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 treatments 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.
What Is Revision Total Knee Replacement
Revision total knee replacement is the replacement of a failed total knee prosthesis with a new prosthesis. In simple terms, it is the replacement of a knee replacement .
Knee revision surgery is a complex procedure that requires extensive preoperative planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques to achieve a good result.
Protection Rest Ice Compression And Elevation
Rest, ice, compression, and elevation may help treat mild knee pain that results from a soft tissue injury, such as a sprain.
Protection refers to protecting the knee from further injury, for example, by taking a break from the activity that caused it.
Rest can reduce the risk of further injury and give tissues time to heal. However, stopping all movement is not advisable, as this can lead to stiffness and, in time, muscle weakness.
Ice can help reduce swelling and inflammation. It should be wrapped in a cloth and applied for 20 minutes several times on the first day of injury. Never put ice directly the skin, as this can lead to further damage.
Compression with a knee support, for example, can increase comfort levels. The support or bandage should be firm but not tight.
Elevation, or keeping the leg raised, will encourage circulation and reduce swelling. Ideally, the knee should be above the level of the heart.
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Side Steps With Resistance Band
The outer quad muscle tends to be weaker than the muscle that runs along the top of your thigh, which leads to the kind of imbalance that causes your kneecap to pull out of line. The solution? Strengthen that outer muscle, says Butts.
How to do it:
In This Video Our Patient Jeannette Had Issues With Spinal Stenosis And Problems Post Knee Replacement
- Jeannette starts discussing the knee replacement complications at 2:30 into the video. Jeannette is 81 years old.
Jeannette describes a foot tingling problem. She cannot sit down and relax at the end of the day, it is uncomfortable for her to put her feet up or down because it is tingling. She had a nerve conduction study that shows an injury to her peroneal nerve.
The peroneal nerve branches out from the sciatic nerve. As it provides sensation to the front and sides of the legs and to the top of the feet, damage to this nerve would result in burning and tingling or numbness sensation in these areas. Further damage to this nerve would also cause loss of control in the muscles in the leg that help you point your toes upward. This can lead to walking problems and possibly foot drop, the inability to lift the front of the foot or ankle. Knee and hip replacement are leading culprits in the cause of peroneal nerve injury.
In Jeannettes case, she had two knee replacement surgeries in that knee. After the first knee replacement surgery, the implant started to protrude away from the limb. The knee replacement became loose. The second surgery to fix the first one occurred in 2015.
- It was determined after examination that Jeannettes knee ligaments were loose. Her knee was hypermobile and unstable. This was causing pressure on her peroneal nerve. Knee ligament damage and weakness is also a complication of knee replacement surgery and is discussed further below.
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Harvard Medical Schools Findings Surrounding The Phenomena Of Continued Pain Following Total Knee Replacement
Here are some more quick facts surrounding the phenomena of continued pain following total knee replacement from researchers at Brigham and Womens Hospital, Harvard Medical School.
In this 2017 study published in the medical journal Osteoarthritis Cartilage, the doctors found:
- Approximately 20% of total knee replacement recipients have suboptimal pain relief. .
- Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach a clinically meaningful difference in pain, pre and post replacement
- Patients with widespread pain along with the pain catastrophizing problems may help identify persons with suboptimal total knee replacement outcomes.
Pain Level 5 Months After Knee Replacement
Five months after TKR and Im able to do every activity I did before my surgery without the bone-on-bone pain I experienced for so long. I still have some soreness and swelling at times after activity.
I continue to elevate and ice my knee often after activity .
Im playing pickleball 3 times a week on a hard surface . When I play, I reach and squat to hit and pick up balls frequently.
I dont feel like I am any quicker with my movements front to back and side to side, but my knee feels much more stable.
I feel the leg press and squat exercises have helped me gain muscle in my legs and theyve taken some pressure off my joints.
However, I dont feel Ive reached my peak in recovery. My doctor advised me that the knee would remain swollen during the first 6-12 months.
I was also told the knee would feel 5 degrees warmer, which it does, and I may hear and feel clicking when going up and downstairs.
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How Long Will It Be Before I Feel Normal
You should be able to stop using your crutches or walking frame and resume normal leisure activities 6 weeks after surgery. However, it may take up to 3 months for pain and swelling to settle down. It can take up to a year for any leg swelling to disappear.
Your new knee will continue to recover for up to 2 years after your operation. During this time, scar tissue will heal and muscles can be restored by exercise.
Even after you have recovered, it’s best to avoid extreme movements or sports where there’s a risk of falling, such as skiing or mountain biking. Your doctor or a physiotherapist can advise you.
What Can I Do To Help Ease The Pain
Once the knee replacement surgery is completed, its imperative that the patient gets up and walking on the new knee as soon as possible to prevent blood clots. Putting pressure on the newly operated joint, as well as bending the knee will cause initial pain but will fade as the healing continues. Fortunately, knee replacement surgery technology and pain management have come a long way since the first days of the procedure, so today knee replacement surgeries involve less pain and patients are able to heal faster than ever before.
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Complications And Side Effects Of Pain In The Back Of Your Knee
Some treatments may cause possible complications and side effects. It is recommended to speak to your doctor about the best options available for you. For instance, if you receive peripheral nerve stimulation or genicular nerve blocks, you may experience:
- Nerve damage
- Damage to the surrounding area
- Worsening pain
Other medications may have different side effects. Consult your healthcare provider about possible complications of any medications you might take for relieving pain in the back of your knee.
How Bad Does Your Knee Have To Be Before Replacement
Surgery is a last resort for many patients. In most cases, doctors will try more conservative treatments first before recommending any type of joint surgery, including knee replacement. Conservative treatments mean treatments that dont use surgery. These include exercise, physical therapy, injections, medications, or non-surgical procedures.
Some doctors also recommend that patients lose weight before considering knee replacement surgery. Losing weight can often improve knee pain.
But if you have these symptoms, you may want to consider a more aggressive treatment: knee replacement surgery.
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Knee Replacement Complications In Former Athletes
In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular and periarticular osteoarthritic fractures the knee.
However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.
- The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population .
- The healthier post-traumatic total knee replacement group had the following complications:
- higher rates of superficial surgical site infections,
- bleeding requiring transfusion,
- increased length of hospital stay,
- and 30-day hospital readmission.
In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.
This included:
- knee wound complications
- need for revision surgery.
Can Rehabilitation Be Done At Home
All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.
For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
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Problem: Fixing Pain After Total Knee Replacement May Include Amputation
Three in 1000 patients will need to have their leg amputated.
The causes of the amputation were:
- infection around the implant ,
- soft-tissue deficiency surrounding the implant ,
- severe bone loss ,
- fracture around the implant ,
- circulatory damage .
In 80% of the cases, there were more than 2 of these factors for amputation.
In research from April 2017, doctors writing in the European Journal of Orthopaedic Surgery and Traumatology wrote:
Treatment for prosthetic knee replacement is becoming more common. Infection is an arthroplasty-related complication leading to prolonged hospitalization, multiple surgical procedures, permanent loss of the implant, impaired function, impaired quality of life, and even amputation of the limb.
The purpose of this study was to identify risk factors for amputation in the periprosthetic infected knee through a case-control study, analyzing patients treated from January 2012 to November 2016 in a hospital with a high incidence of this diagnosis. We included 183 patients with periprosthetic knee infection 23 required amputation as definitive management .
They found that patients with:
- Increased surgical time > 120 min,
- smokers,
- diabetes mellitus had an increased risk of amputation.
Helping Patients To Make Informed Decisions
We’re funding research to improve patient experience before, during and after knee replacement surgery. This includes a project based at the University of Sheffield which aims to help patients make informed decisions about their surgery. The research team will use the UK National Joint Registry dataset to develop and validate a personalised, web-based decision aid to help patients considering knee joint replacement to make informed choices about their treatment.
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How To Relieve Knee Pain Naturally
Knee pain is a very common symptom in many people, it may be the caused by bad posture, a sports injury or conditions and more serious illnesses such as tendonitis, arthritis or osteoarthritis, among others. Because knees withstand all kinds of movements and body weight it is one of the joints that suffers the most, which gets worse with age due to suffering major wear and tear. In addition to medical treatments that must be strictly followed to solve the problems that affect our knees, we can also use certain safe methods that will help us relieve knee pain naturally. We show you the most effective in this OneHowTo article.
A very popular and effective method to relieve knee pain naturally is to apply cold to the joint, especially when it is inflamed because of a blow or tendonitis. To do this, you can use ice packs and even cold compresses, but never apply ice directly to the skin. It is important to use a towel or cloth to cover it and keep in direct contact with skin.
Also, patients suffering from chronic knee pain without inflammation find relief by applying heat. Use hot water, hot packs and even a heating pad if this is the case.
Coconut oil also has anti-inflammatory properties that are effective in alleviating joint pain. Heat ½ cup of coconut oil until warm and gently massage the knee.
If you want to read similar articles to How to relieve knee pain naturally, we recommend you visit our Diseases & secondary effects category.
How Serious Is A Knee Replacement Surgery
As with any surgical procedure, knee replacement surgery carries risks. These risks range from infection and pain to blood clots. However, the AAOS point out that more than 600,000 procedures take place each year in the United States alone, with fewer than 2 percent resulting in serious complications.
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How Long Should I Ice My Knee After Knee Replacement Surgery
According to the American Academy of Orthopaedic Surgeons, swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, it’s generally recommended you use an ice pack three to four times a day for about 10-20 minutes during the first few days after surgery.
When Pain After Knee Surgery Isnt Normal
A total knee replacement is supposed to relieve knee pain, not make it worse. Find out if the post joint replacement pains youre experiencing are normal.
webonAugust 10, 2020
If you have arthritis or damage that caused wear and tear to the knee, you may have had a knee replacement to restore function to the joint. After surgery, some pain is normal. About 30 percent of patients experience moderate pain after a total knee replacement. However, if the pain lasts for several weeks following surgery, it may be a cause for concern.
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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.
Walking When You Have Knee Pain
The best rule of thumb is to monitor what your normal pain levels are during a day. Then ask yourself if your pain is more than 2 to 3 points higher than normal affects your movement patterns considerably. Should you be experiencing these problems then start off with a short, light walk to see if the pain increases or decreases. Sometimes going for a walk can reduce your pain and mobilize your joint fluid and lubricate the joint.
The day following your walk, monitor your pain levels on a scale of 1 10. When you are looking at 0/10 that would mean you have no pain at all, 5/10 would be that it is affecting your daily movement and 10/10 would be severe pain which requires an immediate hospital visit. As long as your pain doesnt increase by more than 1 to 2 points, then you are fine. However, it would be appropriate to take a day off between workouts to allow the knee to settle down to its regular level of pain.
Osteoarthritis quite often leaves you feeling torn. You have intense knee pain, so you dont want to move, and then the pain gets worse from inactivity because the joint isnt getting greased up with synovial fluid. You just need to know if you get up and move then eventually given time and increased stability, your knee will feel better. Exercise also gets you prepped for rehab, so you will heal better if you require a joint replacement!
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