Less Pain, More Gain after TKARecovering from total knee replacement (TKA) surgery involves pain. Pain relief medicine is a standard part of treatment after surgery. Pain relief is important--and not simply to ease the distress and discomfort of pain. The saying "no pain, no gain" is just not true when it comes to knee replacement surgery. Pain makes it harder to move and exercise the knee, which slows recovery. Pain also affects the muscles and other soft tissues around the knee.Â
Pain relief is not practiced consistently in hospitals and rehab centers. Most often, patients are given fast-acting opioids when they ask for them. (Opioids are strong pain killers that must be used with caution because they can be addictive.) This means that patients get sporadic pain relief only after their pain has built up to the point that they have to ask for help.
These researchers tested whether regular doses of a long-acting opioid called oxycodone would help patients recover faster from knee replacement surgery. Patients recovering in an inpatient rehabilitation hospital were divided into two groups. The first group of 29 patients got the long-lasting oxycodone twice a day. They could also ask for fast-acting oxycodone if needed. The placebo group of 30 patients got capsules twice a day that looked like the oxycodone but contained no medicine. They could also ask for pain medicine as needed. Other than that, both groups were on the same schedule of medications, physical therapy, and other treatments.
The patients were checked before and after undergoing eight physical therapy sessions. They answered questions about their pain and did functional tests. At the first session, the two groups showed about the same test results. But by the last session, there was a marked difference. The patients who had gotten the long-acting oxycodone had greater improvement in all functional tests. They were also discharged from the hospital an average of 2.3 days earlier than patients in the placebo group. Patients in the placebo group were also a bit more likely to be discharged to home physical therapy or transferred to another inpatient rehab center.
The authors conclude that regular, strong pain relief can be a big help in getting knee replacement patients back to full function. These patients experience less pain, recover knee strength faster, and need less continuing health care. In other words, these patients had less pain, but more gain.
Andrea Cheville, MD, et al. A Randomized Trial of Controlled-Release Oxycodone During Inpatient Rehabilitation Following Unilateral Total Knee Arthroplasty. In The Journal of Bone and Joint Surgery. April 2001. Vol. 83-A. No. 4. Pp. 572-576.
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