TKR 17 Days Ago. Need pain medication advice.

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Hello everyone! I'm brand new to the forum and looking for advice about pain meds. I'm in the US, medium sized city in the Midwest. Surgery done at a top notch hospital. Stayed 2 nights with no complications other than severe pain. While in the hospital I was on a regimin of Norco 10/325 and 5mg oxycodone, staggered every 3 hours. Upon discharge, surgeon wrote prescriptions for 2 weeks of the same strengths of both Norco and oxycodone, each to be taken every 4 hours. I scheduled them so I'd be taking one or the other every 2 hours. For the most part this has worked well. There were only a couple times when I took two oxys at the same time after physical therapy. The pain was almost unbearable.

I had my 2 week post-op visit and staples removed earlier this week. Saw my surgeon very briefly and I asked for a refill of both meds. He looked at me with a scowl on his face and told me "we don't prescribe narcotics beyond 14 days". I explained I was having trouble sleeping due to waking up in pain. Most nights I'm lucky to get 4 hours of sleep. I mentioned how much pain physical therapy was causing, including the obvious fact that pain was keeping me from being able to do specific exercises.

To make a long story short, surgeon grudgingly agreed to one more week of just the oxycodone. In my opinion, it's gonna take a week just to taper off the oxy. I've started trying to go 6 hours between doses but it's not going well. Pain is not going away anytime soon. I ice and elevate at least 30 minutes every 2 hours.

Please don't suggest I talk to my PCP. He is so anti pain medication that upon meeting him the first time several years ago, the VERY first words out of his? mouth were "We don't prescribe narcotics here".

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  • Posted

    I think docs are overboard on thinking you will become a addict. 325 norcos are light. They gave me 25 of those for a outter ear infection I had last month. They are not strong.
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    • Posted

      True.  Norco 5/325 is the lowest possible dose.  Contains 5 mg hydrocodone and 325 mg acetaminophen (Tylenol).  There is no 2.5 version unless you snap the pills in half.  A doc might prescribe doing just that so as to titrate down from the larger dose and transition to Tramadol or an OTC painkiller. 
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  • Posted

    "...unbearable"...  Yup...  Welcome to the club.

    The next step down is Tramadol (Ultram).  Technically still an opioid narcotic, it's waaaaay weaker than what you've been taking and can be viewed as the transition drug between the heavy-duty narcotics and ibuprofen or acetaminophen.  Docs usually have no problem prescribing this.

    This may help with your sleep...

    https://patient.info/forums/discuss/trouble-sleeping-post-tkr--539591

    PS: I have never heard of a doc prescribing BOTH hydrocodone (the Norco) AND oxycodone simultaneously.  They gave me Percocet (oxycodone + acetaminophen) and Flexeril (a muscle relaxer) at the same time...not two opioids.  That's weird...  Anyone else get that mix?

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    • Posted

      Thanks Chico. I was prescribed tramadol in the past (several years before it became schedule 4) and will never take it again due to nasty side effects. When I was in the hospital for my TKR, my surgeon wanted me to take gabapentin, which I refused. Another drug I've taken in the past with nasty side effects, not to menton it does nothing for arthritis pain. 

      My surgeon did have me on diazepam in the hospital and had no trouble writing another 2 week rx for it. But here's the weird part. My first night at the hospital, after the block wore off, my pain was so bad even though I had been taking both the Norco and Oxy all day and night. Definitely an 8, almost a 9 on the pain scale. Nurse asked if I wanted Dilaudid IV which of course I did. But even that didn't help with pain. Just made me groggy and a bit spacey and I finally fell asleep.

       

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    • Posted

      I get 2 mg Dilaudid IV when I'm in the ER with a kidney stone...which used to be my 10 on the pain scale.  Works great for me; maybe they only gave you 1 mg IV.  The next step up for you would be Fentanyl but that's top-shelf stuff.  I don't believe there's anything more powerful than that.  Comes in patches for 24-hour controlled-release delivery.

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  • Posted

    I am 5 months post TKR. I was on Norco for 2 weeks (every 4 hours). I was still in extreme pain but the Norco is very constipating so my doctor changed me to Oxycodone. I was on that ( 2 every six hours, except on PT days when I took an extra two pills.). My doctor only gave me prescriptions for seven days at a time so I had to call and pick up new prescriptions. In all I would say I was on Oxcodone for 12 weeks, but the times between meds increased until I was only on meds at night. By four months I was off all meds, except prescription strength Naproxen (as needed). I could not have gone through PT, home exercises and the small amount of sleep I got without pain meds. I suggest you get a referral to a physician who practices in a pain management practice. If you read this forum, you will find that most of us have gone through extreme pain. This is a surgery that I found to be brutal. But, there is a light at the end of the tunnel. I walk my 87 pound Golden Retriever for about 2 miles each day, able to return to my everyday activities. ( Although, last Friday, I went to my Granddaughters school conference and had to climb three flights of stairs to our seats. Not too bad. Coming down was exhausting and since there was a crowd pushing, I lost my balance and tripped. )

    Pain management is essential. My question to you is, why did you go to a surgeon who does not believe in pain meds?

    Elllen

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  • Posted

    These jerks that are so caught up in this "everyone's gonna be an addict" thing that the gov't is promoting ate doing a disservice to their clientele. I'm also in the Midwest and use the ortho group at a teachi g hospital which of course means, my surgeon is also teaching professor. They have limits for automatic refills but my Dr is a compassionate, common sense guy that says he knows I'm not selling them on the street corner nor am I eating them like m & m's. Of course, I've had many , many surgeries on the knee and leg so I'm in a little different category, patient wise. You didn't mention your age and if you are on regular insurance or Medicare but if you can escape these two illogical jerks and find a pain management group. If you are on Medicare you can go where you want to go without referrals. Some other plans require the referral nonsense.

    I'd ask the PCP what his take on prescribing antibiotics happens to be now that the gov't is telling him we are over prescribing in that area as well. If he doesn't believe in pain meds for people with acute pain may be he has a couple of voodoo tricks up his sleeve for people like you. Personally, I'd dump both of these clowns asap and find professionals that believe that the patient comes first.

    BTW, I would never tell a Dr that I wanted pain meds because I can't sleep. That can be a red flag. What you need pain meds for is so you can participate in therapy to the fullest which you cant when your body is screaming with pain.

    Sorry to say but the actions of your Drs sort of override the earlier statement about the hospital being top notch.

    Keep us advised, in the meantime, ice, ice, ice and add something like Aleve every 12 hours as an anti inflammatory if your stomach can handle it.

    For reference sake, I'm in the greater Kansas City area and go to the local university med center

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    • Posted

      You can't get addicted in 30 days...you just can't...especially when the docs titrate you down to Tramadol or an OTC.  I have found that recently it has become harder to get prescriptions written for Vicodin or Percocet.  Everyone's scared that their name will show up on some list for prescribing the meds.  Really terrible for people who genuinely need them...and TKR patients definitely need them.

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    • Posted

      This govt sanctioned witch hunt is really making it difficult for those that really are in need. The pendulum will swing the other way when a few malpractice lawsuits start popping up filed by these TV based law firms. When Drs start having to take a week off to go to court to justify their actions then it will be a different wheel that's squaking

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    • Posted

      I'm 56 and have health insurance through my employer. Definitely need to change my PCP, but unfortunately in my area (Western Michigan) the predominant mindset is to completely do away with access to opioids. It seems like every night the local news channels are reporting on the opioid "epidemic". Doctors are freaked out about getting audited by the state and then possibly losing their license. Even pain management clinics here will not prescribe pain meds as a general rule. Just prior to my TKR I was seeing a doc at a pain clinic for another issue. Over the course of 4 months he did nerve blocks every 2 weeks, radiofrequency ablation and gave me an rx for PT. When I mentioned pain medication at around the 4th visit, his response was "we don't prescribe pills for your condition". My diagnosis was CRPS.

      The hospital I went to for my TKR was rated 4th out of the top 100 large hospitals in the US in 2017. They have been consistently in the top 5 over the past few years. I'm sure they are not using patient pain med satisfaction as one of the criteria.

      I do take both tylenol and ibuprofen at almost max doses and have been for many years. Very little pain relief from either. And I do ice and elevate every chance I get. When my Oxy runs out in a couple days I don't know how I'll even be able to do my PT. 

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    • Posted

      "I do take both Tylenol and ibuprofen at almost max doses and have been for many years. Very little pain relief from either."

      Then stop taking them.  Both have negative stomach side effects when used long-term.  Not good for you.

      Get a prescription for Voltaren Gel...second best topical anti-inflammatory on the planet.  Rub it in multiple times a day, especially 15 minutes before bedtime.  Ortho would give me a script for five (5) tubes at a time.  Very good stuff especially for PT.

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    • Posted

      Yep I'm just outside of Grand Rapids. Home of the Van Andel and the DeVos billionaires. As in Amway and Betsy. Ugh.

      The Frankfort area is beautiful. I really enjoy traveling to any part of the northwestern lower penninsula.

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