My current dosage is 0.8995mg/day of Dilaudid; 89.95mcg/day of Baclofen; and 0.8995 Bupivocaine. I did not want Prialt because I have adverse reactions to gabapentin, Lyrica and Cymbalta, and Prialt sounded similar. It also has scary potential side effects, like psychosis. Dilaudid was always the best pain med for me so I asked for it. My prior and current pain docs are both fans of microdosing, less than 1mg of Dilaudid/day. My doc started me low and bumped it up 10% every week or so until I got relief, which I think was at about 0.79mg/day and I bumped it up once. In Dec, I was going thru a lot of pain, and my upped me to 1mg/day, his max. However, it was making me dizzy, especially if I gave myself a bolus, so I asked to drop back down to where I am now.

As to Bacolfen, I have a lot of back spasms so my doc added it, but I never thought Baclofen oral helped and don't think the small amount of Baclofen I get is doing anything for spasms. The Bupivacaine was added when I started having the pain last Fall. It may help some, hard to say.

I also ended up having a spinal cord stimulator implanted when my pump quit helping as much. I have a congenital defect in my spine, misshapen vertebrae, that cause my disks and facets to degenerate faster than normal. I developed severe stenosis at L2/3, which is adjacent to the top of my fusion, as well as SI joint issues, and I think the two just overwhelmed the pump. The SCS helps some, but what really has seemed to help the SI and L2/3 facet pain has been Placental Tissue Matrix injections. I have probably had 15 epidural and facet steroid injections and one in my SI joint. No help. The PTM injections have been helping.

So, I would ask your PM doc about PTM injections if he is not helping with a pain pump. Good luck to you and please let me know if you have any other questions.