The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: mikeks on October 11, 2010, 06:58:33 PM

Title: Painkillers that work ??
Post by: mikeks on October 11, 2010, 06:58:33 PM
Todate on my right knee I have had arthroscopy Dec 08, Total Knee Replacement June 2009, revision TKR surgery June 2010. All have failed to eradicate the intense pain that led to the start of this process. Today the pain is excruciating and apart from more physiotherapy and painkillers the hospital is of little help. Does anyone know of any painkillers that will work ? I am currently on Tramadol and Paracetamol. Before these was on Diclofenac and Co-codamol. None really help.
Title: Re: Painkillers that work ??
Post by: knee always hurts on October 11, 2010, 07:43:07 PM

Given that you describe the pain as excruciating, the only class of drugs that would likely be helpful would be the opioids.

Tramadol and Co-codamol both contain opioid ingredients, but perhaps they are not strong enough. If your doctors think that this is going to be a chronic and/or incurable condition, then I think you really need to fight to get the pain medication you need. If your current doctors won't help you, look for someone else. I think the problem tends to be that opioid pain medications are generally scheduled substances, which means that doctors who over-prescribe the medication will find that they draw the attention of their country's drug enforcement agency. But persistent excruciating pain is precisely what these drugs are for, so I would imagine that you could find some doctor willing to help you out.

I would suggest reading that Wikipedia article and perhaps doing some of your own research on the options available, and then discussing that with a pain management doctor. You might also consider anti-depressants or anti-anxiety medications, as these conditions amplify the perception of pain, thus causing you more suffering.

Good luck!
Title: Re: Painkillers that work ??
Post by: dm on October 12, 2010, 06:35:11 AM
The only thing you can try that's over the counter is to alternate ibuprofen and acetominophen every 4 hrs, to try and break the pain cycle. Don't recommend this for more than 24 hrs, but it may help. If the codeine containing compounds aren't strong enough (parcetamol or co-codamol I believe) and the non-narcotic tramadol just isn't touching the pain, then you need to get in touch with your doctor about something stronger.

Here in the US, painkillers with codeine are not available over the counter, like they are in the UK.

If you just had surgery today, and you can't reach your surgeon for a call-in to the pharmacy for something stronger for the pain, then perhaps a visit to the emergency room is in order, you shouldn't have to suffer.
Title: Re: Painkillers that work ??
Post by: Vickster on October 12, 2010, 07:55:08 AM
Acetaminophen is paracetamol :)

If you have ongoing severe pain, I would ask your GP to refer you to a pain specialist (assume you are in the UK)
Title: Re: Painkillers that work ??
Post by: kscope09 on October 12, 2010, 10:15:11 AM
What about morphine patches?  My grandad has them on his back all the time.
Title: Re: Painkillers that work ??
Post by: Lottiefox on October 12, 2010, 10:34:30 AM
Apart from just considering drugs I'd be asking why the pain is still so bad; is this to be expected after a TKR and revision and will it/should it settle as the knee heals this time? I know TKRs can bring varying degrees of pain over varying lengths of time, but it may be that you're still having relatively normal pain levels after the traumas the knee has been through.

This doesn't help manage it though I accept - have you considered anything like acupuncture, massage therapy, etc in combination with drug regimes? A pain management centre should look at things holistically if you can get a referral. Personally for me, the only thing that helps OA knee pain is Celebrex, but doctors are wary of this due to the Vioxx withdrawal but it works for me and I have no adverse effects with blood pressure etc.

Hope things improve

Title: Re: Painkillers that work ??
Post by: kscope09 on October 12, 2010, 12:30:27 PM
Does celebrex really wrk?  I got an advert for something called celabolin that said it could protect cartliage and significantly reduce pain and it was supposed to have celedrin in it.  I nearly ordered some until I googled it and found from tiehr forums that it was just a scam and the drug doesn't exist.

If celebrex works then I waqnt some.  I've got all the classic arthritic sumptoms but they won't diagnose me with it even when they admitI've got the symptoms.

Anyway, have the docs said you should still ahve some pain or are they all telling you that you should be pain free by now?
Title: Re: Painkillers that work ??
Post by: Vickster on October 12, 2010, 12:34:59 PM
What about morphine patches?  My grandad has them on his back all the time.

Morphine is pretty full on and addictive/habit forming.  Certainly, age and lifestyle needs to be considered when going down that road

Celebrex certainly worth a discussion as Lottie says but use is retricted both from a cost and adverse event risk point of view.  I'd be asking to see a pain specialist tos discuss all the possible options.
Title: Re: Painkillers that work ??
Post by: Lottiefox on October 12, 2010, 02:17:51 PM

Celebrex is an NSAID - a COX2 inhibitor rather than a COX1 inhibitor as found in naproxen etc. COX2 is the inflammatory element linked to things like arthritis rather than COX1 which is also responsible for the good stuff we have in our guts. Hence why things like COX1 NSAIDs can cause gut issues. COX2 NSAIDs were developed to lower the risk of gut problems, but Vioxx was withdrawn as it was linked to elevated heart attack risk. Personally I have fewer symptoms on Celebrex than any other variant of drug but the concept of life long pill popping til I need a TKR isn't one I relish. It can other insidious side effects...but having relatively normal knees is worth that at the moment.
Title: Re: Painkillers that work ??
Post by: dm on October 13, 2010, 10:25:58 AM
The guy really ought to just show up at the er and demand that they do something. so that they give him a referral to orthopedics, to at least get the ball rolling, so they at least get him in the queue for a referral to pain management, since he seems to be being ignored by his current physicians. Nothing else seems to be working.
Title: Re: Painkillers that work ??
Post by: Vickster on October 13, 2010, 10:53:59 AM
Unfortunately, the system doesn't really work like that in the UK as all referrals happen via the GP (gatekeeper within the system, even for referrals to private specialists).  Most GPs won't rx strong opioids with specialist direction, hence need to see a pain doc :)
Title: Re: Painkillers that work ??
Post by: Feely08 on October 13, 2010, 11:07:35 AM
After 15 surgeries in the UK and US I have had quite a few different types of painkillers. The best one by far is a drug called Percocet. It is rarely offered in the UK but is very common in the US. Your GP should be able to prescribe you it if you ask him. I would be more worried about why you are in so much pain, and not to worry you but, you might want to go and see your consultant and check that there is no infection etc. As I know from my own experience that they only time I suffered a lot of pain was when I had an infection.

In my experience of some of the other drugs:

Morphine just makes you feel sick
Codoamol is ok but makes you constapated
Diclofenac is a good anti-inflamatory but doesn't do much for pain and can cause internal bleeding
Celebrex is also a good anti-inflamatory and is an ok painkiller has been found to be unsafe and their are links to it's use with heart attacks and strokes
Ibuprofen is a good anti-inflamatory
Paracetamol is probably the best painkiller on the market and you can take up to 1000 mg three times a day

I hope this helps

Title: Re: Painkillers that work ??
Post by: knee always hurts on October 13, 2010, 10:03:07 PM
Just from personal experience, I have to second Feely08. A few years ago, I had an absolutely horrid back problem that kept me up a whole night in agony. I took some Percocet, and it took the edge right off, and I drifted happily into sheep jumping fence land. The percocet contains acetaminophen/paracetamol as well as oxycodone, but I'm not sure how much the acetaminophen is going to do for severe pain. But I had taken ibuprofen, which was useless for the problem, and the percocet worked.
Title: Re: Painkillers that work ??
Post by: mikeks on October 16, 2010, 09:17:42 PM
Thanks everyone for your responses. Since my last post I have seen my Consultant again and he now thinks that after looking at more Xrays  that muscular contraction during the healing process on the right side is pulling the kneecap into contact with the upper new joint and said that Cortisone injections  would resolve and eradicate my pain.He does concede that by now I should be pain free !!!!!  In fact the injection has resulted in the worst ever 14 days I have experienced, the pain is now as intense or even more worse than ever if that was possible  :-[ and is now affecting my normal sleep pattern.
Title: Re: Painkillers that work ??
Post by: knee always hurts on October 16, 2010, 10:04:10 PM
Wow, that is sad to hear. I think someone had a good suggestion in an earlier post. Get thee to an emergency room! If you're in that much pain, maybe they'll be able to help you out. Let's hope that the doctor is right and you'll eventually be out of pain. But for now, you shouldn't have to suffer.
Title: Re: Painkillers that work ??
Post by: luckygrandma6 on October 18, 2010, 11:00:39 PM
Instead of talking about pain killers why not talk about why 3 knee surgeries has not taken care of the pain and why they all failed. I've beem down this road. I had severe pain down the back of my leg and first and arthroscopy was done and the pain was still there. Then I had a PKR and the same pain was still there, Then I had a revison of my PKR to a TKR and the pain still existed. Then I started to have a hyper- extension problem to the knee and it was collapsing on me and I had a spacer exchange opening up the knee again. This too failed. Through all this it turned out the pain was coming from my back and not my knee and that pain went away with the back surgery, but not before my knee was screwed up and I had to go to a specialist and he stopped the Over-extentsion by putting in a Hinged Prosthesis. All this time the doctors all knew that I had Spinal Stenosis. After the TKR I was referred to a back doctor and ended up having 2 back surgeries in 3 weeks. In three years I had 7 major surgeries and a manipulation trying to figure out where the pain was coming from.  Now three years later I have a  different kind of pain due to all the surgery and I have a balance problem from so many surgeries in a short time and put under anesthesia so many times. I have to use a walker all the time and I have taken some serious falls, one being the Sternum injury I talk about on the Bulletin Board. Don't let the doctors do any more surgery on you until they locate and tell you what exactly is causing the pain. With the surgeries they are guessing. My life will never be the same the day I got a pinched nerve in my leg. It wasn't the knee surgery that failed but rather the doctors.
Title: Re: Painkillers that work ??
Post by: subwayknees on August 11, 2011, 06:30:59 PM
There is a reason morphine has been referred to so ofter as God's medicine.  It works.  While it is addictive and has some side effects it is the best long term remidy for chroinc pain.  Every other drug trys to copy the responses that morphine gives.  In the U.S. I know that aside from inpatient hospital settings most doctors who are not pain management specialists will not write for it.  I have been in pain management for many years after a dozen knee surgeries and failed revision.  While with my pain there are days that even fairly high doses up to 500mg morphine er and ir do not totally control the pain most of the time I get enough relief to sit in my wheelchair, I can no longer walk more than a few steps, and do light things around the house.  I would not suggest anyone asking for it until they have tried other drugs but in the end where little else works you can count on morphine to at very least take the edge off.  After a while you can function rather well on it once the body gets use to it.  You can drive, work etc but it does take a little while for the body to begin to function well on high doses.
I am not suggesting it as the first choice but when everything else fails it is time to talk to a pain management doctor about morphine, I have never gotten a high on it in all the years i have used it so I personally would not worry about that.  Of course once you are on it a while you cannot just stop it right away because the body will become addicted to it the doctors will have to withdraw you slowly over several months, but in the end when nothing else helps you will know why it is called God's medicine