Need TKR terrified am on methadone surgeon conerned about post op pain

HI I am new to this forum but have been doing a lot of surfing for information. I am at the point where my only option left is a TKR. I am currently on 60 mg daily of methadone to control my knee pain and pain from a herniated disc (3 failed microdisectomies) I have constant sciatica pain along with the knee pain. I had rotary cuff and a labril tear surgery in January 2013. I live in the Amarillo TX and even though it isn't a small town it sure seems like it the surgeons and doctors are not sure what to do with me. I was put on methadone in California and then I had a great PM doctor in Boise ID. HE had me on 100 mg of methadone when I got to Texas the PM Dr. immediately dropped to 80 mg and then after a year he dropped me to 60 mg. He said that he doesn't have any patient on that much pain meds. I am glad in some ways to be at the lower dose but my pain is still bad.

ANYWAY, the main concern I have and my surgeon has is he does not know how he will be able to control my pain after the TKR surgery and he doesn't prescribe anything stronger than Vicodan for post op pain.
My pain doctor won't go to the hospital where my surgery is going to be done. MY surgeon did say that he would talk to my pain doctor about managing my post op pain but he was suppose to do that when I had my shoulder surgery and when I called to get stronger meds than VICODIN.His nurse told me he could not treat post op pain. LUCKLY I had some left over Percocet that I had gotten for break through pain that I was saving for those 9 pain days.
THANKS for letting me share my fears and if anyone has any advice I would appreciate it.

MIRTH

Hello Mirth and welcome to HW. I'm from the chronic pain forum here at HW and just happened to see your post. We have a lot in common and I thought I may be able to help.

I've had numerous knee ops and even a partial and eventually full replacement that was later broken in a MVA. I also have a Pars defect in the lumbar region with nerve impingement that leaves me with sciatica. And I've been on methadone for almost 13 years for chronic pain.

Drs for the most part overthink post-op pain treatment when it comes to patients on methadone. First the Dr that prescribes Vicodin may have to change his prescribing tactics as the regulations have recently changed drastically with this med.

The FDA has gotten rid of all hydrocodone that contains more than 325mgs of tylenol, and they're coming up on reclassifying it. Its also just been released in a time release form with zero tylenol and that will be distributed as Zohydro. All these articles regarding this can be found in the CP forum if you would like more info.

Post-op the protocol that works best is increasing the methadone for a few weeks and using the hydrocodone (Norco) will be the brand replacing Lortab, as a BT or Rescue med. Thats after the initial day or 2 that you should be on a pain pump. Morphine will be your better med for post-op replacement of your methadone for the pump.

I would not schedule or even agree to surgery until all your treating Drs are on the same page. If they dont have a adequate pain relief regiment in place it could leave you in a great deal of pain therefore hindering the post-op healing process that could negatively effect the success of your replacement.

Check out the threads in CP and if you have anymore questions that maybe I can answer for you feel free to email me.

Good luck