Pain Management Post TKR

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Topic Title: Pain Management Post TKR
Created On: 12/21/2008 09:33 PM

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 12/30/2008 03:32 AM

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lgchap

Posts: 109

i will add my two cents worth about pain meds--- yes, you do need it!!but more about your IT band--- i too had a real problem with it after my bkr 2 1/2 yrs ago-- here's what i did, and still occassionally do-- massage it with the tips of your fingers, kinda roll your fingers over it, all the way up & down, and also use heat, hell, i sat on a heating pad for almost 2 mos; ice on knees, heat above!!!! ha!!! i also had trouble with the piriformis muscle right smack in the middle , and a little higher, of each buttock . in think i remember sometimes these go together. i did have ultrasound on my butt, but i can't remember about the IT band. i'm going to my pt for other issues in the next week or 2, hopefully, so i'll check back after i see myn pt "hero". good luck, hope this helps!!!laurie
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 12/30/2008 03:32 AM

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lgchap

Posts: 109

i will add my two cents worth about pain meds--- yes, you do need it!!but more about your IT band--- i too had a real problem with it after my bkr 2 1/2 yrs ago-- here's what i did, and still occassionally do-- massage it with the tips of your fingers, kinda roll your fingers over it, all the way up & down, and also use heat, hell, i sat on a heating pad for almost 2 mos; ice on knees, heat above!!!! ha!!! i also had trouble with the piriformis muscle right smack in the middle , and a little higher, of each buttock . in think i remember sometimes these go together. i did have ultrasound on my butt, but i can't remember about the IT band. i'm going to my pt for other issues in the next week or 2, hopefully, so i'll check back after i see myn pt "hero". good luck, hope this helps!!!laurie
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 12/28/2008 03:43 AM

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gammawbecky

Posts: 319

Hi there. Just a quickie....you are only almost a month out of very serious surgery and NOT taking your meds is really not a good idea. Your body needs to be pain free as possible to heal. I have this thing about Percocet - I don't think it lasts nealy long enough and so you have to take it alot. Why not ask your OS for hydrocodone which is not quite as strong, but lasts much longer. I'm sure he will be happy to do that for you. Chin up, take your meds and get after that PT! Just be careful not to do too much or it will taka longer for your knee to heal...and heavens know we don't want that!!!!Becky
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 12/27/2008 10:56 PM

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3059nickn

Posts: 47

Sorry I hit the wrong key. As I was saying, my knees really ache before the weather changes and sometimes I have to take a pain med for that. I have been told this whole process can take a year to 18 months to be fully back to normal. That doesn't mean that you can't live a good life, just that your knee or knees are going to be stiff and sore for quite a while. I went back to light duty work at four weeks, sitting at a desk and back to full duty work, ( Security Officer at a hospital) at 11 weeks. I am doing fine and have gotten used to the idea that it will be awhile before my kness are back to normal. I am extra cautious when it snows here, cincinnati Area, but other then that I can do pretty much what I want with limitations.I do encourage you to use your pain meds before your PT or workouts. Using them only for that should be ok. Check with your Doctor first but mine is fine with my use of them.Keep working, It will get better.Nick
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 12/27/2008 10:45 PM

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3059nickn

Posts: 47

Tim,Just wanted to add a little more info. I am 4 months out from my bitkr and I still have stiffness and soreness after my workouts and PT. I still take a pain med before the workouts so I can do as much as I can. My OS is fine with that.
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 12/27/2008 08:26 PM

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timmckenna

Posts: 3

Hi. I am doing ok. I have got my flexion to 90+ and close to 0 on extension. But, I am still dealing with pain. Lately, I have been waking up because of pain. I am using an ice machine and that helps. I have scaled back my percocet but I am not getting as much releif for obvious reasons. Maybe, I have been too agressive with the PT. I was told to take it slow but I am. I guess I am so use to PT from the other surgeries that maybe I am pushing oo hard.I think alot of the pain is the IT band and surrounding muscles. I do have some ache in the joint but we are having some weather changes and a cold spell. I have been masaging the muscles but I aggrevate them everyday when I do quad sets. But, I need to get stronger. I had hoped that I would return to work in four weeks but that is out of the question.In about one more week, I am going to start outpatient PT. I was going to start earlier but the home PT thought that because of the surgeon specifically told me to take it slow. Also, I am doing the same exercises that I would if I were to go.Thank you for all your responses. I hope everyone had a Merry Christmas and have a Happy New Year.Tim
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 12/23/2008 11:48 PM

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3059nickn

Posts: 47

Hi.Becky is right. I am four months out from a bitkr and I still take a pain med before I work out or see my PT. My knees are great but I still have some hamstring problems and I couldn't get the exercise I need without them. It isn't a strong med but it works.Good luck.Nick
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 12/22/2008 10:07 AM

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gammawbecky

Posts: 319

Hi Timmckenna and welcome to Knee 1. Yup, you have found the right place to go when your TKR is going south it seems and you are in pain. First off, let me tell you I will have my 16th surgery on my left knee in a week at Mayo Clinic. Even they are having fits getting it right! So much of you story sounds like mine - injury to left knee, tough surgeries, the knee just destroyed by complications. I am NOT saying more and more surgeries is the answer because it certainly isn't. I am lucky to be able to go to Mayo for my treatment because they do things no one else does...and I have needed them all it seems!!Here's the big deal for me to write to you. It is the way they are treating you with pain meds. So many healthcare personnel are used to doing the same thing for everyone and there is no way that can be the thing to do. First of all, Percocet is fine for a fast acting (20 min) med but it doesn't last much past 3 hours. Now, hydrocodone (which can be prescribed over the phone) takes forever to work (1 hr +) but it lasts longer. Now, this is something I don't understand.....why can't they give you both? Percocet for fast relief and hydrocodone to increase the time it all works. I'm going to ask about this when I'm in the hospital and see what happens! Morko is right about needing pain meds to be working while you are working on exercises - it is essential to you being able to accomplish as much as possible. And, you need to take your pain meds an hour ahead of time so they are working well by the time you start exercising.Your idea that your past drinking might be a deterant to getting the pain relief you need without begging is probably right on. Have you told them that your girlfriend is in charge? Sometimes it helps to keep a log on when you take what so they can see you are being as careful as possible. I also wonder why they have not put you on a Fentanyl pain patch....even Mayo does it because it works so well and you only need to put a new one on every three days. There is no "high" feeling with it.....it just works great. Don't stay on them for more than a couple of weeks because they are highly addicitive but the best for very intense pain. I hope something here can help you because pain shadows everything you do and hurts beyond belief.PLEASE keep in touch and let us know how you are doing and if there is anything else we can help you with.Becky
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 12/22/2008 12:48 AM

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morko

Posts: 141

You are not at all unusual to still be needing pain medicine. Maybe they are concerned about your previous history, but surely they realize that you still need something. Maybe they can suggest something different that wouldn't be hard to get them to refill. There are many different pain medicines.This is a very painful surgery and a very slow recovery. If you are going to do the therapy that is needed, you have to have pain management. Everyone is different, but like you said even taking the medicine doesn't make the pain go away, it just makes it tolerable. It's like childbirth in that unless someone has been through it themselves, it's really hard to explain what it is like. Good luck but keep in mind if you continue to be unhappy with how you are treated, you can always switch to another doctor/ nurse.Audrey
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 12/21/2008 09:33 PM

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timmckenna

Posts: 3

Hi, I had a TKR on Dec 1st. This being my 4th knee surgery on my left leg and my 5th overall. I am only 40 but, I had a very traumatic injury to my knee when I was 18 over 22 years ago. My first surgery was a full reconstruction with a full open "baseball" style incision. Since then, I had 2 meniscus repair and microfractures. So, I have been bone on bone for many years. I ended up injuring my rgith knee and had an ACL replacement with meniscus trimming. This aggraveted the left knee and it started painful bucking.I spoke to various surgeons and the only thing left for my knee was a replacment. Everything went well in respect to the replacement. I was told there had been a lot of damage and huge osteophytes. Since my first surgeon opened my knee with an incision that I am now being told is not the proper way, I was taken off the CPM because of a lot of inflamation along the flap of tissue. My pain level has been very high. According to the nurse practitioner, my surgery was complex because of all the other ones. I had my staples removed a few days ago over one week after it was scheduled to be removed.I guess what I am getting at is the nurse practitioner has been really pushing me to wean off of the percocet. The thing is well over a week ago, I went in to the clinic because I was at a 10 and was afraid that something was going wrong. It was ok but one of the fellows said that my tissue balancing was extensive. Even the nurse practitioner herself agreed that my recovery is different from the norm and that it would be a slower recovery.Now, I am taking 2 percocets every 6 hours. It is not like the pain is gone. It is just made more manageable. Now, the nurse did write me a new script but, I just feel like I have to beg her to do so. I am in pain and my IT band feels like someone is stabbing me repeatedly there. What is the norm in terms of pain management? Am I wrong to think that I should be able to get pain meds without a song and a dance? I think it is possible that the nurse is going overboard because I did say that I am a recovering alcoholic. But, I gave control of my pain meds to my girlfriend just to keep me honest so I am not just abusing it.Thanks.
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