Total knee replacement nighttime pain control.AVI

A common after effect of surgery may involve a poorly understood effect similar to phantom limb pain that vets would experience.
I am 63 and having completed a staged bilateral TKA within a four week period I find that the most recent knee operated on insists on waking me up at night. For me, pain meds were only partially effective in easing the discomfort of the nightime 'phantom' pains. These pains seemed to arise simply from contact with the bed sheet or sometimes arise from my mind just anticipating pain.

Here is what worked great for me. Since my incision was well healed I applied some hand creame over the knee area and wrapped with the clear food service plastic film. This made for a smooth surface that did not seem to generate nerve stimuli for the brain to misinterpret as aches, sharp pains, dull pains, bone pains, etc.
If your incision has not fully healed I personally would completely wrap the knee once with a standard white kitchen paper towel and then apply the food service film over that. The paper towel contains the natural ingredient 'Lignin' from pulp which is somewhat antibacterial.
If you have a lot of nighttime pain try making a compress with a cloth towel soaked in hot water. Sprinkle on some epsom salt if you have it. Lay towel on the leg and then wrap with a plastic garbage bag or similar to keep the towel in place and prevent leakage to your bed. The epsom salts contains magnesium which typically has a relaxing effect on muscles, etc.
With my left TKA at four weeks post op, the plastic bag has been essential but I still had spontaneous nite aches in my leg muscles. A Physical Therapist specialist (Josh MIller with Body Structure Med. Ctr.) suggested doing the following:
"Take a suitable elastic band (e.g.theraband, etc) and tie the ends to form a loop. Lay the loop down as a linear form.
Grab each end and place around the TKA joint with one side of the band above the back of the knee joint and the other below. Fasten the two ends to an immovable anchor post at the same hgt. as your knee. Facing the anchor post and with the band pressing above and below the BACK of the knee (this is so you are not putting pressure directly on the center of the joint itself) move your leg back until you feel medium tension from the elastic band. Now raise up on your toes on the leg...increase the tension a little and then push the heel down to the floor. Do this about 25 times. I felt an immediate muscle/fascia release. My random muscle pain at night left for good. This really worked great for me.
I am 3 months post op on my right knee and everything seems to be pretty much normal. I did encounter a period of time in which I had a different kind of night time pain.
I determined that this was pain from a wave of muscle spasms that began just about anywhere on my entire right leg. The spasms mainly involved the Illio tibial band of muscles. I discovered by accident that if I strapped on that cast like contraption that I was sent home with the spasms stopped. That made for uncomfortable sleeping.
A visit to my surgeon brought about a better solution. He prescribed CYCLOBENZAPRINE 10mg three times a day for the spasms. I got relief the first day. He also prescribed TENAZEPAM 30 mg at night for sleep. (none of the other meds could give me sleep). That worked great.
UPDATE: (I just did an extensive update and it disappeared into cyberspace.) Here is the shortened version.

WHAT WORKED BEST FOR ME (better than tenazepam):
CVS "ice bag" , 3qt capacity, About $13USD incld tax. Put about 1-1.5qts water into bag, then pour in one or two tablespoons of salt.
Tip1-depress ice bag until water level reaches that of lid. Fasten lid tightly.
Tip2-Press down firmly on ice bag for 1 min to test. Do on a smooth counter or paper towel (don't trust your sense of 'feel').
(Remember these are made in China...my first bag leaked all over my mattress about 2am...so not good. The leak was from a tiny puncture in the plastic bag from the manufacturing process most likely.
Tip3- Place the bag on the knee for 20-30 minutes before bedtime or go to sleep with it if you want.
(Don't get the bag too cold or you won't like that either)
RESULT: My rogue nerve stimulii disappeared...finally. What a relief.

I did look at bags at Wal-mart and didn't like any of them that I saw. The internet site for wal-mart shows a pack with a wrap to hold it in place but the store didn't have that.
CVS had some other types as well such a pouch with 'little plastic peas' that gave it flexibility...looked pretty good but was a little smaller than the "ice pack". Either one should work fine.


Now it's just a matter of strengthening muscles and working to increase flexion. I am now at 120 deg. flexion if I really bite my lip.
I hope this info will help someone deal with pain.

UPDATE: I am now at 128deg/135 deg flexion and 3,5 months post op on bilateral TKA. I will say more about that on another post.

Category:

Education

Tags:

• Ben Blyton
• TKA
• knee replacement
• knee surgery

[solda14073]

Thank you so much for the video. My wife was miserable with the pain she was experiencing at night. Large amounts of pain pills were marginally effective, and her requests for sleep aids went unheeded. A little Saran wrap and her favorite lotion resulted in the first good night's sleep she's had in a while.

Thank you.

Thank you.

Thank you.

[32f3245f4]

@solda14073

Thanks so much for the compliments. Just remember that you may need to alternate techniques every other day or so because of the way our brains constantly try to interpret sensory signals. I used the fluffy wool lined plastic leg support that the hospital sent me home with to alternate with the plastic wrap.One nite one material and the next nite the other material.

I do find it interesting that the docs usually never mention night pains and meds don't offer much help.

[allaboutrandom]

Ben

I am 12 days post op from my tka and am not sure that i didnt make a huge mistake. I can flex 120 easy but cannot straighten to 0 yet. Mucho pain all the time this is very frustrating. I am 55 yr grandma and i've just got to get back up and going. I really enjoyed your video re phantom pain. My husband is aquiring the material now. Any ideas for increasing extension.

[32f3245f4]

@allaboutrandom

Congratulations on doing 120 deg. flex...that was the toughest for me.

The flex will come with time and patience but the two things that I did for extension were:

1) Immerse yourself in a tub of hot, hot water for loosen up leg muscles, and apply downward pressure while immersed. Do sets of thirty seconds, relax, again...etc.

2) Take pain meds then lay in bed with foot resting on raised platform so leg is concave.

Try to sleep that way if possible.

Ben

[grapernator]

I hope this will do the trick Ben! Night time pain is so frustrating. I thank you in advance. JMG 8 weeks post op

[32f3245f4]

@grapernator

Thanks. So far this technique has proven 100% successful but be sure to alternate with another technique from time to time (eg. using the furry lined plastic leg support). The idea is to not allow the brain to redefine it's pain signals. The plastic wrap creates an absence of stimulus while a furry (wool, etc.) cast overloads the sensory system to help negate stray pain signals.

Wish you the best!

[32f3245f4]

@prdasful

One last thing...here is one thing you should rule out. It's possible that extreme hip flexion could produce knee pain. Try not doing any splits for a few days to see if knee pain is reduced.

[32f3245f4]

@prdasful

Hi!-I really needs tons more info. but here are my best guesses. 1) I do not think it is growing pain.

2) Possibly a harmless (or not) growth on a bone in the knee joint. 3) Possibly a shoe/arch support problem. 4) Possible a referred pain from lower back vertebrae.

I kind of suspect (2). You can try arch supports and test guess #3. Try any spine extension exercise and test (4).

I assume there is no swelling, you have had no falls on your knee, and that the pain is local.

[prdasful]

it stay like 1 hr i always take tylenols sumtimes both knee hurts sumtimes only 1. i never had surgery. i dont play any sports but i do splits. i have no prov with sitting nd standing

[32f3245f4]

@prdasful

Ok, be patient and stay with me. I still need more info. Is the type of pain sharp or dull and throbbing? How long does it usually last? Could it be work or sports related? What kind of meds do you take to stop the pain? Is it one knee or both that hurt? Have you had any surgery on or near the knee in the last year? Do you have any lower back pains? Do you find your knee painful after you have been sitting in a chair and then attempt to stand up?