Pain Awareness Month Stories: Pain Management Choices
I had a patient recently referred to me because she had a previous knee replacement, used hydromorphone postoperatively for almost 2 and a half months, and, when she stopped, she went into full blown withdrawal and had to be hospitalized to treat her symptoms and stabilize her. She was then referred to pain management and was eventually given a slow taper using oxycodone and has not used opioids since. However, she had continuing pain in the non-operative knee and was contemplating another knee replacement, but was so afraid of using opioids and colored by her previous experience that she kept putting it off. She was extremely anxious.
We reviewed her history and tailored a plan for minimal opioid exposure. She specifically requested that hydromorphone not be used. She had spinal anesthesia, nerve blocks, adductor canal catheter, standing acetaminophen and IV ketorolac, and use of a cryotherapy compression brace and aromatherapy. She used minimal doses of oxycodone 5 mg in the hospital over 3 days and was discharged home with no opioids per her request. We took a holistic approach to treating her acute postoperative pain, taking into account her specific wishes and concerns.
Much of the public still believes that pain management = opioid management. There are so many procedures and alternatives that we can use. It's rewarding to help patients navigate these choices to enable their recovery and improve their quality of life.
Dr. Rim is the director of Pre-Surgical Chronic Pain Management at the Hospital for Special Surgery, clinical assistant professor of anesthesiology, and clinical assistant professor of Rehabilitation Medicine at Weill Cornell Medicine.