TKR What was your limit on pain meds.

Chrissick

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Hi all,
I had a RTKR on January 11th, 2023 so I am about 17 days post op.
Can I ask what some of you experienced as far as pain meds?
I was given a prescription for only 25 5mg Oxycodone when I was released the day after surgery ( the pharmacy only gave me 22 because that is all they had in stock). I have since received 2 refills of 25 each. My surgeon’s physicians assistant more or less told me this is the last refill. In 17 days I’m averaging only 3 oxycodone a day which is under the prescribed amount of 1 every 4-6 hours . I am finding that Ibuprofen and Tylenol in between aren’t helping much at all. Is this normal? To have such a relatively small amount of prescribed pain meds given the pain level of this surgery? I’ve never taken pain meds before for my knee pain or anything else and it makes me feel like I am being treated like a drug seeking addict. A bit frustrated why they prescribe a pill every 4-6 hours and then only give you 4/days worth. Anyone have any advice?
 
Sorry to hear about your pain. It is tough in the early weeks. I hated the codeine/ opiate based meds due to constipation.
I found naproxen a better pain killer than ibuprofen. It lasts longer. The non steroidals seem to work more on inflammation and take a today or so to kick in. Talk to your doctor about the options. Also if sleep is bad then a sleeping medication might help and cut your need for stronger painkillers at night.
I am 14 weeks post surgery and off all painkillers although I still get some stiffness/soreness, especially at night and take sleeping medication.
Good luck!
 
Unfortunately, since the attention of opioid overdose, doctors have been hesitant to prescribe many of these. We suggest that you call your PCP and ask him/her to prescribe them. Many of our members have had success with doing this.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, and 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 the 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

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

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.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep
 
Hi, sorry to heae that you are so much pain. I am 12 or from my LTKR. My OS prescribed Dilaudid. The first week I took them regularly. Now I use Tylenol Max. My OS also sent me home with an ice machine that chills the knee. It is wonderful and I believe that is a god send. Are you icing? Elevating? Both are helpful for both pain and swelling. Good luck.
 
I agree about the icing. That was at least as good if not better than the painkillers. I still ice every day and at night.
 
One more thought. When I had shoulder surgery a few years back, the doc gave me Oxy. For me I found that 1 whole one knocked me out. I would cut them in half and fond out it really took the edge off on my pain.
 
In some states the legislatures have set limits on how much/how many a physician can prescribe at any one time. Again, recognizing the current opioid epidemic...
 
@Chrissick
We had surgery the same day.
My meds... 40 5 mg hydrocodone with 325tylenol (Norco), gabapentin and meloxicam 2x day. ,
I was able to fill initially the day before surgery, then twice after that. So, I'm on my third round.
On first refill PA also put me on baclofen (muscle relaxer) upped gabapentin and meloxicam to 2 pills 2x day. Higher dose of meloxicam made me violently ill. Discontinued it.
The added muscle relaxer and higher dose of gabapentin have helped me use much less of Norco.
Second refill was Monday. 40 (Norco) It will last me about 1 week. And I will definitely refill it. When the knee feels better there can be setbacks so I always have pain meds on hand.

I would call your doc and tell him/her you need better pain management.
If they won't cooperate try your primary care doc.
This recovery is too difficult without proper pain management.
Please let us know how it works out.
 
I agree you need to talk with your surgeon or your primary doc if the surgeon won’t help you. I had a TKR 9/12/22 and my surgeon would renew my prescription for oxycodone for up to 6 weeks then no more. What they did was only give me 20 pills at a time and each time they renewed they reminded me to try and take less and use Tylenol and Motrin more.

I found the pain to be the worse at night. Please don’t just suffer. Some people don’t need much meds but some do. As I am constantly being told a knee replacement is a major surgery and is very painful. Try icing and if you don’t already have one I would highly recommend an ice machine. You can get one on Amazon put frozen water bottles (small ones) and rotate them as needed.

Hang in there. It does get better it just takes time.
 
I found that Tramadol was the best for me. Oxy made me dizzy and knocked me out. Agree with icing and elevating. I always did this after PT or home exercise. I was not allowed to use ibuprofen due to blood thinners. So after each surgery would ween off pain meds once I could take ibuprofen after about 1 month.
 
The pain medicine you need is the pain medicine you need. My first TKA I was on 7.5 of oxycodone every 4 hours. I set an alarm to wake me at 2 a.m. because if I missed a dose I was miserable. I have had two revisions on that knee since with a much better surgeon and all I needed was 2.5 mg at bedtime for 2-3 weeks. But I also took NSAIDs the 2nd and 3rd time, which made a world of difference for me.
 
My doctor stopped my pain meds at 5 weeks and refused to prescribe more. I was in so much pain it was hard to finish physical therapy. I had tylenol but it didn't help much. My PCP told me if the surgeon would not prescribe for pain he would, and he did.
 
It is horrid how - thanks to phatma and over-prescribing docs how this mess was created in the first place. And now folks in real need of meds…pay the price. And I definitely shared your feeling of 'being treated like an addict.' Everyone here has offered good advice - esp talking with your surgeon or primary if you need more help fighting the pain. I will just note that - for me, at least - the need I felt for the meds dwindled rather abruptly. So I went from worrying and counting/spacing out pills to, somewhat suddenly, realizing I was getting along ok. I hope it will be that way for you. Good luck! Also, folks react differently, so perhaps a different med will be more effective for you…
 
Interesting topic. Same day outpatient I went home with the nerve block stint, my mid-thigh (inserted for about five days). My meds otherwise were OTC Tylenol, Celebrex, Methocarbamol and chewable aspirin. My area pharmacy claimed they would not have Oxy for two weeks so I moved on receiving them from hospital. Did not use all and no major side affects except feeling somewhat 'medicine head' when talking or trying to multitask to much. I heard about the abuse of Oxy and those taking them inappropriately. At the height of my pain they did what I needed: reduce the edge of my TKR pain.

As I wean off Oxy I'm finding Methocarbamol helpful. The tablets are scored so you can take half. I'm looking forward to zero Oxy so I can resume driving.
 
...So I went from worrying and counting/spacing out pills to, somewhat suddenly, realizing I was getting along ok. I hope it will be that way for you. Good luck! Also, folks react differently, so perhaps a different med will be more effective for you…
Yes, I recall getting worried about running out of Oxy so I request a refill from doc. Which now I doubt I'll use up. But at the time pain was very strong, and I was starting to count and spread out pills then noted one day that's exactly what I wanted to do and COULD do. Your body will tell you.
 
Thanks all for your responses. I contacted my PCP and she needs to see me before she will consider prescribing so I have an appointment with her on Monday. This has been so frustrating. To be cut off of pain meds prior to your 3 week mark feels wrong. Maybe some of these doctors and physician assistants need to go through a knee replacement so they will have a clear picture of the pain level this surgery brings.
 
Yeah, Chris, let them get that first hand experience. Hang in there. Glad you are complaining.
 
Sorry your experiencing pain management issues. I was on Oxy (Percocet) for almost two weeks when I was cut off. It provided marginal relief. Now at 22 days, I am taking 4,000mg of Tylenol per day along with 300mg of Gabapentin at night. Still uncomfortable at times, but reducing the swelling has been helpful in reducing pain! I can’t take Ibuprofen or Meloxicam due fo kidney issues. We all experience this journey differently. Rest, ice and be careful to not overdue the PT. This all will pass
 
Hello Chrissick,
A belated Happy One Month Anniversary! I hope your appointment went well and you were able to get your prescription refilled allowing you to stay comfortably mobile and make steady progress. Please update us as time allows and take good care!
@Chrissick
 

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