Acute Joint Pain
It’s a bummer that you are in pain, but we are here to provide you with some solutions so you can be in less pain prior to your visit with us. Pain is caused by three common responses that can be modified and controlled if you understand the pathways. The common responses of your body after an injury are:
1.) The response of the pain fibers from the injury site going to your brain.
2.) The response of the local pain fibers around the injured site.
3.) The response of your brain to the two above responses. We will review each response so you can clearly understand what can be done to control and/or modify each:
The response your pain fibers have from the injured site to the brain is one of activation.
When the pain fibers around your injured site are stimulated, they send impulses up through your spinal cord to your brain. Your brain senses where the pain is located, and thus you are able to identify that your right or left knee is having pain. Spinal and general anesthesia methods block this response. Analgesic medications such as Tylenol or Aleve also help to reduce the activity of the nerve pathway to your brain as well as helping to slow the response back from your brain to this local stimulus. The medical science of anesthesia is based on identifying methods to reduce this activation response and make you more comfortable.
Methods to control this response
Reduce the activation of the pain fibers by using simple medications such as acetaminophen (Tylenol) or Naproxyn Sodium (Aleve). Using a pain blocking medication on a regular basis such as every 6 hours for acetaminophen, or every 12 hours for naproxyn sodium will help slow down this reaction. It is important to first understand the risks and benefits even of these simple over the counter medications and you should discuss the correct dosing with your physician. Normally, you can not take more than 3 grams of acetaminophen which means you may not take more than 9 regular strength Tylenols per day, or more than 4 Aleve tablets per day. Sometimes you can take the Aleve and supplement this with Tylenol as needed throughout the day.
The response of your local pain fibers at the incision site
Cutting, stretching and pulling on the ligaments, muscles and bones cause bleeding, bruising, swelling and pain. Techniques used by the surgeon can reduce some the severity of the damage, but regardless or the surgeon, or the surgical technique, most people will experience a little bit of each. The area of the surgery will respond to these insults by producing localized swelling, bleeding, bruising and generalized soreness.
Methods to control this response:
1.) Ice, Ice Baby: Not only is this the best song ever made by a white suburban pseudo rapper, but it also helps you remember that ice will make you comfortable as a baby in a bassinet. Cooling your joint and surrounding tissues can help reduce swelling, bleeding, and bruising. Icing the area all the time for the first 48 hrs is critical in reducing these components of local pain. Obviously, cooling your joint has benefits, but there are also some risks and complications such as skin damage. These risks and benefits must be considered prior to deciding what is going to be the best way to cool your joint. Simple bags of ice can be used, but these MUST NOT be placed directly on the skin. ALWAYS cover the skin with a dry towel to prevent skin damage. The problem with ice bags are that they normally leak. Thus, you can use some frozen vegetables. These last longer than regular ice and they also keep the area cooler over a longer period of time. I normally recommend buying 4 bags. Keep 1 to 2 on your injured area and the remainder in your freezer. Rotate these about every 90 minutes. Make sure you cover your knee with a DRY cloth so there is no direct contact. A normal knee or ankle may accommodate 2 bags while a wrist or hand may only accommodate one.
Whenever there is a skin incision, your body starts an inflammatory response. Providing you with medications and supplements that can reduce this response will help control the pain. The problem with providing these medications and supplements prior to your surgery is the fact that some of they can interfere with the way your blood clots causing more bleeding during the surgery and more bruising afterwards. Do not take them unless you consider these risks and benefits. The most common is naproxyn sodium otherwise known as Aleve. Some other options include Motrin, Nuprin and Advil. To achieve the anti-inflammatory effects of these over the counter medications, you should take the higher doses. This means taking between 600 to 800 mg of Motrin, Nuprin and Advil (3 to 4 tablets) every 6 hrs. Aleve is taken 2 every 12 hrs. Prolonged use of these medications can lead to some serious side effects such as stomach ulcers, gastro-intestinal bleeding and even kidney failure. So, please consider these risks whenever taking these medications.
Elevate your extremity
Elevating your leg above your heart is a very simple and effective manner to reduce the normal swelling of your leg after surgery. However, doing this in an effective manner may be difficult. For elevation to be effective, most experts suggest keeping the extremity at least 10 cm above your heart. Thus, you can see that resting your knee on a recliner chair will never achieve this goal. Thus, a simple and economical option is to take one large couch cushion and one large head pillow from your bed. and place these under your leg or arm while you are laying flat on your bed. This should be at least 10 cm above your heart while keeping your hip flexed no more than 45 degrees and your knee flexed at 20 degrees.
Use of local topical agents
You can apply some topical agents to the injured area to reduce and slow down the pain fibers. Obviously, you do not want to apply these to areas where there is an open cut or sore. Simple analgesic creams such as Aspercream or Ben Gay may be used as recommended by the manufacture. These act by delivering some of the same analgesic agents found in active ingredients of pills directly to the area of the injury. Some also have some counter-irritant ingredients that either warm or stimulate the local skin and superficial tissue to increase blood flow or to activate some superficial pain fibers confusing your brain in the process. Thus, your brain has a hard time understanding if you are having pain, heat or cold to the area.
The response of your brain to the both pain fibers heading toward your brain and the local response to your knee are affected by something loosely termed your mood. For example, when you are upset and frustrated and you stub your toe, you may scream some obscenities that you never knew were inside of you. However, if you stub your toe on the way to your favorite sporting event or movie, you may laugh. Why is this? When you are anxious and scared, your entire nervous system is activated and your body response is exaggerated. Think about how many funny home videos you have seen where they scare someone who is already anxious and scared. It is a classic response we can all laugh at, but when we are in pain from this same response, it is rarely funny. When your brain is activated into a mood of fear and anxiety, the receptors of the pain fibers are over excited and respond in an exaggerated response.
This is not something you imagine, because it is real and not imagined but yet you can modify this response by reducing the feelings of anxiety. Simple techniques such as listening to your favorite music have been shown to help reduce postoperative pain in well-designed controlled studies. Other patients have found that biofeedback techniques or meditation have helped to reduce the intensity of pain. Prayer and simple visits by family and friends can also help reduce these feelings. So, take out a sheet of paper and write down what causes anxiety, and for each item, write at least two techniques you will use to reduce this anxiety. For example, I might be anxious about having an IV started, but two techniques I will use to reduce this anxiety are imaging my nurse in a clown suit (but not a scary, creepy mass murdering clown!).
Hopefully, this brief summary will help you with your pain. At Advanced Orthopedic Specialists we strive to serve your needs as someone in pain looking for solutions, and we plan to provide you with these solutions.