Pain control without opioids at all?

[Raven22]

My friends father just had a knee replacement in Colorado and the surgeon refused to give him any opioids at all. He had no medical contraindications. He was given ibuprofen and tylenol after the block wore off. Needless to day he didn't do well. I am absolutely freaking out. I can't take any NSAID's at all because of gastrointestinal issues. What the heck am I supposed to do?

 

[Jaycey]

Discuss this with your surgeon or the anaesthetist at your pre-op assessment. There are plenty of alternatives. Frankly I think your friend's surgeon is cruel. Perhaps suggest he see his family doctor for appropriate pain management.

 

[Raven22]

Yes, I think it is cruel and we know that uncontrolled pain early on can lead to chronic pain in the long run. I was floored by her story. I will be very careful in interviewing my surgeon's about pain control. I'm just annoyed that the whole thing is scary as heck, and now I have to worry about pain control on top of it.

 

[Jaycey]

now I have to worry about pain control on top of it

Please don't worry. I am sure your surgeon will have a strategy for pain management. If in doubt also discuss this with your family doctor. Typically the hospital discharges you into the care of your family doctor. You may get a small prescription and will need to ask your family doctor for a refill.

 

[Jockette]

Interview is exactly the word to use. If you don’t like one surgeon, or his/her protocols, interview someone else. There are many and we don’t have to accept the first one we go to.

I regret that I did not get more than one opinion. In my innocence/ignorance I trusted the first and only surgeon I saw.

 

[Jamie]

Typically the hospital discharges you into the care of your family doctor.

While this is true for our UK memebers, it's not quite the case in the US. You will still be under the care of your surgeon when released from the hospital for at least 6 weeks following surgery and his office can and should provide you with whatever pain medication is needed for you to stay comfortable as you recover. However, with the current dust up here in the US in regard to the FDA "guidance" about prescribing opiate pain meds, some doctors have taken the stance that they just won't use them at all. You need to find out if that is the case with your surgeon in advance of surgery day.

Most surgeons have a policy of minimizing their use as there are other options for pain control these days. Take a look at our Pain Management tab at the top of the page and the articles there will give you an idea what I'm talking about. These non-opioid options work for a lot of people. But a good surgeon will have opioid options for when they are deemed necessary. As mentioned, to do otherwise and say a flat "no" to any opioid pain relief is just plain cruel. One of the most common combinations you'll see discussed here on BoneSmart is the use of Tramadol (a synthetic opioid that is not so tightly controlled as drugs like Percocet, Hydrocodone and Oxycodone) and Extra Strength Tylenol together. This may be an option for you.

All this said, should you find yourself in the early weeks of recovery and your surgeon is demanding a taper off any prescription pain medications when you're still having significant pain, it is possible to get your GP involved. My personal experience as well as working with members here on BoneSmart is that your GP may be able to allow you to continue a bit longer with managed prescription pain meds if it's needed.

 

[Raven22]

Thank you for your advice. I can take Tramadol and Tylenol, it works OK. It really, really stinks not being able to take NSAID's pre or post surgery and now the opioid crisis (i.e. more like hysteria in my mind, I've had 17 surgeries and procedures that required opioids and I've never gotten addicted, not sure why they don't take that into account when doing their "individualized" pain plans). I am looking into acupuncture and radiofrequency ablation as alternatives as right now so at least I can talk intelligently to the surgeon about the non-opioid options. I already use the Curable App and do mindfulness meditation, but it doesn't work all the time, especially when the pain levels really ramp up. Insurance doesn't pay for a lot of the alternative pain modalities which really irks me.

 

[Jajakio]

I was like Jockette and would have used the same orthopedic surgeon I had been seeing for years. In a way, I was lucky my insurance changed and I couldn't use the only hospital he practiced at. I was upset at the time but it forced me to interview new surgeons and I found there were far more differences than I imagined. Don't make assumptions just because one surgeon does things a certain way. See more than one surgeon and ask lots of questions. If pain relief is a big concern for you, ask what is going to be used, how long they will prescribe, what they will do if you are on their standard regimen and it isn't working for you?

This is a big surgery so I felt it made sense for me to interview more than one surgeon. Some big differences, some small ones. For example, my old doctor told me i would have to stop Meloxicam 10 days prior to surgery. The one who actually did my surgery told me to take Meloxicam up to the night before because he felt it gave him a less swollen area to operate on. I'm not sure that makes on surgeon better than the other, just an example of the differences. You might want to consider calling or emailing the office with a question a time or two prior to the surgery and see how good they are about getting back to you. I've heard horror stories about people with problems waiting several days with no response. For me it was very important to have someone who would follow up in a reasonable time frame if I needed help.

You may have other concerns. Make a list and try to discuss these issues with the surgeon. If he brushes you off or hustles you through without addressing your concerns, that might be another clue this isn't the surgeon for you.

 

[Raven22]

Has anyone had the problem of having 15 minutes with the surgeon and then all questions have to go through their medical assistant? I didn't get a chance to talk to mine about a very bad nickle allergy, chronic UTI's, my depression and anxiety, pain control, infection control, type of wound closure - nothing. Is that normal?

 

[robert johnson]

If I can make a suggestion. Next time you're scheduled to see your surgeon, go in there with your husband(or brother/sister/friend) and a notebook with all your questions written down.

It works wonders anytime I do it. He knows there are questions in the notebook and in my wife.

 

[Raven22]

So I talked to two surgeons about pain management for a TKR. Both expected to me be off of opioids in 7 days in accordance with state law even though I can't have NSAID's. If I needed more than one week, I would have to climb in the car and come to their office in person, per state law, every week. I'm in Michigan, does anyone who has RECENT surgery know where things might be different? This law went into effect this January. I won't have surgery under these conditions.

Thanks and I can't believe this.

 

[Kenello]

I don’t know about the law per se, but was prescribed 40, and could have one refill within 2 weeks, but we had to go to the doc’s to get the scrip, but they could also mail it. Hopefully you can do Tylenol. It’s scary to anticipate being in terrible pain, but ice does wonders (my new best friend) and the first few days after, the nerve block from the surgery helped a lot.

 

[julie1968]

Not sure if that's just the law there. I'm in MA and had a surgery few months ago on abdomen my Dr gave me 60 pills and I could just call for a refill in 3 weeks and she send directly to pharmacy. Hope you find more info and able to get what you will need

 

[rosieNZ]

Thats just cruel.
That said ice really helps and I have a cryocuff which works well (a good supply of ice packs close at hand is next best thing). I think the Game Ready machine may be even better. It helps to decrease swelling (a cause of pain) and numbs the area. Having a machine is easier to manage but they do the same thing as ice packs. Game Ready uses compression better than the cryocuff.
Next thing is to elevate your legs to reduce swelling (swelling increases pain). Lounge Doctor leg cushion is good.
Acetaminophen/paracetamol taken with opoids increases the effectiveness. You need regular, by the clock meds but maybe you can lengthen time or decrease the opoid dose to make your prescription last a day or two longer or maybe with the help of ice etc you could decrease the dose you take during the day so you get an extra day or two longer from your prescription.
Sorry that's what I would do in your position (get the max dose they will prescribe, use ice and elevate religiously, take paracetamol with the meds and try and make them last as long as possible before you make the trek for a repeat). So sorry you are in this position. Now the job is to get thru it. The first 2 weeks are the most challenging. After that it gets better quickly.

 

[Raven22]

Thanks guys. It's the law here. I will try another state if I can but it's obviously going to be hard to manage that. No way can I do this with just Tylenol. I've already had 2 ACL's when I could have narcotics and I know this will be a whole lot worse. I also had 2 labrum and rotator cuff surgeries with narcotics and ice machines. No way could I do it with Tylenol and an ice machine. I will wait until I can find another option. Perhaps a trip to Mexico - I heard you can get them for like $7000 cash there. At least I won't be tortured. I can't believe the doctors aren't sticking up for us more. Just. Can't. Believe. It.

 

[alexthecat]

@Raven22 I've merged your two threads about pain management. This will make it easier for people to see what advice and feedback you've already had, so we aren't repeating the same information.

 

[Celle]

@Raven22
Have you looked at the section on Pain Management (in the blue bar at the top of the page)?
There are lots of ways of controlling pain.
Using Opiates and NSAIDs is not the only way. In fact, NSAIDs are not very good pain killers anyway.

Some surgeons and doctors are allowed to prescribe Tramadol, which is a useful "step-down" drug from the opiates and it combines effectively with Tylenol.

I have had 3 knee replacements and I only took opiates for the first week post-op.
I also can't take NSAIDs.

As long as I took it on a regular schedule, Tylenol/Acetaminophen/Paracetamol controlled my pain well, provided I combined it with rest, ice, and elevation - and just a little, gentle exercise.

If you have a skilled surgeon in whom you have confidence, I think you would be foolish to now start looking for another surgeon in another state.

 

[Raven22]

Thank you, in Michigan Tramadol is now regulated as much as Oxy so no leeway there. You must be tougher than me. No way could I make it on Tylenol and ice. I apparently don't do well with pain even though I have tried. My previous orthopedic surgeries have shown me that. My last 2 shoulder surgeries had blocks and ice machines. I still needed narcotics just to function at a minimal level of "get up to the bathroom" for over 2 weeks. This would be my third surgery on my knee. 1 meniscus removal when I was 15 years old and an ACL repair when I was 25. The ACL was an overnight gig back then. I had to call my husband to break me out of the hospital because the nurse was on lunch and didn't give me my pain meds before she left. I cried all the way home. Took days to get things back under control.

 

[Celle]

No way could I make it on Tylenol and ice. I apparently don't do well with pain even though I have tried. My previous orthopedic surgeries have shown me that.

I have no doubt that your surgeon will have a plan to control your pain. You can't be the only patient to have a TKR since the regulations came into effect. Have you talked it over with him?

Don't just get fixated on opioids.
It's possible to have a long-lasting anaesthetic inserted into your knee during the surgery, or to have an On-Q ball that administers local anaesthetic into the area surrounding your knee after surgery.

What other orthopaedic surgeries have you had, apart from the shoulder?

 

[donnag1108]

I am in Nevada. I talked to 3 surgeons before choosing the wonderful one I have but I have to say I did not ask about pain meds due to my ignorance. Fortunately I got very lucky. I have not had single issue getting a refill on oxycodone. While I no longer need it very often and stopped requesting it I just got a refill today as well. I am returning to work Monday and work about 55 to 60 hours per week and I was concerned about pain at the end of some long days so I wanted it on hand for night time just in case. They refilled no problem. While they can only prescribe a week supply at a time I just called once a week and they refilled with no problem. I hope you find the right surgeon as it really does make all the difference!