Staying ahead of pain: how your Rest-Assure plan works.

Patients sometimes look at their medication plan and ask why it is so specific. Two of this, two of that, then one of each every twelve hours. The schedule isn't arbitrary. Each part has a reason, and knowing the reasons makes the plan easier to follow.

Start before surgery does.

Your first doses go down at home, the morning of surgery, before you leave for the surgery center. That timing is deliberate. By the time surgery begins, the medicine is already working. Pain is far easier to prevent than to bring back under control once it has taken hold.

That first morning is also the one time Journavx needs an empty stomach, which fits neatly with fasting for surgery. After that, you can take it with or without food.

Three medicines, three jobs.

• Journavx quiets the pain signal in the nerves, close to where it starts. It is not an opioid.
• Celecoxib (Celebrex), a COX-2 inhibitor, calms the inflammation and swelling that create much of that signal in the first place.
• Acetaminophen (Tylenol) works through yet another pathway. You can take it in between your other doses to fill any gaps.

Each one covers something the others don't. Together they control pain better than any one of them alone. That is how we keep opioids out of most recoveries.

Why a bigger first dose.

On the first morning you take a larger dose, then drop to one of each every twelve hours. The larger first dose brings the medicine up to a working level quickly. The smaller doses keep it there. Your medication plan shows exactly how many of each to take, and when.

On schedule, not as needed.

For the first few days, take your doses on time, even when you feel fine. If you wait until the pain comes back, you start from behind, and catching up takes longer. Phone alarms for the morning and evening doses help. The printable plan has a tracker you can check off.

Nausea is part of the plan too.

That same morning, most patients also take one anti-nausea pill. Patients who have had nausea after past surgeries may get a scopolamine patch behind the ear, and patients whose blood pressure runs high may start a clonidine patch a few nights before. Your plan shows which of these apply to you.

What to avoid.

• Don't add ibuprofen (Advil, Motrin) or naproxen (Aleve). Celecoxib already covers inflammation.
• Avoid grapefruit and grapefruit juice while you take Journavx.
• Don't drive while taking any opioid pain medicine, or if you feel drowsy or dizzy.

Where opioids fit.

With this plan, many patients never need one. If your surgeon prescribes one for breakthrough pain, think of it as a backup, not the plan. Using less of them means less nausea, less constipation, and a clearer head.

Your exact doses and times are on your medication plan at specialsurgery.com/patients/medication-plan. Bring your questions to your free Rest-Assure consultation. I would rather walk through it with you twice than have you guess on the morning of surgery.

— H. Rand Scott, MD

This article is general information and is not medical advice for your situation. Follow the instructions you receive from your surgeon and the NCSS team. Brand names are used only to help you recognize medicines; NCSS has no affiliation with their manufacturers.

H. Rand Scott, MD is founder and Medical Director of Newport Center for Special Surgery. Board-certified anesthesiologist, subspecialty training in interventional pain management at Penn State Milton S. Hershey Medical Center. He personally offers a free Rest-Assure pre-operative consultation to every scheduled surgical patient at NCSS.

The right starting point is a conversation.

Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before the day of surgery.

Monday–Thursday, 8am–3pm · Friday by appointment only.