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He is amazing and a blessing to have in the medical industry. Very positive experience at Bone and Joint Clinic in Baton Rouge. There is often swelling of the knee and severe pain with walking, running, twisting, or moving the knee. Grant H. Garcia, MD 148 subscribers Dr Garcia demonstrates his new meniscal extrusion technique to further improve meniscus root repairs. Sutures are passed through the meniscus, and then pulled down into a bone tunnel located at the same site as the root attachment before it tore. Meniscal repair may be performed either by open surgery under direct vision or minimally invasively using an arthroscope that can be inserted into the knee through a very small key-hole incision to locate and repair the damaged meniscus. The recovery time for meniscus surgery depends on the type of surgery you had. Highlights from the StartingStrength Community. A possible cause for knee pain 1 year after meniscus surgery would be a re-tear of the meniscus. The goal of a meniscus root tear repair is to locate the torn root and tack it back down to the bone using strong sutures. short distances based on their motion and Swelling and stiffness. As of August 20, 2019, it will be six months post-op. Dr. Burnham made sure I knew what was happening and what could happen. I would recommend his services to anyone. I could no longer deadlift from the floor, and was having trouble squatting below parallel. Video chat with a U.S. board-certified doctor 24/7 in a minute. If it is the right knee, the average time until the patient is able to drive is 6-9 weeks. In terms of when, one should plan to perform a meniscus root repair as soon as it is diagnosed as long as ones articular cartilage is still fairly intact. There are 2 main variants of the transtibial root repair technique. If you break down what most healthcare provision professionals tell their patients, it could be an orthopedic surgeon, or even a physical therapist, its telling somebody whos just had a meniscus surgery, theyll say, well, 80% of healing is done in the first two to three months. A physical therapist will be assigned to you and begin a routine of light exercise to help stabilize the knee. That means that the remaining meniscus is smaller, but still taking the same pressure. Many tears have better outcomes if they are treated early. Further study into meniscus root tears and radial root tears is ongoing by our research laboratory to try to improve the treatment of these complex problems. Ill def refer friends and family! As a result, two weeks after surgery I was able to start driving my car, which is a manual. If it is your right knee, it will be at least a week before you can drive, as it would be risky to have to hit the break too soon after surgery, and you would be a risk to yourself and everyone else on the road. He listens and address every concern with appropriate solutions. I was worried for my future with my legs letting me walk but she put me at ease letting me know she will do everything in her power to fix me or send me to whatever specialist I need to see to make sure I have a good chance walking in my future, and they all truly fantastic doctors. - Privacy Policy - Louisiana Retina, Dr. Jeremy Burnham, MD - Sports Medicine, Orthopedic Surgeon, Knee Doctor, Jeremy Burnham, MD - Sports Medicine & Orthopedic Surgeon, __CONFIG_colors_palette__{"active_palette":0,"config":{"colors":{"f3080":{"name":"Main Accent","parent":-1},"f2bba":{"name":"Main Light 10","parent":"f3080"},"trewq":{"name":"Main Light 30","parent":"f3080"},"poiuy":{"name":"Main Light 80","parent":"f3080"},"f83d7":{"name":"Main Light 80","parent":"f3080"},"frty6":{"name":"Main Light 45","parent":"f3080"},"flktr":{"name":"Main Light 80","parent":"f3080"}},"gradients":[]},"palettes":[{"name":"Default","value":{"colors":{"f3080":{"val":"rgb(23, 23, 22)"},"f2bba":{"val":"rgba(22, 23, 22, 0.5)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"trewq":{"val":"rgba(22, 23, 22, 0.7)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"poiuy":{"val":"rgba(22, 23, 22, 0.35)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"f83d7":{"val":"rgba(22, 23, 22, 0.4)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"frty6":{"val":"rgba(22, 23, 22, 0.2)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"flktr":{"val":"rgba(22, 23, 22, 0.8)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}}},"gradients":[]},"original":{"colors":{"f3080":{"val":"rgb(23, 23, 22)","hsl":{"h":60,"s":0.02,"l":0.09}},"f2bba":{"val":"rgba(23, 23, 22, 0.5)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.5}},"trewq":{"val":"rgba(23, 23, 22, 0.7)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.7}},"poiuy":{"val":"rgba(23, 23, 22, 0.35)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.35}},"f83d7":{"val":"rgba(23, 23, 22, 0.4)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.4}},"frty6":{"val":"rgba(23, 23, 22, 0.2)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.2}},"flktr":{"val":"rgba(23, 23, 22, 0.8)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.8}}},"gradients":[]}}]}__CONFIG_colors_palette__, Cartilage Damage: Symptoms, Causes, & Treatment, Elbow Rehabilitation and Postoperative Protocols. And people are often disappointed to find out that as they begin to get back to normal, as theyve been told that they probably could and should they start to get swelling in the knee, they start to get a pain, of course. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. More diffuse pain over the inside of the knee which becomes progressive over time can be particular ominous because this may mean that the cartilage is wearing out fast or that one has an insufficiency fracture or spontaneous osteonecrosis of the knee, occurring due to the fact that the meniscus is such an important shock absorber. I dont remember how or when I tore my meniscus. If I could give more than 5 stars, I would. We are so grateful for you both! Yet, if you feel discomfort, you can take over-the-counter pain medication. At the beginning of April, I was dancing at a friends wedding when I suddenly heard and felt a loud pop in my left knee. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. This is done to protect the repair and let the body heal it. In radiologic terms, this is called a bony ossicle. The technique for a repair for a bony avulsion, called a type 5 meniscus root tear, is similar to the other techniques other than it should have the bone piece shaved down and cleaned off such that it can be pulled back into the area where it had been avulsed from. Previous attempts to make it better provided only temporary relief. Thank you for choosing Dr. LaPrade as your healthcare provider. Later that day, I trained. It is felt that most meniscus root tear repairs are sufficiently healed to start these activities between 5 and 7 months postoperatively. A week later, I got my MRI results and I was told that this was going to be a very long recovery, but I had other plans. Factors Affecting Meniscus Tear Healing and Prognosis AOSSM Lecture from Jeremy Burnham, Ochsner-Andrews Sports Medicine Institute, Copyright 2022Jeremy Burnham, M.D. During the procedure, Dr. Vidal will isolate the root, pull it against the tibia and place sutures in the meniscal attachment. Meniscal Ramp Lesions. This allows the meniscus to heal back to the bone. Arrange for someone to drive you home as you will not be able to drive yourself after surgery. They walked me through the process from beginning to end. And this channel is dedicated to helping people stay healthy, active and mobile. Meniscal repairs offer the benefit of preserving the native meniscus, but they require a longer rehabilitation protocol as compared to a meniscectomy. This can occur with turning, twisting, or pivoting activities or sports. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. Sit at home on the couch and watch T.V.? Then, in January of 2018, while warming up in class one morning, a sharp, nauseating pain shot through my left knee, which made me start limping. Therefore, we found that non-anatomic meniscus root tear repairs were not successful. Identifying and properly treating meniscus tears (with or without surgery) will lead to the most rapid reduction in your symptoms and is crucial to optimize the long term health of your knee. The next steps involve placing self-capture sutures into the end of the meniscus root and then drilling cannulas into the area that was decorticated such that the sutures placed into the meniscus can be shuttled down the cannulas and then tied over the tibia. Dr. Burnham and his remarkable staff have been a godsend for our son. Definitely recommend. 4010 W. 65th St. Jerrica, Dr. Burnham, and the therapy staff (Luke and Joey )were awesome. Heavy lifting, manual labor, strenuous exercise/activity, and sports should all be restricted until 3-6 months after surgery. The roots of the meniscus are responsible for transmitting weight evenly across the surface of the tibia. Your care after surgery may involve: Crutches to take stress off the knee as it heals. In particular, these younger patients have to look at a meniscus root repair as soon as possible to ensure that they dont develop arthritis. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. Did you have any meniscus surgery in the past and youre still dealing with pain, swelling and possibly even losing motion in your knee? I switched out the single leg deadlifts for trap bar deadlifts on mats, and added low step ups on the left leg. Often the best medicine to take is NSAIDs like naproxen and ibuprofen. They are connected to your tibia by meniscal roots. Oftentimes healthcare providers will tell you go walk your knees operated on its good youre the we took out the chunk that was you know causing your need to lock up the meniscus we did a meniscectomy or we repaired the meniscus and its all sewn together now so you can go ahead and walk all you want and some people take that to heart and to go walk you know three miles a day or even 10-20 miles a week and their meniscus just doesnt heal enough and they get that swelling. Can you tear your meniscus again after a surgery and if you do how can you tell? Matthias J. Feucht1,4 Received: 19 May 2022 / Accepted: 13 February 2023 And unless you have been following my Instagram page and know about my rehab, you would never even know that I had knee surgery. I was also allowed to bear weight on my leg while in the brace, which meant no more seated presses. Therefore, our surgical technique, using specific guides to avoid the eminences to ensure that one can place the guide exactly where one wants to have a cannula come out in the joint, using cannulas to allow for placement of passing sutures quickly and efficiently, having 2 separate cannulas with 2 separate tunnels for the meniscus repair, releasing the meniscus thoroughly to pull it back in the joint so it functions most effectively, and then having self-capture suture devices, which can place suture or tape into the meniscus substance, shuttle them down the tibia, and then tie them over a metal button on the tibia. An ACL tear most commonly occurs from a turning, twisting, or deceleration mechanism in a noncontact mode. So go check out that video on how to exercise your glutes theres five exercises in there that you can start doing them i would do them every day i do them a couple times a day even more if you can i would do what you can tolerate without it being too much soreness and your glute muscles and they should all generally be okay on your knee theres some where you got to kneel you can adjust it you can not do that exercise if you want. I think my clients thought I had lost my mind, but what else was I going to do? Meniscus root tears are now being recognised as a significant cause of pain, disability, and rapid joint deterioration. You should also be able use your leg for driving after one to two weeks, as long as you're not taking opiate pain medication. But if we are stronger, we are harder to break, and we most certainly recover faster and better. Meniscus root repair surgery recovery Most patients can return to full activity 4-6 months after a meniscus root repair. In cases the patients undergo meniscus repair or ligament reconstruction, they are given a brace to support the knee in full extension. This specific type of tear makes up 90% of all meniscal root tears. . I was training one afternoon, and I noticed some swelling, not too much, but enough for me to start keeping an eye on it. Had a meniscus root repair yesterday and the surgery was successful. 5 wks into recovery of acl/meniscus tear surgery, I am still taking pain medicine. I would recommend his service to any recreational athlete. Phase 1: 0-2 weeks post-operatively Goals Protect repair Minimize pain Minimize swelling . %PDF-1.5 The feeling that your knee is giving way, locking, or catching when you bend it. They may start the use of a stationary bike, and may slowly wean off crutches starting at 6 weeks post-operatively. #JimmyWinkfield is 1 of 5 men to win the prestigious twitter.com/i/web/status/1, What are #loosebodies in the #hip? When you put weight on your leg, it is the meniscal roots that transfer the axial loading forces of the knee into hoop stress in the meniscus. While you're recovering from your meniscus surgery, you can expect to feel pain while you heal. I am a coach, and I have two boys playing sports, the best thing I can say is that my sons will go see Dr. Burnham in the event they are injured, and I will always recommend him to my athletes. Normally, you should refrain from driving for at least 1 week after an arthroscopic knee operation, until the swelling reduces and the knee motion improves, but you should establish with your doctor when it is safe to start driving. 181 West Meadow Drive Suite 400 Vail, CO 81657. Everyone I was in contact with, from support staff to Dr. Burnham, was kind, friendly, competent, and generous with time and information. Begin passive range of motion exercises Start physical therapy or home exercise program 1-3 days after surgery Work on quad recruitment Brace/Crutch Use 25% weight bearing with crutches, brace 0-90 when ambulating and sleeping, can remove . We validated that the 2 simple suture technique had the least amount of loosening over time, but the other techniques were stronger. Thanks to his staff for being so helpful. The root attachments of the posterior horns of the medial and lateral meniscus are very important for joint health. You may need surgery to restore full knee function. What most people just dont get from their medical professionals is that the meniscus is a type of cartilage. The next day, my left knee blew up to the size of a grapefruit. They can occur in younger patients as a result of high energy trauma, but are more common in patients between 45 and 60 as a result of degeneration of the meniscus with age. No swelling. So if youre sitting at home right now, and you just had your meniscus surgery a month or two ago, and youre thinking, gosh, why arent I much better already. I felt very informed and well cared for. It is shaped like a C and it serves to cushion and stabilize the knee. very elderly patients). Theyre kind of done with you too but what if you want to go play with the grandkids do you want to kneel what do you want to exercise youve got to set your expectations to still take it easy still rehab or strengthen the right muscles or do the right kind of treatment for yourself so that you can continue to heal. In general, in our practice, most patients who do have pain after a meniscus root repair fit into this category. I got a lift home, and returned to the gym later that evening for more coaching. Super knowledgeable. Timeline: 1 week to 5 weeks after Surgery. Towards the middle of March, I was finally given wall slides (mini squats) and step ups for the left leg by my physical therapist. My daughter journey was very trying and hard but we made it through with all of their help. It is critical that patients following a knee joint repair refrain from squatting for at least four months after the procedure. Wednesday: 8:00 am 5:00 pm The most important aspect to assess when one is looking at a root repair is to ensure that ones cartilage surfaces are still fairly normal. The most important thing as one gets older is the quality of the cartilage present. Dr. Benedict Nwachukwu, orthopedic knee surgeon has extensive experience in treating meniscus root tears and can help patients in Manhattan, Brooklyn, New York City and the surrounding New York boroughs. Does having a cortisone shot help a meniscus tear or is surgery the only option? If the meniscus is extruded, the patient may not be having a restoration of their shock-absorbing capacity of the meniscus. They are also important to the stability and function of the knee, keeping the meniscus in place. And Im a specialist physical therapist El Paso manual physical therapy. 1) You must be off narcotic medications for a . Life happens and our bodies will sometimes let us down. The surgery performed was a knee partial meniscectomy, a common surgical procedure used to repair a torn meniscus. Thus, when one does sustain a lateral meniscus root tear with an ACL tear, consideration should be given to having a concurrent lateral meniscus root repair so the ACL graft does not stretch out. After creating two transtibial tunnels, passing sutures through the detached root of the meniscus and down the tibial tunnels, the sutures are tensioned to reduce the root of the meniscus to anatomic position. <>>> Patients often report hearing a pop at the time of injury. In recent years the importance of the meniscus root has become more apparent. Typically begins 3-5 days after surgery; Precautions Toe touch weight bearing with brace; Gradually unlock brace for 6 weeks; after 6 weeks no brace Patients are usually kept non-weight bearing for the first 4-6 weeks, then advance gradually. Knee popping after meniscus surgery can occur due to fluid accumulation, scar tissue, swelling and stretching of the tendon and ligaments, weakened leg muscles, changes in patellar tracking, underlying knee arthritis, unstable meniscus, and inflamed plica. Dr. Burnham clearly cares about his patients and their follow up care. So the focus of physical therapy after a knee meniscus surgery is getting your motion all the way back and then getting strong enough to stand and do some walking. No, I didnt say pain free, or I didnt say get back to normal, just strong enough to get back to standing and walking because nobody wants to be in a wheelchair or not be able to get to the bathroom in time because of your knee not working right or being very painful. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you b. Everyone made us feel comfortable, and they were all polite and professional. A meniscus root tear occurs when one or both of these roots tear away from the bone. Therefore, it is strongly recommended to proceed with a meniscus root repair whenever possible, with patients up to the age of 70 being reported as having excellent return of function. And cartilage is one of the slowest healing tissues in the body. Ive dealt with other knee doctors in prior injuries, but Dr. Burham and his team clearly stood out. I was going to rehab myself, and keep training as normally as I could. They moved my knee a bit, and I had decent ROM, better than expected. The transtibial meniscal root repair is emerging as the gold standard treatment due to its ability to restore a large footprint at the meniscal root's native attachment site and restore normal joint contact pressures. In general, one can follow the small tunnels from the transtibial technique up to where the root attachment should be. Drivers: The meniscus repair surgery to prevent osteoarthritis is expected to drive market development. Amazing doctor, amazing family mantreats patients with the highest level of care, compassion, and quality! Should a meniscus tear repair surgery be hurting 7 weeks post-operation? I chose not to use my crutches anymore. The High Tech Shirt Problem in the Squat Rusty Holcomb, Observations on Training by an Old Guy Phil Ringman. Later that summer, the left knee began to bother meagain. When the tear is examined during arthroscopy, Dr. Hess will decide if the tear is able to be repaired . The mini First-Pass device allows placement of either a suture or an UltraTape through the substance of the meniscus, capturing the end of the stitch as it is placed through the meniscus and then it can be pulled out of the joint. The most common method to fix meniscus root tears is through a tibial bone tunnel. The back attachment of the medial meniscus, called a posterior horn attachment, is the most common location for meniscus root tears to occur. But typically physical therapy goes two to three months you get 80% better and a lot of times people have the expectation setting themselves that they can get back to everything that theyre doing before and thats just not the case they can do a lot of things now that they couldnt before the surgery typically. How long did you have to avoid driving after meniscus surgery? amount of, supply and beyond the age of 15 has limited healing without surgery. He did a great job of explaining both the progress of my injury and the way ahead as it applied to recovery. The technique of a meniscus root repair involves isolating the root, placing a minimum of 2 sutures in the remaining meniscal attachment, and trying to reposition it back to a more anatomic position. Medial Patellofemoral Ligament (MPFL) Reconstruction . Most root tears involve either a direct tear of the meniscus off bone or a split of the meniscus within 1 cm of the root attachment. This is because the signs of arthritis are usually pain and swelling with activities. There was absolutely no knee pain. The meniscus is a piece of cartilage in the knee, often injured in sports. In particular, making sure the meniscus has a thorough release from scar tissue and making sure that ones sutures or UltraTape are placed into the best substance possible for the meniscus root repair, are important considerations to maximize the chance of healing of the revision root repair procedure. Tuesday: 8:00 am 5:00 pm BJJ was also becoming more and more of an issue, and the warm-ups were now next to impossible. Specializes in Orthopedic Reconstructive Surgery. Dr. Burnham was very thorough with his examination and diagnosis. Dr. Burnham has an awesome bedside manner. Progression of range of motion is more limited than for a standard meniscus root repair, usually limiting patients to 0-60 or 0-90 degrees range of motion for the first 4 weeks and then slowly increasing range of motion as tolerated. It was glorious. My name is Dr. David Middaugh. Weight bearing as tolerated after 6 weeks. To accomplish this goal, Dr. Nwachukwu drills a small hole from the outside of the tibia (shin bone) into the knee joint next to the natural attachment of the meniscus root. Realize that, as discussed above, the torn part of your meniscus was removed. Dr Burnham is so personable. When one drills a tunnel and tries to place stitches up a tunnel without a cannula in place, it can be extremely technically challenging. Dr. Burnham was very personable and explained my situation in great detail. I did a few jungle gym rows, and finished with planks. I rate him 5stars. Sometimes the meniscus damage occurs more gradually as part of degeneration. Meniscal Repair. After meniscal surgery, rehabilitation with a physical therapist or athletic trainer is needed to restore range of motion, strength, movement control and guide the athlete's return to sport. When a torn fragment is floating in the joint, patients will feel a sudden, sha twitter.com/i/web/status/1, According to an injury study done in 2021, #Pickleball has been deemed safer than #tennis and better for individual twitter.com/i/web/status/1, Cysts Acetabular Paralabral and Subchondral, ACL Anterior Cruciate Ligament Injury of the Knee, Patellofemoral Pain Syndrome Runners Knee, PVNS of the Knee Pigmented Villonodular Synovitis, Osteochondral Allograft Transplantation Surgery (OATS), Patellofemoral Arthroscopy Runners Knee Treatment, Stabilization for Instability-Arthroscopic, Subacromial Decompression for Impingement, How to prevent common skiing and snowboarding injuries | Ski Injury Doctor Manhattan, BICMD Co-Founder and Co-CEO Announces Expansion of Services, Patients are partial weight bearing for the first 4 weeks and then during weeks 4-6 are progressed to full weight-bearing. There are many factors that go into this, including a patients weight, with overweight patients putting more stress on the meniscus root tear, ones alignment, where one being bowlegged with a medial meniscus root repair putting extra stress on the repair, and also the amount of underlying arthritis present prior to the root repair. Your doctor put a lighted tubecalled an arthroscope or scopeand other surgical tools through small cuts (incisions) in your knee. This technique allows one to place passing stiches up the cannula, which has significantly decreased the operative time. Their sense of compassion and understanding is more than we have ever experienced. So you need to just have that expectation right now if youre going to go get a surgery, or if youve already had one, if its been more than six months, or youre in that you know, past six months, six to 12 months range or longer since your meniscus surgery, then its okay as long as you dont have another tear or some other massive injury to it, you can probably get that swelling under control, regain your motion back as long as it hasnt been too long. In general, almost all meniscus root tears require a 6-week period of being nonweightbearing to maximize the healing potential. In layman terms, I had completely torn my medial meniscus from the bone, and it had to be sewn back on. xYIoH8(Jr@fI)/_U}|xW&JDIraqm Meniscal repair may be performed either by open surgery under direct vision or minimally invasively using an arthroscope that can be inserted into the knee through a very small key-hole incision to locate and repair the damaged meniscus. Meniscus root repair rehab will usually start 1-2 days after surgery. Browse archives. Call your doctor or 911 if you think you may have a medical emergency. I was cleared to drive at my followup appointment 2 weeks after surgery, which was exactly what my surgeon had told me to expect. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again. You'll likely regain your previous muscle strength in the leg by. You can schedule an office consultation with Dr. LaPrade. The torn meniscus is corrected via a minimally invasive procedure depending on the kind of injury. Examination of the medial compartment revealed a complete radial tear proximally 1cm medial to the posterior root insertion. I did a little internet searching, and diagnosed myself with a Bakers Cyst, which I discovered was pretty common with meniscus tears. If your job mostly involves sitting at a desk, you may be able to get back to work in a week or two. The meniscus root is where the meniscus attaches to bone. We found that the technique was very successful at restoring function to patients and significantly reducing their pain. If one has too much arthritis, then the chance of a meniscus root repair helping one to slow down the progression of arthritis is probably not worth having the meniscus root repaired. Medial meniscus root repair midterm results suggest excellent outcomes in a well-aligned knee with minimal degenerative change. Each week my leg brace is put to a different degree so I learn to bend my knee again. Never disregard or delay professional medical advice in person because of anything on HealthTap. His extensive schooling, research, and commitment to his craft shined through at every turn as he evaluated my injury, presented all my options (clearly explaining non-surgical options and expected outcomes), and helped me plan my course of treatment and recovery. And then after the surgery, the focus is doing physical therapy, typically if he gets sent there, and youre going to lose some motion in the surgery so your knee wont be able to bend or straighten all the way. The meniscus is a very important piece of cartilage in the knee. Then, in September, at the Charm City Strongwoman Contest, I sprinted into the gym from the outside looking for one of my volunteers. I plan to squat 135 pounds for three sets of five on this day and am scheduled to deadlift 200 pounds on August 23. And I feel my rode to recovery will be wonderful. In the early stages of your meniscus tear you can take these conservative and essential treatments which are as follows: Rest Ice every 15 minutes in every 4-6 hours Compression with an ACE wrap or sleeve Elevation of the leg Nonsteroidal anti-inflammatory medications (NSAIDs) for pain.