If the doctor gives you Vicodin for your pain, that should not affect your GERD. Ultram and NSAIDs, such as ibuprofen, naproxen, and diclofenac, are more likely to cause you problems. Vicodin does not contain any NSAIDs and should be a better option than the Ultram.   However, if the Vicodin does cause the GERD to worsen, you can speak to your doctor about taking a higher dose of Nexium. Nexium is available in 20 and 40 mg strengths. I've seen several patients who take 40 mg twice a day to get their symptoms under control - just make sure you clear this with your doctor before you start taking a higher dose.    Best of luck, Casey