Pain Management

Pain management is very important in your early recovery. If your knee pain is not controlled, it may interfere with your ability to move and walk. This can result in complications and an extended stay in the hospital. Depending on your condition, one or more of the following methods will be prescribed by your doctor to help control your pain:

  • PCA (Patient Controlled Analgesia)- The PCA pump allows you to medicate yourself as needed. A prescribed dosage of medication goes directly into your vein through an IV and keeps your pain at a tolerable level. The machine is programmed so you can't give yourself too much medication.
  • Epidural- A catheter is placed into your spinal area before surgery. It may remain in place after surgery and may be used to administer continuous medication.
  • IV injections- Pain medication is administered through your IV by your nurse.
  • Pills- Your doctor will prescribe pain pills once you are eating regular foods.

Remember, it's important to control your pain for quicker healing. Let your nurse or therapist know whenever your pain is unrelieved by any of the above methods. As your healing and recovery progresses, your need for pain medication should decline.

The proper use of pain relievers before, during, and after surgery is a very important aspect of your treatment, can promote healing, and can make your joint replacement a more satisfying experience. Discuss options with your doctor before your surgery.

How Pain Affects the Body

When you are injured, pain is your body's warning sign to protect yourself and avoid further injury. However, unrelieved pain can be harmful, especially when you are sick or after surgery. Pain can interfere with your ability to move and walk. This can result in complications and a longer stay in the hospital.


About Epidural Pain Management

Your doctor may decide to give you epidural morphine. This is administered outside your spinal area. It may be used for pain management both during and after your surgery.

How Long Will the Epidural Morphine Last?

The pain relief can take up to 2 hours before fully achieved and generally lasts 24 hours. Your doctors will determine if you are a candidate for epidural morphine.

What are the Goals of Pain Management with Epidural Morphine?

  • to keep pain from becoming severe and out of control
  • to keep comfortable so that you can sleep, walk, participate in therapy exercises, and visit with others
  • to decrease the length of time spent in the hospital

How Does Epidural Morphine Work?

Pain medicine will be given through an epidural catheter, which is a tiny tube the anesthesiologits will put in your back before surgery.

What are Some of the Possible Side Effects of Epidural Morphine?

  • itching is not an allergic reaction but instead a common side effect
  • nausea may occur, which can be treated with medicine
  • you may have difficulty urinating
  • constipation may occur
  • you may experience drowsiness after receiving the pain medicine
  • breathing difficulty can occur but is rare
  • numbness and tingling around the surgical site is common--if you experience numbness in any other area, such as your legs, let your doctor or nurse know.

Report all side effects to your nurse.

Pain and Therapy

The more pain you have, the more uncomfortable it will be to participate in therapy. If you're taking pain medication, request it approximately 45 to 60 minutes prior to the start of your physical therapy session. You will have a much easier time completing neccessary exercises to strenghten and stretch muscles surrounding your knee.


Why You Feel Pain

Pain helps you protect your body against harm. It makes you pull your hand away from a flame, or avoid walking on a broken foot. But sometimes the body's pain-control system doesn't work the way it's supposed to.

Acute Pain vs Chronic Pain

Acute pain is caused by an injury or health problem that leads to tissue damage. The pain has a definite source. For example, if you poke your finger with a needle, pain signals travel from the injury along the nerves. "Gates" in the nerve pathways open to allow these signals through to the brain. This tells you to pull your finger away from the needle. While your finger heals, the brain's normal pain-control system lessens the pain. This is done through the release of endorphins. These natural chemicals reduce pain by closing the "pain gates." Once the injury or health problem heals, the pain goes away.

Chronic pain is pain that lasts over a long period of time. This includes pain that you feel regularly, even if it comes and goes. Chronic pain may be due to chronic stimulus from an ongoing injury or health problem. Common causes of chronic stimulus include joint degeneration (arthritis), back injury, nervous system damage, and headaches. But chronic pain is not always a signal of harm to your body. Problems with the pain-control system may lead to a chronic pain syndrome such as fibromyalgia.

Chronic Pain Syndrome develops when pain persists and no cause can be found. This may occur because the brain can't produce enough endorphins to shut the "pain gates." In some cases, pain signals continue after an injury has healed. In others, increased pain sensitivity makes even minor injuries very painful.

Breaking the Cycle

See your doctor. He will evaluate your pain and will design a treatment program to break the pain cycle and better control pain.

The first goal of your treatment plan is to break the pain cycle. It will also help you learn to prevent or cope with pain on a daily basis. It will be based on self-management, and will most likely include a variety of therapies and techniques for controlling pain. It may take a little time to find the right treatment for you.

Treatment plans for pain control may include, but are not limited to the following:

  • Activity can improve your mood and your overall health. Start slowly and safely. As your body becomes stronger and more flexible, it will be better able to relax, helping to relieve pain. Exercise several times a week. Consider working with a physical therapist if you haven't exercised in a long time. They can get you started on stretches and exercises that fit your fitness level and condition.
  • Therapies for mind and body. Both the brain and body are involved in the pain response. The brain reads the pain signals from the body. Mind-body therapies may help change how your brain reads pain signals. Some methods include:yoga, relaxation, visualization, and meditation, coping skills, biofeedback, and self-hypnosis.
  • Complimentary therapies are therapies that compliment medical care. These include massage, chiropractic treatment, acupuncture and accupressure, and certain vitamins and herbs. Look for licensed practitioners with experience working with chronic pain.
  • Medications will most likely be part of your treatment plan for chronic pain. You may use prescription or over-the-counter meds. Some of these medications include: analgesics such as nonsteroidal anti-inflammatories (aspirin, ibuprofen), acetaminophen, cox-2 inhibitors (nonsteroidal anti-inflammatories that may be easier on your stomach), and opiates (codeine). Antidepressants are often used in low dosages for sleep problems, even in people who are not depressed. Other medications may include topical creams and muscle relaxants.

Other Treatments include:

  • TENS (transcutaneous electrical nerve stimulation) uses low-voltage electrical currents applied through electrodes taped to the skin. This may keep pain signals from reaching the brain.
  • Injection therapies include: nerve blocks, trigger point injections, epidural steroid injections, and corticosteroid injections.
  • More invasive procedures include spinal stimulation, implanted spinal pump, and neurotomy.

If you've tried the above treatment methods and have found no relief for your pain, you may be referred to a special pain program or pain clinic. Talk to your doctor.

The above information is meant for informational purposes only. It is not medical advice and should not be treated as such. Always consult with your doctor before beginning any exercise or treatment program, or before taking any new medications, vitamins, or herbs, as they may interfere with your current medication or have serious side effects you are not aware of.

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