Same shape here, different drug. The thing that helped was documenting the refusal rather than re-arguing it. They refer rather than write.

Sleep first. Bad night, bad day, more symptoms. Fix that before changing anything else. Tolerance was my main issue with chronic pain too.

I would stop trying to convey how bad it is and start saying what you want them to do.

I would take the narrow conclusion. Broad ones are more interesting and less true.