Coming off pain relief following TKR

Bones, joints and muscles
1

Hi all 

Can anyone offer some advice? I had a TKR 5.5 weeks ago things are going really well. I’m planning on returning to work in three weeks and want to reduce my pain relief. 

Following my op I was put on zomorph 2x 10mg capsules morning and night and 4 hourly paracetamol and ibruprofen.  The zomorph was due to the severe pain following 4 previous knee ops and complications during surgery. 

I went to the docs requesting to be weaned off the strong pain relief, he suggested codine 30mg 4 hourly with paracetamol. I spent a day on this and the pain went through the roof..... I feel shocking and my knee is so stiff it’s unbelievable.  I was doing so very well and really don’t want to struggle in this level of pain but understand there will be withdrawals. Is this typical or not? Should I do a week of 1 10mg zomorph then switch to codine?? Your comments welcome. 

2

I could not imagine going back to work so soon after such major knee surgery. Also I remained on heavy duty pain medication until 12-16 weeks post op. Time, rest and physio will get you mobile however you cannot force the recovery to fit in with your schedule. Request pain relief to for as long as you need it. Hope things get easier for you.

3

What is your activity level? Are you walking without or with support? Are you on your feet a lot?

To reduce pain and swelling you may need to adjust what you are doing in terms of activity maybe?

Then you have some chance of reducing your medications.

Going back to work might be worth delaying if you have some choice in the matter?

4

I had my TKR 4 months ago and I'm thinking of going back to work in a couple of weeks on phased return. I'm becoming more active now but still requiring pain relief to carry out the exercises. Initially I was on tramadol 100mg 4 X day and diclofenac. After 2 months I went on to  cocodamol 30/500 x2 4 times a day and the diclofenac plus 10mg of amitriptyline on a night. I've cut back today but my knee isn't comfortable so even now I think it's too soon to cut down or stop the meds. Listen to your body, if you need them take them. I'm getting stronger everyday because I am able to do the exercises to strengthen my leg if I'm in pain I'm not going to do them therefore I won't recover.

there is no way I would have been able to go back to work at 8 weeks, I had too much swelling go on after just walking short distances. I can walk 6 miles with just a small amount of swelling now but I still need the meds X 

5

I’m really active and start back at the gym tomorrow following the PT advice I guess in order to be this active I will require the pain relief but I have an allergy to tramadol so that was ruled out for me.  I guess I may be pushing myself that bit too much 🤔 

Thank you for your advice x

6

I can only take another two weeks if required as I have have 300 days off over the last 3years due to numerous operations to try to preserve my knee. I guess continuing with the pain relief is my only option for the moment but then I worry about coming off zomorph as it’s highly addictive........ catch 22! 

Thanks for your reply. 

7

I thought I was going back later than most after reading some of the posts. I guess I will just have to battle through as we are all doing. I think we all deserve a medal for getting through the surgery it really is a challenging time. 

Thank you for your advice. X

8

You're so welcome. Be patient. xxx

9

I’m 4 months post and went back after 2 months but built up the time gradually. Was still taking a few paracetamol daytime and codeine at night. Full time at around 3 months and off pain meds altogether. But we are all different. Your knee will tell you when it’s ready and it won’t be rushed! Take it too quick and you’ll know about it. Good luck! 

10

Yes, indeed. It is early days...maybe aim to be off the zomorph by three months? And reduce very very gradually! A bit of both might work? I would hold off the gym until you are not needing strong painkillers myself. The strength work is more something that is relevant to three months to nine months post op, well, just based on my own experience. Keeping swelling down and range of motion are the name of the game right now.

What sort of work do you do? Some folk find a phased return good if that is an option at all. Sounds like you had a rough time pre op....I wish you a very good recovery now

11

Hi Jen, 

Yes pretty tough time pre TKR, lots of scar tissue floating around. I’m a teacher due to the amount of time I had off previously work were unable to support this operation hence me having to return ASAP.  I will take your advice and hold off on the gym.  I guess I’m just looking to strengthen my leg in order that the transition between being off and working is as smooth as possible. 

Thank you for you best wishes for recovery x

12

Wow that’s fantastic well done, I hope I’m just having a blip and that things will settle again ASAP. 

Thank you for your reply x

13

Hi Tina,

I went back to work at three weeks post op from a total knee replacement on a part time basis. I started off two days for 5 hours then built it up. I’m now six weeks P.O. and working three full days and a half day. I take one codeine at night and no other pain relief unless I need a naproxen during the day. Hope all goes well for you.

14

Last Year, after my 1st TKR (right knee),  I went back to work at 12 weeks. It really was a little early but I survived. The knee would be hot, swollen & painful after work, but that was on a short day phased return 2 days a week! I worked in a dental surgery as a receptionist, which involved climbing onto a step stool to get records out of tall filing cabinets, amongst other things, on my feet mostly.

It's difficult for a teacher to sit with foot up to rest the knee, apart from lunchtime. So I really wonder if you aren't trying to do too much too soon. I hope not as your knee will surely let you know if you are!

Sort the pain relief out before you think about going back to work! If you are needing strong painkillers still you are still healing!

Concentrate on ROM, elevating & icing to get the swelling down, but please don't worry about the strengthening until healing has taken place.

Keep the joint warm for exercise, ice for after exercise. Just make sure you build on ROM, flexion important, extension crucial. Take lots of rest & hydrate well. Don't push your joint just because you're going back to work. Work with your body & it will work with you.

I am at 5 weeks now with TKR no2 (left knee) & so glad I retired at the end of October! This time around I can concentrate on rehab & myself not thinking I have to go back to work soon!!

You've got 3 weeks to get the knee into shape, I hope you do it!

Just listen to your body, you have had a major operation. If you haven't seen the YouTube vid of TKR, watch it. 

The knee is in charge of your recovery/rehab ignore it at your own risk!!

Good luck, I really hope you do well.

Let us know when you have gone back & how you're doing.

Marilyn 

XX

15

You should not be driving on ANY of those meds!  Think you're going back to work in 3 weeks?  You go back to work when your knee says your ready to back to work!!!  { mic drop }