Having surgery? Settle your sensitive nervous system!

Many people with osteoarthritis look forward to having a new hip or knee joint because it’s such an effective treatment. Yes, it’s a BIG operation, and yes it’s expensive, but it holds so much promise for people who find it hard to walk, drive, kneel, go up and down stairs, and all those really important daily activities that get affected by osteoarthritic pain.

What isn’t always recognised is that the results are not necessarily as good as anticipated, and one of the reasons is whether you have pain in other parts of your body as well as your affected hips or knees.

In a recent study, researchers studied people having hip and knee joint replacement surgery. Before surgery, they asked participants to complete a questionnaire to identify in how many places in their body they had chronic pain, and how painful this was. The aim was to establish whether there was a relationship between pre-existing widespread pain and the need for greater amounts of opioid pain relief after surgery.

The scale helps to identify how sensitive the nervous system is – the “fibromyalgianess” of a person. Fibromyalgia is a chronic pain condition in which pain is experienced throughout the body, along with fatigue, poor sleep, cognitive or “thinking” fuzziness, and often other painful conditions. It’s not a life-threatening problem, but it is life-altering. People with fibromyalgia have been found to have more natural opioids circulating in their body, meaning they have fewer neural receptors able to use artificial opioids. As a result, they often need greater amounts of opioid to have any effect.

What these researchers found was that the higher the score on their “fibromyalgianess” scale, the more these people needed opioids.

What this might mean for you, if you’re going to have surgery for your osteoarthritic hips or knees, AND you have pain in many other parts of your body, you might want to take some extra steps to help your sensitive nervous system settle down a bit. And you can start right now, because the sooner you learn and the more your practice of these techniques, the more effective they are when you really need them.

  1. The first thing to learn is some good diaphragmatic breathing. Long, slow breaths that go right down deep into your belly. http://www.youtube.com/watch?v=8-_NNCrrdus
  2. And mindfulness is a great thing, too. Mindfulness link
  3. You might find imagery helpful – imagine your body going through its normal movements smoothly, fluidly, comfortably. Imagine the two hips/knees feeling the same, moving the same.
  4. Learn as much as you can about the surgery. Know that your surgeon will put your new joint through its full range of movement while you’re still on the operating table, so any limitation you feel after surgery is simply due to your tissues settling down. It’s perfectly safe to move – and in fact, any swelling and bruising will settle down more quickly as you get moving again.
  5. Work with your allied health team – your occupational therapist, physiotherapist, and your nurse. Let them guide you – but also, ask what they think you should be able to manage each day, so you have some targets or goals to work towards.
  6. Make sure you get some pain relief before you get up and move while in hospital. Give it some time to get into your system before you begin exercising, it’ll help you feel more relaxed and help you get going more easily.
  7. Keep doing your exercises and movements when you leave hospital! This is the time when it’s easy to let things slip, until six weeks when you head back to your surgeon and you find you can’t move! Use your prescribed pain relief AS ITS PRESCRIBED so you CAN do your exercises and keep moving.

Try the first four steps out now, before your surgery – and let me know how it’s gone for you!

Here’s a great video from NOI Jam – from a patient’s point of view.


2 thoughts on “Having surgery? Settle your sensitive nervous system!

  1. Do you know of any studies that show this, “People with fibromyalgia have been found to have more natural opioids circulating in their body, meaning they have fewer neural receptors able to use artificial opioids. As a result, they often need greater amounts of opioid to have any effect.”? I would like to look into this info further for my own research. Thanks!

    • The two references from the article I quoted are:
      Baraniuk JN, Whalen G, Cunningham J, Clauw DJ: Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet Disord 2004; 5:48

      Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK: Decreased central mu-opioid receptor availability in fibromyalgia. J Neurosci 2007; 27:10000–6

      The article I used was: Brummett CM, Janda AM, Schueller CM, Tsodikov A, Morris M, Williams DA, & Clauw DJ (2013). Survey criteria for fibromyalgia independently predict increased postoperative opioid consumption after lower-extremity joint arthroplasty: a prospective, observational cohort study. Anesthesiology, 119 (6), 1434-43 PMID: 24343289

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