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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@bushy Welcome to connect you where right in medicating with pain meds before exercise. Actually pain meds help heal also and you by exercising after this moved the pain meds where it was needed so keep that protocol up

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@bushy I am not a medical professional, but if it helps then I would think it's the best thing to do. I never took medication before PT, although the first time I had it I probably should have. That therapist had me literally screaming at some points!
The orthopedic surgeon I used for my second TKR insisted on gentle PT so I was never put through that much pain.
JK

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@bushy: If it helps you, by all means take some pain medication before PT. When I had my first shoulder surgery (repair of rotator cuff, removal of bone spurs, severing of 1 of my biceps tendons) I was encouraged to do that. However, since I valued my independence – as in driving myself – I never did. My therapist group is very much tuned into each individual patient, so even without pain medication they kept the ouch factor within reason. Another shoulder surgery, knee repair surgery, and finally TKR – all without pain pills for PT, and even post-surgery pain management at home max 9-10 days of opioids in each case….. worked for me.

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Thanks for the comments. I just had hip replacement, 6 days ago, and am experiencing a lot of pain, but have resisted taking narcotic pain meds, however, want more info or suggestions from people that have been through it. I don't want to be sleepy/drowsy if possible. And especially not stomach sick. I was nauseated after the surgery and vomited a couple of times. I'd like to avoid the harsh side effects of narcotics. I was prescribed oxycodin for one, and extra strength tylenol, but have resisted taking the oxycodin because I'm afraid of the side effects BUT the pain is very difficult to deal with. So not sure what to do. My health care practitioner knows I'm a crazy person and tries to work with me kindly. He wants me to take the pain meds. I DON'T KNOW WHAT TO DO, in other words, if taking the pain meds (strong ones) will help me heal faster. I gotta heal. Thanks.

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@ellerbracke

@bushy: If it helps you, by all means take some pain medication before PT. When I had my first shoulder surgery (repair of rotator cuff, removal of bone spurs, severing of 1 of my biceps tendons) I was encouraged to do that. However, since I valued my independence – as in driving myself – I never did. My therapist group is very much tuned into each individual patient, so even without pain medication they kept the ouch factor within reason. Another shoulder surgery, knee repair surgery, and finally TKR – all without pain pills for PT, and even post-surgery pain management at home max 9-10 days of opioids in each case….. worked for me.

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@ellerbracke : Not sure if I understood your comment, or if you're still there because you wrote this quite a while ago — but did you say that you took opioids for 9-10 days at home after your surgery?

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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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@cindiwass

Thanks for the comments. I just had hip replacement, 6 days ago, and am experiencing a lot of pain, but have resisted taking narcotic pain meds, however, want more info or suggestions from people that have been through it. I don't want to be sleepy/drowsy if possible. And especially not stomach sick. I was nauseated after the surgery and vomited a couple of times. I'd like to avoid the harsh side effects of narcotics. I was prescribed oxycodin for one, and extra strength tylenol, but have resisted taking the oxycodin because I'm afraid of the side effects BUT the pain is very difficult to deal with. So not sure what to do. My health care practitioner knows I'm a crazy person and tries to work with me kindly. He wants me to take the pain meds. I DON'T KNOW WHAT TO DO, in other words, if taking the pain meds (strong ones) will help me heal faster. I gotta heal. Thanks.

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@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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@cindiwass

Thanks for the comments. I just had hip replacement, 6 days ago, and am experiencing a lot of pain, but have resisted taking narcotic pain meds, however, want more info or suggestions from people that have been through it. I don't want to be sleepy/drowsy if possible. And especially not stomach sick. I was nauseated after the surgery and vomited a couple of times. I'd like to avoid the harsh side effects of narcotics. I was prescribed oxycodin for one, and extra strength tylenol, but have resisted taking the oxycodin because I'm afraid of the side effects BUT the pain is very difficult to deal with. So not sure what to do. My health care practitioner knows I'm a crazy person and tries to work with me kindly. He wants me to take the pain meds. I DON'T KNOW WHAT TO DO, in other words, if taking the pain meds (strong ones) will help me heal faster. I gotta heal. Thanks.

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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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@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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@tsc I would just caution that one size does not fit all. I hope as a society we can embrace that different things work well for different people but it is important to support the right of everyone to be able to choose what works for them. We seem to demonize things because of a couple rogue stories or media hype but when you dig into the actual facts, that's a different story.

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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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