My doctor has suggested a pain specialist

Dr David Colvin workers compensation

04/04/2018 Dr. David Colvin, trained in orthopaedic surgery in Perth. David's specialty is knee and shoulder surgery and sports injuries.
pain specialist

Successful pain management is critical to the recovery from any injury. Some patients struggle with pain management and are referred to pain specialists.  This can be invaluable, but if we are needing their services, we are already facing an uphill battle.  We should plan not to need their help.

The workers’ compensation scheme places a heavy emphasis on early return to work.  One of the benefits of early activity is its positive impact upon pain management.  Activity reduces pain sensation.  One the explanations for this is the gating theory of pain.  This theory says that if your brain is busy processing signals regarding movement and activity, then there is less brain processing power available to analyse pain signals.  

Bombarding your brain with normal signals leaves less scope for the painful signals to get through.  Early use of an injured body part reduces stiffness and muscle wasting and this results in a positive cycle of recovery.

On the other hand, long periods of reduced activity lead to muscle weakness, joint stiffness and increasing pain.  The end result of this can be a condition called complex regional pain syndrome or CPRS (previously called reflex sympathetic dystrophy - RSD).  One factor that can precipitate CPRS is failure to get things moving immediately after surgery.  We rarely completely immobilize a joint.  There is always some rehab to do right from day one, especially with shoulder and knee surgery.

Immediately after surgery, strong narcotic painkillers are often required.  It is essential to have your pain under control so that you can get away to a good start with the rehabilitation.  However, stronger painkillers are usually only required for a short period of time.  There should be a plan in place to wind down the stronger painkillers gradually and substitute simple analgesics. 

Patients and doctors worry about addiction to therapeutic drugs.

Generally speaking, you will not become addicted to analgesics when they are being taken for strong pain.  For shoulder surgery, stronger painkillers will be required for some weeks or even months (see my guidelines here). 

If you have been taking narcotic analgesics over an extended period and particularly if you have been taking them before surgery as well as after surgery, then you may experience some degree of withdrawal when coming off the medications.  Symptoms of withdrawal can include irritability, anxiety, insomnia, general aches and pains, sweating, nausea, vomiting and diarrhoea. 

The pain specialist can help with sensible strategies to manage your current pain and a long term plan to wind things down. 

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