Pain Thresholds

Bones, joints and muscles
1

Having read many posts, I wondering just how much pain a patient with severe arthritis needs to be in before the NHS will consider surgery.  I have read posts where patients are in such excuriating pain they cannot work, and are suffering financially.  In a situation such as this they will be in all kinds of debt before they can even consider returning to work, and this is going to impact significantly on their recovery.  I am thinking mainly of patient on no hours contracts.

In the US, where I have lived and worked for most of my life, more than likely you would find yourself out of a job!

Surely, a diagnosis of severe arthritis should be enough to justify surgery, without compelling patients to suffer unendurable pain, for weeks/months on end, jeopardise their livelihoods, and then at almost the last minute, in many cases, cancel surgery the day before!

This is inhuman.  The RSPCA would not stand for this, if in the case of an animal....!  Would they...?

Is this common in the UK, now?

Best,

 

2

I have consultation on Thursday I am going to ask if I can take a cancellation if any come up January seems so far off II need it doing so I can return to more or less normality I've been so down with it xx

3

Very often the GP refers for X-rays and or the physio first. Then to the hospital, choose and book, appointment times vary, after seen by specialist op, should be within 18 weeks. 

In my case I had very very bad knee pain, luckily the GP asked for X-ray of both knee and hip. Hip was bone on bone so op agreed by consultant. The knee pain was referred pain from the hip. 

Seen in November, op in April

4

Hi Maggie:

Went through the physio two years ago, almost to the day, after 2nd set of xrays showed moderaate to severe arthritis.  Physio gave me several exercises that involved some stretches, which I feel are important as the leg muscles have atrophied.  Due for third set of xrays on Thursday, as I have some days of crippling pain and have to get into bed.  

Main concern is that I have read posts where patients are left for months on end with unendurable pain.  Bath Circle quoted me 6 - 8 weeks after referral, as an NHS patient.  I am now doubting this as your op was 5 months after referral.  Of course, Christmas causes massive delays, which in all likelihood, is going to be the very situation that I am likely to be faced with.  

Op in March/April, would not be too bad as the weather will be better, and not as challenging and depressing as going through all of this in the Wintermonths - to look on the positive side....  

However by that time, I should be on the verge of jumping into the canal......!

5

Hi Susie,  Ali 2 again.  I had hardly any pain and rarely took painkillers so was very shocked actually when I was told I needed  a full hip replacement.  I backed out initially when first appointment date was offered.  My GP told me I would find recovery easier if I had the operation at this stage in my life and that it would have to be done sooner or later as my leg had a habit of crumbling ..not completely and not often but enough to make me wary when crossing the road. My only regret is would I have to have this new hip replaced in my life time as it is implied the new hip should last 15 years..I am hoping it will last longer and not sure I would want to do all this again..not that things are diffcult now they ARE better and i am only experiencing the operational pain if any pain at all...

Are you an american lady now living here?

Ali 2.

6

I too wasn't in excruciating pain. I had no mobility. I had Perthes disease as a child. I'm sure there are many of us on this forum. I'm aware of the age cycle of the replacement.  However looking forward to some improvement in my movement and general day to day living. Quite looking forward to going back to work!

 

7

Susie - Here in Australia, New Zealand, And I presume England there are no charges when you go to a public hospital, Government Funded, it all comes out of the taxpayer dollar. Of course then because it is free, you get all the dead heads using the public system and clogging the system with minor complaints. Imagine Emergency Department filled with vomiting, drunk, self inflicted idiots, torn out fingernail, waiting in line to be served with broken arms, strokes, etc, although triage do try to care for the really ill first, where in a lot of cases they could go the the local GP's clinic, no charges in some of these clinics, in Australia it called bulk billing, some of the Bulk billed clinics are very good, others are production line, but I have also stuck production line service in an expensive reccommeded clinic. Re pain in public hospital system, here in australia pain is not a reason to get into hospital, apparently function is, or thats what I have been told, bet you its the same in England. Why they think that putting off working tax paying patients is beyond my understanding, wouldn't it make economc sense to have got me fixed up, back at work, and paying tax again, I was earning in excess of $1000.00 a week and paying close to $300.00 of that in taxes, unfortunatley my husband being diagnosed with heart failure has put paid to me working since I have been 59. Being brave and appearing at your GP nicely dressed, walking resonably well is not going to get you a referral to specialist, you would have thought for example my case, from about 2000 onwards I was being prescribed painkillers on a regular basis, and x-ray showed moderate arthiritis, that slowly got worse over the next ten years, so by 2008 I was no longer working, couldn't sit on bus for 2 hours to go to work, because at the end of two hours I coudn't get out of seat. Not elegible for benefits as husband was earning too much. Finally 2011 seen by specilist who was shocked by state I was in, not walking without 4 wheeled granny walker, even then had to wait 32 weeks from first appt with specialist to surgery, with right hip basicly broken down.

8

There are two options really Susie, private health insurance which usually means you can choose your surgeon and the operation date, provided you are medically in need of a hip replacement at that time.

I also know you can pay privately without insurance it is around £10,000 or thereabouts.

Or you can go through the usual routes of the NHS. I have to say the hip care is exceptional for patients. They supply aids to your house, come out to check your home and offer community care afterwards, as well as hip school and general care. You will not receive this through the private pathway.

To qualify for hip replacement you have to have significant damage on your xrays and MRI. For some people they are not in pain, through childhood diease of different reasons, but for others they are in terrible pain. Usually these patients have left it too long for their own reasons, or the GP was slow to refer them etc...

A diagnosis of severe arthristis may not be enough if it does not show actual damage by xray. There are other ways to control arthristis such as anti inflammtories, biologic drugs that may help a patient without the need for surgery. Surgery may not be needed at all.

It is common in the UK for most patients to be looked after very well is my view.

9

Hi Rose:

Many thanks for your response.  I am due for a third set of exrays on Thursday, for obvious reasons - pain from arthritis.  Had surgery performed in San Francisco for removal of the third distal joint, dominant hand due to arthritis in 1987, where I was initially diagnosed.  So, I have lived with this situation for some considerable years.  As a consequence of the surgery, I lost my living as an Interior Designer as I was unable to do the fine work required on the drawing board - technical drawing.

First set of exrays, the GP, a locum, I believe, advised that I did, indeed have arthritis in my right hip, but he went on to advise that should I have surgery, I would contract MRSA!  Hardly encouraging and reassuring!  Second set, taken around this time, two years ago, showed moderate to severe arthritis, and I was referred to a physiotherapist, who gave me a set of exerccises to do.  Co Cadomol was prescribed.

My new GP, with whom I have been for over 10 years, stated that she was happy to put me on anti inflammatories, but for a limited time, only,  I opted out.  I am well aware that there is damage, because it presents during exercise, and is unmistakable.

As I have spent most of my ife in the US,, mostly San Francisco, I do not have private medical coverage, although I did in SF.  I returned to the UK, to address issues with my elderly and increasingly frail Mother, now deceased.  We were in London and although I was able to locate medical help for her, no GP would take me on as a patient, for whatever reason!  So, the amount of lifting and heaving, moving furniture, etc., that I had to do, exacerbated and aggravated the arthritis.  I was unable to obtain any form of pain relief, other over the counter, and quite frankly the local practices were not interested in my problems any more than Social Services, who became involved in the last year or so of my Mother's life.  Overall, my impression was, that I was regarded as a machine to take care of my Mother, but maintenance and my own medical issues were ignored.  Lack of any form of medical care, least of all any level of concern for my well being, continued for over eight years.

My current GP does take good care of me, and we are able to have intelligent dialogues as to diagnosis, prognosis and what would be the current best course of action.  The new set of exrays, will reveal all that is necessary to either refer on or not.  I suspect, that due to my current codition, it will be the former, but you never know...!  Not much to be gained by referring a patient on for THR when the condition unsupported by Exray, and the pain experienced is from another cause!

 

10

Your new GP sounds wonderful, and you seem confident in their care which is good, and I am sure he/she will refer you immediately if they see that your condition needs a THR.

During the early stages there are so many things that can be done to ward off the surgery, and these are often used successful for a few years. I have had hip pain for ten years now before finally and somewhat painfully making the decision to have a replacement at the grand age of forty.

Some of ways I knew I definitely needed one were similar for everyone: I couldn't bend, can not put shoes or socks on, can't walk far (longer than 10 minutes) can not bear to stand still and and can not live a normal life. These things can be controlled by various forms of pain relief which definitely be explored but there comes a point when they do not work, and in fact the damage on the xrays points to the need to replace.

If your joint has a few more years then this is a wonderful thing for you! You are very fortunate. Especially if you can get your pain under control and can enjoy your life. I had hoped never to have the replacement, but sometimes you end up with one anyway. Once you get to that stage Susie, I am sure you will be well care for, please try not to worry. 

I am not sure how badly your hip is affecting you, and how limited you are in what you can do. It is good to discuss with the doctor what can be done in terms of support.

Good luck with your xrays, and make sure you ask to have your back checked as well. The pain signals often get mixed up!!!! And the pain presents in the wrong place in that area...It is good that it is free here in England and you do not have to pay high insurance costs anymore, because this kind of care costs a fortune from start to finish. I am always amazed at how much an MRI is, or a simple blood test! My bills are horrific!

 

11

HI Ali:

REally sorry that you have had such a rough time of it.  I think with THRs, high impact sports should be avoided, that will prolong the life of the new hip.  In 15 years, should you need a replacement, you will be in a good position to know what to expect, but science progresses all the time, and you may find that you are looking at an entirely new and less troublesome procedure!

The pain you are in now, is a positive pain, as you will continue to improve day to day.  It is not negative in terms of what you were experiencing pre op, as this was your body telling you that it needed attention.

No, I am not American.  I was born and educated here, but left at a relatively young age to take up a job offer in New York, met my former partner, and we moved to San Francisco when both our jobs came to an end.  We split up, and I married my former husband, who was from the Netherlands, in San Francisco.  

All the best,

Susie

12

Hi Susie,  Oh how nice  I didn't have too rough a time though..but is harder on your own. My husband  (2nd had been alone for 25 years)died 14 years ago after only one year of marriage..very suddenly..now that was hard!  If you married your former husband is he with you..? It is just you say you are now on your own. I thinbk I havr ead your post wrong!

I am improving each day.  Went to see a wonderdful film 'The Lady in the Van' this afternooon and sitting for 2 hours made walking a problem but not for too long.

Keep reading your posts .

Kind ERgards,

Ali 2

13

Hi Ali:

No my former husband, Dutch, is still in San Francisco with his now, third wife.

I have been wanting to see Dame Maggie.  Anything she is in, is well worth the visit.  However, I will wait until it comes out in DVD.  Interesting that she should take a part that is the exact opposite of Downton.  I watched the re run of "Tea with Mussolini" over the weekend.  She is more of a "character" actor, and never was never a glamour queen, for which I am thankful.  There are so few parts for older women, but those that are still active in their profession are there because of their enduring excellence.  My daughter's father, Frank Marcus, was one of the few playwrights who wrote leading parts for women.

All the best,

Susie

14

European private insurance, which we have to have in

Portugal, to cover us also in uk, is horrendous.

Cathie

15

If you are covered by NHS care your gp will decide

if you need a consultation, or xrays, I think it has

always been like that. I was bone on bone with both

hips. A hip replacement will cure arthritis in your hips,

but not general arthritis pain, caused by ageing.

Cathie

16

Hi Cathie I'm bone on bone on both hips can you have both hips done at once? I am seeing my consultant on Thursday x

17

I am only forty and have had arthritis for years, so you can be younger and still have chronic arthristis, it is not always related to age. 

General arthristis can now be treated with biologic drugs which will preserve joints, so well worth looking into. 

18

You might find one is not is bad as the other.

if one hip could not support you when you had the other

one replaced they would, sometimes reluctantly, do both

at the same time. A consultant's decision, based on your

xrays and general health. Good luck, you will get a fuller

picture on Thursday.Take a list of questions written down and have

someone else in the room with you, because you won't

remember everything he says.

love Cathie

19

Hi susie

i waited just under 4 years to have the first one done I was in agony with both but not as bad as now. I am 8 months since having my left hip done and will be going in for my right hip 10 days before Christmas. 

I am am in so much pain now I went to my pre op in a streacher because I can't walk. I was also on gas and air ( nitrus oxide ) for the 30 mile trip to the hospital because the pot holes and switch backs made me suffer. 

Good of thing was I phoned ahead and they were waiting for me wheeled me straight in did my tests and shipped me off home again all within 30 mins. 

20

Good luck for second op hailea .poor poor you I am in a lot of pain and waiting for my first thr very scared but desperate to get rid of this pain which is getting me down so much :-( and also a lot of people don't actually understand the pain you are in and expect you to do more than you can:-( hope the hip you had done is fine does it feel loads better take care and hope you ate pain free soon xx