Your Guide to Post-Operative Pain Control After Joint Replacement

Undergoing joint replacement surgery is a major step toward improving your quality of life. However, minimizing pain during your recovery is crucial for a smooth healing process. The first step in achieving this goal is minimizing trauma at the time of surgery. Click here to learn more about the benefits of minimally invasive joint replacement.

But what about after surgery? With so many different pain management options and protocols available, it can be overwhelming to know which one is right for you. This guide explains how Dr. Trevor Stefanski’s pain management plan works, the rationale behind it, and the levels of treatment available to keep you comfortable during your recovery.

Why a Multimodal Pain Plan?

Instead of relying on a single medication, a multimodal pain management plan targets pain from multiple angles, giving much stronger relief. When used in the right combination, the pain-relieving effects don’t just add, they multiply! This approach reduces the need for higher-risk medications like opioids, keeping you safer with fewer side effects, and promotes a faster recovery.

The pain management plan described below is intended for a healthy individual. However, your personal medical conditions and other factors may require medication adjustments. Always discuss with your provider before implementing or adjusting any medication regimen.

The “Levels” of Pain Management According to Dr. Trevor Stefanski

Level 0: Rest, Ice, Elevation, Compression

The foundation of your pain management plan starts with non-pharmacological methods. Rest, ice, elevation, and compression reduce swelling and improve your comfort naturally. The impact of these simple interventions is often underestimated. Don’t skip this step!

Bonus: During the first 2 weeks, Dr. Stefanski typically prescribes tranexamic acid (TXA), which works to prevent microscopic bleeding. A two-week regimen has been shown to reduce swelling and pain and lead to better function at the six-week mark compared to placebo.[1]

Level 1: Acetaminophen (Tylenol)

Tylenol provides baseline pain relief by blocking pain centrally. It is well-tolerated, does not affect the stomach, and has very few side effects. Most patients take Tylenol every 8 hours for the first 1-2 weeks to maintain baseline pain control as pain subsides.

Level 2: Anti-Inflammatory Medications

Targeting inflammation is essential for recovery. A study by the American Family Physician (2018) showed that 400 mg ibuprofen combined with 1000 mg acetaminophen provides pain relief comparable to Percocet, making it a powerful alternative to opioids.[2]

NSAIDs: Nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen, and meloxicam, are excellent at reducing inflammation.
Steroids: Prednisone or other steroids can help minimize swelling and pain, leading to a faster recovery. Clinical studies show that steroids, when used appropriately, provide significant pain reduction and inflammation control during recovery.[3]

Note: Use either an NSAID or a steroid, but never both at the same time, as this combination can increase the risk of gastrointestinal issues such as ulcers. Always follow your provider’s instructions carefully.

Level 3: Cannabidiol (CBD)

CBD targets the endocannabanoid pathwas, and offers natural relief. Studies show it is especially helpful for nerve pain, anxiety, reduce need for addictive narcotics, and can improve sleep quality post-operatively too! [4] Be cautious with over-the-counter CBD products, as most contain small amounts of THC, which can have mind-altering effects and may cause a positive drug test for marijuana.

To ensure a safe, THC-free experience, Dr. Stefanski recommends Corganics, a pure CBD option available exclusively available by physician referral. For more information, please discuss this option with Dr. Stefanski at your next visit.

Level 4: Pregabalin (Lyrica) and Gabapentin

The skin contains a network of microscopic nerve fibers. While larger nerves can be avoided during surgery, small branches are inevitably affected. Gabapentinoids such as pregabalin and gabapentin help stabilize nerve membranes and reduce pain caused by irritated or damaged nerves at the surgical site. These medications play an important role in managing post-surgical nerve-related pain and have been shown to reduce the need for opioids.[5]

Level 5: Antispasmodics AKA Muscle Relaxants (Optional)

Even with muscle-sparing techniques, retracting muscles can cause irritability that may lead to spasms. This level includes medications to address muscle spasms:

Muscle Relaxers: Medications like methocarbamol, tizanidine, and cyclobenzaprine help alleviate discomfort from spasms by reducing muscle irritability. These medications are sedating, so they are recommended only when spasms are present. If you’re not experiencing spasms, the side effects may outweigh the benefits.

Methocarbamol is Dr. Stefanski’s preferred muscle relaxant, as it works well, has few side effects, and is less sedating than many other options.

Level 6: Opioids

Opioids, such as oxycodone and hydrocodone, are reserved for breakthrough pain that cannot be managed with other treatments. They have the most side effects, including constipation, nausea, itching, and respiratory depression. Additionally, opioids are addictive, and studies show that even a short three-day regimen can begin to induce physiological dependence.[6]

It is essential to use opioids sparingly and to wean off them as soon as possible to minimize the risk of side effects and dependence.

Your Recovery Matters

Pain management is an essential part of your recovery journey. By following this comprehensive, step-by-step approach, we can minimize your discomfort and get you back to doing what you love as quickly as possible.

If you have any questions about your pain management plan, don’t hesitate to reach out to Dr. Stefanski and his team.

References

1. Journal of Arthroplasty, 2024. "Extended Postoperative Oral Tranexamic Acid in Total Knee Arthroplasty."
2. Slawson, D. "Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain," American Family Physician, 2018.
3. Clinical Research Highlights, "The Role of Steroids in Postoperative Inflammation Control," 2023.
4. Study on Cannabidiol in Postoperative Pain Relief, 2018.
5. Analysis on Pregabalin and Gabapentin Efficacy in Reducing Opioid Use, Pain Management Journal, 2022.
6. Opioid Dependence: Risk Factors and Early Onset, Pain Medicine Reports, 2019.