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 

Yoga vs gym  
Any form of regular exercise is a must for a healthy lifestyle. While some people prefer to work out in a gym, others like the calmness of their own house where they can practice yoga or a walk in the park. Each style of exercise has its own pros and cons. Let's take a look at working out in the gym vs yoga and regular walks.

Benefits of yoga and walking over going to gym:

Good for both - the mind and the body
Yoga is a lifestyle and not merely an exercise routine. Thus, it not only builds and tones muscles but also strengthens your lung capacity, digestive system etc. It is also said to increase the ability of the mind to focus and attentiveness.
You could walk on a treadmill in the gym but taking a walk outdoors does more good to your body. Being with nature when you walk outdoors is known to be an effective stress buster and helps you calm your senses. Walking can also help improve your moods and is a form of treatment for depression as well.

Does not need any special equipment
With yoga, there is no need for weights or special shoes. All you need is a flat, firm surface which could be the carpet in your bedroom or your lawn outdoors. The only equipment you need for a walk is a pair of sturdy, comfortable walking shoes. This makes yoga and walking budget friendly as well compared to gym membership costs.

Can be done anywhere
Since yoga does not need any special equipment, it can be practiced anywhere and at any time. Taking a break from sitting at your desk - try doing pranayam. Keep a pair of walking shoes handy and at lunch break take a quick walk around the block - there's nothing to stop you.

Less chances of injuring yourself
Once again, since yoga does not need specialized weights or equipment, there are less chances of injuring yourself. Yoga also does not focus on speed, allowing you to move comfortably - in a way that your body always feels good.
Walking again is an exercise that allows you to work at your own pace and does not make you compete with others. As long as you see where you are going and avoid walking on tarred surfaces, the chances of injuring yourself while walking are also very low.

Long term weight loss  
A reason most gym enthusiasts prefer a strenuous workout to yoga and walking is faster weight loss. These techniques do help lose weight but the process is slow. However, since this weight has been lost gradually, it is more likely to stay off.

Yoga Vs Gym

7 food combos to help you get that gorgeous figure

Nowadays, each and every one of us is extremely conscious of our dietary habits and make sure that we consume the right foods. Thus, we are also aware of many healthy foods which not only help us crush fat but also provide a great boost to our metabolism. We bring to you 5 food pairings which work wonders for your figure when consumed together:

1. Ginger and tuna
Ginger prevents inflammation of the body caused due to bloating and also speeds up gastric emptying. Tuna, on the other hand, stops the growth of belly fat cells and contains docosahexaenoic acid which protects against stress chemicals, thus preventing flab storage. Thus, start pairing up your tuna roll with that ginger pickle!

2. Honey and cinnamon
Daily dose of honey with the goodness of cinnamon is the perfect recipe for a picture-perfect body. Cinnamon is packed with healthy antioxidants that help curb belly fat accumulation. Moreover, honey is known to aid in weight loss and enhance immunity.

3. Raspberries and yogurt
This combination is an extremely effective slimming agent. Yogurt is a rich source of vitamin d and calcium which helps prevent the absorption of fat. As for raspberries, they contain polyphenols which stop the formation of fat. Also, they are packed with insoluble fiber that increases ghrelin levels, a hormone that regulates hunger.

4. Spinach and bananas
Spinach contains almost zero calories and is known to significantly increase satiety levels. Bananas are packed with potassium that prevents bloating and gives the body a lean look. They also contain resistant starch which resists digestion and thus not only promotes oxidation of fat but also brings down the level of abdominal fat. So go make that smoothie now.

5. Watermelon and apples
Apples are abundant sources of fiber which is essential for the reduction of visceral fat. Watermelon is the perfect fruit for decreasing fat accumulation and improving lipid profiles. Consume these fruits together as a salad, dessert or snack; they are packed with good health!

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7 Food Combos to Help you get that Gorgeous Figure

Sedentary lifestyles have taken a toll our health, impacting the stamina of our body. Whether you are an athlete or a regular person who requires building physical and mental stamina in order to easily perform daily tasks, try these 5 highly effective ways to do so.

1. Stay hydrated: Drinking adequate quantity of water goes a long way in maintaining a good stamina level and also building it gradually. Water also helps fight muscle fatigue and you can also combine its consumption with certain sports drinks such as gatorade.

2. Maintain a stable sleep schedule: Chronic sleep disorders have been known to lead to troublesome issues such as rapid weight gain and high blood pressure. It is very essential to get sound sleep for an adequate time period on a daily basis in order to keep your body fresh and increase stamina.

3. Follow a strict exercise regime: Exercise is the best way to help your body build up stamina and increase energy levels. People who exercise on a regular basis are likely to develop an improved endurance level and stamina. Also, these people have lower fatigue levels. Try and work out for at least half an hour every day.

4. Maintain a healthy diet: Food products rich in nutrients are bound to give a credible stamina boost to your body. Include foods in your diet that are rich sources of carbohydrates and starches, such as vegetables, fruits and lean meats. Also, eat small meals and consume them throughout the day.

5. Keep a positive attitude: A positive attitude helps a lot in keeping your brain cells energetic and excited. Try and focus on the work at hand and complete it in the best way possible. A healthy mind is bound to keep you feeling good and healthy, thus boosting your mental stamina.

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5 Ways To Get The Stamina To Move Mountains

Hot and Cold therapy is one of the most popular home remedies for any kind of joint pain or muscle sprain. In some cases applying heat therapy and cold therapy alternatively, can help relieve the pain while for others only one form of therapy is necessary. To understand what to use when, one should first understand the effect of heat and cooling on the body.

Applying a heat pack or immersing the affected limb in hot water improves blood circulation and makes the muscles more flexible. Thus, it can help relax a muscle and fasten the healing of damaged tissues. On the other hand, cold therapy or cryotherapy reduces blood flow to the affected site. This helps relieve inflammation and pain caused by it. It can also make the area feel numb by reducing nerve activity temporarily.

Types of Heat Therapy
Heat therapy can be categorized as dry heat and moist heat. Dry heat involves using saunas or dry heating packs to relieve pain. This is also known as conducted heat therapy. As the name suggests, moist heat involves the use of steamed towels, hot baths and moist heating packs. This is also known as convection heat therapy. Moist heat is usually considered more effective than dry heat.

Types of Cold Therapy
Cold therapy may be applied to a part of the body or to the entire body. This includes ice packs, coolant sprays, ice baths, ice massages and whole body, cold therapy chambers.

How to use heat and cold therapy?
The sooner heat and cold therapy is given to a person, the faster they will recover from their pains. Heat therapy can be given to a person for extended periods of time but when giving cold therapy, a person should not be exposed to a cold pack or ice bath for more than 10-15 minutes. Care should also be taken no to apply ice or a frozen pack directly on the skin as it can damage the skin and nerves.

When not to use Heat Therapy?
If the injury site is swollen or bruised, cold therapy is better than heat therapy. Heat therapy should also not be applied to an open wound. People suffering from conditions such as diabetes, dermatitis, deep vein thrombosis, vascular diseases and multiple sclerosis should also avoid heat therapy as these conditions can increase the risk of burns and other such complications. Pregnant women should also consult a doctor before using a hot tub or sauna.

When not to use Cold Therapy?
Cold therapy is avoidable for treating stiff joints and muscles. People suffering from poor circulation and sensory disorders should also avoid using cold therapy without a doctor s supervision. 

Hot & Cold Therapy - How It Can Treat Pain?

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