Treating Pain In Knee Replacement Surgery

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A friend has just undergone her second knee replacement surgery and was in excruciating pain.  Prior to now she was using heavy duty narcotic pain meds and was tired of being doped out but also had this severe pain throughout her leg.  The first replacement knee surgery did not take, therefore this second procedure which was much more painful.

This has been an interesting week. I’ve had the opportunity to show her how to use the Infrex Plus unit.

Enlightening Experience

It has been literally decades since I’ve gone to a patient’s home to help so  new experience, but also very enlightening to me since once you see a patient it helps you keep focused on what your real mission is,  helping others not have pain and heal.   Here were my observations:

1.  The first day one major complication was the muscle cramping which occurred during any movement ( cpm being used as well as ice machine ).  Our first mission was to stop the cramping and our remedy was multiple IFT treatments on,  an as needed basis,  to calm the muscles trying  to move them away from tenseness to relaxation.   By second day with approximately 8 or 9,  30 minute interferential treatments the cramping was gone.

2.  The patient described the first day that the one place she was hurting most was the popliteal space ( directly behind knee in crease ) and wanted an electrode put there.  Well the normal electrodes we provided were lacking sufficient “tackiness” and would not stick well enough to go over popliteal area.  On day two I returned with a superior silver electrode which is much tackier and stuck well even allowing some movement.   Going forth we need to look at a larger, better adhering electrode for the patient.  It’ s on our “to do” list as I write.

3.  First day ( this is not first day after surgery, but first day when patient had actually called us,  since she could not take it anymore – hopefully later I’ll find out how long we were post surgery with her ), I saw our patient literally crying and agonizing over her pain so,  in addition to use of interferential,  I left her:

a.  one bergamot oil scented patch which is labeled to relieve “stress” and this was put on her chest so essential oils could be inhaled.

b.  put on lateral inside of knee one Tiger Balm patch

c.  on outside, lateral on affected knee,  rubbed Sombra lotion on.

All of above was done so we could immediately address her most  pressing needs first – pain, much of it due to cramping of leg muscles.  We attacked it with all we had as many of the above products are what are most effective over time for most of our chronic pain patients.

4.  Second day back I showed her and her husband, daughter,  and sister how to use the Tens aspect of the unit.  Width was set at 350 microseconds as we wanted greatest penetration.  Tens was not introduced nor explained on the first day, only on second, and reason for that was wanted to get new electrodes so could put on popliteal space and also patient in so much pain first day doubt she and her sister would have remembered too much information.  She had used only IFT first day and after that first day she was wanting to see if ok for her to get up and walk around house some so showed her tens as as assist modality so she could be more mobile and yet still use tens part as needed.   She had been told our preference was to use the IFT mode with the AC adaptor when possible.  The patient seemed to still prefer the interferential, IFT mode but did like the Tens and was going to use that.

5.  Also on first day had left her one lavender patch to place on her chest to help her sleep as she was in a sleep deprivation situation due to the pain which only made things worse.   By second day she was sleeping longer and more often.

What was learned:

* Better electrodes needed especially for acute situations – electrode tackiness should not dictate placement.

* Use topical pain relieving products when possible and if sleep cycle disrupted then do not fear using essential oils for inhalation.

* Try to intervene as early as possible with IFT post surgery – there’s no reason for the patient to suffer through this when if can start prior to the pain cycle starting then should be better results.  It’s harder to intervene and stop pain once it has been present for long time periods and already into the drug program.

* Cramping is extremely excruciating pain in the affected leg so use interferential to relax the muscles so that does not happen.

* Let the patient decide how often and for how long they want to use Ift mode when in pain.  On this patient she used multiple times during the first 24 hours depending on when was hurting.  I’m not sure one can “overtreat”   but this patient was bedridden the first day of treatment with the unit.

* It’s well documented and known that electrostim will make happen ( 80% of non-union fracture cases ) the healing of bone tissue so seems like e-stim could have helped in first surgery to heal,  rather than redo ( do not know what the complicating factors were such as infection, diabetes etc. so only can guess ). Would estim have prevented the first surgery from failing to mend?  Do not know but would have been cheap and easy to use the unit.  No telling what the second surgery costs and for sure there was a lot of patient discomfort due to pain and missed work.   This lady has a very active physical job.

* Estim,  such as PGS or Tens,  has been shown to help decubitus ulcers heal and accelerate soft tissue heal time in surgical situations so why not use anytime post surgery to facilitate faster heal rates, and less pain through the process.

*  Interferential is a very desirable muscle relaxing form of estim and if had been used earlier maybe the patient would not have had to endure the pain from cramping she did.

* EDUCATE the patient and family (caregivers) well so they understand and also can either help the patient or the patient can self help.  Better understanding then better results will happen.

Will drop by patient’s home tonight to leave some essential oil patches and couple of topical pain patches but from first day of usage of IFT, to second day of explanation of how to use the tens mode, she had improved dramatically as far as pain goes and could now sleep and cramps gone.  Made me feel good that we might have something going here that can help lots of folks not go through this.

Also very appreciative of the orthopedic doctor who was willing to do whatever he could to help his patient.   One phone call and prescription was here.

bobj

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Reader Comments

Hey Bob, absolutely great information. I’m glad to say, I don’t have knee pain myself, but if I come across someone who is, I will send them your way first.

#1 
Written By Optahealth on December 22nd, 2008 @ 4:47 pm

have you heard of a kyro cuff.
its for knee replacement patients
thank you
and where can i get one
thank you

#2 
Written By richard lucien filion on July 3rd, 2009 @ 12:53 pm

Hey Richard,

I think what you are referring to is a cooling cuff to hold down the inflammation of soft tissue following surgery. Think it’s a “cryogenic cuff” or cooling machine that basically replaces ice packs.

Generally if you are getting surgery the “hospital discharge planner” or same day surgery planner has a list of home health agencies that can supply or through their contracts they will have one delivered to you.

Hope I got this right and generally the surgeon/hospital/clinic includes this in total fee package and makes sure insurance covers.

Hopefully this will help you.

bobj

#3 
Written By bob on July 3rd, 2009 @ 4:58 pm

have had a revision knee replacement surgerynine monthsago. The pain just won’t go away. It is aso in the 4th and 5th lumbar of my back. The pain is on the left side of the replacement knee, down the same leg and in my back. The more active I ry to be, the more swelling.I have the Tens unit which helps. However, I have it hard to wear all day. the wires come loose.Any other suggestions?

#4 
Written By Diane on September 12th, 2009 @ 6:36 am

Hi Diane,

Small point here but anytime after activity might behoove you to put on cold pack and also compress to hold swelling down. Elevate when you can.

Tens is delivering you at best 150 pulses per second, ( this simply means unit goes off and on 150 times ) and tens provides no carryover/residual pain relief, ie. if you turn it off the pain comes back. Interferential has 8,000+ pulse or off/on cycles per second, so with a 30 minute treatment you should be able to be pain free for some time period. The time period tends to increase over time with multiple treatments. You may start off with carryover pain relief for an hour, several hours, or days progressing to only doing interferential treatment say weekly.

My guess is in your situation your back pain is the secondary source of pain, not the primary due to the knee replacement surgery, the posturing due to pain, and now the pain is spreading.

You also might want to consider anytime you put tens on your back to also do so with some form of moist heat on top of the electrodes while unit running. Do not use moist heat where swelling is an issue until you’ve used cold first.

If can help then give a call at 800-937-3993 if you live in US/Canada or post back and will comment. Thanks.

bobj

P.S. negative charges of electricity actually repel most fluids that aggregate and cause swelling but both interferential and tens are not constant negative but vacilliate between positive and negative. Sometimes larger electrodes with either of these will help reduce the swelling too but not major point to spend time thinking about.

#5 
Written By bob on September 15th, 2009 @ 3:30 pm

I would also support the use of ice on a consistent basis following knee replacment. As a PT this is by far the best way to minimize swelling, pain, and muscle cramping.

~JTrempe PT, ATC
http://www.joint-pain-solutions.com

#6 
Written By Janelle on July 11th, 2010 @ 7:27 pm

My brother in law had knee replacement back in 2001. All of a sudden he is feeling a lot of pain in both knees. He was given a shot for one knee but haven’t been able to tell him how to help with knee that has had replacement. Can you offer any help in this matter???? It is so appreciated.

#7 
Written By Norman Bouchie on July 14th, 2010 @ 3:20 pm

Hi Norman,

I’m so sorry for taking so long to reply to this. The comments are left in the blog and I’m not notified of such so only today I find your question. I hope your brother in law has found relief by now so what I say is moot. I’m assuming he is no longer having any form of muscle spasms occurring, which would have been more common post surgery in 2001, not now. Sometimes can be a major issue. Interferential is a very good therapy to relax muscle tissue and more importantly prevent spasms. Also assuming he is doing fine with whatever was prescribed then nothing else needed. Knee replacement pain should minimize over time and pain not a permanent condition of the surgery. An obvious question is “is he overweight”?. If so that is important and it’s just the physics of pressure to joint. Is he using or has he tried cold therapy, a pack of ice in a plastic bag with a towel? If there is inflammation and/or the pain gets worse after doing some activity then try ice for awhile.

If you’ve done it all, and the injections not working, then consider interferential. The carryover pain relief is very real and with the ability to use as needed seems to delay and possibly stop chronic pain.

You can email me directly at bobjohnson@medfaxxinc.com. Again sorry for delay.

bob johnson

#8 
Written By painguru on August 27th, 2010 @ 8:29 pm

My 80 year old mother, a life long right leg amputee, had knee replacement surgery about 6 weeks ago. While she is mobile and is celebrating her increasing accomplishments, she is suffering from reoccurring leg cramps in her calf muscle (which she refers to a “charley horse”). She describes the leg cramps as being very painful (note: she has a very high tolerance for pain, so I believe her). Her doctors have said that they have never heard of post operative leg cramps, and so, have not offered any possible solutions. As a runner, I start eating bananas when I get cramps, but she is allergic to them… so this is not a possibility. Questions: Have you ever heard of this situation following knee replacement surgery? Do you have any suggestions? Thanks (in advance).

#9 
Written By John Pooler on November 24th, 2010 @ 12:26 am

Hi Bob,

I had total knee replacement ( both legs) 6 weeks ago. This has been the worst experience I have ever had. Even though I am on a heavy duty pain medicine Pergoset every 6 hours, I am still having a great deal of pain.
I am received PT since the surgery, elevate, use ice pads for inflamation after excercise and as needed for pain. My appetite has been next to nothing because of pain meds making me nauseous. My head feels like it is in the clouds and after 4 hours, my pain returns with a vengence. I need to wait another 2 hours before I can take Pergoset again. It usually takes about 30 to 45 minutes to start helping me with the pain.

I have called to try the Infrax unit. Waiting for perscription to get to you from my Drs. Office.

I hope you can help me. I felt better before surgery than I do now. It doesn’t seem like I am improving at all and want to get off these pain medications.

#10 
Written By Karen Connors on November 27th, 2010 @ 8:11 am

Hi Karen,

Just checking in. Are you doing better now following the dual knee replacement surgery? You brave to do two at once!!

Hopefully by now, one month + post surgery, you are not having the excruciating pain you felt after the surgery. If it’s still excruciating then make sure there is not some complication such as scar tissue impacting nerves etc. as by this time you should be experiencing less pain as the tissues should be healed.

Call if problem and let us know. I assume you did not end up with Infrex as technically your pain should have been temporary and not permananent or “chronic”.

#11 
Written By bob on December 13th, 2010 @ 2:30 pm

Can I simply say what a aid to search out someone who truly is aware of what theyre speaking about on the internet. You positively know tips on how to convey an issue to gentle and make it important. Extra people have to learn this and perceive this aspect of the story. I cant consider youre no more in style since you definitely have the gift.

#12 
Written By Simon Eggett on September 9th, 2011 @ 5:13 pm

Thanks Simon for the nice words. Unfortunately the field of electrotherapy is not widely researched or discussed. For me the key is trying to help people understand what the process is and how to achieve results using electricity. In this field it behooves manufacturers/distributors such as myself to “keep explanations cloudy and confusing” as then allows us to claim our unit is best etc. The patient is left totally confused thinking this one unit is a magic bullet and no other one will work. That is not the case when one understands the basic physic rules of cells and electricitly and duplication.

No one really knows the answers to “why”, but with great education for all we are achieving very good results doing the process, even if we don’t totally understand the why. Thanks for your email. Have a good weekend.

bobj

#13 
Written By painguru on September 9th, 2011 @ 5:31 pm

are you doing better with your knees now?

#14 
Written By painguru on September 9th, 2011 @ 5:32 pm

Dear Sir
I have 4 months ago had a complete knee replacement to my right leg and I am after all this time (dispite having two physio sessions a week) still expieriancing excruciating pain in the front of my knee and also in the crease behind my knee and I cannot bend my leg on my own behond say 40 degrees.
I have bought a tens machine and find reading the manual that it shouldent be used by people with metal implants.
As I beleive my replacement knee to have metal part’s would the manual statement of the tens machine be directed at me.
any advice you could offer would be greatly appreciated
your’s sincerely
Mr M Warburton (United Kingdom)

#15 
Written By Mel on September 12th, 2011 @ 1:58 pm

The metal implant will cause no issues.

#16 
Written By painguru on October 8th, 2012 @ 3:35 pm

How do I contact you for this therapy? Both of my knees are painful. My right knee has been scoped twice,and I have been through countless Cortisone Injections, Synvisc series, and Hyalgon series without any long term relief.Can you posibly help me before I get talked into a knee replacement surgery? That’s the VERY LAST RESORT for me.Thank you for your time and trouble for any consideration you might give me on this endeavor! Sincerely, James King

#17 
Written By James King on July 13th, 2013 @ 3:48 pm

Hi James,

I just saw this post couple months later. If still in distress call me at 800-937-3993. Thank you.

bobj

#18 
Written By painguru on November 7th, 2013 @ 8:19 pm

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This post was written by painguru on December 20, 2008
Posted Under: chronic pain,interferential therapy,knee replacement surgery,pain after surgery,surgical pain
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