I agree with you 100% about opiates. On one had i hate the fact I have no choice by live on them, on the other I always wonder if I have so much pain being on opiates, what would happen if I wouldn't?
You are right about having good communication with your good Pain mgmt DR, this is very important. I am sure you wouldnt take they if you dont have to but if you in so much pain, you need your life quality, no doubt about that.
Unfortunately I am a senior veteran when comes to being on opiates. And unfortunately in time they stop working. Of course depends on a case, depends on injury and on complications. Many surgeries and injuries heal well and people dont need them anymore or they can be on same dose or same drug for a long time and it still working.
My body tolerance is really unbelievable, my PM said I am in a very small amount of his patients who have such tolerance. Thus, doses stop working soon after I start and drugs must be changed all the time as well. And even if your tolerance is normal, it still needs to be adjusted all the time.
As someone with experience, my advice to you: agree to a higher doses only if your old doses and drugs really don't work for you. I usually wait until I cant wait anymore. Only b/c I have fear one day to hear " We tried everything and reached the ceiling, not much I can do".
Not One PM will keep bringing your doses up and up to no end, they are here to protect us. So it all depends how well you manage your pain and how communicative you with your PM.
Believe or not, my wonderful and very experienced PM yelled at me once saying its time for me to go on higher doses and change the previous drug, its not working. He knows me well by now, he doesn't have to worry with me, so I am honest with him and he honest back.
And of course, would like higher doses and stronger drug, but like I said: fear of reaching this ceiling after which nothing will ever help me.
Another fear is Fentanyl patch which is almost killed me... A lot to consider when you on such medication.
I wish you all the luck and less pain!!!