Opiate dependent patint facing total revision and reconstruction

[subwayknees]

I have had a number of knee surgeries and now a failed total knee replacement about eight years out.

I have been opiate dependent on pain management for five years taking over 300mg morphine and additional mehtadone.

Several local but reputable surgeons said they would not operate on me because of the difficulties they have had with pain management on opiate dependent patients..My primary care physician has sent me to two major teaching hospitals where the surgeons have far more experience dealing with pain managemeent on opiate dependent patients.  However I am rather worried now that I realize that there are  issues with adequate pain control with paitients who have been on long term high level opiate therapy.  I understand that revision surgery is more painful and a longer recovery thn primary replacement and i wonder if anyone who had had opiate dependence through pain management has had any major issues during revision or primary recovery.
Thanks

[mlbbarry]

Hey Subway, I was opiate dependent as well for many years due to an auto immune liver disease, that went undiagnosed for a couple years.  Saw a pain specialist regularly that just kept writing new scripts.  Then I was finally diagnosed and treated properly, but continued on pain meds.  After a bit i looked up online dependancy, and realized my body was physically hooked, but my mind wasn't.  Mainly though my pain was real, but it was pain from dependancy and not my illness anymore.  So I told my pain doc that I needed to wean off to see if I might feel better.  Took six months, hardest thing I have ever done, and the entire time I had severe arthritis in my left knee, which I have 8 months ago had replaced. 

My point...... Is it at all possible for you to work on weaning down the narcotics taking the maximum dosage of Motrin while weaning, trying to get it down to half as much, then have the surgery upping the meds as needed?

Dependancy is a tough road to travel on, I hope you can figure something out so you can get your knee fixed, and eventually be pain and drug free

[subwayknees]

Thank you.

You are 100% correct, even though I get the scripts every 28 days from a pain doc does not mean I am not as addicted as God forbid a street addict.  The body does not know the difference.  I have started to work with my pain doc on sutting back on the morphine and methadone so I will have less dependency.  It is difficult, not due to the fgcat that I am withdrawing on the quantity of meds I take, but due to the favt that my knee gives me major pain as soon as I back off.  I cut back by as little as 50mg morphine a day, and by late afternoon I needed to use a wheelchair or electric scooter to even get around the huse.  I know it will take many months to really cut back enough to make a difference, and now that i have finally found a surgeon who feels he can help me, after being turned away from several, I would like to proceed with the surgery.

I will be seeing the surgeon again in two weeks to set a date for surgery and from what I understnd he books about a month out.  That just gives me six weeks to cut back and at my level of dependency that is not a lot of time, then with weather startin to change and going into colder fall weather i know I will be experiencing more pain..

I guess I will just have to "suck it up" as it might be better to deal with some more pre operaive pain now than to be fresh out of surgery and not get needed relief, I hope taht between my p[ain management doctor and my new orthopedic surgeon and the pain management team at Georgetown Universiy Hospital we can come up with a plan.  No surgery is pain free, in my case i need both a total knee revision and a ligament reconstruction with allograft at the ame time, so there will be a lot of carpentry and rebuilding going on and a painful rehab.  I am finding some literature on implanted pumps that can be used to deliver pain medication directly and want to speak with the doctors about them.
My ultimate goal is to be free of all opiates, but I was already told by my pain doctor that at my level of use it would take more than six to nine months to wean me in a safe matter.  I can only wish for the day to come when I do nmot have to reach for a morphine pill although it works with my pain some time, not always, I hate to live with the side effects of heavy opiate use.  I can never figure out why people pay big sum;s of money to use this stuff as I would pay equally if I never had to take a morphine pill again

[Teresa_S]

I am going to honestly tell you what happened to me.  I was on 30 mg methadone daily, and had a knee revision. I made it clear to my surgeon and my anesthe. that I would need good pain control, and I was opiate tolerant. THE surgeon PROMISED me I would have not just adequate pain control but good pain control.  Evidently during recovery (this was told to me as I do not remember any of it) I came out of anesthesia screaming. I did tell them not to do a femoral block. BUT instead of giving me better or more pain meds, they kept giving me versed, which is a hypnotic, which has no pain control, but makes the patient not remember the pain. Evidently I kept screaming, and cussing, and causing a scene, and they tried a femoral block, even though I had refused. I went to surgery around 11am, and ws still in recovery at 7pm with them trying to get the pain under control. MY dr went out to talk with my friend who came with me, and told her she might need to go in there and tell me to stop cussing everybody. She told him that was not me, and what meds were they giving me? THE versed caused all of this, it does not contol pain, make the patient uncontrolled, and the patent does not know it happens. They finally took me to my room, after putting me on a dilaudid pca, instead of morphine, and the anesthe. promised me he had "ordered tons and tons of medsand I would not be in pain. " Last time I saw him during the hospital stay. and I cried all  night long and begged for meds. I started having pain, and used the pca but was not getting good relief, so as the anesth. told me he had ordered lots of med, I called the nurse and asked for one. she said: YOU HAVE THE PCA AND THAT IS ALL YOU GET>   Remember I had not had my methadone that day at all, so it had worn down. Then she came in and wanted me to move my foot, but I could not, SHE SCREAMED at me to move it, and I told her I would if I could to get her the hell out of my room. Finally they figured out they had done the block and it blocked my foot but did not help with pain. I did not know because I refused it, and they gave me so much versed I could not remember. My dr came in at 5 am and I told him I needed my meds. At 7am when they switched shifts, my new nurse came in and I was crying and she asked me WHY didn't I ask for meds before the pain  got out of control and was this bad? she said YOUare a nurse, yo know better than this. I told her I had asked all night long. Well, then they came in and gave me a bolus of my dilaudid, and then all 30 mg of methadone at once, SO I HAD good pain relief for about 3 hours. but after that, it was barely controlled. This took place on Thurs Night, and Firday night they took the pc a and gave me 10mg of oxycontin, and switched to percocet 5mg prn. I was dismissed on Sat. with ONE  tablet of oxycontin, and 30 percocet. To say that that was not enough is way too little. I lived 3 1/2 hours away, and I called the office on Mon, as the script said take 2 every 4 -6 hours as needed, which meant I could have taken all of them in 3 days. By the time I got a new script it was another week. I wish you so much better. I now need  additional surgery but cannot talk myself into it.I wish you so much better .

[Erikka]

Oh, Teresa, what a nightmare! I am squirming and feeling pain just reading your story. It is just unbelievable and my heart goes out to you. I hope by now you are stabilized and things are well.

[huntingandmoon]

Hi Subwayknees,

Just wondering how your appointment went with the doctor at HSS.  Hope you got some answers!

Diana