Um, maybe I missed it in your earlier posts (i.e., any digestive or bleeding issues), but why Tylenol (APAP) w/o an NSAID? So much of our pain for the first few months is due to swelling and inflammation. APAP or even a narcotic will address some of the pain, but it's treating the symptom (pain signals to the brain) and not the cause (inflammation). Ice goes a long way towards relieving the latter but doesn't always get the job completely done. Dilaudid at night but only APAP (and a half-dose at that) during the day sounds like an all-or-nothing approach, like a howitzer at night and a pea-shooter (with a spit-wad as ammo rather than a pea) during the day: you need something "in between" strength-wise for daytime pain, something that will let you function as you intend (and your care team believes is not overdoing it). Talk to your OS, PA or family doc about naproxen, diclofenac, flurbiprofen (the latter two are Rx-only south of the border but OTC in continental Europe--not sure which way it is in Canada) and/or topical forms thereof as a daytime adjunct to that Tylenol. Maybe the Bonesmart Cocktail (400 mg ibuprofen + 1000 mg. Tylenol q.4-6/hr prn) would hit the spot. There's also topical Arnica gel, from the natural food store or the muscle-care aisle at Whole Foods. It helps me with bruising and swelling, a nice adjunct to ice.