Post surgery pain

[dancer2]

I previously posted a question about post surgical pain and Belbuca (buccal Buprenorphine,). I had hip replacement one week ago. The pain is excruciating. I conferred with my surgeon prior to the surgery because I was afraid of this. He told me not to worry. Ha! I am taking Oxycodone every 6 hours with absolutely no pain relief. I'm certain the Belbuca is negating the effects of the Oxycodone. He tells me there is nothing else he can do. And the inflammation caused by the surgery is causing my RLS to go crazy. Is there anything I can do?

[Madlegs1]

I was given Fentanyl 70mcg--- certainly killed the pain.

Also killed my mind- I was like a zombie. Took me 18 months to wean off it.

Ended up on Oxycontin and Oxynorm which does a decent job on the spinal construct insertion and luckily also fixes my Restless legs Syndrome.

[ziggypiggy]

I would think a possible solution would be to reduce your Belbucca while you are trying to treat the pain with Oxycodone. Once you find a dosage of oxycodone that manages the pain I would think it would also cover your RLS during this time. Then return to Belbucca after appropiate time. May not be a perfect solution with smooth transitions but may be worth discussing with your doctor.

[dancer2 in reply to ziggypiggy]

Thanks for your replies. I think it might work except that the surgeon and my PCP who orders the Belbuca know very little about RLS. The PCP has taken info from me regarding treatment of RLS. I take 150mcg of Belbuca at 1530 and 300mcg at 2100. How would you suggest I taper it? I don't think I can cut the buccal patches in half.

[ziggypiggy]

Maybe someone who takes it could suggest a taper down. I'm not sure if you would need to taper though if you are giving the opiod receptors an immediate replacement with the oxycodone. Also a tapering process might be too drawn out anyways to give you the immediate relief you need. Another option is to just keep Belbuca the same but take a larger dose of oxycodone if you can tolerate it. You could ask the surgeon if you could try upping the dose for a day as an experiment with the meds you have and see the results on the pain front.

Chances are your base line tolerance for opiods to work is elevated from daily Belbuca use. Your surgeon is probably prescribing a dosage for a patient with little to no built up tolerance.

Sorry you're suffering. How long is the post surgery pain expected to last according to the surgeon? Usually the supply of oxycodone they prescribe will give you a good indication of that.

[dancer2 in reply to ziggypiggy]

I did reach out to him for help but he said he cannot give me a larger dose. He gave me enough Oxy for 10 days. I only have enough meds for 3 more days. Hopefully by then the pain will lessen some. Thanks for taking the time to help me.

[ziggypiggy]

Bummer. On a side note do you like the Belbuca for RLS management. I'm looking to approach my doctor next month about making the switch from Oxycontin.

[dancer2 in reply to ziggypiggy]

Belbuca has done a fairly good job . However it is very expensive. My PCP is willing to prescribe Buprenorphine but my insurance will not cover it .Even with insurance, Belbuca is very expensive. Buprenorphine costs so much less. I take 150mcg in the afternoon and 300mcg in the evening.

[Joolsg]

I'm sorry to hear this. Buprenorphine can negate the effects of opioids used for pain relief.Can you try paracetamol or ibuprofen?

Or follow others advice and reduce the Belbuca until the pain from the hip is controlled?

[dancer2 in reply to Joolsg]

Thanks. I am trying Ibuprofen. Will see if it works.

[dancer2 in reply to Joolsg]

I really don't know how to taper the Belbuca. And, the surgeon will only give me opioids for 10 days - which ends in 3 days.

[Joolsg in reply to dancer2]

Every hospital is different regarding post operative opioid pain relief. If you're stopping the oxy in 3 days, perhaps wait and then actually increase Belbuca? It covers pain as well as RLS.

Another possibility is medical cannabis. That can be taken as needed to reduce pain.

[dancer2 in reply to Joolsg]

I have really considered medical cannabis. Just not sure what kind to take. And, can it be taken with my current meds?

[Joolsg in reply to dancer2]

Yes. I take it with Buprenorphine and I took it regularly with Oxycontin and pregabalin.You need a strain that helps pain.

I used althea Champlain Indica oil with 20% THC. I use it for severe MS nerve pain. It really helps trigeminal neuralgia and MS Hug ( excruciating chest pain).

[dancer2 in reply to Joolsg]

Thank you. I know absolutely nothing about cannabis.

[Merny5]

I’m so sorry that you are in pain. After each one of my joint replacements my RLS symptoms were horrible. During the time of my last replacement I was taking methadone. The oxy that they gave me didn’t scare the pain in the least! I believe the methadone was preventing the oxy from working. It’s just a guess. I would recommend not taking the Buprenorphine and increasing the Oxy if you can get more from the surgeon. Good luck! I hope you pain subsides soon!!!!

[dancer2 in reply to Merny5]

Thank you. I am sure that is what I am going to have to do. I will double the oxycodone and beg for more at my post op visit with the surgeon. However I think I will run out of meds before then I have already asked him for stronger pain meds, so I'm not sure what the outcome will be

[Purpleyam]

I understand your torment! I had much worsened RLS post hip surgery, which was a result of high inflammation. I couldnt even lay down to rest in order to heal. I can't advise on the pain relief meds, however I can assure you that within 1 to 2 weeks from now you'll be almost rid of the pain. There is a quick improvement in overall discomfort after hip surgery. My RLS decreased as time went by and I focused on eating anti-inflammatory too. It was the catalyst to get me to start reduction/elimination of Pramipexole for good. Best wishes, speedy recovery.

[dancer2 in reply to Purpleyam]

Thank you for your reply. What you said is exactly what I am going through. The surgery caused so much inflammation that my RLS has Increased tremendously. I am not able to lie down so I'm sure I'm making the hip pain worse. You have given me hope that within a week or so, I will have less pain. (Hopefully you don't get this message twice. I thought I had already sent it, but can't find it.

[Purpleyam in reply to dancer2]

Please post back soon. I'd like to know how you are coming along. The pain should come down rapidly, if ou can find a way to get some sleep.🙏🤞 Use your ice machine frequently as directed, or ice lots if you didn't get one with the surgery. It is a good distraction!

[Qalba]

I am so sorry that your pain and RLS are not managed. I chose methadone over bupremorphine because it is inexpensive tablets. It works very well forme. I do sometimes need another dose if the earlier dose wears off, but that is a minor problem.

I had cervical fusion three days ago. I was concerned about methadone inhibiting other opioids. Fortunately that did not seem to be the case. I only took the pain opioids for two days, and switched to acetaminophen. Pain is present, but it is tolerable. I hope your pain level decreases soon.

[dancer2 in reply to Qalba]

Thanks. I have tried Methadone before Belbuca because the Methadone didn't take away all the RLS. I'm glad your worst post op pain only lasted a few days. That's what I was hoping for me. However, that is not the case. I am taking acetaminophen with the pain meds

[Qalba in reply to dancer2]

I hate this for you. I am so fortunate. This can happen to any of us. Keep us informed. Best wishes.