Input from Others with Very Low Pain Tolerance

[TotalWus]

I'm a 54 year-old guy who recently returned to playing hockey after a 24-year layoff. It took about a year to get rid of the rust and I've really been enjoying playing in a 50+ league. My new hockey-caused hip pain has been diagnosed by 3 specialists as OA and they all concur that my only options are THR or BHR. If I do it, it will be BHR with Dr. Marwin in NYC. The problem is that I have such a ridiculously low pain tolerance that I'm considering just scrapping hockey again, instead, because, for now, my symptoms resolve when I don't skate. I've already dialed it back from 4-5 hours/week to just playing actual games about once a week.

What scares me isn't so much the pain right after surgery, but the pain associated with PT, especially anything related to breaking down scar tissue. I had an iliotibial ACL repair in 1982 and I have no intention of ever going through that kind of pain again. Technically, I didn't actually even "go through" it back then, and found a way around it, precisely because I just couldn't take the pain of breaking scar tissue. Specifically, I got myself a bottle of chloroform (not kidding at all) and taught my friend how to bend my knee to break a few degrees of scar tissue at a time. Then, we would knock me out unconscious and he would do it while I was out. He said that even though I was out cold and had no memory of it each time, I still grunted a lot and fought it pretty hard while I was out cold. We did it about a dozen times until I got the 110 or 120 degrees that I was supposed to have by whatever time period required.

My physical therapists thought I was insane, but that was the only way my knee was ever going to bend again. They started bending it in the first session and it was excruciating. I asked if that was how bad it was going to be every time and that's when she broke the bad news to me that she hadn't even done anything yet...she was just testing my pain tolerance and it was very low. There were teenage girls and geriatric men who dealt with it infinitely better than I did. If I hadn't thought of the chloroform, the only way my knee would ever have bent again would have been to do it under full anesthesia a few times.

What I'm looking for is input from other people with extremely low pain tolerance about how much pain we're talking about after BHR. I've been working out all of my life and have always been in very good athletic shape; so, sticking to a recovery workout plan isn't a problem for me, especially since I have my own gym at home...nothing extravagant, but everything necessary for a full-body workout, including a good elliptical machine and a massage table. I still train legs pretty hard using a vertical leverage squat machine and even that doesn't bother my hips; it's only hockey.

What I'm definitely not looking for (and no offense intended):

1. "Spiritual" perspective or reassurance about short-term pain being worth long-term gain.
2. Input from people who don't have a low pain tolerance who thought it was really no big deal.
3. Encouragement to "go for it" if I really enjoy hockey or because I'll have to do it eventually, anyway.
4. Warnings about how dangerous chloroform is or recommendations to use alcohol, instead. (I don't drink because alcohol has always made me nauseous and if I got drunk enough not to feel pain, I'd be puking and hung-over for 36 hours each time.)
5. Reminders that even this is nothing compared to childbirth that every woman endures.
6. Links to the videos of Dr. Rubenstein playing hockey with his patient 7 months after BHR.

I'd really appreciate the perspective of other people with low pain tolerance about how bad it really was...the immediate post-op as well, but mainly the rehab work pertaining to range of motion and (especially) scar tissue breakup or fascia release. Hopefully, some of you who are kind of like me will say that it really wasn't that bad. I've already secured more chloroform and ether this time (because it's much safer), as well as nitrous oxide and I understand that all of this is much more dangerous at 54 than at 20 and that fascia release is more complex than just bending a knee in one plane for a few degrees at a time. I have a good friend who's been an RN for 20 years and would be enlisting her help for this and also doing it such a way that she won't be handling or even touching the device I use for self-administration, for her sake, just in case anything goes badly wrong if I choose that route again.

If anybody's embarrassed to admit to having a low pain tolerance, you can contact me privately instead of posting publicly. Personally, I don't think it's anything to be ashamed of. IMO, the term "pain tolerance" itself is a misnomer in the first place. Nobody can know what someone else is actually feeling; all anybody can know is how most people react to a given stimulus. I don't believe that people like me feel the same pain as other people but that we "tolerate" it less; I believe we just feel more pain from the same stimulus. My father had a very high pain tolerance and he just didn't feel as much pain from certain things that other people considered very painful. He was a nuclear physicist and, unfortunately, I got my mother's pain tolerance and mathematical ability. Incidentally, she only had cesarean deliveries for that reason.

Thank you in advance for your help.

[blinky]

You play hockey and are a wuss??!!!I don't see it.

The drugs are much much better now than back in 1982.


I am not too far along yet, seven weeks, but I don't think  there is a lot of painful PT in this recovery nor a lot of fascia realignment/scar tissue breaking----unless you choose to go that route. Some people seem to hit a wall in recovery and then seek out some of the more painful PTs. The PT I have been given so far is pretty gentle (but yes, I am one of those people who has a high pain tolerance so what do I know). I have done heel slides, muscle tensing, walking, now on to easy stretching and leg lifting. No big, painful range of motion exercises.

[TotalWus]

Thanks for your response, Blinky. Your experience isn't that relevant to mine because you have a high pain tolerance, but I appreciate your input.

You play hockey and are a wuss??!!!I don't see it.

Yeah, I've heard that a lot. It's different. Hockey can get rough, but it's not painful unless you get injured, which you can do skiing or playing tennis, too. The boards give a lot more than you'd think and in a 50+ league, there's only incidental contact anyway, not full checking. This particular league is very gentlemanly, but not a wus about dropping the gloves, either, if that were ever provoked.

PT pain is a different thing than a one-time instantaneous athletic injury or even taking a stick or puck to the mouth. This wus is also one of only 2 or 3 idiots out of 65 guys who don't wear a full cage. I understand that getting blasted in the kisser is a calculated risk but I'm not afraid of subcutaneous needles at all and once a dentist or ER physician shoots me up, they can do whatever they want to my teeth or put in as many stitches as they want, no problem. It's having to submit to pain being inflicted by someone the way it is in a PT setting that I can't deal with. Not the psychology of it, but the pain under those circumstances vs. something that's over by the time you're even aware that it happened, like a puck to the face. What they had to do to me in PT for my knee was like medieval torture. Similarly, I'd be a total wus with any intra-articular needle like Synvisc, too.

The drugs are much much better now than back in 1982.

Last time, I got Demerol and half as much as I really needed was enough to inhibit urination to the point that I was begging for the catheter before they broke it out (twice). So, I'm not a wus in that respect either, and I know most guys are ready to faint at the thought of a catheter. Same thing happened on Oxycodone orally when I had to wait through a holiday weekend to get a dental abscess taken care of. That time, my RN friend came over with a catheter kit but I managed to "produce" before we had to use it. I don't have an addictive personality and I don't get any kind of high from opiates, so that's not a concern, either.

I am not too far along yet, seven weeks, but I don't think  there is a lot of painful PT in this recovery nor a lot of fascia realignment/scar tissue breaking----unless you choose to go that route. Some people seem to hit a wall in recovery and then seek out some of the more painful PTs.

I'm very confused by the part I bolded. A neighbor of mine recently had a THR done through an anterior approach (like Marwin uses for BHR)* and she said her whole thigh got hard like a rock and that the PT to release the fascia was excruciating...and when it comes to pain tolerance, I have a feeling she's a lot tougher than me. I'd also like to know whether the pressure-release can be accomplished more gradually, such as by increasing pressure more slowly than a PT has time for but that we might be able to do at home...or if there's just no way around the full deal because lighter prolonged point pressure just doesn't break up the adhesions if you have them.

[EDIT] *Correction as per Blinky's and Saf57's input. Thank you.

[chuckm]

I'm 49. I've had five knee operations on the same knee. My hip resurfacing recovery was not as painful as the knee. But it was certainly no walk in the park. If you cannot tolerate rehabbing the knee you aren't going to like this either.

Chuckm
 

[TotalWus]

I'm 49. I've had five knee operations on the same knee. My hip resurfacing recovery was not as painful as the knee. But it was certainly no walk in the park. If you cannot tolerate rehabbing the knee you aren't going to like this either. Chuckm

Thanks, Chuck. Would you mind elaborating on the experience?

[blinky]

Ha! I should defer to Chuck.


I didn't know Dr Marwin does an anterior HR. I thought all the docs had moved to posterior.


Ask what PT Dr Marwin requires if any. Dr Gross is not a fan of formal PT and has his post op exercises on his website. You could eyeball them and see if they look that bad.


Never had a knee done, but always heard knees were worse.

[Saf57]

TotalWus--Dr. Marwin does not use an anterior approach, but rather a direct lateral approach, with the incision on the side of the hip. Also, with THR, you are having a rod installed well down the femoral shaft, which may result in more thigh pain. Dr. Marwin resurfaced my left hip nearly 4 months ago, and I believe by any standard, the pain is modest.

[TotalWus]

Thank you both; that's right. I've corrected my post with attribution.

I didn't know Dr Marwin does an anterior HR. I thought all the docs had moved to posterior

TotalWus--Dr. Marwin does not use an anterior approach, but rather a direct lateral approach, with the incision on the side of the hip. Also, with THR, you are having a rod installed well down the femoral shaft, which may result in more thigh pain. Dr. Marwin resurfaced my left hip nearly 4 months ago, and I believe by any standard, the pain is modest.

Mind if I ask how you rate yourself on the following 10-point scale? Total Wus = 10 and Total Non-Wus = 1.

[Pat Walter]

Hi Welcome to Hip Talk

In most cases, hip replacement is much easier than knee replacement.  It normally doesn't take long to have your range of motion back and it doesn't take the pain that knee replacement does. 

Many surgeons don't even suggest PT - just walk, walk and walk.  Most people don't experience pain after surgery since they are able to treat post op pain so well.

I have a very low pain threshold and had little pain with my hip.  I had Dr. De Smet in Belgium do mine in 2006.  I stayed in the hospital 2 days and after leaving I changed just to Advil and that was more for stiffness than any surgical pain.  Most of the 12 people I was with did not even swell or need ice.  A lot depends on the surgical technique used by the surgeons.  Dr. De Smet believes in a large incision so he can get in, see well and quickly place the device.

I used one crutch for 3 weeks and was sight seeing day 6 in Belgium.

I had a very easy recovery.  The recoveries range from 1 to 10, easy to difficult.  Most people fall in the middle, but pain is normally well taken care of.  If the meds you get are not working, then be sure to ask for different meds.  Also don't stop taking them early or if you just feel great.  You need to keep them in your system for awhile.  Once the pain starts, then it is more difficult to get it back under control.  But again, many people don't have a lot of pain post op.  Prepare for the worst - but expect the best.

If you are nervous about the pain treatment, you should talk with your surgeon about it.  Make sure they know your low tolerance.  I do the same when I have surgery.

You will find a hip replacement is quite different than a knee replacement.

I had CDs from Cleveland Clinic when I had my aortic valve replaced with open heart surgery.  I listed and they really calm you down and get you ready for surgery.  There are a number of those available.  Better to listen to those and settle your mind than worry about pain.  By the way, hip replacement was a piece of cake for me compared to the open heart surgery.  It took a lot of pain pills and slow recovery for me on the heart - while my friend was out of bed walking quickly with no pain.  You never know.  Just KNOW that if you are having pain - SPEAK UP so you can get it under control.

Good LUck.

Pat

[TotalWus]

Thanks, Pat; that's exactly the kind of thing I was hoping to hear. Appreciate your taking the time to provide all those details.

Anybody have any thoughts about whether to get a stationary bike? I have an elliptical but I can imagine there being a period immediately post-op where the bike might be safer.

[RebeccaT]

Well I am only 2 weeks out but the pain from exercises that Dr Gross recommended is 0 at this point. I am not taking any painkillers at all today (off narcotics at a week and Tylenol as of yesterday).
There is definitely stiffness but it is more bothersome than painful.

About a month ago I had my wisdom teeth out ... Only pulled, mind you, not cut out ... And that was WAY worse than the hip. For like 3 weeks.

[chuckm]

Pat makes an important point which is that surgeons are less concerned about physical therapy after surgery.

The knee was quite different. Every knee surgery I went through was accompanied by pressure to get the knee mobile as soon as possible (even while the incision still had stitches). That was quite painful. One therapist even threatened to call my surgeon because I wasn't bending it enough soon enough.

But with the resurfaced hip you can go at your own pace and it seems that taking your time does not have any long term negative affects. But, if you want to get right back into things - say in six months - you are going to have to push through some pain.

Chuckm

[dleogallag]

Hey, I probably don't share your low pain tolerance - I suffered for 7 years before getting my left BHR (4 years ago) - really pretty intense pain - that makes me tough!  And dumb!  After the BHR 4 years ago, first week, maybe 2, kinda bad moving around but you heal so fast, and the meds can really ease you thru it. The PT I went thru for it was really not bad at all - I've heard from people who've had knee surgery, and his PT was excruciating - my was not at all - a lot of stride work with stretchy bands, standing on balance balls, I don't remember a lot of physical stretching beyond pain. (Although maybe I've forgotten - I find out tomorrow - I had my right one done Dec 17th, start PT tomorrow - looking forward to the fast recovery.

I also played hockey on my left BHR for a season (and felt it was probably the best PT I could do for it) - it was great fun! Life's too short to watch from the sidelines, or to find excuses on why you can't do something you enjoy.  4 years ago, I waited 7 years to get it done - this time, it started to hurt, I called and got an appt. (I'm 52).  Good luck! PT will be worth it!

[karlos.bell]

  Yo TotalWus. Interesting reading. Bilateral operation in April 2015 was real painful for 2 days Morphine required. Pandols for 2 weeks. No pain there after like you say due you are walking with crutches and this is why the scar tissue does not build up as much.
Good luck with your decision.
Cheers K