Mom wants to avoid hip replacement surgery, but she hates taking pain medication for her arthritis. Any advice?


Her pain is terrible and she has to take Codeine and Paracetamol (she's tried other painkillers with bad side effects). She wants to avoid an operation due to having a stroke and age, but she is so sick of taking painkillers all day - they are making her sleepy and feel crazy! Any advice or help would be really appreciated.

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Success with any joint replacement depends on motivation and preparation.
Spinal anesthetic and heavy sedation is the way to go. As someone said you don't want to hear the saws and hammers during the surgery. There can also be considerable discomfort to the shoulder you are forced to lie on for a couple of hours for a hip. Surgery won't be successful if you don't do the rehab. It will be uncomfortable but take your pain meds half an hour before the session and it won't be too bad. Being overweight greatly reduces the chances for a successful joint replacement.
The use of narcotics for pain relief is greatly misunderstood.There is a big difference between addiction and dependence. I use the analogy of the diabetic who is dependent on Insulin. Using narcotics where there is a genuine need for the relief of pain for a short time will not cause addiction. Long term use again with the need for pain relief will cause dependence. Overtime the need to increase dosage or change the narcotic may make it necessary to increase the dosage as the patient becomes tolerant of the medication.It is very important to treat pain before it becomes intolerable as once it gets out of control it is much more difficult to relieve and may require much higher dose of the drug with the danger of side effects. It is very important to remember that any drug combination that contains Acetominophin {Tylenol} does not exceed the recommended daily dose because this may cause serious harm to the kidneys and can lead to death. If pain is out of control it may be necessary to use a more potent narcotic to regain control. Narcotics are not necessarily the first choice for pain relief. heat, ice, muscle relaxants, massage, anti seizure meds and OTCs all have their place to mention a few as with relieving other bodily problems such as infection, constipation and urinary retention. after a joint replacement swelling, stiffness, pain and some loss of blood are all normal but if the area becomes red and hot and the bodily temperature is raised along with increased pain these are all indications of infection and need immediate medical attention.
I have had a hip and knee replacement and can report excellent results. I was active before the surgery but am now active and pain free.
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Get her to talk to some folks who have had it done, like dandibelle. I just had a knee replaced April 19, spent two weeks in rehab (Nursing Home) and feel just great.
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I am a senior. I fought for 2 years against having a replacement hip operation even though the pain was unbearable. I couldn't walk in the end. I decided with great trepidation to go ahead and do it. What a wonderful operation. From when I came round from the anaesthetic I felt so much better. I was out of hospital in 4 days and could walk up and down stairs. 5 months later I had the 2nd one done. My life is is unbelievable from what it was just a blur of pain. I can walk for hours pain free. Go for it. There is no life without the operation.
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yes I think Lidoderm patches are very good to try.
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Pain relief can happen using a number of various alternatives that have far less adverse effects.
Any that decrease inflammation, help both to lower pain levels, and also, help body repair itself.
Hospice practitioners know, that dosing anti-inflammatory agents is FIRST choice, to reduce inflammation, THEN see if further pain meds are needed...that tactic usually allows far less narcotics to be used, which increases quality of life.
Some non-drug anti-inflammatories include:
==TURMERIC. For large problems, one might need to use larger amounts. capsules that equal about 1 tablespoon a few times a day, if pain is real bad, then decrease it to learn what is best for person. Take it with food. It tastes like Curry, because it is part of what curry is made from.
==OMEGA 3 fatty acids: for greater pain, one may need to consume 1000 mg. per day or more, of only the omega 3's. this stuff not only lowers inflammation and pain, but it helps mental processes, helps overall health. It can be got from fish oil, flax seeds, chia seeds.
==MSM: Methylsulfonylmethane. This is fundamental sulfur--NOT sulfa drugs. One cannot be allergic to MSM, or they pretty much cannot be breathing!
Fundamental sulfur is one of the body's main building blocks.
It can help decrease inflammation, decrease pain, and helps rebuild/repair body. I have started with a lower amount, like 1000 mg daily, then built up to several grams daily. Maintenance might be 1000 mg daily, and can be split over the day.

Acupuncture is great stuff, done right.
You could see if an acupuncturist in your area would teach you to do the required points, and/or, show you how to use magnets instead of needles--that way, fewer office visits to pay for.
SOME insurances DO cover acupuncture, particularity for pain control--while Medicare does not, if one is enrolled in a Medicare Advantage Plan, some of those plans DO cover it.
Group Health, in WA does, for instance...if they lack in-house practitioners for it, they will refer a person to an outside practitioner, and cover it as if done in-house.
Kaiser Permanente might do that now, too--years ago, they were just starting to get their feet wet in that art, so didn't really offer it then--they might, now.
Ask around!

She's got rheumatoid auto-immune issue. Which might men she is more sensitive to many medications. Talk with the Docs--they know how to arrange these things.
While there is a potential that surgery might stir up/aggravate an auto-immune issue, it is more likely that removing inflammatory issues, by replacing the deteriorated hip, might help calm down the auto-immune issue with the rheumatoid arthritis, simply by decreasing the amounts of chemicals that rattle around in the body flaring things up.

The real key is, your Mom sounds like she is raring to get out and do things--tht means she is still motivated.
Those already impaired too much by illnesses, lose motivation, and stop doing their exercises or complying with protocols that would help them--or else, they are too confused or tired to do it.

OTHER pain meds: non-standard:
While many do not live where it has been allowed for medicinal purposes,
SOME do.
It requires a medical recommendation to get Medical Marijuana.
It can be got as a Creme, which, applied to skin over painful areas, does a remarkable job of killing pain, with few side effects. Those types with higher CBD's are most medicinal and less sleepifying.
Got as a liquid, it can make some folks very sleepy, kills pain, can reduce gut irritations, relieve some asthma, and can decrease some myoclonic seizure activity.
And no, it does not cause "munchies", but, it can allow those who have stopped eating related to nausea from chemo or other ills, to eat.
It is less addictive than harder drugs, and has far fewer adverse effects.
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Tell your Mom, that these days, hip replacements and repairs are usually done laparoscopically. That means, instead of huge incision, only smaller holes are made to access the works, which means, people are usually able to get up and at it far faster--sometimes same day.
Pain levels for recuperation are much less than dealing with deteriorating joints!
A spinal anesthesia might be accompanies with some general relaxants--one usually does not want to hear the sounds of that operation!
I spoke with a gastroenterologist who had picked just the right anesthesia--it was far easier on me than some others.
TALK with the anesthesiologist, to let them know to use gentler, easier to recover from anesthesia types.
As for a spinal anesthetic:
Rule of thumb I learned in nursing school was, keep that patient FLAT down, for 8 hours post-op, before letting them, or anyone else, lift their head, at all---this prevents post-anesthesia headaches happening.

Knees: If the hips are not working right, knees can suffer.
If knees are not working right, hips can suffer.
Often, the lateral leg muscles that control ability to swing leg away from midline, get weak with age and disuse. When that happens, knees start to bow in--become more knock-kneed, and this can cause increased pain in both hips and knees. Solution to that: exercise those lateral muscles--it helps those and helps the buttock muscles and low-back muscles to support both hips and knees.
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I have my fiances mother who lives with us. she is a cancer survivor, had diabetes, a heart condition, and numerous other medical problems. she fell last year (she is 89) and broke her hip. she had the hip replacement, and is fine. she gets around just like she did before. She did everything the doctors and therapists told her to do.
I know it is hard to get the elderly to realize that they will be better off after the surgery. My own mother had both hips replaced (she is also 89) refused to do the therapy and now can barely walk because she did not do what she was supposed to do. She also can't hear, see, has fluid buildup in her ankles and has a large cyst on top of her head. She refuses to get any of them taken care of. "no more surgery for me" she says.
So there you have it. I have seen it from both sides and I can tell you Ruth (Fiances mom) gets alot more respect from me than my own mother, who just doesn't take care of herself at all.
Your mother should get the surgery and then she will not have to take the medicine anymore. all she has to do is work with the doctors and the therapist and she will be fine. If Ruth can survive this at 88, I am sure your mother can too.
She will be so surprised at how good she will feel and move too.
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That's a hard decision at your mothers age and considering she has had a stroke and has knee pain as well.

Hard to tell whether it will be for the best or not.

My father in law had his knee replaced AFTER having a stroke....he walks EVEN LESS now.

He too was in his mid 80's

For my father in law it didn't help because, he caught an infection in his leg....he told them it hurt, but doctors didn't realize until a year later that he had a bad infection going on inside his knee/leg that had the knee replacement. He then had to have a second replacement.

Another downside for my father in law, was that, he is weak on the opposite side of the knee replacement from the stroke...that makes it hard for him to walk, because one side is weak from stroke and the other is from a replacement.

Also, he grew tired and did not want to do that physical therapy.

His other knee hurts him now...he wont have it replaced.

Its so hard when they get to a certain age. Iv read we should have replacement done by our 60's or 70's....or if we are older than that and in very good health....
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Sunflowers45, I just want to say right off that I know nothing about knee/hip surgery, and have heard opinions for and against. I myself have severe chronic pain from various sources (fibromyalgia, arthritis, disk surgery, Degenerative disk disease...) and was places on the Fentanyl Patch, which is pretty much the only game in town for pain, if your Mom doesn't want pills. Not only is this stuff prohibitively expensive without good coverage, it is addicitive. When I say "addicitive," I am really referring to drug dependency, which may not have anything to do with a person's likelihood of abusing drugs. Your body simply makes the decision without input from your brain/heart, and that's pretty much that. Once dependent, a patient may, over time, require higher and higher dosages to get the same relief, but given her age, that's unlikely to be much of a problem. I would say do whatever is necessary to stop her pain. Why on earth should she be in agony all the time? However, given the fact that narcotics can be dangerous when one is extremely old, extremely young, or weakened from other conditions, I would definitely say go to an Orthopedic Surgeon first, as has already been suggested.
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As someone suggested Voltaren gel, just be aware it causes stomach upset, and not just a slight tummy upset. Use cautiously! There is even a small ruler inside the box to dispense a small amount. I used half of what was recommended, and I became extremely nauseated. I stopped and the nausea stopped (this side effect is listed). Have you tried acupuncture for pain? It works great except Medicare doesn't pay for it - yet.
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