post-op painkillers

[kittykat]

this is my first time posting.

I am 50 yrs old and had THR on may 28th, so I am about 8 or 9 days out.

my question is, how long do people need to usally stay on painkillers after surgery? I was on painkillers for ~1yr before my surgery, and built up a tolerance. now I would like to cut down, but it's hard for me to differentiate between the post-op pain, and the aches and pains that come when I decrease my painkiller dosage.

how long should I allow myself to continue with prescription pain meds? I'd like to be off them as soon as possible, but I also don't want to make my post-op rehabbing too miserable.

thanks.

 

[Josephine]

Welcome to the forum, kittykat, and I hope we manage to answer your questions here.

As regards pain killers, did you expect to be off them by now? I only ask because you are barely one week post op after a VERY major op and realistically, you can expect to need pain relief for another 4-6 weeks at least. Don't be too hard on yourself or have too high expectations. Allowing yourself to be in pain will only hinder your recovery. Be kind to yourself!

Also, you say you built up a tolerance pre-op but I would venture to suggest that it only seemed so because your condition was getting worse and the meds couldn't get on top of it.

Funnily enough, the issue of coming off meds doesn't seem to have been discussed overmuch in this forum but it's been addressed a fair bit in the knee forum. Of course, TKR is a LOT more painful and drawn out than THR but the problems are much the same so far as the painkillers are concerned.

I found a few threads from there were it was discussed ...

Finally off the dope

pain meds

Cut back again

Getting Off Pain Pills - Maybe

Percocet

coming off Percocet

Pain Meds


Plenty of reading there for you! Hope they help a bit.

 

[westexas]

Hi Kittykat,
I Am Also 50 And Had My Left Thr On Feb.26th. Stayed On Hydrocodone For Many Weeks And Then Weened Myself To Darvocet.
No Reason To Be In Pain. I Finally Stopped The Darvocet At About 6 Or 7 Weeks. I Occasionally Take Tylenol When I Need It. Give Yourself Time. There Are Also Threads On Insomnia Too If You Find Yourself Not Being Able To Sleep. I Had That Problem. Keep Us Posted. Patty

 

[kittykat]

thanks, everyone -- great resources and replies.

I think I am expecting too much of myself -- I am only 10 days out and I guess it is normal to have pain. I guess I just get scared because I get an "anti-opiate" vibe from my surgeon, and I was on opiates for 1 year prior to my surgery so I do have a tolerance (have not abused meds, just have a tolerance). since I don't know my surgeon's prescribing practices, I am nervous that he will cut me off before I am ready or when I am still on a higher dose and I will then be left to CT it.

I do have my family doctor in my corner, though, who is backing me and will prescribe if needed. but I hate feeling guilty for needing pain meds! they prescribe like 40 at a time, no refills, and that's good for about 5 days!!

I'll keep reading and posting here. everyone seems awesome and WOW what great senses of humor!!!

 

[*gmac*]

Taking a pain pill every 3 hours? How would you wean yourself? One every 6 or 8 hours? That would stretch the prescription out. But would you be in more pain then not? When I thought I was ready to cut the meds umbilical cord, it (the pain level) was tolerable for 2 days then I went back on them (meds) for 2 days (cause I pushed my self on a weekend). I'm not a doctor but I think your body will let you know when its time. Were all with ya and we'll all get through this together.

 

[Josephine]

I think if she is taking two at a time as most people do, that would work out at 6hrly which is ok.

 

[kittykat]

I am doing much better. I appreciate everyone's input. I have come down on my meds the last few days to ~100-115mg/day and feel confident I will continue to be able to decrease as I gain in strength and get further away from the surgery.

I read a lot of posts about pain meds in the knee section, as directed by our good moderator (thank you!) -- they seem to get into this more -- and I realize I am being a bit hard on myself considering what a short time its been since my surgery (day 12 now), and that I had a tolerance to pain meds before my surgery.

I do find that each day, as I do my exercises and clear out the d*mn anesthesia (that stuff is sooooo toxic!) from my system and walk outside and spend time with friends that the depression is lessening. I am listening to my body as far as my need for pain meds, taking them when I feel the pain is coming on (still pretty much on schedule, every 4 hours) and also being reassured by the knee people that as my pain resolves, the need for the pills will kind of "fall away". I trust that because I feel it is already happening.

one of the things that kind of automatically makes my daily dose higher is that I am taking oxycontin 20mg 3X/day -- so that's 60mgs right there. then if I take 1 or 2 percocet every 4 hours on top of that, and I am up 16 hours/day, thats up to 10 percocet/day -- another 50 mgs.

plus when I first got out of the hospital I was taking oxycodone IR -- 1-4 tabs every 3 hours (each tab 5 mgs) instead of the percocet -- so the max of that was 20 mgs every 3 hours -- another 100mgs, bam. so it wasn't just percocet I was taking, it was more concentrated pain meds that they first discharged me on. I'm grateful they did, too, because it helped. now I'm cutting down using just the oxycontin and percocet, and I find that moving around/walking when I have pain, and then icing helps a lot, too.

soon I will ake the oxycontin 2X day and supplement it with the percocet. I have been trying to take just 1 percocet each 4 hours, at least in the daytime, and some days have done that for the day. but then I pay for it at night. so I think I'm not really ready to do that yet. today I took 2 tabs every 4 hours except for 7pm, when I took 1 with my last oxycontin for the day.

anyway....it sounds like an alphabet soup but I am beginning to see that this will all be resolved in the not-too-distant future. I feel I am doing great, with my leg strength feeling more and more balanced, my muscular control getting better and better, and I'm not limping when I take a few steps w/out my crutches (as long as I take it slow and careful!).

I saw one of my daughter's teachers today, who had this same procedure with the same surgeon, and she said it's so cool, that each time she gets to a point where she feels she is finally all better, she then hits yet =another= point where she's even =better= and she can do even =more=! she said it's so liberating, she just keeps getting better and better and doing more and more. I believe that will be me too!

best to all,
kittykat

 

[Vjklander]

I took the Percocet about 2 a day in the hospital for my hip. The anti-inflammatory helped a lot for my knee which was tweaked during the surgery. Once I got home and took Celebrex, I cut back to 1/2 an oxy for a week then stopped that. I'd say 75-90 % of my pain and discomfort came from them messing up my knee, but that is coming around.

 

[kittykat]

I took the Percocet about 2 a day in the hospital for my hip. The anti-inflammatory helped a lot for my knee which was tweaked during the surgery. Once I got home and took Celebrex, I cut back to 1/2 an oxy for a week then stopped that. I'd say 75-90 % of my pain and discomfort came from them messing up my knee, but that is coming around.

WOW! I would LOVE to have been on so little! now I have tapering to do on top of (well, preferably, NOT on top of) post op rehab!!

you're lucky. 1 perc would cover me for about 1 hour right now.

 

[JudyS]

Welcome to the forum, kittykat, and I hope we manage to answer your questions here.

As regards pain killers, did you expect to be off them by now? I only ask because you are barely one week post op after a VERY major op and realistically, you can expect to need pain relief for another 4-6 weeks at least. Don't be too hard on yourself or have too high expectations. Allowing yourself to be in pain will only hinder your recovery. Be kind to yourself!

I just came home today from right hip replacement and was part of an IV tylenol pain study. The study Dr. was supposed to be in charge of prescribing pain med. He gave me a prescription for 20 percocet pills, no refills!!!
Judy

 

[JudyS]

Obviously I had no clue how to do the quote thing,next time I will try to figure it out first!!!
judy

 

[JenniferG]

Hi Judy, welcome back. We've been waiting for you. (almost sounds creepy, huh?)

 

[kittykat]

Obviously I had no clue how to do the quote thing,next time I will try to figure it out first!!!
judy

thanks for your encouragement, judy.

I think I was worried b/c I didn't know what my surgeon's practices were re prescribing pain meds, and my impression of him was that he was a bit hard-nosed. having a tolerance, I was worried he would just treat me like any patient, with the same dose regardless of individual circumstances, and then cut me off to "suck it up" on my own after a couple of weeks. part of this was b/c he prescribes 40 percocet at a time -- I was used to getting 120, 150, 180, even 240 tabs -- my GP trusted me with a month's supply and wrote for that. so I was like, "what's with this 40 tabs? is he going to cut me off after a couple of weeks?" I knew I would end up in a cold turkey situation if he did that, so I was scared, and thought maybe I would have to start cutting down now to make it less miserable.

anyway, I think I was wrong. I decided to just =ask= them (why do I never think of that until last???), and so I called his office monday and asked his secretary (who's VERY nice and helpful) what his approach to pain management was, and that I have a tolerance and am very willing to cut down and be off these meds altogether at some point, but that this would not be a very good time for me to do so. they gave me a new rx (for 40), but I'm beginning to think that they are just used to prescribing that amount and continually renewing the rx, maybe they can keep better track that way. I noticed on the prescripion that it says that these 40 tabe are 4 days' supply -- so he's expecting me to be able to get a new one in 4 days!

of course it would save me a lot of co-pays if I could get one big rx for the next 4-6 weeks, but maybe he just doesn't prescribe that way. so, I feel reassured that I will not be cut off at the knees (no pun intended. and besides, it was my hip I had done!).

BTW, judy -- to quote, just hit the little "quote" icon at the bottom right of the post you are quoting, and a window will come up automatically with the words quoted. if you want to cut the quote down a bit and only use part of it, just make sure you keep the whole [/quote] thing at the beginning and end of the quote -- only cut out the words between those to brackets.

 

[JudyS]

Kittykat,
Thanks for the quote info!!!

I called my surgeon's office today to ask for more and tell them that the pain research doc had only prescribed 20 tablets. They gave me a prescription for 75 more. My husband had to go and pick up the presciption at the office as it can not be called in here in Ca. That is percocet I was talking about. I had some leftover from arthroscopic hip surgery and was saving them and trying to conserve in case I did not have enough, so I totally understand your worries.
I did feel like a druggy asking for more
Silly
Judy

 

[kittykat]

Kittykat,
I did feel like a druggy asking for more
Silly
Judy

I know, me too. I think that's why it's uncomfortable to get a small amount at a time, but I don't care, I am not going to put myself through hell (although I am feeling better and better each week!). I know my GP will prescribe for me if my surgeon decides not to.

I actually have no reason to think my surgeon won't keep me covered -- I really don't know him -- but I really think it's only b/c he prescribes these small amounts that I perceive him as stingy!

good luck, jude.

 

[JudyS]

kittykat,
Some docs are that way, aparently my research anesthesiologist is one of them.
My OS did prescribe 75 more (sorry if I am repeating myself), I see my OS next week and I know he would give me more if I needed it then.

I haVe to go to the hospital for the last lab work for the study. I will make sure the research doc comes to see me and let him know I was out of his 20 on saturday, or earlier!!!!!

I think I need a hypnotist to get over the strong desire to cross my legs!!!!
judy by the way I love the jude, back to childhood and teenage wild memories

 

[Josephine]

Obviously I had no clue how to do the quote thing,next time I will try to figure it out first!!!
judy

I corrected it for you!

kittykat,
I think I need a hypnotist to get over the strong desire to cross my legs!!!!

Everyone struggled with that. I know I would - big time!

 

[JudyS]

Thanks Josephine,
Glad your knee will hold out longer. Do you have any thoughts or info on low bone density with hip replacements.? My OS told me he had to wire the bone as it was beginning to crack.
I was going to beg for some up trail running when healed. I crossed that off the list. I was wondering what else I should cross off.
JUdy in So Cal

 

[Josephine]

Osteoporosis? Poor you. The only things that come to my mind are making sure you eat plenty of calcium rich foods (milk, cheese) and maybe some supplements. Talk to you PT as I know that loading increases the mineral content and therefore density of bones so maybe some time in a treadmill will be beneficial. But, as I say, ask the PT as it's not really my field.

 

[kittykat]

so...the conversation came up that I suspected/expected would. I am 2.5 weeks out from THR and my doctor approved my request yesterday for more oxycontin and percocet, but his secretary says he wants to see me b/c he is "concerned" that I am still on high levels of pain killers, and I think he either wants me off altogether or switching over to vicodin (which apparantly is his favorite "step down" drug).

I want to get off these meds (esp the oxycontin) myself, and asap, but it's hard b/c when I begin to cut down, my pain goes up. some of it is the aches and pains of decreasing opioids - that just goes with the territory. but it's hard to differentiate between that and post-op pain.

anyway -- I will see my surgeon on tuesday. I'm actually glad to be seeing him (normally he's like NO SEE until 6 WEEKS!!) -- because there are a lot of things I want to ask him (like can I not use my crutches sometime? can I PLEASE walk in the pool? do I have to wear these horrible support hose all day, everyday? etc)...but I just wonder how any of you would approach this conversation/topic. how long is reasonable to expect pain meds after THR? I have this complication of tolerance which evolved over 1 year before my surgery.

so....how do you go about decreasing pain meds and still get pain control?

thanks, everyone.