Linear Healing and non linear Pain, or “Why pain, why here, why now?

It's like another SUNDAY!!  no mail, Fed holiday and it's Thanksgiving in Canada - what does that mean?  I can watch the Minnesota Wild at noon and Packers at night!!

OH yea - some of you have to work.  Just wait - when you get old enough you can retire and have your body take a dump on you LOL  I hope not and this is only temporary.

Actually I'm doing better.  My left arm can actually reach the blinkers in the car now.  I feel so liberated.

ANYWAY - as you can imagine for someone who gets obsessed over things I've been doing a lot of reading about pain management and TKRs (Total Knee Replacements).  The one thing I have learned is you either are in extreme plain and complaining OR - there is absolutely zero mention of pain which tells me . . . there is a LOT of pain.   

There is an article that makes s TON of sense on pain and why . . .it's not a BAD thing when it comes to TKRs.

Linear Healing and non linear Pain, or “Why pain, why here, why now?

It was going so well. Off meds. Biking until it smoked. Sleeping so much better. Survived PT..barely! I was starting to believe I made right decision, very minimal pain, walking more, longer distances, stiffness definitely better........but then.

If you have not had any “but then” moments....you probably will. Depending on the patient, they can create fear (something must be wrong), deceptive (I will never walk never again), drop some into depressive states, or, search for the “why”, and continue to progress.

This hopefully is a “why” explanation.

It starts before the scalpel gets near our leg. 😳

All of us have in our mind that knee replacement surgery will be a “painful process”. But the definition of “painful process” is probably much different for many of us. What does “painful” mean? ( I have high pain threshold. Or I’m a wimp). What does “process” mean. (I’m guessing I will hurt a few days, but after a month should be fine, or, I’m guessing all in all, should take about a year).
However I think there is broad agreement that what we experienced may have likely exceeded whatever we understood “painful process” to mean. In fact, I believe most of us would agree that whatever understanding and EXPECTATION we had prior to surgery, at times we weren’t even close, based on comments such as, “I’d never have had this done if I had known......! Or, I will NEVER do this again. “Unrealistic expectations on our part? Perhaps. Insufficient pre op info about the surgery. Perhaps.Whatever it is, thankfully most of us walk away happy we did the surgery.

It’s my opinion that the biggest problem is a lack of understanding of the “process” of injury, inflammation and repair. But why should anyone know and understand? Healthcare education requires an intensive class called pathology, which breaks down these 3 separate but related phases to the cellular level of every type of tissue in the body. Bones, muscles (3 types), connective tissue, tendons, ligaments, fascia, nerves, vascular elements.

I loved/hated that class.

Each tissue goes through the same 3 phases, but each have different time tables. And in our case, multiple types working interdependently AND independently, to make healing happen, some things healing first (early pain) so that other things can happen to heal (later and new pain), and on and on.

This called “cascading”.

But what I overheard today I thought was priceless. Someone was unhappy with the fact that they could still have almost as intense pain as on day one, but weeks later. To which the doctor replied, “it IS day one for what needs to be healing now.” 

Isn’t that interesting that on day one, we won’t even have some tissues “capable” of healing and thus hurting until 2nd or 3rd month! Or that in the healing phase, new tissues grow that didn’t exist at day one.

The fact is our leg has many day ones. It’s just day one for a specific tissue that happens 3 or 4 mos. post surgery. And we’ve become tired, impatient, and ready to be finished. (Week 4 and 8 seem common for complaints).

Zingers are perfect example. Zingers are nerves finally called in during that cascading process, in search of what they are to ultimately connect with according to a magnificent plan. They may be looking to hook up with another nerve. So, the newly recruited nerve send out out “shock” (electrical), signals, like our “find my phone” app to locate their ultimate destination. Maybe new skeletal muscle fibers, are now ready and in need of a nerve that tells them when to contract (motor), or when to say something hurts (sensory). because they are finally being used and need protection from their owner’s” overuse which may cause damage. (We can be our worst enemy, speaking from experience.). So until they hook up, there no pain. And we sigh, and say “finally”! After nerve hook ups, well, new and unexpected pain, and we wonder “what happened”

So allowing you to peak behind the curtain may allow you “visualize” the sequencing (linear healing) and understand “why this, why here, why now ?”

I’m sure I didn’t do this topic justice, but I think even the slightest understanding might make the later pain more manageable, and maybe even reduce the anxiety that accompanies the unknown

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this is like our hours.

https://youtu.be/SUV6RqJZucc




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