Limb Lengthening Forum
Limb Lengthening Surgery => Information About Limb Lengthening => Topic started by: mediocre on January 30, 2014, 02:12:00 AM
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I think everyone would agree that one of (if not the) most pressing problem for LL, post-surgery is pain. I don't know if there's any thread in old forum discussing each oral painkiller and reviewing.
Now, to begin with, I work in the ER and I know that each patient would respond differently from different types of painkiller. And to make it worse, pain is a very complicated bloke—there are different types and in fact, there is a subspecialty in Anesthesiology where doctors get subspecialized in pain control alone.
Types of Pain
But for all intents and purposes, we'll be talking about bone pain and neuropathic pain (different from neuropraxia). Bone pain is an example of nociceptive pain (http://projects.hsl.wisc.edu/GME/PainManagement/session2.4.html).
During lengthening phase, the main cause of pain would be neuropathic.
In general, bone pain (http://learn.chm.msu.edu/painmanagement/neurobonepain.asp) is treated with paracetamol, NSAIDs +/- opioids (opioids are very poor bone painkillers).
In general, neuropathic pain (http://www.iasp-pain.org/AM/AMTemplate.cfm?Section=HOME&CONTENTID=15084&TEMPLATE=/CM/ContentDisplay.cfm&SECTION=HOME) is treated with meds with neuropathic component like opioids.
NSAIDs: eg. Ibuprofen (Advil)
Opioids: eg. Tramadol, Oxycodone
Technically speaking, paracetamol and NSAIDs have no neuropathic component, but in real life, they may augment the opioids in treating neuropathic pain.
Then the question of NSAIDs affecting bone healing. I can tell you now that there is not a good evidence supporting this. Link 1 (http://www.medicine.ox.ac.uk/bandolier/booth/painpag/wisdom/nsaibone.html) | Link 2 (http://www.ncbi.nlm.nih.gov/pubmed/20552333)
Aside from the painkillers mentioned above, there are adjunct meds (http://www.tneel.uic.edu/tneel-ss/demo/comfort/frame3.asp)—the plan B/C kind of analgesics like anti-depressants (TCAs like aminotryptiline), anti-convulsants (carbamazepine), anti-hypertension (clonidine), steroids, cannabis, and many others. There are also non-pharmacologic agents aside from these drugs, to treat pain, and also probably psychological route of treating pain.
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With this aside, I'd want to ask LLers what's the:
1. Best painkiller for each phase of the journey?
2. Side effects, if any, of each? (For me, tramadol makes me nauseous, and in general opioids can cause constipation and drowsiness), including the most addictive
3. Worst/No effect painkiller?
4. Onset? (fastest and slowest, in minutes, hours)
Again, each patient's response would be different and each country has different regulations, but I want to know what's your review from every painkiller you tried.
This is a good info to know so future LLers would opt to bring their own painkiller that is suited to them rather than experiment each drug during the journey.
Thanks.
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Nice idea... as pain is the hardest part of LL. I wouldn't mess around and experience things on my own. I would take what my doctor prescribes to me.
As I like to do things the healthy way, I like to minimize my intake of painkiller as much as possible. Painkiller increases your risk for stomach ulcer. I would only pop a tablet only when it becomes unbearable (it's always unbearable).
I didn't find tramadol work that well for me. However, I heard from other patients that it has worked for them. I prefer mobizox. It's a muscle relaxant. I find myself falling asleep more easily taking mobizox. As with all painkiller, they wear off as you take them more often. So you would have to take a higher dose in the middle and near the end of your lengthening phase to achieve equal result. Again, that's why I would try to minimize taking them as much as possible and only save them for when it becomes unbearable. Because you know you would need it near the end.
Beside taking the prescribed medicine, I enjoy a daily dose of comfort food like a chocolate bar or a bag of potato chips. These food provide a boost to morale. If you find your pain becomes unbearable, try watching porno. Seeing all those perfect bodies will make you eager to accomplish your goal or as well as getting that 8 seconds of pleasure... I didn't watch porno b/c my ex girl took that all away from me.. you can find out from my diary.
As I mention before, I find the hardest part of LL is the lengthening phase. Many ppl fail to reach their goals because of the pain or having other complication, like a serious infection. I would try to get the length as quickly as possible. Once I achieve my lengthening goal, I would be happy. Then concentrate on your recovery, which is a breeze.
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All they had in Beijing was Tramadol, and they were very stingy with it. If you really complained you could also get some ibuprofen, but only a temporary short-term course.
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The nerve pains can be pretty gnarly, and it's the only time I've opted for a pain killer. For general pains in the muscles I'll have a beer to dull it, lol.
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May Novalgina be a good help against LL pain?
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Hi I'm half way thro ll and the pain relief I use is butrans patch trampoline and paracetamol then I take vit d supplement as nd calcium and magnesium supplements and a b complex supplement. ...I also take lanzopazole to line my stomach as I have ulcerative Coltishall so can't take anti inflammatory. ...I've started to use diazapam after ll with my machine to relax the muscle 3 times a day....I ice pack every 3 hours to reduce swelling if any or just to help with the ache.....avoid warm compression.....
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Which doctor did you have your LL with?
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This would have been a great article if it was complete. I need some pain med guidance myself
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The best pain management method is a multimodal method.
It needs to be classified by type of pain:
Surgical and post operative pain, Lengthening pain, neuropathic pain, or pain related to complications such as unstable construct, Deep venous thrombosis or stress fracture.
1) For surgical and immediate post operative pain, Epidural is recommended. It helps with immediate rehab while in the hospital.
We also use tylenol around the clock and Toradol which is a strong anti inflammatory for 24hours after surgery. Low dose opioids such as oxycodone or TRAMadol are recommended for breakthrough pain although they are highly addictive. Opioids should be the first medication to be stopped.
2) I recommend tylenol throughout the course of lengthening as pain managemwbt adjunct.
Non Steroidal Anti Inflammatory Drugs (Nsaids) such as ibuprofen, naproxen had a bad reputation for a while as they were blames for poor bone healing but this myth has now been debunked They are very safe to use during lengthening. Opioids have actually been correlated with delayed bone healing more than NSAIDS
3) sometimes during lengthening, patients may develop neuropathic pain from nerve stretching
the first pain management method in those instances should be to slow down lengthening and allow some nerve recovery
Gabapentin or Pregabalin can be used to decrease nerve pain
4)pain related to complications such as blood clots or stress fracture are best treated by management of the underlying complication. This is why thorough followup is required by the surgeon. Pain related to muscle tightness can be alleviated by night time bracing and aggressive physical therapy
Hope this helps! don’t hesitate to PM me if you need more information
Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
www.limblength.org (http://www.limblength.org)
massayag@lifebridgehealth.org
@bonelengthening on Instagram
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The best pain management method is a multimodal method.
It needs to be classified by type of pain:
Surgical and post operative pain, Lengthening pain, neuropathic pain, or pain related to complications such as unstable construct, Deep venous thrombosis or stress fracture.
1) For surgical and immediate post operative pain, Epidural is recommended. It helps with immediate rehab while in the hospital.
We also use tylenol around the clock and Toradol which is a strong anti inflammatory for 24hours after surgery. Low dose opioids such as oxycodone or TRAMadol are recommended for breakthrough pain although they are highly addictive. Opioids should be the first medication to be stopped.
2) I recommend tylenol throughout the course of lengthening as pain managemwbt adjunct.
Non Steroidal Anti Inflammatory Drugs (Nsaids) such as ibuprofen, naproxen had a bad reputation for a while as they were blames for poor bone healing but this myth has now been debunked They are very safe to use during lengthening. Opioids have actually been correlated with delayed bone healing more than NSAIDS
3) sometimes during lengthening, patients may develop neuropathic pain from nerve stretching
the first pain management method in those instances should be to slow down lengthening and allow some nerve recovery
Gabapentin or Pregabalin can be used to decrease nerve pain
4)pain related to complications such as blood clots or stress fracture are best treated by management of the underlying complication. This is why thorough followup is required by the surgeon. Pain related to muscle tightness can be alleviated by night time bracing and aggressive physical therapy
Hope this helps! don’t hesitate to PM me if you need more information
Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
www.limblength.org (http://www.limblength.org)
massayag@lifebridgehealth.org
@bonelengthening on Instagram
Cannot emphasise enough how overrated tramadol is, it does not even equal to half the power of say codeine.