TKR Pain NOT managed well

[Swish1212]

Hi,

I had a total knee replacement 10/10/22. I am a 64 year old female and the pain was unbearable! I was literally laying in bed sobbing. I was given Tylenol and low dose fast relief OxyContin that only lasts one hour. I do not believe with the knowledge and medicine we do not practice a pain step relief strategy!

 

[Layla]

Welcome to BoneSmart and recovery. Thanks for joining us! Which knee did you have replaced?
I am sorry you had a rough start. Hopefully things have progressed nicely for you over the past month. I will leave our Recovery Guidelines, much of the info will still apply. Wishing you the best as you continue your healing journey!

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Swish1212]

Thank you for replying so quickly! Yes I am finally starting to feel better. PT is very happy with my progress. I did discuss this with my surgeons assistant who is the pain management decision maker my suffering. I had to beg for help! I understand each office has a standard pain management, however not every patient is the same! I need to have my right knee done as well very soon and I am afraid It will break me!
Any suggestions?

 

[Layla]

Thankfully you're feeling better and doing well. That's great news! I guess I am wondering if you were satisfied with the conversation you had with your surgeon's PA? Hopefully you felt as though you were heard, he has a clear understanding about your concerns and offered you reassurance that there wouldn't be a repeat of what happened this time with your next surgery. This may sound like cold comfort, but each surgery and recovery is different, even with the same person, so hopefully you will get lucky and not struggle with the magnitude of pain you did last time. I hope that's the case for you.
@Swish1212

 

[Swish1212]

Yes the conversation should have been before the surgery!

 

[Zanza]

Hi,

I had a total knee replacement 10/10/22. I am a 64 year old female and the pain was unbearable! I was literally laying in bed sobbing. I was given Tylenol and low dose fast relief OxyContin that only lasts one hour. I do not believe with the knowledge and medicine we do not practice a pain step relief strategy!

Unfortunately pain management is not a priority with doctors in the United States. They're so afraid of patients becoming addicted to narcotics that they don't want to prescribe anything until you are out of your mind with pain. That said, there is hope. Prescription guidelines have been revised, and more doctors are willing to work with patients to manage pain. The trick is to advocate for yourself. Arm yourself with as much knowledge as you can about pain management and talk to your doctor with clear expectations about pain management.

 

[Jockette]

Another way to lower your pain level is to be very gentle with your rehab. Don’t do any PT that either hurts at the time, or causes increased pain and swelling within 24 hours after.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[eaglemom]

And don't forget the importance of proper elevation and icing. Ice is a good pain reducer - no, it doesn't take the pain away completely, but it does settle the knee down. You need to make sure your doing this multiple x's a day, at least 45 minutes each time.

Hopefully that will also help.

 

[lovetocookandsew]

I'm sorry you had to suffer through so much pain. Before your next surgery, learn as much as you can about your options for pain relief. Have a plan, in writing if necessary, that you and your surgeon discuss and agree upon. Ask him about him putting in a nerve block during surgery. Also, another thing that some doctors will do is the OnQ pain ball. I had those after some surgeries and they're amazing!

I can't take any kind of pain meds, so we had to use different methods for pain relief. After the OnQ was empty, which, between all the different things we did after surgery in stages, was somewhere around 2 weeks post-op, I only had my ice machine and elevating for pain relief. Luckily, by then my pain wasn't as severe, and the ice took away most of the pain that I still had.

No one should have to suffer from pain as you did, and you have the right to have the pain relief you need. Your doctor needs to address it to your satisfaction, so you go into surgery knowing your post-op pain will be controlled.

 

[Flashlight]

I'm sorry this happened to you. I think the most important thing to do is act as soon as you feel your pain protocol isn't working. That's what I did by the 2nd day I knew oxy wasn't working for me. The first 2-weeks are the worse. If your OS isn't helpful contact your PCP for help. Ice really does help and during that time keep it on. They really don't talk to you about pain management until after the surgery. I didn't think to ask about it. I know some hospitals have the doctors follow a pain management protocol at discharge but what your OS did was very poor.