9. Recovery at Home

Managing Pain

The more patients know about what is happening to their bodies the better they will be able to manage their TKR experiences. This is particularly true when it comes to performing the painful rehab exercises that dominate the first few weeks of recovery. During this period of Eat, Exercise, Sleep, & Repeat, when you may feel like a stranger to yourself as well as to others, the last thing you want is to suffer more pain. Yet your daily schedule includes exercise sessions that guarantee it. Based on my own experience, I believe that patients who understand why they are asked to perform such exercises will find it easier to comply with their PT’s directives. Exercises are not just motions you go through to please your physical therapists; they are your first ‘job’ post-surgery. Just like any other job, the more you know about the work you are doing, the better you’ll be able to do it. Knowing which muscle was the target of a particular exercise and why that mattered to my recovery helped me focus on doing the exercise well. It was a matter of mind meeting muscle.

As I’ve stated before, I was not an athlete when I was younger and did not know how to push through pain. Exercise, however, involves pain and this is where the athlete has an advantage over the non-athlete. Part of athletic training is learning how to push through pain to achieve desired results. There are, however, other ways to deal with this inevitable component of recovery. We discussed using ice and controlled breathing: Practical Wisdom and Ideas for Prehab II. Several other techniques are presented below.

The first is simple and comforting. Giving yourself a hug, with arms crossed over your chest, confuses the brain as to the site of the pain. Information from the right side of the body appears to originate on the body’s left side while stimuli located on the left side of the body are traced back to the right side. Looking down at your hands increases this confusion.

Distraction – by squeezing a ball during procedures, fixing your attention on something in your environment or thinking about something that brings you pleasure (such as a favorite sport or vacation spot), you can limit the brain’s ability to process pain signals.

Replacing an awareness of pain with a positive image is a way of exercising control over the mind and, through the mind-body connection, the body as well.

We cannot talk about managing pain without also discussing the importance of medication. The hospital where I had my TKRs (Beth Israel) prescribes an integrated selection of pain modulating medications that work together to minimize the use of narcotics during the first month post-surgery. These include NSAIDs (non-steroidal anti-inflammatory drugs) such as Aleve, Advil, and Tylenol that relieve pain by reducing the effects of inflammation (the stimulation of pain signals by nerve receptors) within the joint and surrounding soft tissues. These are given intravenously while the patient is in the hospital and taken orally when the patient leaves.

While NSAIDs work to reduce pain, other drugs – such as Gabapentin and Lyrica – work to lower the perception of pain. They also lessen the need for narcotics. In addition, I was prescribed the narcotic Oxycodone in low dosage pills. I made it my objective (in discussion with my health care providers) to carefully follow all instructions for taking medication during the first few weeks post-surgery but then, to the best of my ability, reduce the use of Oxycodone.  Even so, after reducing my consumption to just one pill a day for nearly a week, I found giving up that last pill very difficult – costing me two days of significant discomfort and a few night’s sleep. 

Confusing the brain . . .