Pain Management in Total Shoulder Replacement

A common concern for people who are considering shoulder replacement surgery is fear. Some people are afraid of the pain associated with surgery. They may have heard something like, “shoulder surgery is the worst, and the pain is horrible…” 

The reality is that people who are considering shoulder replacement surgery are already in pain from arthritis or a previous shoulder injury. Without surgery, their arthritic shoulder pain will worsen, and their ability to perform everyday activities such as getting dressed, lifting, driving, or working will create even more pain.

How do people resolve these conflicting fears? I believe that facts are the antidote to fear. Here’s a recap of what people with severe shoulder pain should know.

Every surgical procedure generates pain. But, pain after surgery is usually temporary and it can be managed. Because each person’s pain is influenced by multiple internal and external factors, there’s no “one size fits all” approach to pain management after shoulder replacement surgery. Things that work well for one person might not work for others. 

People who have undergone previous surgeries often have an idea of what kinds of pain management works well for them. For others, pain management will be a process that may include several different approaches. In either case, it’s important to discuss pain management with your surgeon before the procedure takes place. It’s also important to remember that pain from surgery should diminish as you heal.

Here are some of the options for shoulder replacement pain management that you can discuss with your surgeon.

1. Regional anesthesia (nerve blockade)

This technique uses medications that block nerve activity in your arm following the surgical procedure. This prevents transmission of nerve signals that control sensation and muscle activation. The result is often numbness in the arm as well as the inability to move the arm. This is similar to going to the dentist and getting an injection that numbs your teeth.

There are many different types of medications and methods of performing a regional nerve blockade for shoulder replacement surgery. These techniques are successful at reducing pain for several hours to several days after surgery. As with any procedure, there are risks which should be discussed with your surgeon or the anesthesiologist who will perform the nerve block.

2. Cryotherapy

This is simply the use of cold packs or ice to decrease pain and inflammation. It’s a simple and effective strategy to decrease pain following injury or surgery.

3. Medications/alternate treatments

There are many medications and practices that can help alleviate pain following shoulder replacement surgery. Here are some common options:

Non-narcotic pain relievers

Acetaminophen works to control mild to moderate pain and is available over the counter. It’s sometimes used in combination with prescription pain medications that combine acetaminophen with a narcotic drug or an anti-inflammatory.

Narcotics

There are many different narcotic pain medications available. These are strong medications that help to control acute post-operative. But, narcotic pain medications can also create side effects including nausea and constipation. While taking narcotic pain medications, you may need to take a stool softener too. Narcotics also have the potential to cause dependence and addiction.  The opioid epidemic in our country has resulted in a significant decrease in narcotics usage following surgical procedures.  If you are prescribed a narcotic medication, your surgeon will discuss limiting the use of narcotic pain medications and how to wean yourself off of this medication as soon as possible following your surgery. 

Non-steroidal anti-inflammatories (NSAIDs)

There are multiple NSAIDs available either over the counter or with a prescription.  These medications work to decrease the inflammation and block pain. These medications are sometimes used in conjunction with other medications as part of a pain management plan. 

Keep in mind that NSAIDs can have side effects including stomach discomfort. Patients with a history of stomach ulcers, kidney problems or those on blood thinning medications should check with their doctor prior to taking NSAIDs. 

Mindfulness and meditation

Although the experience of pain is not pleasant, it’s your body’s alert system. Pain is a signal that your shoulder has been injured and you need to allow yourself to heal.  Accepting the pain you’re experiencing as part of the healing process can often help make the pain more tolerable. Mindfulness, meditation and relaxation techniques are helpful because they decrease muscle tension and spasms that can often make surgical pain feel worse. One of the simplest methods for easing pain is to imagine that you are breathing in wellness and breathing out pain.

Positioning and sleeping

In many cases, your shoulder will be in an immobilizer or sling for a period of time following shoulder replacement surgery. The arm should rest comfortably in the immobilizer. If your arm is uncomfortable in the immobilizer, contact your surgeon to discuss adjustment. Your surgeon should discuss activity restrictions after surgery. You may be told to remove your arm from the immobilizer periodically so you can straighten your elbow, move wrist and flex your hand. These movements can help reduce post-operative pain and stiffness. 

Most patients find sleeping is the most challenging part of recovery from shoulder replacement surgery. Finding a comfortable position is often difficult and many patients will find lying flat in bed increases pain in the shoulder. Typically sleeping in a slightly upright position (reclining chair or adjustable bed) is the most comfortable for patients following shoulder replacement surgery.  

Shoulder replacement surgery has been shown to be a successful way to relieve arthritic shoulder pain for many patients. Certain patients may continue to experience some level of pain or immobility following surgery; talk to your surgeon about this and other potential complications associated with shoulder replacement surgery. You will likely experience some pain during the post-operative period, but with good pain management, the painful period should be temporary. If pain persists or worsens following shoulder surgery, notify your surgeon.