Yes, I just ended up increasing by .25 mg each time. I stayed at .25 mg for 2 weeks, then increased to .5 mg, and so on, until I reached 4.5 mg. That was the goal my PCP and I agreed upon.

If I experienced side effects for 2-3 days, I dropped back to the previous dose for another 2 weeks, or like you I suppose I would also have gone down to 1/8 of a milligram. Then, I'd moved forward again.

The only thing I did to titrate faster was that later in the game, I waited only 7 days before increasing the dose. I don't really remember when I started doing that, though. It might have been after I got to 2 mg or so. I still followed the same template; if I had side effects that lasted for more than 2 days, I dropped back to the previous dose. But that is my usual model for how to incorporate new interventions for my body though. It's how we manage my central sensitivity syndrome.

The only side effects I had were feeling too energized/alert and difficulty sleeping, which is are known sides effects. I believe GI symptoms and flu-like symptoms may also be known side effects. I didn't have increased pain.

I hope it helps you too.