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My wife had a total knee replacement two weeks ago. We thought we were prepared for the pain but we were wrong. She has been so sick with intense, intense pain and vomiting so bad we are both up all night long night after night. Is this really how it is for everyone?

any people in need of a knee replacement hold off much longer than they should. The reason? They've heard horror stories about how painful the knee will be after surgery. They are told that it's a different kind of pain -- much worse in some ways than the arthritic pain. But in time, the pain will work its way out and they will be able to move pain free once again. In fact, this bad reputation of postoperative pain after total knee replacement has a large measure of truth. There are many physiologic, biologic, and patient-related reasons for this increased pain. It does sound like your wife's experience may be at the extreme end. Let's look at some of the factors and see if any might help explain what's happening. Why is the pain so much worse after knee joint replacement? First of all, the surgery sets up an alarm in the nervous system that signals to the brain that there is a problem. But the signals that get started amplify and prolong the initial pain until it becomes severe and chronic. At the same time, the tissues are injured as the surgeon cuts through the skin and removes the old joint. The body responds with an inflammatory cycle that releases many chemicals and substances that have the effect of lowering the pain threshold. That means it takes very little to set off the pain signals and a lot to turn them off. Not only are the cells of the injured tissue reacting, but so are all the pain receptors in the surrounding tissue that hasn't even been touched. Not everyone has the same pain responses so there must be individual factors at work, too. Some people just perceive greater pain than others when given the same stimulus. This could be a matter of coping skills, the presence of psychologic depression, or the lack of certain enzymes needed to benefit from pain medications. Studies show that patient-controlled narcotic pain medications work much better than nurse-administered methods. Instead of waiting for the nurse to bring the next dose of pain medication, the patient can decide when it is needed. Staying on top of the pain is a key part of successful pain management. Delaying medication too long can make the pain cycle much worse. There are medications that can help with the nausea and vomiting. These are called antiemetics. Avoiding or minimizing nausea right from the start is the most important thing here. Like pain signals, once the body sets up a nausea response, getting ahead of the vomiting and turning off those signals can be very difficult. You are best advised to keep working with your surgeon to find the right combination of medications that will help your wife. This could take some time with trial and error before the optimum aproach is discovered. Be patient. Don't give up. The situation may seem difficult but it is not impossible. Time will help as well but that's not very comforting when you are suffering.

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