Pain relief without meds...

[JHuxlet]

Hi

I have had a seris of ankle reconstructions, arthroscopies and other porcedures to and relieve pain and increase my mobility. I am still in lots of pain and can't walk well. Over time I have been on different pain med combinations. Currently I am only taking Tramadol HCL. My body has become very addicted to the drug, but I am not mentally addicted, in fact I want to stop as I don't like being addicted to things.

This presents me with a problem as I am still in need of pwin relief and am likely to be for the rest of my life.

Any suggestions for non-drug therapies?

[Red931]

My ankle reconstruction was February 18th, 2009. Prior to that I have had 8 shoulder surgeries since August 18th, 2006 and as I said it looks like there is going to be another. My ankle was scoped back in December, 2004 and that procedure got me by for a little over 4 years.

I will look into Arnica. Currently I use the Multi-Purpose Massage Cream that they use in Physical Therapy. I have injured my right ankle the same way back in 1991 almost exactly a year after the left one. It hasn't bothered me as much as the left but it is acting up a little bit now because of the extra weight being put on it. The pain is on the outside of the ankle where I tore the ligaments.

I also have the pain that you are describing in my toes as well as the numbness and shocking sensations along the side of my foot. I still can't wear a pair of sneakers. I have to wear my house slippers everywhere.

[JHuxlet]

Sorry to hear you are having a hard time. Thanks for taking the time to chat to me I have enjoyed swapping stories and thoughts with someone who understands and has been through similar expreiences..

How long ago was your surgery? It sounds quite recent, if this is the case then I think its normal. I experienced similar things in the first 3-6 months. Just odd shooting pains and sensations like things are crawling on and under  your skin. i was told a similar thing and thats its part of how the nerves 'wake up' post surgery. It gets very annoying specially the crawling thing! I also had aches in the joints of my toes and other parts of my foot due to it being imobile for so long. Hot baths really helped.

I am quite into herbal remadies for things and always take Arnica for a few months either side of the surgery. It can help with bruising, swelling and healing. It comes in tablet and gel form. I use the tablets throughout and the gel when the wound has totally healed and the scar is properly formed. I did not do this for the first surgery, but have for the rest and it seems to really help and speed up healing especially in the early days. It should be in health food stores but I am in England so don't know about US

I am due to see my surgeon the day after you. I am being re-evaluated and assume this will mean a short appiontment to book another MRI or other type of scan. I have to wait at least a year untill he will considered another operation and it's going to depend on how it heals. I have developed another area of pain around the joint from the big bone of my leg. My physio thinks it's either a group of spurs or cartalidge/capsule damage but i wont really know till scans are done. Think this will mean another operation later this year.

[Red931]

My last surgery was similar to yours except my ligament and tendon grafts were done with donated organs from someone else. I also had to have a small joint by the talor dome removed as I had crushed it years ago and cysts were continuing to form there. I think I told you about that earlier.

I am being told it will take 10 months to a year to heal from this surgery. Lately I have been experiencing a stinging pain that shoots through my ankle joint to my heel. The surgeon said this is pain from the nerves and resolve itself over time. It started as soon as he took me out of the walking boot on Tuesday and has been constant ever since. It amplifies the throbbing pain that goes into my foot and toes.

I think it is healing well compared to my shoulders, especially the right one. I have to get an EMG tomorrow morning and then go back to have another surgery scheduled on May 18th, which apparently is unavoidable. I have already got a second opinion and surgery seems to be the answer. If nerve damage is found tomorrow I will have to see a different specialist for that. I am a bit bummed out over the fact that my arm will be in a stabilizer and then a sling for the entire summer again, but it is impossible to get a decent night's sleep with shoulder pain and like you I would like to be able to one day not have to take any pain medication at all.

[JHuxlet]

Hi

Thank you for your responses. Sorry I did not explain the ligament thing properly, I am dyslexic and somtimes muddle things. I get the doctors to explain exactly what has been done each time after the surgery as I think its important to know. Below is a brief account of what happend. I missed out the minor op's (Arthroscopys) to remove excess scar tissue and spurs etc.

They took an old reconstruction, an Evans tendosis, out and put in a different kind of reconstruction using part of the  Ligament that was there from the Evans, after first splitting it to make it smaller. This was then fixed to the Talar joint creating stability.

With an Evans tendosis they take a ligament that is in your leg that you dont really need/use and split it to make it thinner. They then drill a whole just above your ankle on the fibular (smaller bone) and feed it through and then attach it, I cant remember where but quite low down.

Over time the way in which the scar tissue delevoped and due to it moving slightly (I slipped and jarred it badly), it began to restrict the movement in my sub-talar joint and heel. Spurs formed and the cartilige got damged.

So when my doctor opened it up to sort it out he ended up having to remove the cartalidge, he did not want to do this originally. Cartalidge cannot re grow exactly, but a kind of tissue that works sort of the same can. But its not as good as cartiladge.

What they do to stimulate the growth of this new tissue is get a little pick and puncture lots of tiny holes in the surface of the joints to make them bleed. Over time this bruising affect casues this new tissue to grow. So yes for a while it was bone on bone but I was in a plaster cast for 4 weeks then a removable air cast for 12 weeks. It was another 4 weeks before I was allowed to weight bare. The tissue can take 6-12 months to fully form and heal.

Hope this helps to clarify things.

Jay

[Mollyrae]

Hello JHuxlet and welcome to the Pain Forum.

You have received some sound advise from Red and Nick. I would like to add their comments. Please don't feel like you have an addiction....you DO NOT. You like most of the rest of us need pain relief and this means taking pain meds. They are available for ppl like us so that we can lead a normal productive life...Participate in society you might say.
You no doubt have a dependancy on the Tramadol and that is normal. With the Tramadol not working and you being dependant on it, you might want to consider seeing a Pain Specialist who are very knowlagable in treating your pain in a professional manner.
Don't let society play a role in that. You need to fix you. You are the one who needs to be comfortable. A Pain Specialist will do that for you and ease the burden of your daily pain. Make an appt. with one and go from there. I'm sure that they will have some good suggestions for you.
It it a proven fact that you don't heal as well when your in pain and when the pain is lessened, you can start that process. Don't be afraid of medication.
Please take care and I hope that you use the advise given.
Mollyrae  

[Red931]

Unfortunatley, you are in the same position as most of us are in and facing the possibility of having to take pain medication for the rest of your life.

I am still a bit confused as to what was done in your ankle.Do you mean that you had to have a new ligament graft done last September? I am asking because if a ligament was just removed it would make the ankle very unstable. The fact that you had cartilage removed makes it even more unstable. Was there something artificial implanted in there to replace the cartilage? I would think there would have to be or it would be bone on bone.

Has your Orthopedic Surgeon told you that an ankle replacement may be necessary in the future?

You know the thing with the ankle is that there is no room in there for anything extra so even a ganglion cyst will cause severe pain. Once we have these surgeries to get stability back due to injury we sometimes end up with a more stable joint but with not much pain relief, especially if the patient is over 40 years of age.

My injury has ended my career as a police officer. I am glad my Orthopedist was able to get me as far as he did. I injured it back in 1990 and he was able to keep me in the game all the way up until now with a couple of Arthroscopic Surgeries. The problem is the delayed manifestation that occurs because you have to put all of your body weight on the joint everyday. If you are in a very physical occupation as I was it will breakdown on you sooner than the average person. I was pretty lucky.

[JHuxlet]

Hi

Thank you all for taking the time to reply I appreciate any advice. i am not sure if I worded my question very well though.

My last surgery was in Sept 08. This was to remove a ligament reconstruction and to examine the joint surfaces. Unfortunately the cartalidge was very badly damaged and had to be removed so this has caused additional pain. I have tried most of the things that Nick30 suggested as well as a few other things. I have tried TENS machines but these dont help anymore, in the past these provided some level of relief. I guess I was just wondering if there is something I had not heard of that could help.

I have been on codeine phospate in the past but had problems with side effects so was switched to Tramadol. When I tapered the codeine I had very few w/d's. I have been tapering the Tramadol very slowly and am still getting w/d's. I have gone about as low as I can but the pain is starting to get worse. I am trying to aviod upping the dose again and was looking for alternate non-drug therapies.  Guess I'll go talk to my GP...

[Red931]

BTW: As you probably already know, you don't want to be soaking that ankle for quite sometime as that scar should be pretty bad for sometime and you don't want your foot to get water logged. You should take showers and remove any dead skin and apply
Multi-Purpose Massage Cream on the scar and on your foot.

I don't know how long ago your surgery was but if it has not been much longer that me your ankle is problably still very purple and painful along the incision. The other pain that you are experiencing is nerve pain. Those stinging pains that go though the joint are from nerves and it takes forever it to heal.

I also have similar problems with my shoulders as I have incisions over the long thorasic nerve that have caused damage to the nerve. We will have to speak about this another time as it is bothering me right now and I haven't done my daily trackers yet.

[Red931]

Nick has given you some very good advice. I too have been through many surgeries in the past two years such as an ankle reconstruction as you have had and multiple shoulder reconstructions. I am heading into another shortly. It takes 10 months to a year to get some relief on the ankle reconstruction maybe longer depending what you had done, number of grafts, screws, plates, etc.

You may want to talk with you doctor about a pain medication that is time released for your current condition. As Nick stated there is a difference between addiction and dependency. You should not have much trouble coming off a medication once you have become dependent on it for legitimate pain. You slowly and safely wean off of it.

I am down to just about half of my dosage since my last surgery in February. My current dosage (Oxycontin 20mg. 1 daily and Percocet 5/325 1-2 daily for breakthrough pain)  keeps me at a toleratable pain level. I am by no means pain free. You should not be totally pain free. You have to use alternative methods to make you more comfortable thorughout the day. IcePaks, Heat, Stimulation, Physical Therapy, etc.

I hope this helps you.

Good Luck

[nick30]

Hi there,

I'm sorry that you're experiencing alot of pain. Most if not all people on strong painkillers experience physical dependance to thier meds. You should not feel bad about it but if you want to get off tramadol then i suggest that you involve your dr in the decision making process as tramadol can have serious side effects when reducing the dosage.
There are of course many different ways to treat pain and i think the best thing for you to do is to not focus on any specific technique but rather to do as many things as you can that help relieve your pain.
You are probably well aware of many of these techniques already, such as using hot/cold packs(or showers/baths), chiro/physio, excercises, stretching, having a healthy diet, keeping your mood positive, trying to take your mind of pain (distraction techniques), etc.
If you involve as many of these options at the same time you will probably have more luck compared to just trying to rely on one particular thing(unless of course there is one thing that really makes a significant difference to your pain levels).
Have you discussed this with your doctor? I'm sure he/she will have some options and opinions for you.
Have you found any techniques that reduce your pain yet? or are you really starting from scratch?
It might be worthwhile going through some older posts to see if anyone with similar problems to yours have been able to find something that works for them.
Be sure to include keywords in your search as this will help turn up more accurate results.
Also there are a few nurses who post here, they may be able to give you some more specific advice.
Best of luck,

Nick