I think it is a form of Morphine and since Morphine has a low bioavailabilty rate, I would think it would be the same with Hydromorphone. Morphine didn't help my pain either. I am currently on Oxycontin with Roxycodone for b/t. It has helped a lot better than the other two. Hope that helped.
Khilee

For example, for acute pain, 10mg IV morphine = 60mg oral morphine = 1.5mg IV hydromorphone = 7.5mg oral hydromorphone (according to one respected chart).

And that's without opioid tolerance. With tolerance, I suggest that your doc is severely under-dosing the drug.

It seems to me that since I get such a good result from the LA Oxy that I would do well with some type of IR Oxyy?

Since I take Prednisone as part of my daily meds, I don't really see any reason for me to go with any of the meds mixed with ASA, Ibuprofren or tylenol.

That explains a lot. I am a little surprised at my doc. He is usually better at conversions, although I did get the feeling that hydromorphone is not a medication he often uses for break through. It seems to me that since I get such a good result from the LA Oxy that I would do well with some type of IR Oxy? Since I take Prednisone as part of my daily meds, I don't really see any reason for me to go with any of the meds mixed with ASA, Ibuprofren or tylenol.

And yes, you are correct Nephro. Increasing my own dosage, while oh so tempting, would be ultimately a very bad idea. Hmmm...."Ah? Doc? I tried taking 4 of those little tabs instead of the one you ordered and it worked much better!" I think his response would be "see ya later, Doodle!"

Thanks for the conversions. Now comes the tricky part. Letting my doc in on this little bit of info without sounding as if I am just saying "More! More! More!"

Thanks again.

I'm down to 20 mg of Prednisone daily. I sure wish it could be less. I don't think that patients are well informed about the side effects--particularly how it affects the mental and emotional status of the client.

meta I was given 10mg of oxycodone in hospital and it knocked me around big time. I felt really strange and totally off my head. I must say though it is absolutely AMAZING for pain. All my pain left. As I said to the nurse, its fab for pain but unfortunately I feel really "stoned" when I take it. I went down to 5mg and found it really great for pain and I could still function. I have had morphine in the past that did nothing. I think OP, oxycodone is probably worth thinking about.

I have been using hydrocodone (norco) as a breakthrough med for years now. Over the past few months, I have noticed that it gives me zero increased relief. Perhaps a tolerance issue, although I have read that sometimes the body just needs a change up. In any case, when discussing this with the doctor I jokingly said that the best break through relief I ever got was while in the hospital (^ times in the past year) with IV hydromorphone. (Dilaudid) He immediately said "I can give you some oral as break through.' so he switched me off of the Norco onto the oral Dilaudid, 2mgs, three times a day as needed.

I'll admit that I do not know the cross tolerance for the two medications, but I have to say that this medication has been a big fat bust. I have not gotten even a scintilla of extra relief from it. Back in the day when the Norco was still working, when I took it for break through it would lower my pain levels within a half hour by a good two or three levels. The dilaudid does NOTHING.

I vaguely recall reading something about the oral bio-availability about oral dilaudid. Does anyone have any knowledge/experience they can share about this medication?

BTW...I did mention to him that the dilaudid was not giving me any relief (at all!) but I am not going to ask for any kind of change in my pain meds for at least a couple of months. I had also asked for an increase in my anti-depressant at the same time and I want to give that a chance to work. My doctor is great about listening to me and is always willing to work with me. I want him to know that I am willing to work with him and give things a chance to work and also that I understand that pain management does not mean the magic removal of all pain at all times. It is kind of sad, but it is a fact of life that we have to be on guard at all times so that we do not appear to be seeking or scamming. If I had a medication that was not controlling my hypertension well, I would have no trouble calling him as often as it took and changing meds as often as it took, to get it under control. Unfortunately, until the medical establishment, the DEA and even the public understand how dangerous intractable pain is, this is the dance we must dance.

I wish my present pain management doctor understood this, Nephro. He won't even prescribe codeine unless you're a cancer patient (a fat lot of good codeine is going to do for cancer pain).