Post-surgical pain - none and then a lot?

January 19, 2024 1:20 PM

How to deal with periodic post-surgical pain - none and then a lot?

So, I broke my ankle. I had surgery yesterday and everything went well. They did an ORIF to fix the bone (plate and screws) and they sewed up the ligaments in two places. All good.

My question is about swelling/pain. Since the surgery (yesterday), I have had only two painful moments - otherwise I have had long stretches with no pain at all. In both moments, it felt like my foot/ankle was suddenly swelling up like a balloon and smashing against the side of the splint, and I had like stabbing pain. In both instances, I took all of the pain meds they gave me - ibuprofen, tylenol, and some kind of opiod. This eventually turned the tide on the swelling/pain sensations and I was able to wait it out. I would say the "attack" lasts about 20-30 minutes.

The weird part is that, other than those two moments, I have felt 100% fine. I went like 6 hours this morning with no mediation and no pain at all - felt perfect. So, it feels like the painful thing happens when I have some kind of swelling attack that comes and goes.

Here are my questions: (1) does this fit with anyone else's experience?; (2) should I do anything with medication to try to head off the pain cycle? Today for a long stretch I felt 100% fine so I took nothing - was that a mistake? (3) is there anything that can be done to control/elimate the sudden swelling attack? Keep it elevated?

You are not my docotr - I don't think I am experiencing anything weird/unusual enough to call the doctor, and the pain, while not awesome, is not too much to handle with the medicines provided. I.e., I think this pain is probably super normal and expected.

Thanks for any tips!

posted by Mid to Health & Fitness (14 answers total)

The best pain management advice I’ve seen is “stay ahead of the pain.” Take your meds as scheduled, unless any of them are specifically prescribed as-needed for breakthrough pain or pain above a certain level. There 100% should be a nurse or similar person you can call to walk you through this if you’re not sure what you should be taking when
posted by MadamM at 1:38 PM on January 19 [17 favorites]

I've had different surgical experiences than what you have, but I've always had pain that comes and goes. I always assumed it was just how my pain tolerance cycles throughout the day, sort of like circadian rhythms. I have no idea if that's scientifically valid, but that's been my experience. I usually do fine during daytime hours with little to no pain, and then early evening hits and it's suddenly becomes super painful. I've just taken pain meds when I needed it, but I dislike the feeling of being on opiods so I err on the side of taking fewer meds. Staying ahead of the pain sounds like a reasonable plan, too.
posted by shornco at 1:41 PM on January 19

With surgeries I've had (non-Lasik laser eye and a dental bone graft), I've definitely found this. It's like the body has a period where it is in shock post-surgery because it's trying to figure out what is going on because it has been opened up and poked around in - highly unusual - so it is preoccupied with doing that and then once it figures it out it's like "Oh right, this is PAINFUL" and activates its pain; it just takes it a while to catch up. I'm sure that's a *very* technical description of what's actually happening.

When I had my eye surgery, I remember a couple of people who had had the same surgery told me that the worst day was day three where there was unimaginable pain and I was like sure, okay, and followed the pain killer regimen I'd been given (ibuprofen and acetaminophen alternating) and didn't touch the stronger painkiller I'd been given just in case. Day three passed without issue so I thought I had missed the dreaded day three pain... until I got to night three, where I was up in excruciating pain for most of the night. I think I eventually passed out from the pain and then in the morning it was just... gone. No idea what the hell goes on on day three but apparently that pain cycle is a thing.
posted by urbanlenny at 2:24 PM on January 19 [2 favorites]

Yes, I've had that experience before. I agree with MadamM, it's best to take pain meds to prevent pain rather than in response to pain. When I was recovering from my foot/ankle ORIF, I found caffeine surprisingly helpful as a painkiller. For nighttime, cannabis didn't reduce pain much, but did help me care less about it.

Elevating is definitely helpful for swelling.
posted by wheatlets at 2:25 PM on January 19 [1 favorite]

this is totally normal, and will happen. when i broke my leg, one of the most painful things that would happen was like, i'd be on the couch or whatever, realize i had to pee, get the crutches, stand up, and then for like a few moments it would feel like ALL THE PAIN IN THE WORLD was rushing down to my leg. it would be like breathakingly painful for just a minute or so, then would subside and i could hobble to the bathroom or whatever.

thirding the rec to stay ahead of the pain!!! also i would use ice a lot, i had a a couple of ice packs that i'd use for 15-20 min at a time, they really helped. sorry, this sucks, you're gonna feel a looottt better soon i promise!!!
posted by capnsue at 3:00 PM on January 19 [2 favorites]

hey, i have patients who are recovering from ORIFs at work, the experience you are describing is common. please take meds as scheduled, your pain will build up and increase and be harder to control if you skip a dose or space them out further apart than they should be. there is a reason all the surgeons at work do around the clock multimodal analgesia (tylenol + aleve or advil + opiate + also sometimes gabapentin) for every single patient unless someone has a contraindication to tylenol or advil, like significant liver or kidney disease. if you don't like the opiate or have side effects from it, take the smallest effective dose and/or space it out an hour or two more, but don't skip it for the whole day or night like 8 hours at a time, and stay on schedule with the other medications.

we give people ice a lot, if you dont mind cold i would recommend that as well. if you're resting keep the foot/leg elevated if you can. some people find cannabis or CBD helpful for pain so if you want to do that also a good idea!
posted by zdravo at 3:46 PM on January 19 [7 favorites]

What zdravo said. Take any pain killers they give you, as much as they will give you. Not too much, keeping in mind they are giving you opiods. But pain-wise, they are pretty great.

Having spent the last year with many painful wounds and healing, it is not a straight line. Haven't had your symptoms, which are indeed weird, but have had enough of my own that weirdness happens. You will be feeling pretty good, and then for no reason, you are feeling pretty bad. Give your body time to heal. Don't be all, "I can do this!", (good chance you can't).
posted by Windopaene at 3:58 PM on January 19 [1 favorite]

Nth-ing staying ahead of the pain.
Hopefully they also provided you with a schedule for the Ibuprofen and Tylenol. If not, here goes:
You shouldn’t take a dose of either more than once every eight hours, so alternate
Tylenol at noon
Ibuprofen at 4pm
Tylenol at 8pm etc

Ibuprofen controls inflammation and attendant swelling, Tylenol (and opioids, if they were prescribed) control pain. By alternating, it is possible to stay ahead of it most of the time.
Icing also helps with inflammation and pain (via numbing). Just be mindful not to put anything super cold against bare skin, and give yourself a 15-20 minute break between icing sessions.
Good luck!
posted by dbmcd at 5:23 PM on January 19

Didn't anyone tell you that pain medication is about management, and management means staying ahead of the pain? Quit trying to tough it out--letting pain and inflammation go is detrimental to healing. Agreed that there is a cyclic nature to pain, even when under control, but the diminution of the swing in the cycle is what lets you know you can start backing off. You're not a wimp to take pain killers, and you won't become addicted to codeine in a couple of days. The problem with managing pain is that you're probably the type of person that figures that if it doesn't actually hurt, you ought to be able to boogie. Stay off the foot, keep it elevated, and keep it iced. It's taken me multiple surgeries and a couple pretty good wrecks to finally realize that if I just give it that initial three-four days, or even a week, things heal easier and faster, no setbacks, and I can get on with my life.
posted by BlueHorse at 6:00 PM on January 19 [1 favorite]

Take your meds as scheduled

This 100%. I have a plate and 6 screws in my clavicle, and I every time I figured it was time to start pushing through the pain, I quickly reached a point where I’d do almost absolutely anything (I wouldn’t have murdered my then 7 year old daughter, but everything else was on the table) to make the pain stop. Keeping my med schedule was the only way to not experiencing periods of time where I literally wanted to kill myself.

Take those pain killers.
posted by Back At It Again At Krispy Kreme at 6:27 PM on January 19 [3 favorites]

Yes, staying ahead of the pain is key! But so is physical therapy.

I am not in the same situation as you, but I also had an ORIF fracture and two surgeries in my left radial arm/wrist over the course of the past few years. I had a horrible physical therapist immediately after the first surgery, and then subsequent physical therapists (I think I've had 4 or 5 of them now in total), and I can absolutely state that having a good physical therapist who listens to YOU and your body is 100% crucial to your healing process. Just as important is following up with your physical therapy at home in your own time. That will carry you so much further than just attending the PT sessions alone.

I had my ORIF fracture in my late 30s (39, okay, I was 39!), and I was advised that recovering from a bad break like mine would be a lot "easier" if I had broken it in my 20s. The younger you are, the faster the body bounces back. But I think that it also depends on how hard you work at getting back to your normal life after injury.

I am not a medication person. I am a bad patient in that sense. I hated the meds they gave me to stay on top of the pain to the point I just didn't take them. But I did the physical therapy. I cried through some of those sessions, but I worked my little heart out through them and kept up at home as best I could. I'll never be 100%, but if I didn't work through it, I wouldn't be at the 95%+ that I am today.
posted by chatelaine at 10:24 PM on January 19

I agree with what others have said about med taking but i understand also that some meds have side effects we dont all tolerate well so ..i get it. But .. I would also add dont be afraid to be a squeaky wheel.. if you think you are having a level of pain that isnt normal, say so to your doctor. Particularly if the tightness of the post operative splint is something you feel is related to your pain. The odds probably aren't wildly in favor of it being relevant for you, but sometimes those things can be wrapped too tight and that can have negative consequences. If its internally fixated the post operative splint can be removed to examine your foot, make sure there are no pressure sores or anything else unusual, we'll say, developing, and rewrapped very easily. Better safe than sorry/better to trust your gut than regret not speaking up if you have an intuition that something just isn't right. Sorry for typos amd poor punctuation typing on tiny screen ..
posted by elgee at 12:32 AM on January 21

Response by poster: Thanks everyone! I have been doing a better job of taking medication - esp. ibuprofen - on a schedule and not just when it hurts. Now that I am a few more days into it, I have realized that one of the worst pain moments is when I stand up after a long time with the leg elevated - it is like all of the blood rushes into my ankle, the ankle swells up like a balloon, and presses against the sides of the splint in a painful way. Other than just managing when and how often I stand up, is there anything I can do to start working towards not having this massive swell-up when I put my foot down? Exercises or anything? I am almost wondering if it would be better to take some breaks from having the foot elevated, dip it down, get the "blood rush" and then put it back up, to sort of get my body used to regulating this. That's probably stupid - I should probably just keep it up as much as possible as long as possible - but man the "rush" part is painful! Everything else is pretty manageable. Thank you!
posted by Mid at 8:28 AM on January 21

Hmm, do it slowly?
You're on a pillow on a stool. Take it off the pillow for a couple minutes. Lower it another six inches for a bit. Slowly put it on the floor and leave it a while before standing up.

When I had my knee replaced, they told me to change the position of the elevation just so the knee would be going from 180 to 45 to 75 etc. Knees suck. Riding the bike the first time was absolute misery.
posted by BlueHorse at 11:09 AM on January 25