issues w/pain management after surgery

Good afternoon

This is my first time on this forum and am optimistic about healing well.  This is my issue...

My husband has had two hip surgeries, most recent one was in 11/2011, had cadaver cartilage put in place.  He is having alot of issues with pain control, and I'm becoming very pessimistic with his current care.  I'm in the medical field myself.  I'm thinking of transferring his care to a different doctor because he can't sleep because of pain/uncomfortable position.  Can anyone give any advice, didn't want to post too much since it's my first time on this forum.  Thanks for all of your advice ahead of time...

Thanks for the response!

My husband is young, only 35.     He had cadaver cartilage put in place because his first surgery cleaned out a deformed labral cartilage.  It was literally rubbing bone on bone.  He had the cartilage put in place, had a ton of scar tissue removed.  He was in the OR over 5 hours, instead of the 2 hours expected.  He had weeks of Pt immediately afterwards and went back to work after being at home nearly four months bedridden, with CPM machine.  His surgeon doesn't deal with pain medication, he's with a different doctor because of that.  I don't feel comfortable putting too much detail on board, but he has taken percocet and straight oxycodone before, vicodin with little relief.  I have a tens unit at home and also use a heating pad, which doesn't help at all. 

Again, any help from the community would help with advice regarding pain management, alternative therapies, etc...

 

       Thanks for the information jm77!

            ...well a couple of suggestions! 1. get a second opinion to make sure the surgeon did his job correctly...and 2. You really need to get him to a "Pain Management Dr"

   a patient can take the correct pain med all day long, and be the wrong dosage...so you really need a PM who will know how to treat him. Many times this move has to be referred by the PCD...  Is that a possibility for you without causing too much of a stink with his Dr? Or, can you pick a PM without a referral?

Your husband is young..so this could be part of the problem with the Dr not wanting to script. There are other med's and possibilities for him to try. Is this Dr just flat out refusing to up his dose or trying other med's on him? If so...then take a walk...and get your husband the help he needs.

One other thing...and I'm the wrong person to judge the time line on healing...but it may be that he simply needs more time to heal. A fusion like I had on my spine takes 12 to 18 months. I do have friends who have had a shoulder replacement...and it took several months to get over the pain.

 *´¨)
¸.•´¸.•*´¨) ¸.•*¨)
(¸.•´ (¸.•`    SE

Hi JM and welcome to the forum. So sorry to hear about your husband's situation. Its a shame after all he went through the outcome has not been that good.

Does he have the same pain as before surgery or is it a different type of pain? Does he say whether it is any better, the same or worse.

If he has a lot of inflammation going on in the hip, then I would limit the use of the heating pad as that can aggravate things.

If surgically everything was done correctly, then it sounds like your husband is left with chronic pain. He may want to consider consulting with a good reputable pain mgt dr.. He will need one that will script meds if the dr feels they are necessary and one that does injections and procedures. There are two types of pain mgt drs out there. One will do injections and procedures only, no meds at all and the other will do the same but will also give meds. If you are in the medical field perhaps you can get some top notch info on some good pain mgt drs in your area.

Most orthos will script meds short term and usually are limited on what they use. A good PM dr specializes in pain so he has more knowledge when it comes to which meds work better together or alone. Pain is no fun and having a good r makes all the difference.

Keep us posted.....Susie

Good morning everyone and first of all, THANK YOU ALL FOR YOUR KIND WORDS AND ADVICE!!! 

Ok, a bit more info for everyone.  My husband's ortho surgeon is a top notch hip surgeon, one of the best in the country.  I feel as if my husband is definitely in extremely competent, professional and compassionate hands.  His surgery was done because the doctor believes it was a combo of sports related trauma(when he was younger) and possibly a congenital defect because of the appearance of the labrum (spelling?) and femur head.  The issue I'm having is he does have a PMD, but I am at the point where I don't think he's being properly helped anymore.  It also sucks because the PMD is a doctor that I refer alot of patients to and also receive alot of referrals and my office staff has a good relationship with, so it's kind of awkward.  I've started researching a possible new doctor to take my husband to, but we are going to wait until after we see the ortho doctor for a f/u office visit, since we just did a few MRI's and are thinking of getting a PSOS injection.  He's actually on a month supply of celebrex to help with swelling/inflamation.  He has a machine at home that we got after his first surgery that is a huge rubber? pad that wraps around his hip/leg and is constantly circulating ice cold water. 

Does anyone have any suggestions regarding different pain medications?  experiences? 

Once again, thank you all!!!!!!!!!!!!!!!!!

Hi there...

It sounds like you all have a good plan of action to wait and see the surgeon...and if needed, switch to a new Pain Mgmt. Dr..

No one can really give any suggestions about medication as we are all different in what is causing our pain, how long we have been in pain mgmt., etc.

How long has your husband been seeing this PM? I guess before switching...I would go in one last time and have a real heart to heart.

Have your husband keep a pain journal starting today. Write down what activities cause more pain...what helps. When he takes his medication...Write down what type of pain. Dull, throbbing, sharp, burning, aching, etc. Give as much detail as possible to the Dr.

I would also be asking the surgeon what pain levels he thinks are "normal" at this stage of recovery. The key is making sure there isn't anything actually wrong with the recovery.

And maybe the surgeon can speak with the PM Dr. about what is going on and try to figure out if this should not be happening....or how to help him better over the next months.

I haven't had that type of surgery, but I've had numerous others including 3, two-level, cervical fusions and that takes at least 12 months to fully heal/recover...

Did your husband go from 4 months at home not being mobile back to full time work? I couldn't tell from your post. It doesn't sound like he eased back into activity so maybe he needs to just be back at work for less hours.

Obviously with any type of surgery the regular things of maintaining a health weight to not add any extra strain on the body. Not smoking, eating healthy, doing daily stretches, PT at home, walking/exercise, (as approved by the DR.) are all important in the recovery process.

When is the appt. with the surgeon and the next one with his PM? Hope these are soon and you all can get a better comprehensive plan of action to help in his recovery.

Keep us posted.

 

      ...at this point all I can do is to list off med's for you, and still suggest that you either have a serious talk with his Dr or start looking for another one.

     Have you asked the Dr you work for? I'm guessing since you are referring patients to a PMD, and have a staff working for you, that you are a little higher up on the ladder within his practice.

      Some of the med's are of course, Oxycontin, Oxycodone, Percocet, Hydrocodone, Dilaudid, Fentanyl, Methadone, Opana, MsContin. There are nerve med's as well,...Cymbalta, Gabbapentin (Neurotin) Lyrica. Let's not forget Tens units..and pain pumps as well.

     To me the least in strength of pain meds that I have listed is the Hydrocodone...and the strongest would be the Fentanyl....however, all of them are relative to the patient, and what best works for the type of pain he has.

      There are many others...and I'm sure others will chime in and help me out here with them.

   Good luck, and I hope you find a PMD that will help your husband out with his pain. Also, your PCD that you work for, should have more than one PMD referral to send his patients to. I believe I would ask him,... as this would be your best source of, and professional information for all of these questions. I sincerely hope we have given you some suggestions here, and if you have any other questions, please feel free to ask. We are here to support anytime!  

  *´¨)
¸.•´¸.•*´¨) ¸.•*¨)
(¸.•´ (¸.•`    SE

Jm 77, welcome to the forums :)

I agree with what Snowbunny said. Pain itself is very relative to the person and condition. The cause of pain (example nerve vs joint inflamation pain vs muscle spasmodiic vs intestinal + acute vs shooting) type of pain (acute, shooting, burning, throbbing) and body chemistry (things like having ADD and thus low dopamine + Norephedrine levels can affect pain response, not to mention the rate at which an individual builds tolerance and metabolizes medication) ALL play a factor and which is why some medications could be someone's hell riddled with side effects and low relief where as the same medication can be a godsend with view side effects for someone else.

Personally, I really don't care for oxycodone but would accept it for sevre break through pain if my doctor wanted to go that route. Personally, I feel Nucynta (Tapentadol 75) works more efficiently than say oxycodone 10 and it lasts for about 5 hours vs oxycodone which seems to be closer to 3.5. Me and my doctor have discussed this medication in depth and he personally LOVES this medication compared to other narcotics because it builds tolerance much slower than oxycodone but delivers comparable pain relief to the lower dosing range of oxycodone (10-15mgs). This is because the medication has potent NRI properties which are stronger than tramadol's, lower seratonin effects than tramadol, but strong Mu Opioid agonism than tramadol so its well suited for nuero-pathic pain. Personally, I cannot take breakthrough doses of this medication cause the NRI effects are simply "too potent", and recently he gave me hydrocodone for breakthrough after a procedure (1 nucynta + 1 hydrocodone) rather than having to endure the over stimulation effects of 2 Nucyntas.

All narcotics are not equal and the same goes for NSAIDs, muslce relaxants, and nueropathics.

The best you can do is have him keep the pain journal and document the relief experienced, what additional methods were used to calm the pain, the type of pain, and give it one more go with this PMD. If you still feel that after explaining the issues in depth with recorded pain data isn't producing the desired results, then I would totally agree its time for a new PMD.

Keep in mind, PMDs are also trying to balance treating the patient with the potential risks of treatment. While it might seem conservative, its easier to go too low with dosings and ramp up, vs too high of dosing and then ramp down. Almost all medications asside from NSAIDs build tolerance and with higher doses come more side effects.

best wishes - James