|
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
General Joint Surgery Information
The Patient and the Pain Pill
The management of post-operative pain is an important concern
for both patients and physicians following total joint replacement
surgery. Pain clearly influences a patient’s perception
of the success of a surgical procedure as well as the skill
of the surgeon who performed the procedure.
Pain is a complex dynamic experience influenced by many factors.
It is highly variable and subjective affecting both behavior,
thought and activity. Opioids (narcotics) are the agents most
commonly used for the management of acute post-operative pain.
This is because they alone have sufficient strength to predictably
relieve post-op pain for most procedures we do. There are numerous
opioids that have been developed. They differ in potency, onset
of action, duration of action and side effect profile. Different
patients can respond quite differently to the same narcotic,
so adjustment in dose and type can be necessary.
Narcotic usefulness can, however, be limited by side effects.
These can include mental confusion, lethargy, respiratory depression,
nausea, loss of appetite, constipation and itching. Also, if
used over a long enough time period, they can become habit forming.
As time passes, and as healing occurs, pain typically decreases
and as it does, less and less narcotic should be needed. For
this reason, as we refill narcotic prescriptions, the frequency
of dosing is steadily decreased with each refill. Once narcotic
requirement has decreased to only a few doses daily, patients
are encouraged to switch to other non-narcotic medication alternatives
as needed. For many patients, this transition can occur soon
after surgery — within days or a few weeks afterward.
Others may require more time. Experience has taught that with
very few exceptions, patients should be transitioned off all
narcotic medication within 3 months or less after surgery. Continued
need beyond 3 months typically requires careful evaluation for
other problems and sometimes referral to a pain management specialist
at this point is appropriate.
Non-narcotic modalities that can be considered include Tylenol,
Ultram®, many different anti-inflammatory and anti-depressant
medications. Non-pharmacological techniques such as rest, elevation,
ice and heat and various physical therapy techniques can also
be helpful.
Successful post-op analgesia depends on proper patient education,
appropriate therapies and the ability to alter the course of
treatment in response to patient need.
|
