The biggest anxiety before taking Joint Replacement surgery with the majority of patients is post-surgery pain. How badly is this going to hurt?
The bad news is that some pain is an inevitable companion to most types of surgery. The good news is that there are many highly effective medications to keep post-surgical pain under control. Surgical pain is an unpleasant sensation caused by the damage done to tissue by the incision, the procedure itself, the closing of the wound, and any force that is applied during the procedure.
Pain control after surgery is a very real concern for many patients. Some lucky patients are astonished at their lack of post-op joint pain, citing immediate relief (a true Christmas miracle!). On the other hand, some patients experience long, lingering pain after surgery. Even if you fall into the “unlucky” group, one thing is for certain: you will eventually experience less hip or knee pain than before surgery and you will find your “new normal”. With some preparation, we are better equipped to deal with the discomfort, pain, and other associated hurdles after the procedure. Here are a few things to consider that may help through the process.
There will still be pain after the procedure
This is almost inevitable and it’s important to come to terms with this before moving forward. The goal of orthopedic surgery is to reduce pain and improve function, but that pain reduction usually comes after a period of recovery and rehabilitation. Everyone’s pain tolerance and the way in which they respond to painful stimuli are different. Having pain doesn’t mean we are weak; it just means we’re human. The role of the operating team is to help reduce your pain after surgery, but it most likely won’t be eliminated.
Opioids for post-op pain control
These medications can be dangerous when not taken as prescribed or if they are relied upon for long-term pain control. They do have a high potential for addiction. They are now prescribed for initial days in small quantities with the intention to wean off these and transition to non-opioid medications as soon as possible after surgery. Opioids have other troublesome side effects in some patients like nausea, vomiting, and itching.
Multimodal Approach (a cocktail of a variety of options)
There are various concepts of pain management protocols. Many surgeons now utilize combinations of medication and pain reduction techniques using non-opioid medications either in addition to or to replace opioids after surgery. These medications might include pain relievers such as acetaminophen, non-steroidal anti-inflammatory medications (NSAIDs), or even medications that treat neuropathic (nerve) pain. Other useful pain management methods might include cryotherapy (icing the surgical area) and gentle massage of the muscles. However, it is typically recommended not to massage too close to scars or wounds before they are healed. When physical therapy is used after surgery, one of its initial goals is pain reduction. Joints and muscles are designed to move, and avoiding stiffness can help with short-term and long-term pain.
Follow your exercises
A physical therapist will recommend exercises to help strengthen muscles, increase range of motion, and increase blood flow around the knee. This promotes healing and helps drain fluid away from painful tissue
It might not feasible to eliminate our pain by wishing it away, but there can be real benefits to having a calm environment, a clear mind, and taking some time to meditate before or after surgery. A good support system of friends and family members also can be helpful. The time after surgery is a good time to steer clear of people or things that cause you stress or anguish.
There are many different types of treatments used in combination to control pain:
- physical therapy
- cold (ice packs)
- integrative therapies: music, relaxation techniques, massage & meditation
- nerve blocks
Taking pain one day at a time with the support and mentorship of others who’ve overcome this trying time can make the pain, well, less painful. In summary, pain is real. But remember, there are many ways to help you cope with a certain level of discomfort or pain after surgery. As with any concern, don’t hesitate to discuss pain and pain management with your surgeon prior to surgery. With these new multi-modal therapies using a cocktail of concepts, pain is way better controlled today.