opiate addict in recovery has questions about her opiate response after major surgery 4 weeks ago.

hello members.
I am brand new here and I hope starting a new post is the best avenue for help. I am 60 yrs old and had a total knee replacement 4 weeks ago. I have been in recovery from a 2 year opiate addiction for 6 years now. I told my surgeon my addiction history and she sent me to her pain management specialist before surgery. good doctor! The surgery is very very painful. I wanted to prove to myself, my children and family that I could take the opiates as prescribed, so I endured severe pain and a lack of sleep for almost 4 weeks. I called my surgeon and told her and she prescribed a mild sleep aid and told me to change my ice 4 times a day instead of 2. I did that and it brought no relief. a few days later, to not take one extra opiate I started taking more much tylenol and aspirin and other " non-opiod " medicines which also brought no relief. I now know that taking that much tylenol etc. is really serious and to NEVER do that again. I was crying for 6 hour stints and several one hour stints as well off and on during a 24 hour period and had been so preoccupied with pain that I had not eaten in 3 days and I could not think straight . Thankfully I had this moment of clarity that I needed help since I was seriously in a bad place. It was after hours for my surgeon so, I reached out to my son who is a also a doctor. He helped me make sound decisions like call the surgeon immediately and tell her about the tylenol use and that you have hit your limit and to do that right now at night after hours. I could not think straight by this point, so was glad to have his direction. my surgeon called me back within 5 minutes of my leaving a message late at night. she is sending me back to the pain management specialist and also wrote me a higher dose of the opioids to bridge me over to that appt which is in 4 days...now I feel so much better on a higher dose. I still have pain. I still do cry, but, I can adjust my physical therapy and rest for a bit to be able to stop the pain and then continue with the physical therapy.

MY QUESTION IS THIS: the doctor told me that it was not my fault that I thought I needed a higher dose of narcotics and she understood exactly why that was. But! I am so curious to find out why after 6 years of total sobriety, I would need a higher dose than she was comfortable prescribing ? Do I need more since I was once seriously addicted for 2 years and went thru a 7 week horrendous cold turkey withdrawal to stop taking them? I thought since I had not taken anything for 6 years, I would have the same relief as any other patient. I am not 'high' on the higher dose, just the knee pain stops and I can function-eat , sleep at least 4 or 5 hours, and do my physical therapy......I don't get it. Does anyone know why I am experiencing this? thank you very much.

Marie:
One effect of taking opiates on a long term basis is that it resets the brain’s opiate receptors (as well as dopamine receptors). The result is that a person’s perception of pain is heightened. That is, the central nervous system becomes hypersensitive to pain. The term is “centralization of pain.” The experience of pain and the use of opiates causes changes in the central nervous system (CNS) whereby a person experiences more pain and is more sensitive to pain with less provocation.

Centralization of pain is one factor that causes many people to need an increase dose of opiate over time to achieve a similar level of pain medication/control. That is, long-term use of opiates can cause an increase in one’s subjective pain experience.

Despite your several years of opiate abstance, your central nervous system likely remains hyper-sensitive to incoming pain stimuli.

I have been on opiates for about 4 years for pain due to avascular necrosis of my hips and jaw due to corticosteroid use. I do not doubt for a second but that I have also developed a degree of pain centralization. That is, a portion of my pain has as its source changes in CNS opiate receptors. It is a sobering reality.

Every 3-4 months, my Palliative Care physician purposely lowers my overall opiate dosing for 6 weeks. For example: Reduction in dosing of my duragesic patch from 50 mcg to 25 mcg. The intent is to avoid continued upward opiate tolerance and to keep pain centralization in check.

Total knee replacements are painful. There is no way around the fact that the intra-medullary prostheses cause bone pain. There is no way around the fact that the rehabilitation (ROM and strengthening) is painful. Knee replacements are generally more painful than hip replacements owing to the knee having less inherent bony stability.

There are portable cold-therapy devises available for home use that provide a sleeve through which ice-cold water circulates. I am surprised that your orthopedic surgeon has not suggested a cold therapy unit for use at home. Icing of the joint keeps inflammation in check, thereby keeping pain in check.

Frequently moving the knee is also key to lessening pain. The knee is particularly susceptible to stiffening with rest, with an uptick in pain when reintroducing movement. CPM units (continuous passive movement) machines are also available for home use if you find that your knee is one that stiffens markedly with rest.

I commend you for doing that hard work that comes with a total knee replacement. And I commend you for having an open dialogue with your orthopedic surgeon and pain management physicians regarding your pain levels and how it affects your rehabilitation efforts.

No two people experience a total knee replacement in the same way. Know that your prior opiate addiction may have lead to centralized pain and increased sensitivity of opiate receptors. This may be why your pain experience seems to me more intense than you were expecting/predicting. Your pain management MD should certainly understand this concept and put you at ease.

Best wishes in your recovery and healing,
Karen

Hello, Pitmom. Hello Seashell.

I wrote this letter originally to pitman. I meant to send it to seashell. I am sorry I got you mixed up. You were both so kind with your letters. so.....I edited the beginning of this here , but the original letter, is starting now.

wow. I am so sorry you have so many painful conditions. God Bless You. Are you or were you an athlete? Maybe an accident ...do not answer that please if you are not comfortable. I have had prior sports injury surgeries (one knee and 2 ankle), and once a rotator cuff that I SWORE was torn but wasn't. A partially torn hamstring twice, bursitis in my hip and a terrible motorcycle accident where I was thrown up into the air over a mid-sized sedan and landed 27 feet further on cement. My helmet had come off also. I had been tightening my helmet when my boyfriend took off on the motorcycle. I was the first bad decision I ever knew him to make on a motorcycle. I was lucky to be alive really. So, all of these incidents were mostly all pre-addiction to opiates.

I did ok with the opiates for the above injuries. I have heard knee replacement is a very painful surgery. Man, the post-op physical therapy is brutal. My doctor did indeed provide an ice cooler. A very awesome device for wrapping around the knee. Sea Shell responded in kindness to my post and was shocked that I did not have ice as a pain helper. I just forgot to put that in my first post. Also I was on max amount of acetaminophen and aspirin and meloxicam and I also take klonapin for sleep which had been reduced by my psychiatrist in order to be able to take opiates for that knee surgery....and my surgery was diagnosed only 1 1/2 weeks b4 I had the darned surgery! I was fine and then..my knee began to hurt enough to hire people to walk my dog-over achieving Labrador- who needs so many outdoor activities ...then I woke in serious pain and that led to my internist suggesting an incredible orthopedic surgeon who found I was bone on bone in two places. boom. surgery. Much consultation was done by the way, to check on the surgeon by my son, the doctor, who saw her impeccable background but still was not convinced as he had not known some patients present suddenly with the knee bone on bone pain. It is not his specialty. Turns out, I had the doctor's doctor. I mean, doctors go to her for their surgeries and oh man....major league sports players, the ballet....she is top of her field. My son loved her. She also was really impressed with him which was interesting for me ...mom....to hear another doctor - a great doctor....talk so highly about my son. enough of that.

sooo..you sound incredibly educated. your post was very informative and I bet I do have that Centralization of Pain syndrome. gosh. getting older is no picnic either. I tried SO hard for So long to work through that pain post-op and just hit a wall. I had, thankfully a moment of clarity one morning after not sleeping but for maybe 3 to 4 broken hours a night and crying for periods of 6 hours at a time...then in one hour sessions during the day as well. I just got exhausted and overwhelmed and could not think and did not know what to do. But, it just hit me. I had not eaten in 3 days and only drank water to wash down pills. I was having such horrible thinking patterns which I recognized due to my psychiatrist telling me for that last 18 years about my noticing thoughts and behaviors that may indicate a depression! Thank Goodness , I Had that moment of WOW. Naturally, my psychiatrist is out of town. There is an on call dr. I have called them before in crisis and it has been very bad. So, I see my shrink this week as well. man. 4 days I have to go out already this week.

I would have contacted my shrink before my son. I had already called the surgeon several days earlier and she had suggested changing my frozen ice water bottles 4 times a day instead of two and prescribed a light sleep aid on top of my klonapin.

Two other big things happened after my surgery as well. The least being the girl who took care of me - in my apartment - post-op, well, her dog must've had fleas. It was a hairless breed. What a hysterical dog, he was. SO SMART ! I loved him and he made me laugh with his manipulating ways. All 5 lbs of him. He was adorable. My dog had been gone for weeks...he still is. Plus my dog is on the latest flea stuff and just had a physical days before my friend came and took him for me due to that knee pain. Her dog was a hairless breed so I think it was not on any anti-flea scripts or the old kind which fleas are not bothered by anymore....Just imagine...post-op.....waking up to a flea infestation. Your friends are all at work, the girl helper had left. oh man. what a painful day that was.....and shoot. I saw a 2nd flea this morning. oh no. I may have to exterminate AGAIN. very hard waiting in an uncomfortable room post-op for 5 hours. I guess it is one day at a time. I have been talking to my sponsor. She was to come over today but my physical therapist changed his arrival time and it does not work for her. I am so bummed out. She will come over though as soon as she can...

Then....it sounds crazy....this girl, it turns out is a terrible person and was like a criminal. I had NO idea. I am very sweet. She played me for months. I met her in the parks near my apartment....very pricey place here....Silicon Valley. She must look for her victims in the wealthy parks and when she found out I needed help she was so there for me. We had become friendly just meeting, I thought, by chance, in the local gorgeous parks where I live. All my other friends work full-time or are in another state, so I thought this person seemed very nice and she said she would be happy to help me for two weeks. She was angelic, until the day she was to leave. Talk about a 180! I was so frightened. I wanted my credit card back since she was to move out the next day. I asked her all day long and she would just look at me and walk away. Then, at 11pm that night, I got tougher about my credit card, I had had enough. ( Since cancelled that card. She did not make any purchases on it that she was not supposed to have made which I guess is a miracle ).
She yelled at me very scary things and threw the card at me out of the blue. I had to duck. it like hit the wall behind me so hard it made this crack noise! She literaly turned into some awful creature. I was never so scared in my life. The next day, I saw that she had taken my car !!!! Major meltdown on my part.

Neighbor was home thank goodness and just took over for me. After several hours and people got off work, more people came over. The poor neighbors were here, some of them for 9 hours, yawning on a work night...They packed all her things up. So, that day I saw my car was stolen, I got in my wheelchair and rolled out to her car and took down her plates info. That evening after many attempts by myself and neighbors to talk to this woman to bring my car back and take her stuff.....we called the police. She yelled and threatened and lied so I have many witnesses to her sick behaviors. Police were in my apartment......Manager here at mid nite changing my locks....One neighbor spent the night with me I was so freaked out. I ended up after a week having to hire Private Investigators. Turns out, this very lovely looking woman can play a role of being an angel but is capable of being dangerous and violent! A true horror story. The day she was to move out, she moved all this crap in!!!! Then, threatened me.....I have never in my life seen a person like this. She did not look human. turns out she got out of prison last year, is homeless- but dressed like a million bucks. has a long and violent rap sheet...and I was friends with her and she said she had broken up with a BF and was staying with friends and I totally believed her. she was just so so nice.

it was a nightmare and I am still under surveillance by PI's that I hired to protect me !!!! it is so much to do deal with post-op. my neighbors had been treated horribly by this woman and I did not know. oh. she also stole my engagement ring and some of my medications. I have police reports and letters in case legally-civil- I need to go to court! she won't pick her stuff up!!!! it is out in the parking lot where she insisted it was placed to the PI's and she has been nearby but they say she is paranoid and thinks a trap is set to arrest her, which it is not. The PI's have camera's set up all around my bldg!

I don't know what to do next. waiting for lawyer advice on how long I am to keep her things before throwing them out. The police took her hi-end high tech burglary kit complete with gloves and some rare stamps, and two items priced at $6k and 10K. She is a criminal !!!!! Also a meth addict. how did I miss that? She was slick. Also a drug dealer and the stolen goods thing too. As I tell this story, I just cannot believe this happened. I guess, really so far....I have been lucky not to have been like shot or something. I do not know. It is not over yet. I hate it.

Now my neighbors are are rallying supporting me. That is so nice. That girl only spent 9 nights in my home. She claims over a month. she is nuts. very very frightening. It sounds too much like a bad lifetime movie, does it not? I will never EVER trust people I do not know for a long time. I am very trusting by nature. I was a sitting duck. She thought she could scare me and isolate me and manipulate me enough to control me so that she could move in !!!!! wow. it was awful. Like, she seemed to think in her mind that it was prison rules , but after the incident where she yelled and threatened and threw that cr. card at me , I texted her that I would never allow anyone to treat me like that and our friendship was over. it is just like a movie. Things are still pretty bad. My surgeon knows this happened. I broke down in tears when I told her at my first post-op visit and she said to me. " DO NOT LET HER WIN, ...DO NOT LET HER WIN ".

Well, having woken this morning at 4am, I cannot tell you how nice it was to see your response to my post. I am waiting here until I can take my morning doses of all my medications. pain reasonable. slept 4 hours. not bad.
I am in AA. started in 2004. had to break off a ten yr relationship in order to stay sober. hard. Congrats on your 22 years.
wow. I made it to the 6am medication taking time. very very hard to wait. I am so thankful that my surgeon was so amazing about my needing more opiates than she was wiling to prescribe me, but wrote one last script at an agreed on higher dose, to hold me over until the pain management doctor on monday. My pain stopped enough for me to eat, sleep, and do my physical therapy. I needed 3 times what I was getting. I was so sad when I told my son that I was unable to make it thru the post-op on the normal amount of pain meds. Really, the only thing that got me through that first 3 weeks of incredible pain was thinking of my 3 children. I wanted them to be proud of me and sucked it up as long as I could, but, I hit the wall. I felt ashamed. My son was unbelievable when I told him. We talked for several hours. He told me to take 15 and not 5 mg of the pain med early on in the conversation. So, when the pain broke, he and I knew I needed more pain meds. He really helped me. Do you have children? If you do, you know how much a mother loves her children. It was a seriously incredible experience having my precious son ask me question after question for hours and then to hear him explain to me what to do with such knowledge. I was and am proud of all of my children.

The first thing I told my surgeon was I was an addict in recovery and would NOT take any opiates for a knee replacement. Then, she spoke with my son and they decided it was impossible for a person to go thru that or at least very very cruel, so I did get some opiate medications. I actually took back to the pharmacy the breakthrough meds at 2 weeks! I really tried man. I am kinda worried the pain mgt. will be causing me to go out of the apt. to see like...acupuncurists and alternative medicine people and that will be painful in itself.. I guess, I have no control now. sounds very familiar to 12 steps. all I know is that the few times I have had to leave the house, it was intense on the pain scale. A few more weeks for me though and I should be done with the pt and have my range of motion back and be weight bearing .....so hard. I do have light at the end of the tunnel. You seem like a really good person. I really am sorry you have pain like you do chronic. I really cannot imagine how you cope. good luck to you. Thank you so. much for being a cyber life line here this morning.
thank you so much. Marie

Post Edited (marie's mouth) : 6/29/2018 8:41:23 AM (GMT-6)

Ok wow marie,

I had an elderly relative, a retired dr. Who had one of those con people attach herself to him in a similiar way.

His daughter got tipped off by some medical staff and got it shut down..that is something that happens especially in better neighborhoods in cali..but it happens here in the east also.

People are great at being cons, wow if they could use that energy for good , our world woukd be so much better..some of them are bi polar by the sounds of things..

Glad you are back to pain management...after that kind of surgery you need the help..they will make sure you wean down when its time..

Not usually in this forum , but saw about the con and just wanted to assure you , happens a lot and they are very good at deception...our uncle was an extmely smart man, but she was that good.