Frequently asked questions about pain

A panel of orthopaedic experts answer the most commonly asked pain-related questions

Orthopaedic experts:

Kelly_F-193x169

Frank Kelly, MD, Macon, Ga. orthopaedic surgeon.

Lajam-C2

Claudette M. Lajam, MD, assistant professor of orthopaedic surgery at the New York University (NYU) Langone Medical Center and the Center for Musculoskeletal Care.

Pfeffer-G_2

Glenn B. Pfeffer, MD, director, Foot and Ankle Center, at Cedars-Sinai Medical Center, Los Angeles, Calif.

Sabrina Strickland, MD, an orthopaedic surgeon at the Hospital for Special Surgery in New York City, and associate professor of orthopaedic surgery at Weill Cornell Medical College.

How do I know if my pain is severe enough to warrant a visit to my doctor or orthopaedic surgeon?

“Any persistent muscle ache or joint pain warrants evaluation,” said Dr. Pfeffer. “Big problems start small; and the sooner a condition is diagnosed and treated the better. If your symptoms last for more than 3 to 4 weeks, get some help.”

What if joint pain is keeping me awake at night?

“When joint pain prevents you from sleeping, it is time to consider a visit to your doctor,” said Dr. Lajam. “Your orthopaedic surgeon will evaluate your joint through physical examination together with imaging studies as needed to determine the cause of your pain.

“When pain is caused by arthritis, the most common cause of joint pain, there are many ways to manage symptoms without surgery,” said Dr. Lajam. “Medication, exercise and physical therapy, weight management and modification of activity can all help alleviate the symptoms caused by arthritis. When arthritis becomes advanced and no longer responds to nonsurgical treatment, your orthopaedic surgeon may discuss surgical options, including joint replacement.”

Joint pain that keeps you up at night is most likely caused by inflammation, said Dr. Strickland. “This can be a result of too much activity or the wrong activity, such as climbing stairs” if you have a knee or hip condition. “It also may be due to bone swelling.

“Ice and over the counter anti-inflammatory medications will usually help limit the inflammation, and as a result, improve your ability to sleep,” said Dr. Strickland. “Stronger narcotic medications will alleviate pain, but will not help with sleep.”

Is it possible to manage the pain associated with my condition without surgery?

“If you are considering an elective (non-emergency) surgical procedure, your physician should at least discuss with you potential nonsurgical options. If not, it might be reasonable to obtain a second (opinion),” said Dr. Kelly in the Ortho-pinion “Sometimes we get paid for knowing when not to operate.”

“Many of the conditions we treat will simply get better over time – without surgery. Others may not get better, but if there is no contraindication to doing so, initially trying a period of non-surgical treatment might be the better way to go,” said Dr. Kelly.

“Depending upon the condition, sometimes a cure can be obtained without any need for surgery. If non-surgical options are not totally successful in treating your condition, and if you decide (to have surgery), some of the steps you have already taken, such as weight loss and muscle strengthening, can potentially lead to a safer and better post-surgical recovery.”

How do I know if I need surgery?

While orthopaedics often involves treating individuals who have suffered acute trauma, the “vast majority” of orthopaedic procedures are elective, said Dr. Pfeffer. They are about quality of life.

“Patients often come to the office and they’re not sure if they need the surgery,” said Dr. Pfeffer. In these instances, when that is truly the case, “they probably don’t need the surgery. Surgery is appropriate when your lifestyle is impacted.”

However, many people are in “denial” about their condition. They don’t realize how much they have developed coping skills to deal with their compromised lifestyle and chronic pain.

A spouse or friend may have a more honest assessment of a patient’s condition. “Sometimes a spouse will be in my office and the patient will say, ‘I can live with this,’” said Dr. Pfeffer. “And then the spouse will chime in and say: ‘What are you talking about? When was the last time you took a hike? When was the last time you took the dog for a walk?’

“Things tend to erode so slowly that we lose track of who we used to be,” said Dr. Pfeffer. In these instances, surgery can have a tremendous impact.

How can I manage chronic, ongoing pain?

“Chronic pain is a serious problem,” said Dr. Lajam. “When musculoskeletal pain cannot be controlled with medication, activity modification, weight management and exercise, it’s time to seek evaluation by a specialist. The most important factor in treatment of chronic pain is to determine the source of the pain, which can be tricky at times.
“A skilled physician will use physical examination and imaging studies, along with other interventions, to learn where your pain is coming from,” said Dr. Lajam. “Once we know where the pain originates, focused, successful treatment can begin.”

“A pain management specialist has some treatment modalities and medication that can decrease chronic pain,” said Dr. Strickland. “Some patients are helped by alternative therapies. Finally, surgical intervention such as a joint replacement or spinal fusion can help other patients.”

How can I manage pain immediately following a procedure or surgery?

“Minor surgeries may require nothing more than acetaminophen or anti-inflammatory pills,” said Dr. Pfeffer. “For more complex surgeries, involving a greater amount of bone and tissue, stronger pain medications, administered soon after surgery and continuing for a specified duration of time, can severely minimize and manage pain.

“The key is to get in front of the pain as soon as possible,” said Dr. Pfeffer, as well as any side-effects from the pain medication, such as constipation or nausea.”

Read more about managing pain at OrthoInfo.org.

Are narcotic medications addictive?

“Narcotics have a critical role in providing pain relief after most surgeries,” said Dr. Pfeffer. “The goal is to have as little discomfort as possible after surgery, and part of the way to do that is to take as much pain medication as you need. Most patients stop taking narcotics after a few days, while some need them for up to a few months. The key is to wean off them as the pain subsides. There is no chance of addiction, if a patient and doctor work together to stop the narcotics at the right time, which is different in each case.”

Can exercise reduce pain?

“Regular exercise has many benefits, including the reduction of pain!” said Dr. Lajam. “Exercise strengthens muscles around your joints, maintains your bone strength, and can help control your weight. Exercise also helps you get a good night’s sleep, which by itself can reduce pain. In addition to its physical benefits, exercise also improves self-esteem and creates opportunities to interact with others.”

Dr. Strickland suggested “low impact exercise, such as swimming and biking for individuals with knee or other joint pain.”

Are there any other non-drug therapies or activities that could help minimize pain?

“Physical therapy often can help minimize pain by improving range of motion, posture and correcting compensatory movements your body may be doing which are causing new problems and discomfort, such as neck pain due to shrugging to avoid moving a painful shoulder,” said Dr. Strickland.

In addition, “braces and joint supports can provide support and feedback to joints to decrease painful movements,” said Dr. Lajam. “The use of a gait aid, such as a cane or a crutch, can help muscles work better to decrease the pressure on painful joints. Massage can help improve circulation to muscles and can reduce (muscle) spasm, which can reduce pain.”

Following surgery, patients should keep the surgical site elevated, if possible, above the heart, to minimize swelling, said Dr. Pfeffer. In addition to pain medications, the application of a large ice pack (alternating 20 minutes on, 20 minutes off) is a good idea. As many ice packs are relatively small, a bag of frozen peas may more adequately cover the surgical site.

###