Joint replacement surgery, such as knee and hip replacement, is often done to reduce the pain caused by arthritis. However, in the days following surgery, some patients’ pain is just as bad or even worse than their original arthritic pain. While we understand that surgery without any pain is the exception and not the rule, we take pain very seriously and take a multidisciplinary approach to limiting pain to maximize recovery.
What is Pain?
Pain is complex interaction between specialized nerves, your spinal cord and your brain. It is a complicated traffic system, with on-ramps, different speeds, traffic lights, varying weather and road conditions, a traffic control center, an emergency response system, and more. And the vehicle you’re in also makes a difference, because the experience of pain varies from one person to another.
Pain is both physical and emotional. It involves learning and memory. It is altered by mood and physical and emotional stress. How you feel and react to pain depends on what’s causing it, and its expression varies from patient-to-patient.
Benefits of Effective Pain Control
- Increased patient comfort. Every joint replacement patient has some degree of post-operative pain, and effectively managing that pain can significantly affect patient comfort.
- Earlier rehabilitation. A patient whose pain is under control is more likely to get out of bed and perform rehabilitation exercises. When done under the guidance and supervision of a surgeon and physical therapist, post-surgical exercise can help reduce the development of scar tissue, increase range of motion, and increase the likelihood a successful recovery.
- Decreased risk of deep vein thrombosis (DVT). Patients who have undergone a joint replacement are at greater risk for developing a blood clot in a deep vein. When a patient’s pain is under control, he or she can move about and perform rehabilitation exercises, which improve blood flow and therefore decrease the risk of DVT.
- Earlier hospital discharge. The sooner a patient’s pain is under control, the sooner he or she can return home.
- Increased patient satisfaction. Patients who are able to be self-sufficient and return to their normal routine on schedule or ahead of schedule tend to be more satisfied with their joint replacement surgery.
Multimodal Analgesia – Less is More
We use combination of pain relief methods that complement each other and minimize side effects, an approach that is called multimodal analgesia. The goal is to target various parts of the Pain Pathway, so that you experience less pain and medication side-effects are minimized.
These techniques involve limiting narcotic medications during surgery to decrease postoperative complications with breathing, thinking, and using the bathroom. During surgery, we prefer spinal and regional anesthesia, which numbs the surgical area and allows you to be completely comfortable for the surgery with light sedation. Don’t worry, you will not be awake to hear the surgery!
Medications that are commonly used include:
Medications at Home
Once you leave the hospital, you will still have some discomfort, especially with activity. It is not uncommon to have difficulty sleeping for 6-8 weeks after surgery. Your joint often feels uncomfortable when you try to fully relax to sleep. This feeling improves more quickly in patients who have better motion and and earlier return of muscle tone.
Your surgeon will prescribe a combination of medications when you go home. The ultimate goal is to progressively decrease medication usage, and we generally recommend discontinuing narcotic pain medications first. Most patients are off their narcotics within 4 weeks of surgery.
Medications you may receive at home include:
Tylenol – in higher doses (>650mg), Tylenol is a very good pain reliever and works well with other medications to increase their effect. Patients with liver issues should consult their physician for dose recommendations. Patients should take no more that 3000mg of Tylenol daily.
Celecoxib (Celebrex) – selective anti-inflammatory medication which has fewer stomach and bone side effects when compared with more classic anti-inflammatories such as ibuprofen and naproxen. We often use Aspirin after surgery to limit blood clots, and Celebrex is safer in these patients for the stomach than ibuprofen (Motrin). It should be limited in patients with a sulfa allergy, renal insufficiency, or severe heart disease.
Tramadol (Ultram) – strong pain reliever that is not a narcotic and is thought to have less addictive properties and fewer GI side effects than opioids. 1/3 patients do experience some nausea.
Oxycodone or Hydromorphone – narcotic medications that are very powerful pain relievers. The do have addictive properties, both physically and mentally. They work very well for post-surgical pain, but the goal is to wean these medications to limit their side effects. They are strongly associated with constipation, urinary retention, and diminished reaction time.