First time around I usually waited to see if I really would need to increase the meds. And I put up with a lot of pain to do that. Then my doctor convinced me that it was much better to "get ahead of the pain." The way the meds work, it is harder and may take even more meds to take the pain away if you let the pain escalate before you increase the meds. The second and third time I had to go on the meds I was quicker to increase them.

For me once the pain escalates, it keeps going until I can't stand the meds and have some procedure done. So twice I had pain escalate, and kept increasing the meds till I couldn't stand the side effects, then had a procedure, got off the meds. Then sooner or later the pain returned and I tried meds again... After the third time the pain started and I got to where I couldn't stand the meds, I had an MVD. That was 3-1/2 years ago and so far so good. No pain, no meds.

So in my experience, there isn't much to gain by not increasing meds if you are still having pain.