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Pain-Guided Healing

By Donald H. Lalonde, MD

I am much better at patient education during WALANT carpal tunnel release than I used to be. Patients love the intraoperative advice from their surgeon. Post-op complications or complaints decrease. I tell them that if they follow the rules, they will be doing most things by 2 weeks except for big thumb power moves.

Most important rule: This hand is on strike (on holiday) for 2-3 days until you are off all pain killers and you know what hurts. You are a one-handed woman, even when you get in the shower tomorrow with a naked hand. This hand stays higher than your heart at all times. Treat it like a sleeping baby: Don’t disturb it! Best positions? Higher than your heart when you are walking around. Elbow on the table with your hand up like your grandmother told you not to. 🙂

What do you normally take for pain with a headache? Advil? Tylenol? That is all you will need after this. You can take Advil or Tylenol (or both if one is not enough) for the sting of the cut which lasts only a day or two if you keep your hand higher than your heart and quiet. By tomorrow or the next day, the sting of the cut will be gone and you will be into the pain of: “Gee doctor, now it only hurts when I put my hand down or when I do stuff.” As soon as you get into the pain of, “Gee doctor, now it only hurts when I put my hand down or when I do stuff,” you quit taking all pain killers and listen to your body! We did not spend 2 billion years evolving pain because it is bad for us. It is your body’s only way to say, “Mary, would you quit that?!! I’m trying to heal in here and you are screwing it up!!” That is a little voice in your head that you want to listen to, but you can’t hear it with Advil or Tylenol in your ears so stop taking that stuff. Just don’t do what hurts. It’s called “common sense.” It’s also called pain-guided healing. Your pain will tell you when you can put your hand down, type, drive, open jars, or anything else you want to do.

It’s a myth that you can’t water fresh wounds. Fresh wounds love to be watered. You can take off the “Hollywood bandage” and get into the shower with a naked hand tomorrow or the next day. You are still a one-handed woman in the shower, but the hand can get soapy water on it and wet. Just rinse, pat dry, and reapply a Hollywood bandage for 4-5 days until you are used to pain-guided healing. You can then leave it dry and open to the air. The only reason I put on a Hollywood bandage is because you are normal, you are human, so you will forget you are a one-handed woman. When you go to use your hand this evening to undress or brush your teeth, you will see the Hollywood bandage and it will remind you (and those around you) to be good. 🙂

I only use simple buried dermal Monocryl sutures so there are no stitches to take out:

Comment (1)
Gustavo Machado
April 9, 2021 4:31 am

Great article. Thanks for all the pearls given to us in a such nice and eloquent way.


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