Mr. Need,
Breakthrough pain is a well documented phenomenon in patients with chronic pain who are medicated round-the-clock with opiate analgesics.
Treatment of breakthrough pain is with a breakthrough or "rescue" dose of opiate pain medication, generally 10%-20% of the daily equivalent two or three times a day as needed.Breakthrough medication is not taken every day, but only on those days when pain flares. For more information, gogle "breakthrough" or search on a general medical site like WebMD.
The solution to your problem sounds easy enough, in theory -- you're having breakthrough pain which is not being managed.
However, I have heard about this PM group with out of state phone numbers, and none of what I have heard about this group gives me confidence in their training and skills. If your insurance plan allows. consider hiring a different pain doc.
In the mean time, I'd recommend that you learn all you can about knees, chronic pain, and pain treatments specific to knee pain. Start with web searches, like "chronic knee pain".
I am really sorry to hear that you went through that. I'm surprised your Pain Management clinic didn't already have you on a "breakthrough" pain protocol from the beginning. I know it is embarrassing, nerve wracking, and makes you feel two inches tall.
First of all, it was very unprofessional for your Pain Management clinic to automatically assume and accuse you of "Doctor Shopping". Poor judgement and bedside manner on the part of the physician and clearly demonstrates that he is out of touch with how his clinic runs while his patient is not right in front of him. Physicians often jump the gun on this and it does nothing but increase the stress level of the patient (which increases pain), decrease the trust level between patient and provider, and the tendency for the patient with chronic pain to be up front, honest and clear about how severe the pain is or how it is affecting his/her daily life drop out of fear of looking like a "drug seeker". Whats even more scary is that when patients DO get to a point where they know that they may be abusing or having problems with their pain medicines they become less likely to be up front and honest with their physicians about it due to physicians perpetuating the stigma in regards to Pain Management and not having an open, compassionate, honest and understanding dialogue with the patient as to how the entire process works with pain management. In Other Words, poorly communicated treatment plan as is evidenced by your confusion as to how to be relieved of your suffering in an acute situation.
You have a legitimate medical issue that needs to be treated, you are in pain, and you deserve to have your pain treated in a reasonable amount of time and with dignity. With that said. I would highly recommend that you make sure you get in writing the PM's "contract" in regards to obtaining pain control medications and since you are having difficulty getting adequate /continuity of care from your PM for acute situations, ask, up front "What do I do when my pain level is x,y,z and you can't see me for days/weeks/etc. they need to provide you with a "plan B" that is acceptable for when they are unable to see you in a reasonable amount of time. The only other suggestion I can make is to do the best you can to see the same PM physician. When new physicians take over your care it just adds a bunch of extra cooks in the kitchen and miscommunication results. This may mean that you need to schedule a consultation with your primary PM and have an open, respectful and honest dialogue with him about your concerns. Ask him what you can do to be the best active participant in your care and maintain transparency since you are still somewhat new to the Pain Management industry. Be specific about what is happening (i.e. you're having acute situations and its taking you 3 weeks to get into PM) the physician may not be aware. Most reasonable physicians will understand that three weeks is too long to wait to treat an acute signifiant period of pain) And ask for the Plan B. I empathize with you and unfortunately, to answer your question, this is very common. I have yet to meet one single pain management patient that hasn't been accused of "doctor shopping" or "Drug Seeking" etc at some point.