Physical Therapy with or without pain medication?

Posted by bushy @bushy, Mar 12, 2020

I medicated last week before my TKR Physical therapy session, and I found I was better with all manipulations/flexion, etc. Thoughts?

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@ellerbracke

@cindiwass : Excuse my additional comment here - I did not see/read your original post until just now. Regarding prescription pain killers, I really do not like them for their side effects, but I found it necessary to take them for a few days after major surgeries. Especially the shoulder surgeries, which were extremely painful afterwards. Tylenol does not really do much, if anything, for me, so I relented and took the Hydrocodone, Oxycontin, whatever I was given. But: once I decided I needed to take them, I did it on the set schedule - it is easier to keep pain at bay then to wait until you can’t stand it anymore, and the try to catch up. For me that extreme pain lasted about 4 - 5 days. There certainly!!! was a lot of pain still, but not to the point where it was all-consuming, so day 5 I started to stretch the daytime intervals to 6 hours, kept 4 hour schedule at night (after 10). Easing up more every day until only 1 Oxy at bed time, then done. Lots of ice, lots of mental tricks (listening to great music while doing the painful PT exercises, doing brain teasers to distract when pain hit), using lots of ice to keep surgery area numb. It is everyone’s choice whether to take opioids or not. For me the short period of using/needing them was the right decision.

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Yes, thank you.

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I am just surprised because the pain tonight by my knee is so intense, even when I am resting.

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@ellerbracke

Yes - maximum of 9 - 10 days, prescription of either Percocet, Hydrocodone, that type of opioid. After any of my 4 ortho-type sugeries I pretty much took them on schedule (every 4 hours, mostly) for about 4 days, then tapered down, and by day 9 or 10 I was totally off them. Never any problem to discontinue, or afraid of dependency. For me they work great to reduce pain, and let me get some sleep, but otherwise I can’t stand the side effects.

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I'm not afraid of dependence on narcotic painkillers. I don't want the side effects, I guess that means right now I will suffer with the pain as much as possible. I am going to put some ice on the affected area, I do not know why the side towards the back of my knee hurts so badly when it is the hip that was supposed to be fixed, more or less. OK, thanks for your thoughts. This isn't good, however, I am going to walk to the freezer and get an ice pack.

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@tsc

Hi @cindiwass, my husband broke his hip and had surgery. He was in rehab, and they wanted him to get moving right away. The doctor prescribed Oxycodone, but because he has Alzheimer's, it was risky. We made do with tylenol, two 325 mg pills, which is the recommended dosage, taken about a half hour before his physical therapy and he did fine. He did not need it constantly. I think that it's best not to let pain get a grip because it just intensifies. Also, ask your doctor if an infrared heating pad would help. It reduces pain while it's on and increases blood flow, but it may not be advisable at this point in your recovery. I wish you the best.

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Thank you all for putting up with me and my questions and complaining. This is one week after the operation. I can't say the pain is getting worse, but I can't say it's getting much better. They told me I have to walk, and I'm trying but it hurts. I don't walk very much, to the kitchen or bathroom and back to my chair. Now I have an ice pack on. I don't want to discourage anyone, and in a way I'm glad the last doctor made it seem like a breeze. (It wasn't.) But I decided to get the operation, and naturally am looking forward (hoping) for the best outcome, namely, movement without pain. Thanks everyone for your comments!

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I had TKR about 3 months ago. I am normally not a pill person, but my block wore off the same day as surgery & they had a hard time at the hospital controlling my pain. I think it was the worse I've ever experienced. After they got it under control, I went home with Oxycontin & Oxycodone. I only took the Oxycontin at night, but stayed on a 4-6 hour regiment of Oxycodone for about a week. One day I forgot & soon the pain was intense. It was hard to get it back under control. After a week or 10 days I was able to stretch the daytime meds into longer periods, but for the first couple weeks, I did take them before PT. I stayed on the night time meds for about 6 weeks, but slowly switched from Oxycontin to Oxycodone to Vicodin to tramadol to nothing. When I went to outpatient therapy (I had 3 weeks of home PT) I was able to drive myself & didn't want to be using heavy meds. There were days I really should have had my husband take me, so I could take something, but I got thru it. I think as long as you're in the first 6 weeks or so, you should control your pain as needed, then you can start tapering off. Normal use of pain meds won't turn you into a druggie & will help you get thru that painful period. It's not fun under the best of conditions.

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Years and years of athletic experience, injuries and recovery have taught me not to take pain relievers before exercise or physical therapy. It's too easy to go beyond what is safe for me if pain is masked. I think there are exceptions, like when your doctor or therapist is going to strenuously release some adhesions, but in general, I found it best to work to a level 5 (of 10) pain during therapy, and take pain meds afterward if icing doesn't relieve pain.

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@karenann01

I had TKR about 3 months ago. I am normally not a pill person, but my block wore off the same day as surgery & they had a hard time at the hospital controlling my pain. I think it was the worse I've ever experienced. After they got it under control, I went home with Oxycontin & Oxycodone. I only took the Oxycontin at night, but stayed on a 4-6 hour regiment of Oxycodone for about a week. One day I forgot & soon the pain was intense. It was hard to get it back under control. After a week or 10 days I was able to stretch the daytime meds into longer periods, but for the first couple weeks, I did take them before PT. I stayed on the night time meds for about 6 weeks, but slowly switched from Oxycontin to Oxycodone to Vicodin to tramadol to nothing. When I went to outpatient therapy (I had 3 weeks of home PT) I was able to drive myself & didn't want to be using heavy meds. There were days I really should have had my husband take me, so I could take something, but I got thru it. I think as long as you're in the first 6 weeks or so, you should control your pain as needed, then you can start tapering off. Normal use of pain meds won't turn you into a druggie & will help you get thru that painful period. It's not fun under the best of conditions.

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I had to Google TKR.

I am plagued by SEVERE sciatica, with bulges at L1-2, L2-3, and L3-4. And I am getting all the PT that my body can handle and my medicare will pay for.

Have you considered cannabis internally or CBD oil topically? I can personally vouch for tokes taking pain and swelling away.

I am on such an olio of scripts I am not quite sure what is doing what what. But Duloxetine (Cymbalta) is the 'heaviest'. The rest are BP and digestive related and not as 'critical'.

I had seen something, I believe here at the Mayo site, about depressants being prescribed for some neuropathy, neuralgia, and Radiculopathy.

And though mine was scripted for my depression and anxiety, when I was cut cold turkey due to incompetence at my former Dr., the CHEST pain I was feeling from esophageal issues almost landed me in an ER. Or morgue.

I am also taking Gabapentin supposedly for pain.

At least that's why we give it to our cats with stomatitis.

It seems rather 'immediate' - 30 minute to take affect - for them, but as I understood for me it is more a residual kind of effect. Take it for a week, or a month, and then look back and see if I have been feeling better.

Same with the Duloxetine (and ANY antidepressant). One doesn't pop one to feel better.

My mom is passed. She had both of her knees done without much incident.

Best of success. Keep up up to date on you progress.

(=^..^=)
KK

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@kaptainkat

I had to Google TKR.

I am plagued by SEVERE sciatica, with bulges at L1-2, L2-3, and L3-4. And I am getting all the PT that my body can handle and my medicare will pay for.

Have you considered cannabis internally or CBD oil topically? I can personally vouch for tokes taking pain and swelling away.

I am on such an olio of scripts I am not quite sure what is doing what what. But Duloxetine (Cymbalta) is the 'heaviest'. The rest are BP and digestive related and not as 'critical'.

I had seen something, I believe here at the Mayo site, about depressants being prescribed for some neuropathy, neuralgia, and Radiculopathy.

And though mine was scripted for my depression and anxiety, when I was cut cold turkey due to incompetence at my former Dr., the CHEST pain I was feeling from esophageal issues almost landed me in an ER. Or morgue.

I am also taking Gabapentin supposedly for pain.

At least that's why we give it to our cats with stomatitis.

It seems rather 'immediate' - 30 minute to take affect - for them, but as I understood for me it is more a residual kind of effect. Take it for a week, or a month, and then look back and see if I have been feeling better.

Same with the Duloxetine (and ANY antidepressant). One doesn't pop one to feel better.

My mom is passed. She had both of her knees done without much incident.

Best of success. Keep up up to date on you progress.

(=^..^=)
KK

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Oh, and my personal PT tore something in her knee, and is getting PT for it. I am going to bet she is sans pain meds.

(=^..^=)
KK

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@kaptainkat

I had to Google TKR.

I am plagued by SEVERE sciatica, with bulges at L1-2, L2-3, and L3-4. And I am getting all the PT that my body can handle and my medicare will pay for.

Have you considered cannabis internally or CBD oil topically? I can personally vouch for tokes taking pain and swelling away.

I am on such an olio of scripts I am not quite sure what is doing what what. But Duloxetine (Cymbalta) is the 'heaviest'. The rest are BP and digestive related and not as 'critical'.

I had seen something, I believe here at the Mayo site, about depressants being prescribed for some neuropathy, neuralgia, and Radiculopathy.

And though mine was scripted for my depression and anxiety, when I was cut cold turkey due to incompetence at my former Dr., the CHEST pain I was feeling from esophageal issues almost landed me in an ER. Or morgue.

I am also taking Gabapentin supposedly for pain.

At least that's why we give it to our cats with stomatitis.

It seems rather 'immediate' - 30 minute to take affect - for them, but as I understood for me it is more a residual kind of effect. Take it for a week, or a month, and then look back and see if I have been feeling better.

Same with the Duloxetine (and ANY antidepressant). One doesn't pop one to feel better.

My mom is passed. She had both of her knees done without much incident.

Best of success. Keep up up to date on you progress.

(=^..^=)
KK

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Kaptainkat: I read that you take Cymbalta with CBD oil as well as gabapentin. Dangerous! Your doctor should know better. CBD oil and gabapentin taken with Cymbalta can cause serotonin syndrome. And your liver can be seriously damaged. Serotonin syndrome is increasingly being seen from drug combinations that use the same enzyme for breakdown. But some doctors are not aware.

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@jip499

Kaptainkat: I read that you take Cymbalta with CBD oil as well as gabapentin. Dangerous! Your doctor should know better. CBD oil and gabapentin taken with Cymbalta can cause serotonin syndrome. And your liver can be seriously damaged. Serotonin syndrome is increasingly being seen from drug combinations that use the same enzyme for breakdown. But some doctors are not aware.

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Good point, @jip499.
@kaptainkat @karenann01 and others in this discussion. Use caution when taking multiple prescriptions and CBD or medical marijuana and supplements. Don't be fooled by thinking CBD and supplements are "natural".

A number of over-the-counter and prescription drugs may be associated with serotonin syndrome, especially antidepressants. Illicit drugs and dietary supplements also may be associated with the condition. Read more from Mayo Clinic here:
- Serotonin syndrome https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758

If you have questions about drug, prescription and supplement interactions, don't forget that a pharmacist is a really useful member of your health team. They can provide more information about possible interactions.

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