Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

How To Control Nerve Pain?
Nerve pain or peripheral neuropathy, as it is medically known, is characterized by pain, numbness and weakness that arise out of nerve damage. This pain is usually restricted to the feet and the hands.
What are the common causes?
Diabetes is the most common cause for this condition. However, other causes, such as injuries, infections and prolonged exposure to certain toxins can also trigger nerve pain.
How can you control nerve pain?
Nerve pain can be managed and taken care of at home taking into consideration the points that have been mentioned below:
Topical Painkillers: Certain over the counter ointments and creams can help relieve nerve pain. These medications act as local anesthetics; that is they numb the area of the pain. Capsaicin, a derivative of chili peppers, is one of the major ingredients used in these medicines. Others use botanical oils as the major ingredients.
Painkillers: There are painkillers available OTC which can curb nerve pain. However, painkillers such as ibuprofen, aspirin and acetaminophen do not really work well for severe pain of the nerves.
Supplements: The lack of Vitamin B12 is considered to be a very important cause, and at times, a catalyst for nerve pain. In a case such as this, Vitamin B12 supplements or injections might be administered. Although more research needs to go into this, but certain supplements, especially gamma-linolenic and alpha-lipoic acid can help soothe nerve pain caused by diabetes.
Acupuncture: This time honored Chinese approach is a proven alleviator of nerve pain. Acupuncture releases chemicals which numb the pain, or prevent the pain signals from travelling to the brain.
Physical Therapy and Massages: Physical Therapy can especially heal and strengthen weak muscles that can stem from acute nerve damage and pain. Though more evidence is needed, according to a few sufferers of this condition, massages can be helpful with the tremendously painful muscle spasms that can so often result from nerve pain.
Relaxation Techniques: In combination with the above mentioned approaches, relaxation techniques can go a long way in relieving debilitating neural pain. Besides being helpful with dealing and reducing a few stress phases of life which can cause nerve pain, these techniques might actually root out the actual pain itself.
Lifestyle Modifications: This one s always a winner! Eating a well-balanced diet that guarantees all nutrients in uniform amounts can never go wrong. Regular exercises for about 30-45 minutes can remedy different types of pain; nerve pain being one of them. Try and limit alcohol intake (a peg once a week won t harm one, but binge drinking can play the ultimate spoilsport and make all health plans go topsy-turvy!). Abstain from smoking or chewing tobacco as this is usually the primary contributor towards any medical condition or disorder.

Nerve Pain - 7 Ways You Can Control it 

Ankylosing spondylitis is typically associated with inflammatory back pain that can impair movements and reduce the quality of the patient s life. Here are 5 exercises that can be used to treat ankylosing Spondylitis.

Walking: Walking is a low impact workout that can be very beneficial for ankylosing spondylitis patients. This is the ideal way to ease the body into exercising. Start with a short 5-10 minute walk and gradually increase the duration of your walks to half an hour at a stretch. Try and keep your spine as straight as possible and hold your head high while you walk. Walking can help relieve pain and increase the range of movements.
Swimming: Swimming is another low-intensity workout that can help. This type of exercising helps strengthen the muscles and heart while minimizing joint pain. Swimming puts no pressure on the joints and hence is ideal for ankylosing spondylitis patients. The breaststroke can help build chest expansion and make your neck and shoulders more flexible. For a little extra pampering, you could go for a swim in a heated pool.
Lightweight Training: Look for lightweight training exercises that help strengthen your muscles without putting pressure on the joints. Plank exercises are great as they work many muscle groups simultaneously. You could also try lifting light weights or household canned goods to strengthen your limbs. Exercise machines can be helpful but must be used with caution. The key to exercising is to start slowly and gradually increase the duration of time you hold a position and the number of repetitions.
Yoga: Yoga is very beneficial for patients with musculoskeletal conditions. It reduces pain, increases flexibility and helps open out the joints to make them more mobile. Yoga also helps boost mental health and reduces stress and anxiety. When practising yoga, start by stretching the muscles and gradually work your way through the asanas. Do not be in a hurry to move from one position to another. You should ideally aim to fit in half an hour yoga into every morning.
Dance: Dancing is the most fun way to exercise. This helps burn calories that in turn helps with weight management. The lower your weight, the lower the pressure on your joints. Pick a tempo that you are comfortable with and limit repetitive motions to avoid straining any part of your body. If you like you could even join a dance class.

5 Exercises For Managing Ankylosing Spondylitis!

Your knee is a very complex structure consisting of bones, ligaments, cartilage, tendons, muscles and meniscus. Most people encounter knee pain at some point in their lives. If your knee pain is chronic in nature, then it may last for a prolonged period.

Many causes may be responsible for your knee pain. Some of the causes are stated as follows:
1. Your knee is very much prone to injuries. Knee injuries may happen due to accidents, falling down carelessly or while playing sports. The most common knee injuries that may be the cause for your knee pain are mentioned as follows: 
a) Fractures may cause you to feel pain in the areas of your knee bones.
b) Anterior Cruciate Ligament injury (ligament injury caused by twisting and a sudden motion) or Medial Collateral Ligament injury (injury to the tissue in the insides of your knee) is very common to sportspersons and may be the reason for severe knee pain.
c) Sometimes your knee bones may get dislocated from their usual alignment. This can also make you experience severe knee pain.
d) Ligament injuries, meniscus tear or tendon tear can also be responsible for your knee pain.

2. Sometimes pain in your buttock or foot region can also result in mild knee pain.

3. At times chronic problems like osteoarthritis that affects the cartilage can cause the problem of knee pain. Other chronic problems like Gout, rheumatoid arthritis can also cause severe knee pain.

4. Being overweight can also result in knee pain.
The symptoms of knee pain may be different in each case. The most common symptoms are mentioned below:
a) Stiffness of knee
b) Swelling of your knee
c) You may also feel unstable
d) Difficulty in walking or bending of your knee.
e) You may notice redness in your knee area.

Knee pain must not be ignored. It is highly recommended for you to seek advice from an orthopedic as soon as you encounter any of the above mentioned symptoms.

Suffering from Knee Pain - Know What Causes it? 

Osteoporosis is a medical condition marked by a decrease in bone density. It results in the brittleness of bones and their fracture. Osteoporosis does not display any signs or symptoms but manifests itself in advanced age.

Homeopathic remedies for Osteoporosis

Silica or Silicea-This remedy is for people who are often nervous, feel sweaty during the night, get easily tired and are a highly nervous lot. The injuries of such people take the time to heal/ are difficult to heal and their spine is weak. Generally, these patients have delicate or refined features.
Symphytum- Meant for those fractures that occur because of mild trauma, this remedy is useful in cases where pain persists in old but healed fractures and also when bones need to be strengthened.
Calcarea carbonica- This remedy is administered to people who are overwhelmed by a lot of work and stress, get tired easily after work and have a proclivity to stress a lot. Generally, these people are overweight and have a lot of body flab and easily get depressed by cold/chilly weather and dampness in the air. They have swollen joints, experience a recurring back pain and get a sweaty head in the night. An interesting characteristic of these people is also that they have a craving for eggs and sweet things.
Calcarea phosphorica- This remedy is meant for people who have a deep, uncontrollable and intense desire for travel. They want a change in their environment and have a general sense of dissatisfaction. People requiring this medication have pain in their neck, upper back and hips. Fractures, if any, are slow to heal and there maybe deposits of calcium in the bones. Post-exercise, these people feel greatly tired.
Phosphorus- Meant for people who experience a burning pain between their shoulder blades, phosphorus as an osteoporosis remedy is given to those people who have an intense desire for refreshing foods like ice cream, beverages, carbonated drinks etc. Such people are usually lanky and their faces often get flushed. They are sensitive, suggestible and susceptible to the imagination. They get easily tired after a round of exercise and work.
Homeopathy Dosage
Unless directed by a homeopathic physician, take doses of low potency like 6X, 6C, 12X, 12C, 30X or 30 C if you are going in for self-medication. Follow the instructions printed on the label.
If you are taking a single dose, ten wait for its response. If the medicine is working, then wait for its full effect to manifest. If there is little or no response, take another dose. If there is no response at all after taking the second dose then change the medicine.

Please note that dosage depends upon the individual and the intensity of his/her ailment,

Osteoporosis - How Homeopathic Remedies Can Help?

There are many ways to treat pain and this includes acupuncture, several natural remedies, technological procedures and surgery. Among the different approaches for treating pain, massage therapy is an effective method.

Massage therapy is one of the earliest therapeutic processes for relieving pain for a long time as it provides ideal relief and performs recovery functions as well. In the modern day, massage therapy is a popular pain relieving remedy, which is utilized by people all over the world.
Massage therapy involves manipulation of the tissues, which is performed by special therapists. There are various types of massage therapies, which incorporate different techniques and procedures.
Long-term massage therapy is not very expensive and has no side effects on the body. With the help of massaging, there is an increased lymph flow, improved blood circulation and several positive effects on the immune system. 
Conflicting views

The current studies on massage therapy are quite conflicting and there are negative views regarding the effects of massage therapy to provide pain relief. Massage therapies are successful in treating several cases of lower-back pain. However, many experts consider massage therapy to be a relaxation technique and not a proper treatment procedure.

They say that massage provides relief to pain, but physical therapy, exercise and medicines are far superior in providing pain relief than massage therapy. Massage provides relief to neck pain, shoulder pain, headaches and carpal tunnel syndrome. However, it is considered that this relief is only temporary and not consistent enough. A single session of massage therapy does not really provide a long-term relief from pain. For better and lasting results, massage therapy should be undertaken regularly.

Multidisciplinary treatment

Massage alone will never provide ideal relief from any kind of pain and a multidisciplinary approach should be taken for pain relief treatment, where massage therapy would be one of the elements. For ideal pain relief, you should practice other measures such as physical therapy, behavioral health care, acupuncture, regular exercise and use massage therapy as a complementary relief method.

Massage therapy can never be the main treatment procedure for treating pain and it is an accompanying treatment method which you should practice along with major treatment procedures. Massage therapy combined with other therapies will provide you effective pain relief.

Massage therapy for pain provides effective temporary relief from pain. It should be performed by a trained massage therapist and for good results must be performed every day. However, massage therapy is not a primary treatment measure and should be a part of a multidisciplinary approach for pain relief. In case you have a concern or query you can always consult an expert & get answers to your questions!

Massage Therapy for Pain - An In-Depth Analysis!

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