Second knee replacement 12 weeks after first-- will pain meds work?

Posted by amytro @amytro, Fri, May 3 12:39pm

So I'm having Knee #2 replaced next week. I'm still on a very low dose of oxycodone and will be up until surgery. My surgeon warned me today that the pain meds may not be as effective for me on this time and pain is something I'll have to worry about and manage. Does anyone have any experience with this or can give me some idea of what they went through. Clearly pain is the worst part of this operation– it was bad enough the first time. But now I have to go through it again and am told it will be worse. Help!

@amytro, I found an excerpt from Mayo Clinic regarding pain medications that may be applicable to what your surgeon has said about your upcoming second surgery and pain control (https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371),

"Benefits and risks. Research shows that over time, your body adapts to these medications, and they bring less and less pain relief. This phenomenon, known as tolerance, means you need more of the same medication to achieve the same degree of pain relief. Long-term use of opioids may lead to dependence on these medications and, eventually, addiction.

The longer you use opioids, the greater your risk of becoming addicted. However, even using opioids to manage pain for more than a few days increases your risk. Researchers at Mayo Clinic have found that the odds you'll still be on opioids a year after starting a short course increase after only five days on opioids."

@amytro, have you discussed this concern with your surgeon or medical provider? Have they discussed an alternative or complimentary management plan with you?

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@JustinMcClanahan @amytro is still on oxycodone so I would suspect that does apply to her situation, but I wonder if you are on one of those medications and then are off of it for a long time, as in many months or even years, it still applies. I suspect it does not. I was on oxycodone for about six weeks after my first TKR but only taking a small dose before bed, and I did not get at all addicted to it.
JK

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@JustinMcClanahan

@amytro, I found an excerpt from Mayo Clinic regarding pain medications that may be applicable to what your surgeon has said about your upcoming second surgery and pain control (https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371),

"Benefits and risks. Research shows that over time, your body adapts to these medications, and they bring less and less pain relief. This phenomenon, known as tolerance, means you need more of the same medication to achieve the same degree of pain relief. Long-term use of opioids may lead to dependence on these medications and, eventually, addiction.

The longer you use opioids, the greater your risk of becoming addicted. However, even using opioids to manage pain for more than a few days increases your risk. Researchers at Mayo Clinic have found that the odds you'll still be on opioids a year after starting a short course increase after only five days on opioids."

@amytro, have you discussed this concern with your surgeon or medical provider? Have they discussed an alternative or complimentary management plan with you?

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@JustinMcClanahan : Interesting information regarding potential addiction. I’m surprised that the possibility to become dependent already starts after a few days. I was on Oxycodone or Percocet respectively for 2 shoulder surgeries, and 2 knee surgeries, in the last 10 years. Each time I took the full permitted amount for the 1st 5 days and nights, and then tapered off rapidly, with no more opioids after 8 to 9 days. While I do believe one should be aware of addiction risks, the benefits to me far outweighed them. Perhaps if the meds would have totally eliminated the pain, I might have been tempted to take more, for a longer time, but since the opioids only lowered the pain, the side effects were not worth continuing.

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Thank you everyone for your input. My surgeon chose dilaudid instead of oxycodone for pain relief for the second knee and it's actually a big improvement. I was able to successfully and fairly easily wean off the oxy in 2 weeks without horrible side effects at all. I am expecting to do the same with the dilaudid. With the latter, I was much more clear headed, did not get the oxy "rash" and "itch" issues, and pain management seemed more effective. I am very pleased with the change in medication as a way to improve effectiveness.

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