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[TKR] still at pain level 8<

Discussion in 'Knee Replacement Recovery Area' started by Sophie Sue, Feb 28, 2019.

  1. Sophie Sue

    Sophie Sue new member
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    Hi, I'm Sophie Sue. I had TJR 2/19/19 & still at a pain level 8. The pain involved with this surgery is much worse than I anticipated. My surgeon did a fabulous job, but I'm still not on top of my pain. I'm taking Norcan 10, 2 tabs, 2-3 times a day with some Tylenol Arthritis in between with little relief. Ice & elevate 20 mins of every hour. See my surgeon tomorrow, first post-op visit. Why is Norcan not working??
     
  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!

    I’m sorry you pain level is so high. Good thing you’re seeing your surgeon tomorrow. Sometimes they need to make adjustments to your medications.

    Too much activity can keep pain levels up. Swelling causes pain, also. This is a very traumatic and disruptive to the body surgery.

    I am going to tag @Josephine
    our forum administrator and nurse director to address your concerns.

    I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

    Knee Recovery: The Guidelines
    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
    5. At week 4 and after you should follow this
    6. Access to these pages on the website
    7. The Recovery articles:

    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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
     
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  3. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Your arthritis in your knee is gone now, so what you need is 1000mg of regular Tylenol every 6 hours. But, you can't go over 4,000mg in 24 hours and you have to count the Tylenol, (acetaminophen), in everything you are taking and not go above 1000mg every 6 hours when you add everything together.

    Be sure and tell your OS that your current pain med isn't working. There are others out there that will work better for you.
     
  4. FCBayern

    FCBayern junior member

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    I would try to up the ice to 40 minutes every hour and elevate every minute you can! Toes above nose. The early days suck but it does get better.
     
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  5. Sophie Sue

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    Update: I'm at 2 weeks post-op today. Went to OS for post surgery checkup. He is happy with my healing. I explained my pain level is still at 8. He said he believed since I had to have bladder surgery repair in Sept 2018 & had to take hydrocodone for 3-4 weeks my body may have become immune to hydrocodone. So he added Tramadol 50 mg every 6 hrs along with hydrocodone 10 every 4 hrs. Hasn't helped much. It's been 3 days since he put me on new regimen. I'm icing, elevating, etc as I should. Any suggestions?
     
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  6. julie1968

    julie1968 member

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    Glad your finally getting some relief. Hope it gets easier
     
  7. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Are you icing and elevating for at least 45-60 minutes per session several times per day?
     
  8. Sophie Sue

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    Yes, I ice 30-40 mins every hour
     
  9. Celle

    Celle FORUM ADVISOR Forum Advisor

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    You need to ice for at least 45 minutes every time. In fact, you can ice all the time you're not up and about. as long as you protect your skin from frost bite, you can't do any harm.

    How much exercise are you doing? Too much exercise often results in continuing pain.
    I'm going to ask @Josephine , our Nurse Director, to advise you. She has many years of experience in orthopaedics.
    She'll probably ask you a lot of questions. Do try to answer them as fully as possible, so she has all the information she needs, to advise you appropriately.

    It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.
     
  10. eaglemom

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    I am so sorry your still experiencing such pain. What are you doing when not elevating / icing? Are you doing too much? Its hard to 'do nothing' except ice elevate & medicate but that's all you need to be doing now.

    I know its hard when your in pain - but once you can get ahead of the pain curve you'll be doing well.
     
  11. Sophie Sue

    Sophie Sue new member
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    Good morning & thank you for all the great suggestions. I'm at a pain level 6 tiday. Did major PT yesterday, slept better last night. Praying this pain level continues to go down. Today is 14 dayd post op. Icing continuously 45 mins for every hour. Hydrocodone 10 every 4 hrs, Tramadol 50 every 6 hrs
     
  12. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    This is most likely keeping your pain level high. This early in recovery there really is no need for major PT. Your knee is surgically wounded and needs to heal before you stress it with exercises. Many PTs don’t believe this and they pile on strengthening exercises long before a new knee is ready.
    This is excellent news! :happydance:
     
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  13. Sophie Sue

    Sophie Sue new member
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    I totally agree with you too much PT. I got a break from PT today & I'm completely icing & resting & elevating
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    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?
     
  15. Sophie Sue

    Sophie Sue new member
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    Yes, of course, thank you
     
  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Here y'go 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 ....

    1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in 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?
    ai63.tinypic.com_eta39s.jpg

    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.
     
  17. Sophie Sue

    Sophie Sue new member
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    Here are my answers. Please remember my pain meds don't work well & it has been suggested that due to my bladder repair surgery in Sept 2018 I've become somewhat immune to the hydrocodone.

    1. Pain level at 7

    2. Hydrocodone 10mg every 4 hrs, Tramadol 50 mg every 6 hrs

    3. Swelling - moderate

    4. ROM 110

    5. Ice 40 mins every hour

    6. Elevate 20 mins every hour

    7. Activity level - moderate, prepare small meals, shower every other day, personal hygiene every day, short walks in house every day

    8. All PT at home thus far, 3 times a week, 10 ea of the following:
    Ankle pumps, quad sets, straight leg raises, hip abduction, supline extension stretch, heel slides, short arc quads, knee flexion (sitting), sitting extension stretch, knee extension sitting

    Frankly, I don't think the PT is doing anything positive for me. PT severely increases my pain.

    I appreciate your advice.
    Sharon
     
  18. Kenello

    Kenello junior member

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    Oh ouch! That much PT and activity at pain level 6....not helpful. I did icing and elevating toes over nose all day long unless I was up. My pain level was mostly at a 2, or a 3 during pt. I know I was lucky, but if something caused me pain, I really limited that activity. Please stop torturing yourself.
     
  19. Sophie Sue

    Sophie Sue new member
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    Yes, I agree to stop torturing myself!
     
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I need more detail? Please?

    Here you've obviously fallen into the incorrect idea that ROM only means flexion or bend. It doesn't. It means flexion AND extension. You've only given me the flexion. I also need the extension (straightness)

    If you don't have this from your PT, you can assess it for me yourself using this procedure

    1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
    2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
    3. slide your hand, palm down, under the back of your knee
    a) if you can get your entire hand under easily, it's probably about +10 degrees
    b) if you can get just your fingers under, it's about +5
    c) if you can get your fingers under but it's a push, it's +0
    d) if you can't get your fingers under at all, it's -5 or more​
    Here's a graphic to explain the degrees involved
    [​IMG]
    The question was
    please make a list and not an essay!
    - how many sessions you do each day
    - enter exercise by name then number of repetitions of each​
     

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