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Is Hydromorphone Good At Controlling Pain After Shoulder Surgery?

Posted on Fri, 30 May 2014

Question: I had rotary cuff shoulder surgery a few weeks ago and have tried two different pain meds. I started out with oxycodone-acetaminophen 5-325, taking 2 tabs every 4 to 6 hours or as needed. I asked the PA that since I was taking three-four tabs before therophy and at night to kill the pain to be able to sleep that I was concerned about the affects of all the acetaminophen on my organs and if she could possibly prescribe oxycodone-acetaminophene 10-325 so that I wouldn't have to deal with so much acetaminophene. When I picked up the script from the clinic clerk I noticed that my meds were changed to Hydromorphone 2 mg 1 tab every 4 hours. I have been on this med for about a week now and noticed that one tab had absolutly no affect on my pain. Last night I tried two tabs and noticed no affect on the pain. The pharmist said that the Hydromorphone was much stronger than the Hydromorphone. Question 1: what pain level is Hydromorphone good at controlling mild, moderate or severe? Question 2: I am beginning to think that since this med isn 't working at all that maybe this particular hydromorphone prescription, in this bottle, is not really a medication at all but is a - ie: forgery - . Quesion 3: What source can someone go to determine if this is in all actually what the label says that it is? I have personally experienced two such cases in my life time of medication being substituted with fakes (I am 67) and since most generic meds are manufactured overseas that the FDA cannot inspect all of these facilities. I am in pain and have gotten very little sleep so please forgive my spelling and wording. Thank you,XXXXXX

Answered by Dr. Karl Logan (3 hours later)

Brief Answer:
Hydromorphone should deal with the pain

Detailed Answer:
Hi XXXXX,

Thanks for your question I'll do my best to answer it.

If you do not have preexisting liver disease then your body should easily be able to deal with up to 4g of acetaminophen per day and so I would not worry about your consumption of this medication at current levels.

It is best to medicate for pain is in a stepwise fashion. I would usually start with acetaminophen 4g per day or 1g every six hours. I would use this in combination with an antiinflammatory such as naproxen 500mg twice a day. If taking Naproxen you should combine with a PPI such as omeprazole to protect you GI tract. If you have nerve type pain, burning / hyper aesthesia then Gabapentin can often also be of benefit.

If you are having a lot of muscle spasm a benzodiazepine can help remedy this.

I would then add in the opiate type drugs. I personally do not like Codiene or it's derivatives as a certain number of patients a cannot metabolize the drug.

Hydromorphone is a better choice. having used it myself for a prolapsed disc it is a very powerful opiate, more so than Codiene and I would expect 2-4mg would be enough to deal with your pain. the fact that it is not working is concerning regarding the quality of the drug you have been given.

best wishes

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T