Re: dealing with the post surgical pain of a total knee replacement.

[Guest guest]

Kitty wrote:

> I had my knee replaced on Sept 27 and am still having a hard time. I did well

enough to be released from the hospital and therefore was let go last Saturday.

Hi Kitty

If your surgery was this Sept 27th, then you are not healed yet. You

can expect to have pain for quite awhile longer. A knee replacement is

major, major surgery. There's muscle cutting and bone sawing and all

sorts of things going on. A person doesn't bounce right back from

something like that. It takes quite a bit of time, so you need to be

patient.

Since you chose not to go to rehab, please make sure you are doing all

your physiotherapy. Don't stop doing what you've been told to do just

because it's " uncomfortable. " Since the physiotherapist is coming to

you, ask lots of questions and make sure you have diagrams and some

written instructions for your exercise routine.

Getting a knee replaced is very painful. If you follow all instructions

and keep your weight down, in a few months you'll feel much better.

Lyndi

[Guest guest]

I can't imagine not going to rehab.  I think that was maybe a mistake.  I've 

not had a replacement but know others who did and it was tough getting through

the first few months.  There are certain exercises you must do, even if

painful.  Pain is part of the process but I think rehab would be more helpful in

starting the healing process.  You want the most range of motion possible. 

I think you would get the encouragement needed in rehab.  You won't be having

complete pain relief for awhile and only if healing goes as planned.

>Kitty wrote:

> 

>I had my knee replaced on Sept 27 and am still having a hard time. I did well

enough to be released from the hospital and therefore was let go last Saturday.

>

>I decided not to go to rehab and instead went to my Dad's house (bathroom on

same floor as bedroom). At first it was going OK, but I never felt complete pain

relief.

[Guest guest]

>

> Last Friday they comisserated and called my surgeon for Oxycontin to help my

pain. It has not been the miracle I'd hoped. I would've rather stayed on

oxycodone (even if it didn;t last long enought).

Oxycontin IS oxycodone. That's all it is. It's just formulated to be longer

acting than an instant-release version of the same drug.

What were you on before that you felt worked better? If it was oxycondone mixed

with an NSAID (such as Percodan which is instant release oxycodone mixed with

aspirin) or with acetominophen(such as Percocet which is instant release

oxycodone mixed with Tylenol), then one of two things is different - either the

effective dose of Oxycontin wasn't equivalent to the effective dose of the

Percocet/Percodan (the milligram numbers won't be the same because one is long

acting and one is immediate, so they have to use a conversion chart to figure

out an equivalent dose), or it's really the NSAID/Tylenol that's really making

the difference. Sometimes the NSAID/Tylenol helps make the opiod more

effective.

You could try taking a couple of Tylenol when you take your dose of Oxycontin

and see if it improves the effect of the opiod. Just be careful not to overdose

on Tylenol - it can kill your liver! Don't take anything over the recommended

dosage on the label.

Also, a long-acting opiod MUST be taken at the exact same time every day - you

can't take it as needed and expect it to work. It takes a few days to build up

in your system and really start to feel like it's working too.

And how often are they dosing you on the Oxycontin? Some doctors say only every

12 hours, but it really does not last longer than eight. If you're not getting

a frequent enough dose, it could be wearing off and then it's much harder to the

get the pain under control.

Just a few thoughts to help you talk to your doctors/nurses about.

Cheryl in AZ

Moderator

[Guest guest]

So, help me understand. If I am on Lortab, as needed and have oxycodone for

breakthrough pain, am I to understand that I should stay on Lortab all the time?

I am 47 and am trying to move through my pain. (Watching those arthritis

commercials and following my PT exercises) I do sleep a lot and reaching for

meds is my last resort.

Having said that, I am on Cymbalta and Lyrica daily.

I have bulges and herniated (torn discs) in my neck and back. I also have

osteoarthritis and had arthroscopic surgery in my shoulder to prevent a bone

spur from tearing my rotator cuff.

As the weather changes, I am in increasingly excruciating pain. But, my pm doc

hasn't told me to take the opiods unless I need them.

Is he wrong?

E

> Cheryl wrote:

> Also, a long-acting opiod MUST be taken at the exact same time every day -

you can't take it as needed

[Guest guest]

--- " ellensmith912@... " wrote:

>

> So, help me understand. If I am on Lortab, as needed and have oxycodone for

breakthrough pain, am I to understand that I should stay on Lortab all the time?

>>

>

> > Cheryl wrote:

> > Also, a long-acting opiod MUST be taken at the exact same time every day -

you can't take it as needed

>

Ellen -

It is my understanding that Lortab (which is hydrocodone and aspirin) is NOT a

long-acting opiod. It is an immediate release drug.

So no, he's not wrong. What I wrote in the section you clipped doesn't apply to

that drug. It only applies to long-acting or " continuous release " medications,

such as Oxycontin or MSContin (the " contin " stands for " continuous release. " )

Short-acting or " immediate release " drugs are made to use as needed, and only

have effects for 4 hours or so.

However, it doesn't make much sense that your doctor has given you two

short-acting opiods for pain. If your pain is truly chronic and is consistently

high at all times, you probably should talk to your doctor about switching you

to a long-acting medication with one of the short-acting ones as a breakthrough

medication.

Cheryl in AZ

Moderator

[Guest guest]

Bennie

There is no OxyContin IR the " Contin " in OxyContin means continuous

release. If OxyIR (immediate release oxycodone) works, but OxyContin

didn't work, you were probably on an inadequate dose.

If you take 10mg of OxyIR every 4 hours, you are receiving 60mg of

oxycodone per 24 hours. To convert to OxyContin, you would take your

24 hour total and divide by the number of doses. OxyContin is usually

prescribed twice daily.

So, divide by 2. 30mg OxyContin every 12 hours is equivalent to 10mg OxyIR every

4 hours. If you are prescribed it 3x/day (every 8 hours), 20mg OxyContin every 8

hours is equivalent to 10mg OxyIR every 4 hours. My wife went from 15mg OxyIR

every 4 hours to 10mg OxyContin twice a day. She almost had a heart attack, I

wanted to kill that doctor.

My point is that you should figure out the total daily dose of each.

If one is WAY lower, that could explain the lack of efficacy.

OxyContin DOES have fillers. They recently reformatted it to

prevent injection. I believe it always had some fillers. What dose of

OxyIR helped you? What was the highest dose of OxyContin you tried?

Steve M in PA

Bennie wrote:

> Oxycontin did not work for me but Oxycodone did.  I am on hydromorphone which

is Dilaudid.  You have to call you Doctor and

> tell him it is not working. Oxycontin IR which is instant release helped me

more but did not help but four to six hours and they had

> me taking every eight hours.