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Toronto, AL M5N 2M7
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Fax: 416-483-2654

Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I am having a knee replacement next week. I'd like to avoid polluting my body with drugs and get by with as little medication as possible. My surgeon says my wishes are important but insists that pain control is even more important. I'm not sure if I should say anything more or just give in on this one. What do you recommend?

Research has shown that better pain control immediately after a total knee replacement reduces time in the hospital (and costs), improves function, and gives an overall improved result for the patient. Surgeons have gradually increased the use of drugs to control pain so that it is now common to follow a multimodal pain-control protocol. Multimodal means many ways or methods to achieve pain control. This protocol started with periarticular injections (around the joint) of a numbing agent. That worked well but in order to reduce the need for narcotic drugs after surgery, intraarticular injections (right into the joint) with the same numbing agents was added. Then a steroid was added to the injection to help control inflammation. Nurses who will care for you during the early post-operative period and physical therapists working with you in rehab will encourage you to stay ahead of the pain. Waiting until it is unbearable is not a good idea because pain that intense will keep you from moving the knee and getting out of bed to walk. All of those activities are important in preventing complications and improving outcomes. It's good that you let your physician know your thinking on this before surgery. Likewise, it's good for you to know the rationale behind the use of pain meds. Some hospitals and clinics are offering alternative solutions to pain control such as acupuncture/acupressure, Reiki, massage, BodyTalk, hypnosis, and homeopathic pain remedies. Ask your surgeon if any of these are available in your area. The physical therapist can also provide you with a little device called transcutaneous electrical stimulation (TENS) to help control pain. Electrodes placed around the surgical site provide a buzzing sensation that can sometimes override pain messages. Once it's set by the therapist, you can change the level of sensation for optimal comfort. Be an informed consumer. Find out what your options are ahead of time. See what might work best for you given your goal of minimizing the use of medications.


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