 [ Symptoms ] doc prescribed 4mg dilaudid 3xday not working anymore now that i have returned to work can i also take 50mg tramadol  l5 is bulging and that together with bone spurs creates relentless nerve pain for which i have already missed three weeks of work while off work the 4mg dilaudid 3xday was fine i was barely moving now that the doc made me return to work the 4mg dilaudid 3xday is not enough and she will not approve me taking it 4xday i also have 50mg tramadol can i supplement the dilaudid with the tramadol if so when is the best time to do so since i cannot be falling asleep at work help [ Disease ] the short answer is you should not mix painkillers you should keep your health care provider informed of your physical status limitations and medication usage if you and your health care providers can not be partners then you should find another provider i realize things are never that simple many things may limit your choice of providers from insurance coverage to the number of providers in your local area but seriously do not keep important information from your provider it is not in your best interest try sitting down and having a good conversation with your provider tell him or her you can not take dilaudid in the work environment and when you do not take the dilaudid your pain is not controlled ask to discuss options can you combine two different types of pain relievers can you get some other non surgical type of treatment can you get physical therapy at work find out if you can change anything about your work environment that is aggravating your condition can you take breaks more frequently on a schedule can you reduce your work hours temporarily can you get an ergonomic consultation to arrange your workstation in a way that does not irritate your neck as you can see there are many many ways you can approach this situation without self medicating i encourage you to explore better options with your provider wishing you well