Hyperalgesia (Rebound Pain): OUCH! Do I have this?

[Miss_Creative]

Hi! Me again with another one of my wordy posts! So here it goes: I’m 5 weeks post surgery and I feel like my knee shouldn’t be hurting this bad. I'm in a ton of pain today. I was wondering if I am experiencing this “Rebound Pain” I’ve seen on this forum. If you have experience or knowledge of this, I would love to hear from you! Here's the scoop:

• I still have opiates in my system. I’ve cut down from 15 Norcos/day to 5.5 Norcos/day. Is Rebound Pain something you get only after all the opiates are out of your system, or can it happen during a taper?

• There's no denying I am still grinding bone-on-bone when I extend my knee. It hurts something awful every time the kneecap gets caught and then “pops” to rest in its groove. This is why I had surgery in the first place. But could I be feeling more pain than I am actually having? Also, I have NEW pain under the kneecap, on the right side. I’ve never had pain here before… but it’s driving me mad and hindering me from walking down the stairs without wincing. I saw something online about "Phantom Pain" – am I experiencing that maybe? Not sure what it even is.  

Before I have my follow-up with my Orthopedic Surgeon, I want to know if my mind is playing tricks on me. I don’t want to make a huge deal out of something that is “Fake Pain” because I’m scared the doctor will ask why the Norco isn't helping (he doesn't know about my tolerance, only my GP does), or put me on Prednisone, or even suggest another arthroscopy or surgical procedure. Please shoot me if that even comes up.

I know I deserve this pain for being an idiot about pills in the past. I am sticking to my 5.5 pills/day taper. Please know I'm NOT asking permission to take more painkillers.

SO... Is this real pain? Or am I cuckoo for cocoa puffs?!?

[YesLife4Me]

It was a roller coaster for a while with his pain, pain meds, my addiction, etc.   Thank goodness that is behind us now.  He has more good days than bad now when it comes to the hip and knee, so I know you will get there too!   Had to laugh about the surgeon because that is how we felt when we would go in.   Write down your questions before you go in so you can get them addressed.   Make sure he explains everything to you.   Our experience was that surgeons are primarily concerned with the surgery and healing time they are under your care, so you may need to enlist the help of your primary Dr after the surgeon releases you.   There were so many things the surgeon didn't cover with us as far as what to expect, healing time, and such.   We had to piece things together with help from the PT, Home Health Nurse, Surgeon and Primary.   I feel for you.   (hugs)

[Miss_Creative]

Interesting... Good to know! Ugh - this makes me wish I could taper even faster so I can access myself better. Exercise is such a huge part of me getting off painkillers, and I have no clearance do to squat. Thanks for sharing!

[ricart70]

Hey ..sorry about your new pain. I just wanted to add that I broke my arm a couple of years back when I was in the midst of a huge oxy habit.I broke it badly,two bones in five or six pieces.It did stop hurting and became stronger but not until after I got completely off of the oxys.Then a month or so later it became stronger and stopped hurting nearly as much.This pain may be due to the fact you have cut your consumption but are still taking a decent amount and the jury is still out in your brain on whether or not to start producing endorphin.

[Miss_Creative]

Good call on the nerve damage, maybe that's what's going on... I will mention all this to my Surgeon. I mean, I have been on Norco for Knee Pain as RX'd by him since June. I feel all guilty about the pain killers I took before that for recreational use, so I tend to hide my dependency. But, I think I've been on them long enough from him - I can have this conversation without feeling silly. He's a busy Surgeon so who knows if he'll even listen! IN and OUT like lightning. I'm often left wondering... wait... so am I supposed to get an MRI? Or go to PT? Or come back in a month? Me confooosed. Thanks for reaching out! I hope you and your BF are doing great these days :)  

[Miss_Creative]

Thanks Barb! I guess since I'm not fully off the meds, I can't access much. That's what it sounds like. Wow - you're friend is a trooper. Getting over a surgery is difficult when you abused pain killers before you needed them - STUPID ME. So, there's no way I could have counted on my natural pain killers to kick in after the surgeries to help me out. I would have probably ended up in a padded room. Prednisone scares me because I'm very sensitive to steroids. I took them when I had MSRA and I felt like crap and got migraines. But maybe that was the infection. Really, yes, I'm terrified of the side effects - losing my hair, moon face, weight gain, sleeplessness... Plus I already have so much cortisone in my knee, I have to wonder - do I really need more of this kind of stuff. Argh! I know if I complain about more pain, there's a good chance I'll get on it. But, if this pain I'm feeling is more in my head - then Prednisone wouldn't work anyway, right? Then I'd just be taking more pills! Conundrum. That's for the response! Very helpful :)

[YesLife4Me]

Yep, he says it is a nerve pain too.   Dr said it has to do with nerves being cut and then healing.   BF says the nerve pain is worse than the actual surgical pain.   I would mention it to your Dr.    Rebound pain is real pain.   Our minds have quit putting out the natural pain killers since we have force fed it pain meds.   When we take away the pain meds, our brain doesn't know how to respond to pain.  It's been asleep for a while, so to speak.  It is screaming for us to take something for the pain since it can't right now.   In the meantime, the pain that we have is coming from the lack of pain meds to control it along with our brains inability to function properly to help control it.  As your brain heals, it will be able to start controlling the pain better.  

[BarbRTR]

Ouch, your pain sounds excruciating!! I feel so bad for you!
Why not prednisone? Afraid of weight gain? It's a God sent to a lady I know in her 60's. She has RA badly. Her hand bones are stuck in an awful position.
She had both knees replaced. She declined pain meds after her surgery ( same day) because she said it already felt better than pre surgery.
She is the strongest person I know. She gets LT and has probably taken 6 in a year. She hates the way they make her feel. But swears by the steroid.

I haven't been off long enough to help with the rebound pain question. A little over 6 weeks.

I do know, I had horrible stomach pain the first month, which I know was wd related. I have bladder disease which is painful, and gastritis, but that pain was totally different than the pain I have from the bladder disease. It felt like pure burning from the inside.

I was placed on LT prn for the bladder pain, then a year later  went to oxy for my back.

Those pains are the same now as when taking meds. I got relief from the medicine, but know what the pain feels like from the days I just took 1 in the morning, meaning afternoon the med was gone, so I know what it felt like on and off.

It's the same 6 weeks later, but I'm still waiting, as the rebound pain I learned of here couldn't have been evaluated during my afternoons with no pain meds, not enough time.

I certainly hope you feel better. That phantom pain is a strange thing. The stories of amputees having pain where a limb used to be. Pain isn't studied like it should be. Give an RX.

My friend gained zero weight on the prednisone. I love it when twice a year I get the descending pack. That's all my stomach can handle, and now I'm not allowed those because of the bleeding ulcers.
Have you tried Mobic? It's the so called easiest NSAID on the stomach.
I'm interested to know how long to really evaluate pain too.
Hugs! And post all you want or need!

[Miss_Creative]

Wow! A year of pain. Sounds like fun! So If I'm experiencing anything like your BF, then the pain is legit and I'm not crazy. This isn't "meh" pain - it's like I bend my knee and it feels like a nerve is being severed pain. I know these pills mess with your head so much, I'm sort of hoping it's more in my head and less in my joint. I guess I should probably tell the doctor how bad it is... I'm paranoid these days, you know? "What's wrong with me?" "What's that?" "WHO'S THERE?!" I would just hate to whine about something that didn't need to be whined about. Thanks for the response and advice - I do have a brace that helps with the knee cap, but it makes the new pain hurt more. I take 1200mg of Advil for inflammation and ice it every day. Hmpft. I'm going to continue my path of tapering and just deal. I am still curious about this "Rebound Pain" and how opiates induce it. Strange. Thanks again!

PS: When you post a question, you can also attach a picture. Option is at the bottom of the post :)

[YesLife4Me]

Hi!  How did you get the picture in your post?    As far as your knee goes, my BF had a hip replacement surgery in May and had in redone in June last year.  He has had pain in his knee exactly where you describe ever since.   It pops and grinds along with his hip.   The ortho Dr said it is part of the implants adjusting and fitting together.   One thing he does to help with his knee if to wrap it up in ace bandages.   Ice packs and heating pads are a help too.   He isn't on pain meds anymore, but when he was coming off them, his pain levels were all over the place.  Being a guy, he just toughed it out and kept downing the Tylenol or Aleve in between Vicodin until he was done with his taper.   They said it would a about a year before his pain really starts to subside.  So that may be also what you are dealing with.   :(