After joint replacement you will need pain medication to help with the pain from surgery.
As a physiotherapist I see how important pain management is to how well you will recover.
Patients who told us they struggled with pain management after surgery said they didn’t
know how to get the answers to their questions.
This video was designed to answer some of the most common questions patients have about
pain management.
Hi, my name is Dr. Martin van der Vyver and I am an anaesthesiologist on the Acute Pain
Service.
You will remember that before surgery a member of the anaesthesia team met with you to talk
about the type of anaesthetic you would have during surgery.
We also play an important role in terms of pain management while you are here in the
hospital.
The goal of your health care team is to make sure you are as comfortable as possible.
Good pain control allows you to do your exercises and move around better, which is critical
to your recovery.
The Acute Pain Service will also help to determine what pain medication will work best for you
when you leave the hospital.
Hi, my name is Shirley Musclow and I am a nurse practitioner on the Acute Pain Service.
As a nurse practitioner I have advanced training and I specialize in pain management.
A member of the Acute Pain Service will usually come to your hospital room on the first and
second day after surgery and ask you questions about your pain.
This is so we can determine what would be best for you.
We will ask you to rate your pain using a pain rating scale from 0-10.
The number that you choose on the pain rating scale and how you describe the pain helps
us to determine if the pain medication is working or if it needs to be changed.
Your nurse will also regularly ask you about your pain and we encourage you to let any
member of the health care team know if your pain is not well managed.
Every patient is different in how much pain medication you may need and how long after
surgery you may need it.
Your pain medication will work best if taken at least 30 minutes before activities or exercises.
Pain is often more noticeable in the evening and should be well managed to allow you to
sleep.
When you leave the hospital you will be given a prescription for pain medication from your
surgeon.
Your surgeon will likely prescribe several medications; these may include an opioid pain
medication (such as Hydromorphone or Oxycodone), acetaminophen (which is commonly known as
Tylenol) and an anti-inflammatory.
These medications work together and can help make you more comfortable and able to do your
exercises.
If you notice that your opioid pain medication is running low and you feel you still need
it, please plan ahead and phone your surgeons office 3-4 days before you run out.
If you have already had your first follow-up visit with the surgeon then call your family
doctor.
These medications especially the opioid can have adverse effects or undesired effects.
Many people taking opioid pain medication experience constipation.
If you are having difficulty with your bowel movements you should drink more fluids, eat
foods high in fibre and slowly increase your activity.
In order to help with this you may receive a laxative while you are in hospital and if
you continue to experience constipation while you are at home you may need to continue with
a laxative.
Speak with your pharmacist or family doctor about what would be best for you.
Another possible side effect or adverse effect of this medication is stomach upset.
If your stomach is upset, try taking the medication with food.
If this does not help, ask your pharmacist or family doctor to recommend something to
settle your stomach or try taking a smaller amount of pain medication, for example take
one tablet instead of two.
If these suggestions don’t help with your stomach upset, please call your surgeon.
Your pain medication may need to be changed.
If the pain medication makes you very sleepy, confused or quite dizzy, stop taking the medication
and call your surgeon for further advice.
If your medication makes you a little sleepy or a little dizzy, and your pain is manageable
you can try taking a smaller dose, for example one pill instead of two.
We hear a lot of concerns from patients about the risk of addiction when taking opioid pain
medication.
This risk is low.
However, it is important to wean off the opioid pain medication when you no longer need it
to allow you to do your exercises or move around the home easily.
If you find it difficult for reasons other than pain such as the effect on your mood
or sleep, to wean off your medications please contact your surgeon (if before your first
follow-up visit) or your family doctor (if after your follow up visit with the surgeon).
Weaning off this medication is important because if stopped suddenly you may experience withdrawal
symptoms, which could feel like the flu such as fever, stomach upset, sweating as well
as symptoms such as increased pain, feeling tense and anxious.
Experiencing withdrawal is not a sign of addiction but instead means that you are stopping the
pain medication too suddenly.
You will find a recommended plan for weaning off your medication as well as a tracking
sheet in the pamphlet Top 10 Questions about Pain Medication that you will be given when
you leave the hospital.
We have a few other helpful tips that can help reduce your pain.
Each day it is important to plan to exercise and be active but include rest periods.
Often activities such as standing to cook, sitting in one position for a long time or
walking too long such as grocery shopping can increase your swelling and pain.
Although walking is a good exercise, it should be increased gradually.
The first time you go for a walk, try 5 minutes, if that does not make your pain worse, the
next day try 6 minutes and continue to increase it gradually.
Applying ice to your leg can help reduce general pain and pain after exercise.
It is important though to remove the ice or move it to a different spot after 10 minutes.
If it is helpful you can put it back on your leg after one hour.
After surgery it is very important to manage your swelling.
The best way to do this is to lie flat and raise your leg with your knee straight above
the level of your heart.
While in this position you could apply ice as well as complete your ankle pumping and
buttock contractions.
Ideally stay in this position for 20 minutes and repeat 2-3 times per day.
Your health care team wants you to have the best possible experience following surgery
so if you have any questions about pain management please ask the team.
When you are at home, if you have trouble managing your pain or adverse effects from
the medication please review the pamphlet Top 10 Questions about Pain Medication provided
when you leave the hospital.
If your questions are not answered in this information then call your surgeon’s office
between Monday and Friday 8:00-4:00.
If it is after hours, weekends or holidays please contact the Hospital Coordinator at
416-967-8551.
In summary, Pain management is key to good recovery
Don’t be afraid to take your medication Plan ahead: Take your medication 30 minutes
before exercising Remember to call your surgeon if you are running
out of medications Check the pamphlet Top 10 Questions about
Pain Medication for helpful advice Call your surgeon’s office if you still
need help When you are feeling better remember to slowly
wean off the medication.
It is helpful to use a tracking sheet
We are grateful to the patients who have given us ideas and feedback to help make a difference
for future patients like you.