day.  You probably will have to give up the tramadol, but given the strength of the two, I'd do it in a heart beat.  If you are already taking a stronger dose of Vicodin, start by asking for a full day coverage.

Bear in mind that MDs are down right hassled about writing pain medication scripts.  The scrutiny is possibly warranted in some cases, but the backlash on to good doctors who are taking care of their patients in need makes me see red.  It is very important that your Rheumy understand you are suffering until you find a treatment that works for you, AND be willing to help there.

Also know that around here, you don't have to tell us you aren't a druggy.  We know.  We understand the hate/necessity relationship with these drugs.

Chin up, Heather!