How to relieve pain after bunion surgery and how can Multimodal pain therapy work for you?
Unfortunately, all surgery comes with some degree of pain, and there are always a few snake oil salesman surgeons trying to convince patients that they will not suffer any pain after surgery to get them to schedule their procedure. In the current practice of medicine, most surgeons only prescribe a narcotic(opioid) medication like hydrocodone for post-operative pain. This only address one source of the patients pain, and while it does reduce pain, often results in higher, unnecessary levels of discomfort for patients.
Narcotic medications are often the only pain medication prescribed by surgeons after surgery.
If you have had surgery before, you probably remember heading to the pharmacy and picking up your prescription to help control your pain, most often a narcotic(opiod). These medications are often required, but there are ways to reduce there use.
The discovery and use of opiods for pain control was a revolutionary change in how patients were treated after injury or surgery, but they don’t fully reduce post-operative pain. Also, due to the opiod epidemic, opiods should be used for as short a period of time as possible.
Most foot and ankle surgeons today prescribe only one medication after surgery for pain, an opiod medication like hydrocodone, oxycodone, or codeine. These medication works by blocking pain receptors in your body that record the message that you have had a trauma, and then send that message to your brain. Opiods do not reduce swelling or help increase the rate of healing. When used in isolation, patient often experience prolonged pain, only finding relief when taking high doses of these medications. This is a problem.
Unfortunately, for the majority for patients, alternative non-narcotic medication do not control the pain of surgery as well as opiods, so what are we to do? Fortunately, another option exists for preventing excessive post-operative pain, a treatment regimen called Multimodal Pain Therapy.
There is a better way to control pain after any surgery. In my practice I employ a practice called multimodal pain therapy. Multimodal pain therapy is a method to reduce pain by not only blocking the pain receptors like a narcotic, but also treating the swelling an nerve irritation that occurs after any surgery.
6 month post-op after Lapiplasty correction.
Before proceeding with Lapiplasty® 3D bunion correction, my patients will have a pre-operative appointment. At the pre-operative appointment, patients will receive strict instructions on activity, elevation, use of a walking boot and an icing regimen. Following these tenants precisely goes a long way to reduce pain by keeping swelling to a minimum, one source of pain. In addition to these instructions three types of medication will be prescribed, each with a different mechanism of action to cover possible cause so of pain.
1) Opioid/Narcotic – This is a necessary evil, but use is brief. We want to reduce the need for these medications, and while you will receive a week’s worth of this medication, typically Hydrocodone, the full bottle is often not even completed. In my practice it is rare for a patient to request a refill on these prescriptions. This medication will also contain Tylenol which has been shown to be very effective at controlling post-operative pain.
*If you have an allergy to narcotic medication, a specialized nerve block can be performed that lasts three days and an alternative non-narcotic pain medication can be prescribed as well.
2) Anti-inflammatory – a strong anti-inflammatory drug will be administered in the operating suite into your IV, and a prescription for this medication will also be provided if there is no history of issues with nonsteroidal anti-inflammatory drugs for the patient. This drug acts to reduce swelling after surgery, a causative factor for post-operative pain. This medication will be taken for 5 days, but often an over-the-counter alternative can be recommended after it is complete.
3) Nerve modulating medication– a medication will be prescribed that is most often used for patients with nerve injuries. The foot has many nerve branches, several of which are gently moved during 3D bunion correction, and sometimes small branches need to be purposefully cut to prevent long term pain. These nerves are a source of some of your pain after surgery, but are not most effectively treated by narcotics or NSAIDs. Beginning this medication several hours before your procedure then taking twice daily helps to greatly reduce post-operative pain, and can aid patients during the nighttime hours sleeping.
All three of the medications prescribed for you, can help reduce pain in isolation, but when taken together show vast improvements in patients reported pain after surgery. A regimen will be established for you to alternate these medications, alternating the narcotic and NSAID every three hours, so when one tablets effectiveness starts to diminish, but you are not ready for a scheduled dose, you can take the alternative medication reducing your pain. While pain control is the most important reason for this regimen, another amazing consequence is patients rarely feel the need to continue narcotic medication after the first 5-7 days in my practice. Most patients also opt to take over the counter medications once the 10 day regimen of nerve medication is completed
In my practice, the benefits for patients on multimodal pain therapy versus narcotic medication alone are as follows
1) Less post-operative pain
2) Quicker transition to over the counter medications with less potential side effects
3) Less narcotic side effects
a. Constipation
b. Nausea
c. Vomiting
d. Allergy (itching)
e. Addiction in rare cases(prolonged use)
4) Less post-operative swelling
5) Improved ability to sleep in immediate post-operative period
6) Fewer opioid pills that could be abused in community
Remember, every patient is different and each patient plan for post-operative pain is different. Do not take any medications that are not recommended by Dr. Paul Steinke during your recovery without first discussing with him or his staff. If you are experiencing any side effects from a medication prescribed for you, please call office immediately.
While pain after surgery is a reality, moderate or severe pain does not have to be a reality for you with Multimodal Pain therapy and Dr. Paul Steinke, the 3D Bunion Doc.
Minimal incision bunion surgery and Lapiplasty differences