Bilateral TKR Nerve pain<

[tkrme]

I have had a nerve block shot in my knee before surgery but there may be other kinds. I do know that I have had no pain only mild soreness. I don't know about burning nerves. That does sound drastic and what will be the consequences to the rest of your leg if nerves are burned?

 

[Bsmeahan]

I do have a tens unit I will try tonight to see if it helps.

 

[Bsmeahan]

The pain management dr says they do this a lot and there is no damage to the nerves or any that controls movement or anything. My mom had migraines and they did this to her to stop pain and it worked.

 

[Pumpkin]

Glad to hear the pain management Dr has a lot of experience with nerve ablations, and that your mother has had such a good outcome.

 

[Jamie]

I have heard of a few of our members who had the nerve block. I suppose it might help if the problem really is nerves. I have a couple of questions and I'm going to tag @Josephine who will likely want some more details before weighing in on your discomfort.

How much Gabapentin were you taking when it worked for you (dosage and when during the day/night)?
Is the pain you're feeling the same in both knees and can you pinpoint what brings it on? It sounds like it's primarily at night when you're trying to sleep.

Where are you in Missouri? I can help you find a revision surgeon if I know the largest city you are near.

 

[skigirl]

If you look at the ortho practices in your city, you can then look up the individual docs. They tell you what their main interest is and one of them will probably say that he does revisions. Those docs enjoy the chase and have some experience looking for answers to problem. I would want someone like that on my team if I had recurrent nerve pain.

 

[Josephine]

they put me on Gabapentin which worked for 6 weeks but no more. So now looking at nerve block shots.

My experience of gabapentin is that doctors often tend to under-prescribe it. So what was your prescription for it? (mgs, frequency). Normally a patient is started off on 300mg once daily and then increased to 300mg twice daily, then 3 times daily. If that doesn't work, then the dose is increased in steps to 600mg daily, twice daily and thrice daily. It's possible for the patient to be on this for 3-6 months and even longer. I was on it after my second knee for about 3 months. So if they didn't apply that protocol, then in all honesty, they haven't given you a good enough chance on this to get best effect. I'd certainly want them to do that before resorting to nerve blocks.

I do have a tens unit I will try tonight to see if it helps.

I am dubious whether a TENS would work on nerve pain and it might even make it worse, so do be careful. You could also read this TENS machine article to make sure you're using it correctly.

Oh yes - and you will notice that I have merged your three threads together as we prefer that members in recovery only have one thread so we can access the whole story. I've just read it through and have some ideas of what might be your problem. So I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Bsmeahan]

Thank you and yes please ask.

 

[Josephine]

Here they are then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

Also please answer for how you are right now

1. what are your pain levels right now?
(remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)
Please also include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Bsmeahan]

Pain levels during day are usually around 2-3 at night in be 8-9
Gabapentin 3-300 mg at bedtime
Moderate
My flexibility is great and can straighten them out all the way
I hardly ever ice but I do elevate daily a few hours off and on
I have some problems keeping up with housework have to sit often
Leg lifts 20-3 times a day
Leg circles 20-3 times a day
Side raises 20 per leg 3 times a day
Steps up and down a few times a day
No PT

 

[Josephine]

Pain levels during day are usually around 2-3 at night in be 8-9

wow!

Gabapentin 3-300 mg at bedtime

Am I write in reading this that you take 900mg Gabapentin at night only? That's crazy. You'd be much better taking 300mg once every 8 hours. Either that, or you need to have you dosage increased. Who actually prescribed this for you? You surgeon?

Moderate

Not good at this stage.

My flexion is great and can straighten them out all the way

Okay - but no numbers?

I hardly ever ice but I do elevate daily a few hours off and on

hmmm .... not so good.

I have some problems keeping up with housework have to sit often

Well I'm glad you are doing it like that.

Leg lifts 20-3 times a day
Leg circles 20-3 times a day
Side raises 20 per leg 3 times a day
Steps up and down a few times a day
No PT

Glad you not going to PT but why are you still doing those exercises? Did somebody tell you it was necessary? Because I don't think it is. You have excellent ROM and no longer have any need to work on it.


I'd now like you to answer these questions again but for the first 2 months immediately after the surgery.
Would you do that for me please?