Pain Management 

You will experience pain after surgery. Everyone’s experience with pain is different. Some people tolerate pain well. Other people do not tolerate pain very well. It is our goal to safely treat your post operative pain to the best of our ability. The goal, however, is not to have no pain. The goal is to control your pain the best that we can with the safe medications that we have at our disposal.

The United States consumes 99 percent of the world’s narcotic supply, and this consumption continues to accelerate. No compelling reasons exist for this significant volume increase. In 2011, 50 million Americans were prescribed some type of narcotic pain medication, which was nearly double the number from 2008. In 1990, 627,000 people used narcotics recreationally for the first time. By 2005, that number tripled to 2.2 million recreational drug users. Overdose is now the #1 cause of death in the US in young adults ages 25-45. Interestingly, most pain medication abusers don’t get the pills from dealers, but from friends, relatives, and physicians. The implication is that physicians are prescribing excessive amounts when dispensing pain medications. Physicians are caught between the need to help control pain and the risk of over-prescribing narcotics. Studies show that increasing narcotic dosages do not necessarily correlate with pain relief and patient satisfaction. Factors that predict higher use of narcotics include anxiety, depression, smoking, and previous narcotics use. Fracture severity and number of fractures does not accurately predict a patient’s heavy use of post-operative narcotics. The Drug Enforcement Agency (DEA) recently emphasized that “a prescription must be issued for a legitimate medical purpose by a registered physician acting with the usual course of professional practice.” The courts have indicated the following red flags that may indicate illegitimate use: inordinate quantities, inconsistent intervals, no physical exam, refills in patients suspected of selling medications, use of street slang (eg, “Oxys” “Hydros” “Vikes”), no logical relationship to the underlying condition.

Representatives of the American Academy of Orthopaedic Surgeons have recommended that any evidence of abuse should be documented. Ideally, medications should be prescribed according to set protocols with defined quantities and intervals. Pain management and hospice services can be utilized when necessary. Pain medications are best used when integrated with other pain management modalities such as physical therapy, exercise, and healthy lifestyle habits. Attempting to have multiple physicians unbeknownst to each other prescribe pain medication is dangerous and illegal.

We want to insure that our patients to have adequate pain relief. For this reason, we do prescribe narcotic pain medications in the postoperative period. However, out of respect for the protection of our patients and their families we have developed standard pain management protocols. Our office policies restrict our staff from deviating from these protocols. The narcotic limits set to avoid abuse potential are liberal enough that nearly all of our patients find that they require less amounts of the pain medications than we have granted them access to. In fact, many patients find that they require no narcotics whatsoever. If you are on strong pain medication prior to surgery it is much more difficult to control your discomfort after surgery. If this is the case, we may refer you to pain management or have your primary care provider dispense all pain medications. 

Doing your part:

  • Maintain a positive attitude.

  • Relaxation and distraction techniques to calm anxiety. 

  • Participate in daily exercises if able to do so. 

  • Establish a routine to avoid frustration as normal activities may take more time. 

  • Move surrounding joints multiple times daily to avoid stiffness and discomfort.

  • Elevate the extremity to decrease swelling and discomfort.

  • If you have an external fixator, keep the pin sites clean to decrease irritation.

Pain Management/Medication Protocol:

These are general guidelines that we use for post operative pain management. Your pain management may be tailored to your needs and may deviate from this guideline.

Medications to start the night before surgery:

·      Acetaminophen 500 mg- 2 tablets 

·      Gabapentin 300 mg– 1 tablet

 

Medications to take the morning of surgery with a sip of water:

·      Acetaminophen 500 mg- 2 tablets 

·      Gabapentin 300 mg– 1 tablet

 

Medication regiment after surgery: You may not be prescribed all of these medications.  (start when you arrive home)

·      Acetaminophen 500 mg - 1-2 tablets every 8 hours  for up to 3 weeks.  Stop taking after a few days if you don’t have pain.  Maximum daily dose of 3000 mg. (no more than 6 tablets in a day),

·      Gabapentin 300 mg - 1 tablet in the morning and one at night.  Continue medication twice daily for 2 weeks post operatively then discontinue.

·      Celebrex 100 mg - take one tablet daily for 4 days after surgery then discontinue. Always take this medication with food and water.  Stop taking if your stomach becomes upset.

·      Tramadol 50 mg - take 1 tablet every 4 hours as neededfor pain. 

·      Norco 10/325 – Take 1 tablet every 6 hours as neededfor pain.  (Stop taking Tylenol if you take Norco.  Resume Tylenol once you are off of Norco.)

·      Promethazine 12.5 mg- take 1-2 every 6 hours as neededfor nausea.

·      Vistaril 25 mg- 1 tablet every 6 hours as neededfor itching. You can also take this medication with the Tramadol to increase the pain relieving affects.  It can also be used to help you sleep.

 

Over the counter medications you will need to obtain on your own for after surgery

·      Pepcid 40 mg– 1 tablet once daily for four days.

·      Aspirin 325 mg- 1 tablet once daily to prevent post operative blood clots. Take for 6 weeks

·      Vitamin C 500 mg– 1 tablet once daily promotes wound and nerve healing. Take for 4 weeks

·      Zinc gluconate 50 mg- 1 tablet once daily. Promotes wound healing. Take for 4 weeks

·      Vitamin D 5000 IU(international units)- take 1 tablet once daily. Take for 6 weeks to promote bone healing.