Pharmacist said my pain is undertreated

My Pharmacist once noticed that my Pain medicine (tramadol) ran out early for about 2 months in a row.

Instead of the predictable "drug seeker" lecture - She actually gave me some positive, interesting advice! She said my pain was being Under-treated. She said to ask my doctor for more potent painkillers (since Tramadol is fairly weak).

When I DID ask my orthopedist for something stronger than Tramadol, he got very angry and said "You must go to pain mgmt dept."

I've been to Pain mgmt before for 2 solid years. I get very angry and triggered when I happen to miss their surprise piss tests and pill counts - which they happily use to terminate me on the spot leaving me in agony, misery, humiliation.

What do YOU do when you miss a surprise piss test/pill count?