DEAR DR. ROACH:

I’m frustrated that my physicians aren’t giving me adequate pain relief. I had a shoulder repair with three severely torn tendons and a torn labrum, and the surgeon cut and moved my biceps tendon. I was given 20 mg of hydrocodone and APAP 5/325 mg for pain! Are the doctors legally prevented from giving me pain medication? — J.F.

ANSWER:

This makes me frustrated to hear. There aren’t legal barriers to giving a patient medication to reduce pain, but opiates such as hydrocodone should be given cautiously and with consideration for its potential for abuse. There are many tools to help the clinician decide whether these drugs may be given safely.

During the short-term future after a major (and painful) surgery, hydrocodone and APAP may be inadequate for pain control. A strong opiate (oxycodone or hydromorphone) might be needed, but most people can discontinue it after a few days. There are absolutely situations where prescribing them is appropriate to avoid leaving a patient in pain — without giving a patient so much medicine that they develop tolerance and habituation.

DEAR DR. ROACH:

You recently received a letter about proton-pump inhibitors. My primary care doctor prescribed omeprazole for my indigestion, and I’ve been taking this medicine for the past year.

My first question is: Is there a time limit on how long I can take omeprazole (as it’s definitely working for me)? My second question is: Does omeprazole interfere with my Type 2 diabetes or any medications that I take to control my diabetes? My third question is: Does omeprazole have any impact on essential tremors? — P.C.

ANSWER:

Proton-pump inhibitors (PPIs), as their name makes clear, inhibit the proton pump, which is the way that the body makes stomach acid. When taking omeprazole, the stomach can’t make acid, and many people find relief from stomach symptoms such as heartburn and indigestion.

There are long-term side effects that can occur while taking omeprazole or other PPIs. The body can’t properly absorb calcium, iron, magnesium and vitamin B12, so a person occasionally enters a deficiency state and needs supplements. There’s an increased risk of gastrointestinal infections, especially Clostridioides difficile — a serious diarrheal illness. It’s likely that there’s a small risk of pneumonia. The data are mixed about whether there’s an increased risk of dementia.

With these risks in mind, wise clinicians generally use PPIs for a short time, then see if a person really needs them for longer. Slowly tapering off the medicine helps prevent rebound. Sometimes a person doesn’t have further symptoms; any recurrence can be handled by medications with fewer long-term side effects, such as histamine-2 blockers like famotidine (Pepcid). They can be taken on an as-needed basis, while PPIs can’t really be taken this way. (They take days to reach maximum effectiveness.)

If a person really can’t tolerate being off PPIs, and other medicines aren’t effective, then I’ll usually recommend continuing them while being vigilant to the possible adverse effects. Omeprazole is unlikely to interact meaningfully with diabetes medicines. There may be a small decrease of blood sugar with omeprazole, but it’s not likely to be significant.

There’s no known effect of omeprazole on essential tremors, nor does it interfere with the most common medicines (propranolol and primidone) that are used to treat essential tremors.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved