Catastrophizing Thoughts And Central Sensitization = Catastrophic Results And Opioid Dependence After Knee Replacement
Researchers in Canada writing in the Journal of Pain Research found pain catastrophizing reflects a patients anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain, and a sense of helplessness regarding pain.
Catastrophizing thoughts are unrealistic beliefs that only the worst can happen. A person who goes into any medical treatment believing it will not work is at a significant disadvantage. A patient should relay these thoughts to his/her doctor so that appropriate action can be taken. For some patients, counseling will be effective, for some therapy, for some prayer. The patients must be made aware of options that will help them move from hopelessness to cautious optimism.
A significant problem with catastrophizing thoughts that needs to be addressed is a greater risk for opioid dependence.
Doctors in Belgium write in the Bone and Joint Journal that pre-operative pain in the knee predisposes to central sensitization . Pain due to osteoarthritis of the knee may also trigger neuropathic pain and may be associated with chronic medication like opioids, leading to a state of nociceptive sensitization called opioid-induced hyperalgesiapainkillers increase chronic pain.
With Nowhere Else To Go Doctors Suggest Another Knee Replacement
- Study: Early diagnosis is very important for the treatment of intractable pain following total knee replacement. A reoperation conducted without identification of a specific reason carries a high risk of failure.
- With nowhere else to go, doctors suggest another knee replacement.
- Second knee replacement operation with a high rate of failure.
Recommended Reading: Is Knee Replacement Surgery Painful
Research: Surgeons Warn Surgeons That Knee Pain After Knee Replacement Does Not Automatically Mean Revision Knee Surgery
One of the reasons that people are in our office with continued pain after knee replacement is that they are being told that eventually, or sooner, rather than later if the pain persists, they will have to have revision surgery to clean out tissue that may be causing pain, and to examine the components of the artificial knee.
A recent study from orthopedic surgeons in Italy was published in the Current Reviews in Musculoskeletal Medicine. Simply stated the surgeons warned:
Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis if surgery is performed for the wrong reason, this will surely lead to a failure.
You May Like: Knee Pain And Hip Pain
Patient Expectations Of Greater Independence Immediately Following The Surgery Not Met Patients Upset That They Cannot Walk As Well As They Thought They Could
- Important functions to the patients such as how fast they can walk are typically not measured in determining patient outcome scores, compromising true patient outcome surveys.
- For many patients, simple expectations turned out to be unrealistic expectations as witnessed by research that suggested that people who receive knee replacements expect to have greater independence immediately following the surgery.
In May 2022 doctors at the University of South Australia wrote in the journal Pain reports looked at patient outcomes, in people who experience suboptimal pain relief and functional improvement following knee replacement. Among these patients they found these four main themes:
- Theme 1 addressed experiences of recovery after surgery, which often differed from expectations.
- Theme 2 described the challenges of the pain experience and its functional impact, including the difficulty navigating medication use in context of personal beliefs and perceived stigma.
- Theme 3 articulated the toll of ongoing problems spanning pain-function-mood, necessitating the need to endure.
- Theme 4 encompassed the importance of clinical/social interactions on mood and pain, with reports of concerns dismissed and practical support missing.
What the patients faced simply was the recovery was more difficult than they thought it would be. They were on medications that concerned them. They needed to endure the recovery. They felt that they were not helped.
Also Check: What Type Of Doctor Treats Knees
Pain After Knee Replacement
Knee replacement surgeries successfully treat pain and disability resulting from knee arthritis for thousands of patients worldwide. The complications after a knee replacement surgery are rare but some patients may continue to have pain after surgery. Persistent knee pain is the most common symptom of patient dissatisfaction after a knee replacement surgery.
During the knee replacement surgery, the diseased ends of the knee joint are removed. Prosthetic metal parts are placed at the bone ends that reduplicate the function of the knee joint. A plastic polyethylene insert is placed in between the two opposing metal surfaces.
X-ray showing a total knee replacement.
General pain in the knee after replacement surgery is part of the recovery process. The pain may be associated with swelling and generally goes down in the initial 2-3 weeks. The pain is typically managed with medications such as non steroidal anti-inflammatory medications or short term opioid medications. The swelling is generally managed using an ice pack.
While the general knee pain slowly goes away in the initial few days, some patients may need oral pain medications for several weeks after the surgery. Physical therapy and home exercises help to decrease the pain.
Intraoperative image showing closure of a total knee replacement.
The cause of pain after knee replacement may be due to a variety of reasons.
Don’t Miss: Why Are My Knees Hot
How Long Does Shin Pain Last After Tkr
The answer to this question depends on the individual. Some people may experience shin pain for a few days after their tkr surgery, while others may have shin pain for several weeks or even months. There is no one-size-fits-all answer to this question, and it is important to discuss your individual case with your surgeon to get a more accurate estimate of how long your shin pain may last.
What To Expect Post Knee Replacement
Although the procedure has its limitations, a dramatic reduction in knee pain and a significant improvement in performing everyday activities of daily living is seen in most cases however, total knee replacement does not allow movements more than before arthritis sets in. In addition, with regular use and activity, every knee replacement implant begins to wear its plastic spacer, which may speed up due to excessive movement or weight and cause a painful loosening of the prosthesis. Thus, most specialists advise against high-impact activities such as running, jogging, jumping, or other high-impact sports after surgery. Following a total knee replacement, unhindered activities include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports. With appropriate activity modification, knee replacements can last for many years.
Dont Miss: How To Exercise With Arthritic Knees
Also Check: My Knees Hurt When I Walk
How To Relieve Pain
Immediately after surgery, your physician will prescribe pain medication for short-term relief. Possible medications include acetaminophen, nonsteroidal anti-inflammatory medications or stronger prescription pain relievers, when necessary. Take all medications as instructed.
Attending your physical therapy sessions can help with pain. The main goals of physical therapy are to restore movement and strengthen your knee joint, but gentle exercise can also help lessen postoperative pain. Your physical therapist will give you a set of exercises that are safe for your healing knee joint. During early recovery, you may be prescribed to walk for 30 minutes and exercise 20 to 30 minutes, two to three times daily.
Mild swelling in your knee is normal for up to six months after surgery. To reduce inflammation, slightly elevate your leg and apply a cold pack. Wearing compression socks can also help reduce swelling.
How To Get Rid Of Unused Opioids
Do not keep unused medicine “in case” you think you may need it. Having it in the house where other adults, children or pets could reach it is unsafe.
- To get rid of unused opioids, bring them to a drop-off location or to an Allina Health Pharmacy. To find a location near you:
- Minnesota: Go to pca.state.mn.us and type “household hazardous waste” in the search box.
- Wisconsin: Go to dnr.wi.gov and type “health care waste” in the search box.
Also Check: Why Does My Knee Hurt When I Drive
What About Numbness Down The Whole Leg Or Into The Foot After Surgery
In rare cases, there is potential for larger nerves to have been damaged during surgery.
This article found that 23% of patients with nerve injuries had numbness down the leg in the area shown below.
This pattern of numbness results from damage to the sartorial branch of the saphenous nerve. Which is a slightly larger sensory nerve which supplies sensation to a bigger area.
Every persons nerves will be slightly different, so these body maps are good for a reference, but they will not exactly apply to everyone.
If the area of your leg numbness is largely outside the cream coloured section of the picture , it would be advisable to seek medical advice to get this checked.
As previously discussed, if your nerve was cut in surgery, the chances of a full recovery are slim. However, you may just have a neuropraxia and in this case, you will get most sensation back.
Thankfully sensation changes doesnt usually lead to strength changes as the signals come from different nerves. So there will be minimal chance of numbness leading to your knee giving way or other symptoms of weakness. If giving way of the knee is occurring, it is advisable to also seek medical advice.
Will Your Bones Even Allow For A Revision Knee Replacement
An August 2019 study in the Journal of Orthopaedic Surgery and Research offered this warning to surgeons concerning the problems of identifying whether a patients bones were strong and dense enough to withstand another knee replacement procedure.
Revision total knee arthroplasty is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation.
Look at the study findings:
- Fifty-one patients were included .
- The most frequent cause of failure was:
- aseptic loosening of the implant .
- 18.9% of the cases demonstrated poor bone quality.
What the researchers of this study were seeking to point out is that if revision knee replacement is required, a plan to address and repair the possibility of bone loss, bone weakening, a loss of bone density should be undertaken. This would significantly increase the success of the replacement.
Also Check: What Causes Osteoarthritis In The Knee
Knee Replacement Surgery: What To Expect
This is an important step in many peoples lives. Pain and other symptoms may occur in the days and weeks following surgery. You should check to see if the implant is functioning properly after a knee replacement, especially if you experience knee pain. An infection can form as a result of early post-op pain, problems with how the implant connects to bone, or issues with the implant mechanism itself. When you experience pain after surgery, it is critical that you see your doctor as soon as possible. Within two to six weeks, most of the neural function returns to normal.
Dont Miss: Why Is My Knee Popping
Unchanged Or Worse Pain And Physical Function 1 Year After Knee Replacement Surgery
In September 2020, a multi-national research team including orthopedic surgeons suggested that 20% of patients do not have favorable outcomes following knee replacement surgery and the mechanism for screening outpatients who are at high risk for surgical failure is outdated. Here is exactly what they said in the prestigious medical journal BMJ Open :
One in five patients undergoing total knee arthroplasty experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavorable outcomes is necessary to develop tailored interventions to minimize risk. There is a need to review more current literature with an updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses.
There is a need, according to this paper, to minimalize the risks of failed knee replacement surgery in one out of 5 patients. Simply said.
Lets again stress that 4 out of 5 people have successful surgeries and are very happy with their decision. This article is again for those people who are in the 20%. This is what we hear:
- Is there help for me, I would up with severe pain after knee replacement and now I have to use a walker. The knee is also very stiff but I have been told it is not a hardware problem and physical therapy would help me. I have had physical therapy and it is not helping me. I cannot find any solutions to my knee problem.
Also Check: What Type Of Knee Brace Do I Need
Knee Replacement Shin Pain: Causes And Treatments
If you have had a knee replacement, you may experience some shin pain. This is normal and usually goes away within a few weeks. However, if the pain is severe or lasts longer than a few weeks, there are some things you can do to relieve it. One way to relieve shin pain is to ice the area for 20 minutes at a time, several times a day. You can also take over-the-counter pain medication, such as ibuprofen, to help reduce the pain. If the pain is severe, your doctor may prescribe stronger pain medication or recommend physical therapy. Physical therapy can help stretch and strengthen the muscles around the knee, which can help reduce pain. If you have shin pain after knee replacement, talk to your doctor about the best way to treat it.
It is common for Shin Pain after knee replacement surgery to be caused by Bone Shearing. As a result of the new knee, your shin bone is being subjected to new stresses. One study found that the bone remodeling process was completed within three to twelve months of surgery. There is currently no known exercise that accelerates bone remodeling, but insufficient activity and exercise may slow its progression. You may choose to combine walking and cycling in a post-surgical rehab program in order to maximize your post-surgical recovery time. In addition to walking, ellipticals may be an alternative due to their less impact on the knees and lower legs.
Immediately After The Operation
Doctors have made big advances in pain management after total knee replacement over the last 10 to 15 years due to advancements in using regional nerve blocks, spinal blocks, and other methods of pain control.
During knee surgery, your healthcare team might either use a general anesthetic, where you will be fully asleep, or a localized anesthetic, where youre numb from the waist down but still awake.
After the surgery anesthesia wears off, your healthcare team can provide pain medication either orally or through an intravenous tube.
These medications may include a strong opiate or opioid such as morphine, fentanyl, or oxycodone, and are intended only for short-term use. Its important to note that larger doses over time can lead to physical dependence and addiction. Follow your doctors instructions to avoid adverse effects.
Don’t Miss: How Does Gout Feel In Your Knee
Problem: Difficulty And Pain In Kneeling
Most people had difficulty kneeling because of pain or discomfort in the replaced knee. Many patients described how this limitation affected their daily lives, including housework, gardening, religious practices, leisure activities, and getting up after a fall. Patients often adapted to these limitations by finding alternatives to kneeling, assistance from others, or home adaptations. Many patients had accepted that they could not kneel, however some still expressed frustration. Few patients had consulted with healthcare professionals about kneeling difficulties, and unmet needs included the provision of information about kneeling and post-operative physiotherapy.
Surgeons Say One In Four Patients With Pain After Knee Replacement Had No Clear Reasoning For Their Pain It Wasnt The Hardware It Wasnt Anything Obvious That They Could See
In the research above, surgeons have a road map of where to look for pain after knee replacement. Returning to the findings released in the British Pain Journal , the doctors suggest looking for pain in other places that are usually not explored:
- Our main findings are that some patients have severe pain that interferes significantly with their lives and that a large number of them have pain sensitization problems , many of which can be classified as neuropathic pain , rather than any local, nociceptive cause .
- A heightened sense of pain following knee replacement will be discussed throughout this article.
What is the research saying?
In November 2018 a study was published in the Journal of Knee Surgery. The doctors also were looking at nerve pain after surgery.
- The study had 154 patients with 222 knee replacements
- The goal of the study was to define the prevalence of pain persisting after total knee replacement and determine the impact of neuropathic pain.
- The ratio of patients with
- moderate-to-severe pain was 28% .
- Thirteen patients experienced unclear pain.
- A significant number of patients experienced moderate-to-severe and unclear pain after total knee replacement.
It looked like neuropathy but it wasnt neuropathy.
Read Also: How To Rebuild Knee Cartilage