TKR 8 weeks post op TKR and I want to go on a trip in Sept

[gardenangel]

Hi All, I wish that healthcare providers would furnish patients who are, or who will be on opiate pain meds before and/or after TKR surgery, information about how to wean off these drugs safely when the pain levels would indicate that an otc remedy would suffice for the pain. I thought that I was carefully weaning off the prescribed Vicodan I had been taking for a total of about 8 weeks before and after the TKR, however, apparently I was not doing it slowly enough, which resulted in several terrible days of insomnia, anxiety, night sweats, nausea, agitation, fatigue, chills, and generalized disinterest in just about everything. Feelings frightening and completely out of character for me. It makes me afraid to ever take this type of pain med ever again. So, please, talk with your prescribing physician about weaning off these meds before you take them, and with his/her advice. I wouldn't wish this experience on anyone.

 

[tashia]

I do hope you are ok now. Sometimes this does happen and when it does its sad because the drug is so helpful to take care of the pain of the surgies. I would talk to your doctor if you need to take them again. please take carel Tashia

 

[hhilltop]

I'm at my mother's celebrating her 85th birthday. She's had 2 TKR's in the past year. I'm introducing her to this site. She saw Vicodin in the list of threads and now I'm hearing her stories. She didn't know she was getting Vicodin when she was in the nursing home a year ago.

 

[Ms.fixit]

To make it worse, Vicodin barely does anything for many of us, but it still gets you dependent post-op!
I was on pain management for Fibromyalgia for 4 years prior to my knee replacement..Percocet. Even with a scheduled de-escalation of dosage, I went through the same withdrawal symptoms at the end. I chose to go off prior to surgery so that post-op meds would be more effective. Post op I still needed heavy meds..Oxycontin, Dilaudid (and Ketamine in the hospital), so I did withdrawal again last month, in spite of tapering down. It's been 5 weeks off now and I JUST stopped sweating! This is the fault of the Docs for sure..they should prescribe a last prescription JUST for weaning off with a schedule of dosage, but mostly they don't want to hear about this stuff.

 

[Josephine]

Here is a suggested schedule for cutting back on prescription pain medications. Stay at each level for 3-4 days or even longer if you notice the pain symptoms increasing. This schedule assumes you are starting with one pill every 4 hours before beginning the reduction process.

1 pill every 6 hours and 2 at bedtime
1 pill every 6 hours and 1½ at bedtime
½ pill every 4 hours and 1½ at bedtime
½ pill every 6 hours and 1½ at bedtime
½ pill every 8 hours and 1½ at bedtime
½ pill every 8 hours and 1 at bedtime
1 pill if you are really doing something active during the day and 1 at bedtime

It is usually better to wean off these meds over several weeks, not several days. But if you are still having pain, then your body is healing and you still need pain relief. And in this case, I would discuss your pain management with your GP instead of your surgeon.

 

[maryo52]

Just as an aside, I think there is a fair amount of variation between people as far as physical dependency. A friend of mine tried to stop her vicodin at three weeks and went into terrible withdrawal. It's quite an eye opener, isn't it? And you are SO RIGHT, these should not be prescribed for such a long period without covering the weaning process.

 

[Dewey]

I'm just wondering......Is there any difference with the different narcotic medications as far as addiction/dependence goes? Is one worse than another?

I took Norco with my first knee which caused a lot of nausea. I was only on it for about 2 weeks, and then switched to Tylenol 3. This time, they are going to try Percocet with the hopes that the nausea is better. Do I need to worry about it? Is it more prone to cause addiction and a tough withdrawl??

Thank you, Josephine, for the chart. I think that will be very helpful to a lot of us!!

Gardenangel...I sure hope you are on the road to recovery now and the medication is no longer causing you any trouble! Please take care!

 

[maryo52]

Dewey, I don't think anyone needs to worry about the addictiveness of a med unless they have substance abuse issues. As long as you wean properly, you will not even notice any withdrawal. Percocet is one of the most abused drugs in our state of Maine; my ortho hesitates to even prescribe it. But I found it was a little more effective and I had no nausea on it whereas I was nauseous on vicodin. I was on percocet for six months. I took, at most, 1.5 tabs every 4 hours, then 1 tab every 4 hours, than 1/2 tab every 4 hours, and then I went to 1/2 tab three times a day and so on. I never experienced any withdrawal symptoms although I'm sure if I had decreased more rapidly the story would be different.

 

[Dewey]

Thanks so much, Maryo! I sure appreciate your quick response. I do worry about these types of drugs because I've never taken anything like them. Thanks for easing my mind a little tonight!

 

[Jamie]

Mary is quite right, Dewey. This is a time in your life when you need the pain relief these drugs have to offer. Altough your body may develop a dependency, when you are ready to wean off, it can be done. Addiction and the use of them for non-pain related reasons is a totally different matter. It is a psychological dependency as well as a physical one....much more difficult to deal with. As long as you have no history of drug problems, you should be just fine.

I am on Vicodin myself right now at 3 weeks out from my second TKR. I have discovered a very specific dose that works for me.....5/500 one pill ever 4 hours on the clock. It was interesting that the doctor wanted to prescribe only a 5/325 pill, but just that little difference in the acetaminophen made the medication not work. I would get breakthrough pain at 3 hours. The doctor's office was more than willing to prescribe a higher dose of the hydrocodone, but would absolutely NOT increase the acetaminophen in the prescription for me, even though what I was taking is well within safe limits. Go figure.

So, when you find something that works....go with it. Proper pain management one of the most important aspects of a good recovery.

 

[Josephine]

Thank you, Josephine, for the chart. I think that will be very helpful to a lot of us!!

Actually it's Jamie's work!

 

[gardenangel]

Hi All, Can't believe it's been 5 weeks since tkr...had to wean off opiates because of too many negative side effects and am now existing on Tylenol Arthritis caps at my primary care physician's advice. Am avoiding NSAIDS because I am on aspirin 81mg. for prevention of blood clots. The literature I have read indicates that aspirin's beneficial effects are lessened by using NSAIDS, so I am hurting. Still have good flexion and extension and am mobile with pain, with a cane, visit the Y and am using stationary bike and elliptical under dr.'s orders, but too much time on my feet results in misery and insomnia. Have tried icing, elevation, and rest, but am getting very discouraged. op date 2/28/13 LTKR

 

[jeep02]

You are getting there . don't be dsicouraged . you will improvement soon by leaps and bounds.

 

[izzie]

Hi All, Can't believe it's been 5 weeks since tkr...had to wean off opiates because of too many negative side effects and am now existing on Tylenol Arthritis caps at my primary care physician's advice.........

Hi Gardenangel -- sorry to hear you are having troubles with pain meds. Is your OS aware of your pain and if so, he/she should be able to provide you with something that would help other than your Tylenol Arthritis which, if I understand based on everyone's advise, is not strong enough to deal with your type of pain. Have you been through all your out patient PT? Since you are icing, elevating and resting, I hope you are communicating with your OS so you can receive help from them also. Don't be discouraged. I've learned so much from this website and I know to expect good times and bad. Everyone is a little different, but finally gets a good result. You will get there too - Hang in there! I'm having BTKR next month and trying to learn and get prepared for the big event. Take care of yourself!

 

[kneeper]

You may not believe it, but it actually sounds like you're doing pretty well, particularly if you're only on OTC meds.

 

[Ready]

Anyone know: Is Tramadol a true opiate or does it just act like one. Whatever it is, I am finding it to be keeping my pain under control. Best wishes to you. Keep up the good work.

 

[izzie]

Anyone know: Is Tramadol a true opiate or does it just act like one. Whatever it is, I am finding it to be keeping my pain under control. Best wishes to you. Keep up the good work.

I'm not in the medical profession, but my Rheumatologist put me on a very low dose of Tramadol to treat my arthritis pain and also the terrible pain I experience in my knees. It has helped me greatly. I take it once or twice a day, depending on the level of pain. So glad she had me start using this drug as no amount of OTC pain reliever helped.

Josephine would most likely know exactly how to explain Tramadol. I'm sure she will answer soon. She will also know how it affects the Kidney.

 

[megbabyrn]

Hi Gardenangel!! Wow, 5 weeks and you are off narcotic meds. I was on them (with weaning down). How much were you on of what med?? You could not take less?? Ultram is good for moderate pain. It can be taken q68 hours. Wait for Josephine, or talk to your Dr again.
So sorry you are uncomfortable.

 

[1ELISEA]

Yes, it really does sound like you are progressing well! Good for you.

After having NSAID ulcers, it is no longer my friend either. Fortunately, I had drs that understood that and helped me control pain without NSAIDs for a few weeks more. My dr. even talked about not being a fan of NSAIDs after seeing first hand the effects of it on the organs.

Usually the turning point is around 6 weeks so you're close. The lack of sleep, though, does hang on longer; I remember at two months wondering if I'd every get a good sleep again. Yes, eventually I did and before that I learned to take naps.

Keep icing!

 

[maryo52]

I totally hear what you're saying about side effects, but I'm wondering whether you had good help making modifications to address those side effects. Sometimes reducing the dose (a half pill) works. I had to take metamucil to keep the GI system functioning. I don't mean to pry, but sometimes people give up on a med without having gotten some good help addressing side effects.

Someone on the forum was given a narcotic in patch form that worked well.

Also, there is no reason you have to get the amount of PT/exercise that you are. If you were to cut that back, especially since you have good ROM, and just let life be your PT, you'll find you'll have a lot less pain. This will give your tissues a chance to heal a little more and therefore less painful.

Plus, to be truthful, at 5 weeks post-TKR, even with everything perfectly balanced, life can be difficult. This surgery is not for sissies.