Hi Finz, I was started on 5mg 2Xday then gradually up to 5mg 3xday.(I also was on lyrica 200mg and cymbalta 30mg at the time). I didnt need any breakthru med. I was even backed down to 5mg 2xday. I called it my miracle drug not only to help with pain but it didnt cause side effects like other narcotics. I dont think you can take any other narcotic with it because it is like 10Xstronger than other narcotics and if mixed can cause respiratory depression. Hope it works for you! momof4