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Any tips on pain management for avascular necrosis?

I was diagnosed with stage 2 kienbocks disease december of 2019. Since I am still in an early stage of the disease my doctor performed core decompression of the distal radius in attempts to slow progression of the disease. He also repaired a torn tfcc during the surgery. I've recovered from the surgery and my pain levels are now more tolerable however when sleeping at night I find that my wrist pain often flares up. Any tips for managing this kind of pain at night?
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As far as night pain, I do not like taking anything but have found that propping elbow between pillows to keep arm raised up helps.  I was not diagnosed with Kienbocks until my hand doctor did arthroscopic.  I am a 62 year old healthy female that never had that "ah ha" moment that I did anything but I am quite active. I woke up one night literally crying in pain.  After a month of not being able to deal with it, saw ortho and got cortisone shot which helped somewhat.  Had MRI but no one mentioned dead tissue.  I was told it was synovitis.  Ortho sent me to hand specialist that basically said same thing and scheduled arthroscopic as I insisted I could not continue like this (and I have a very good pain tolerance).  He debrided a fairly large flap central tear.  Then noticed significant loose cartilage along ulnar and central aspects of the lunate, which was debrided and found bone beneath very spongy and not normal subchondral bone.  he shave to smooth surface to a stable edge.  As he put it to my husband "I found pieces of bone and cartilage floating around where it shouldn't have been".  He said he would have to discuss with colleagues as he had not seen this before. Bandages off today and PA told me I have Kienbocks. After reading every thing I can on it, I had all the classic signs but I guess since not a common disease, they didn't know what it was.  Still some swelling of course  and pain (feels like burning),  told to do exercises to regain ROM.  I opted not to do PT at docs office as I feel I can do these at home and it would be a 2 hour round trip.  From what I have been reading, it sounds like this never goes away.  I was given the impression that they fixed it.  Now I guess I just wait to see if the pain comes back?  
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Wow, seems you went through a lot to get diagnosed. I spent months with pain and poor ROM thinking I had torn something in my wrist from work (lots of heavy lifting and pushing and pulling) until I finally got tired of it and went to the doc. Doc ordered x-rays and thought I had osteoarthritis so sent me to ortho. I got lucky and my local ortho studies rare diseases during his freetime so I was diagnosed and sent to a hand and wrist specialist rather quickly. I have different wrist supports that I switch through depending on my needs but unfortunately haven't found any way to ease pain at night. It's progressive and there's no cure so after my initial decompression surgery I was told to basically not come back until I couldn't tolerate the pain anymore. At that point all they can really do is remove the bone and perform a full or partial fusion on the others. Your ROM becomes extremely limited to the point of almost nonexistent so I'd like to avoid a fusion for as long as possible since I'm currently only 23 and already struggle to do basic tasks.
973741 tn?1342342773
Wow, you've been through a lot.  Do you try to sleep with the hand propped up a bit or elevated?  I believe that is the recommendation, to be above the heart especially.  Get some pillows beside you and sleep on your side if able to do this elevation.  Are you taking pain medication even nsaids?  Nighttime would be good for that to help.  Also, perhaps ice before bed would help set you up for the night too. The other thing that they often suggest is 'gentle motion'.  Have they given you some movements to do to stretch and move it a bit? You could keep your ibuprofen or acetaminophen right by your bed in case you wake at night uncomfortable and need to take some to get back to sleep.  

I've also read that avascular necrosis pain can become worse at night.  Ugh.  They may recommend nsaids at night for that too. Do they have you working with a physical therapist?
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I've tried elevating it and sleeping with supports or braces on but it doesn't seem to help any. I havnt tried sleeping on my side with it elevated so I'll have to give that a try. The specialist I see said that physical therapy wouldn't be of much use for me and to just continue using it safely, as much as I can. I havnt been given any specific exercises to do however I was shown one that I can do which sometimes helps to ease the pressure on the bone from swelling. I do it often during flare-ups and it does help some but it only really helps the initial sharp/stabbing pain but none of the long lasting aching pain which is what keeps me up the most. I found that using ice doesn't seem to worsen or lessen the pain any but a warm damp rag does help some.

My biggest issue with finding a way to help manage pain is that most people recommend medication however that isn't an option for me. Due to prescriptions I take for other health conditions (primarily hormone imbalances and epilepsy) I cannot take the majority of pain medications including those that are OTC. What few I can take have to be low doses (for example I can take baby aspirin) and even then I have to still be extremely cautious and use them sparingly. It's not really something I can have on a nightly bases.
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