Adequate Post-Op Pain Relief?

IMHO there is no excuse to not provide adequate pain relief. Pain is debilitating and causes physical and mental problems that can impede healing. I am contemplating TKR and am really worried because of a blood condition I have, I cannot take any NSAIDs, and because of other meds I take, opioids can be problematic as well. Not a fan of pain - which is why I want the TKR to begin with. Good luck.

A slight addendum to the statement above. Moderate excercise elicits moderate discomfort.

I’ve described my case in other posts but want to repeat certain things for you. I too had a problem with opioids and took them only in the first two weeks. The problem was ricocheting between opioid-induced constipation and Senna-induced diarrhea. After two weeks, I got painful hemorrhoids from the diarrhea and decided the mild relief I got from the opioids wasn’t worth it. The NSAIDs (and Tylenol) I took didn’t make a dent in the pain. In fact, nothing ever mitigated the pain, which was excruciating for the first four months. My pain may have been exacerbated by a blood disorder that increases inflammation, though I don’t know that for sure because there have been no studies to prove it. The pain inhibited my ability to do certain exercises, like putting a towel under my ankle to promote extension of my operated knee, I was supposed to start that in the hospital right after the surgery but was never able to do it. I will never achieve full extension, which affects my gait. I also did not achieve adequate flexion, although I’m still making progress in rehab. As such, I cannot yet walk downstairs normally. Your handle suggests you are overweight. That might not inhibit your recovery if you have a lot of muscle mass and are, thus, very strong. But if you’re not very strong, like me, then the excess weight could make it very difficult to do certain exercises, like sit-to-stand, squats, and walking upstairs, which could impede your recovery. I lost 35 pounds to get into the “normal” weight range before surgery, but still struggled with certain exercises. Because of my significantly decreased range of motion and continuing post-op pain, I regret doing the surgery so far. If I end up pain free at the end of the year-long recovery period, then the reduced range of motion might have been a good trade off for eliminating the chronic pain I had pre-op. The jury’s still out for me. If you choose the surgery, at least you’ll have your eyes wide open about the risks. Good luck.

I spoke with my health insurance rep and they told me for future surgeries and pain management was to consult with a Pharmacy Care Coordinator to get electronic prescribing before a surgery. The doctor’s office would work with a pharmacy to plan your pain med prescriptions to be readily available at different days following surgery. The Pharmacy Care Coordinator would help with the prior authorization process of getting pain meds in a timely manner. You would have your first Rx after surgery and for example, you would have a refill ready to fill at day 6 and then day 12.
This is just an example, but my health insurance rep stated this is something that can be started before a planned surgery.

Part of TKA pain relief is being able to sleep. Since nothing helped me mitigate my pain, except the passage of time, it occurred to me that maybe a sleep aid would knock me out enough so I could finally sleep. My surgeon said that was not his department and told me to work with my personal physician. I recalled that, when I was taking antidepressants (SSRIs), my psychiatrist also prescribed Trazodone at night, which is an old, mild antidepressant that has a somnolent effect. He gave it to me as an antidote to the SSRI, which he said has a slight stimulant effect. At any rate, I asked my personal physician if I could try it again to help me sleep and it did the trick. Before my pain began to subside—i.e., during the first four months post-op—I took 100mg at 9pm and then another 100mg when I woke up at 1am. After four months post-op, I went down to just 100mg at bedtime. This may not be safe and/or effective for anyone else, and it’s sometimes contraindicated for men, but it might be worth asking your doctor about if nothing else helps you sleep through the pain. I’d love to know what other people have found safe and effective to help them sleep through the pain.