Post joint replacement surgery: Alternatives to narcotics for pain relief

Pain relief for knee replacement surgery and other joint surgeries has been a hot-button topic over the past decade. With an epidemic of nearly 450,000 opioid overdoses in America since 1999, physicians have been more mindful of the risks of narcotic prescription drugs and more dedicated to educating patients on alternative methods of pain relief.

Orthopedic surgeons perform these procedures to help people who are in end-stage arthritis and living in chronic pain. As with any surgery, some discomfort and pain can be expected after a hip or knee replacement.

There is a range of pain management resources available for patients who have had surgery. From prescriptions to over-the-counter medications to drug-free alternatives, there are safe and effective options for all patients. Let's explain the different kinds of post-surgery pain relief in the following list.

Pain Medications After Surgery (Narcotics)

• Opioids: Opioids like codeine are prescription medications that temporarily change the way your brain perceives pain. For post-surgery hip or knee pain, prescription medication is usually a temporary pain relief technique. Opioids can help you feel better throughout the day but come with a risk of addiction.
• Synthetic Opioids: Tramadol is a common replacement for codeine and other opioids, though it is still a narcotic. Tramadol is a synthetic opioid that affects how you perceive pain, but also influences your mood. Tramadol is regularly used in combination with non-steroidal anti-inflammatory drugs.

Pain Medications After Surgery (Non-Narcotics)

• Acetaminophen: Normal Tylenol taken at doses recommended by your doctor can help with pain relief and have a much lower risk of future addiction.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are a great option for non-narcotic pain medications, such as ibuprofen (Motrin) and naproxen (Aleve). These medications reduce swelling and pain.
• Muscle Relaxants: While they can be addicting in the long term as much as opioids, relaxants like cyclobenzaprine and diazepam can help bouts of extreme pain.
• Antidepressants: In low doses, antidepressants can sometimes help with chronic pain issues, such as lower back pain.
• Local Steroids: Local corticosteroids are given to a patient through injections at the site of pain and can help with flare-ups from arthritis. This is usually done before, rather than after, the surgery, however.
• Topical Analgesics: Topical analgesics are creams or ointments that can be applied to the skin to offer pain relief.

As with all medications, opioids and non-narcotic pain relievers have potential side effects. It is important to discuss your options and experiences with your doctor prior to use.

Drug-Free Pain Relief Practices

• Hot/Cold Therapy: Hot cloths or ice packs can be applied to the site of pain to provide relief and reduce swelling. Make sure you talk with your doctor to ensure you are applying the right temperature for the correct amount of time.
• Acupuncture: Acupuncture is a traditional Chinese medicine and alternative form of therapy where thin needles are inserted into the body. Make sure to consult with your physician prior to having acupuncture.
• Hypnosis: Hypnosis is a trance-like mental state allowing you to feel calm and relaxed. A therapist usually guides a patient into hypnosis through repeating a series of phrases.
• Anti-Inflammatory Diet: Foods that reduce inflammation such as turmeric, ginger and fish oil supplements are said to help with joint stiffness following your surgery.

Building a Strategy for Your Post-Op Pain Management

Deciding what will help you after total knee replacement or total hip replacement surgery should be a discussion with you and your doctor.

Every patient will respond to medications and pain relief techniques differently. When determining your total hip or total knee replacement pain management protocol, your doctor will consider your unique needs. A combined pain management approach is usually the best route. Prescription medications may be used in the short-term immediately after surgery with a transition to non-narcotic pain meds and alternative pain management techniques.

Variables in Pain Level

There are factors that can increase or decrease your level of pain after surgery.

• Activity Level: Movement of the joint and physical activity is encouraged after surgery and should be guided by your doctor and physical therapist. Activity level can increase swelling and lead to more pain. This is normal and can be managed through medications or hot/cold therapy.
• Time of Day: Believe it or not, the time of day can play a factor in your pain level after hip or knee replacement. Pain at night is more common. There are several reasons for this, including being active during the day and increased swelling, as well as not having any distractions at night and focusing on your pain or discomfort.
• Stress: Heightened stress levels can worsen both physical and perceived pain. If you are feeling stressed or anxious, tell your doctor and set aside dedicated time each day to meditate or relax. Journaling, talking with a friend or listening to calming music are ways to relax while recovering from surgery.

What to Watch Out For

It is important to pay attention to your pain levels after surgery. If you are experiencing consistent, severe pain after knee replacement surgery or other joint surgery, it is important to notify your doctor. This could be a sign of infection or other complications.

What to Remember

You will feel better again. When you are in pain after surgery it can be overwhelming and daunting at times. It may feel like you will never get better. Remind yourself that this is just temporary, and that you will get better. There is a more active, fun-filled and pain-free life in your near future.