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

Are you prone to slipped disc problem? + the ideal way to treat it

A slipped disc, also known as a prolapsed disc or herniated disc, is the term given to the phenomenon that occurs when a cartilaginous disc found between the vertebrae in the spine becomes slightly displaced or protrudes, thereby pressing on the nerves in the adjacent areas and causing back pain.
This happens when the soft inner part of the disc, known as nucleus pulposus, bulges out through a weakness in the exterior part of the disc. A prolapsed disc usually occurs in the lower region of the spine and can be of varying sizes. There might even be the development of inflammation around the disc in some cases.

Who is likely to get affected?
Most cases of herniated disc occur in patients between the ages of 30 and 50. The number of men affected is twice as many as the number of women.
Although the root cause of this problem is not yet known, there are a number of factors that may trigger it. These factors include working at a job that requires a lot of lifting, an occupation that involves remaining in a seated position for a long time, weight-bearing sports, obesity, smoking habits and increasing age.

Effective ways of treating the problem
The different methods that are commonly used to treat the problem are:
Medications
There are many different kinds of medicines that are effective in providing relief. These include painkillers, muscles relaxants, anti-inflammatory pills, etc.

Spinal injections
A number of spinal injections are used to treat slipped discs. The injection is done at the opening where the inflamed nerve roots are found and reduces pain, swelling and irritation in the area.

Radiofrequency ablation
This procedure makes use of an electrical current produced by radio waves to reduced pain and sensitivity in the affected area.

Ozone discectomy
As opposed to the surgical removal of the prolapsed disc, this new process makes use of an ozone-oxygen mixture that is injected into the spine to treat the problem. Many international studies have proved its superiority to traditional methods and surgeries.

Those affected by this problem are advised to keep exercising and continuing with their everyday activities as best as possible.



Why You Can Get a Slipped Disc Problem?

Lower abdomen pain can originate from a range of medical issues. In some cases, the pain disappears just like the way it came, in some cases, it takes longer medical treatment to cure the pain. Once the origin and the root cause of the pain are diagnosed, there are plenty of medical options to cure the pain. In this piece, we will briefly touch upon the causes of lower abdomen pain:

Appendicitis: This is one of the most common causes of lower abdomen pain. It typically originates from the right side of the stomach and soon diverges into the other side as well. The pain can become unbearable in a matter of hours.
Pelvic inflammatory disease: This is an infection that is caused in the reproductive system of a woman. This is often characterized by vaginal discharge, fever, weakness, intercourse related pain and pain in the lower abdomen.
Miscarriage: In case there is a loss of fetus on or before the twentieth week, the mishap is termed as miscarriage. It results in acute pain in the lower abdomen pain, vaginal bleeding, back pain, fluid expulsion from the vagina etc.
Fibroids: This is a growth in the uterus that is often non-cancerous and is commonly characterized by symptoms such as heavy periods, constipation, pain in the legs and back area, pain in the lower abdomen area, frequent urination etc.
Cancer: A cancerous growth in the lower abdomen area can lead to very sharp pain in the back and surrounding area. The pain is dull in nature and slowly spreads to other areas in a short interval of time.
Cholecystitis: This is a disorder that results in swelling of the gallbladder area. It results in a sharp pain in the lower abdomen area. A doctor needs to be immediately consulted if a person is suffering from this disease.
Intestinal obstruction: When the lower bowl gets blocked due to the contents of the lower intestine, a person can feel a sharp pain in the lower abdomen area.
Salpingitis: When a woman faces stiff pain in the lower abdomen area due to an inflammation of the fallopian tube, Salpingitis is the culprit behind it. This is a sexual disease and needs a doctor s consultation to get rid of it.
PMS: A woman can face throbbing pain in the lower abdomen area during her monthly periods. Other symptoms include cramps, weakness, fatigue etc.
Endometriosis: When there is an extension of the uterus tissue just outside the wall of the uterus, it leads to symptoms such as lower abdomen pain, cramps etc.
Polycystic ovarian syndrome: This is a disorder of the hormone and can lead to symptoms such as heavy periods, a growth of facial hair accompanied with sharp pain the lower abdomen area.

Pain In Lower Abdomen - What Could Be The Causes?

Pain management is an issue that stares back at mankind, irrespective of the underlying health condition. Whether it is a headache or a back pain, burn or fracture, heart attack or cancer, pain is always a symptom. In some cases like migraines, cancer, etc., the pain is chronic and the patient needs to be constantly on the vigil to know when an attack will ensue. This has also put high pressure on the medical fraternity to identify ways that can provide relief to these people. Various methods have been identified, and one of them is the electrotherapy.

What is done?
A few electrical impulses are directed at the area of the pain using a hand-held device. This is similar to providing electric shocks of mild intensity to the affected area (forehead, low back, neck, etc.). What this does is stimulate the nerve endings, improves circulation and muscle strength and promotes bone growth and tissue repair. The end result of all this is overall improved functioning and pain relief. Depending on the actual condition, the sessions will have to be repeated. In some patients, the electrotherapy is used in conjunction with other therapy so that they can go about their routine exercise and pain relief.
The sessions may also have to be repeated as most often these are used in individuals with chronic pain. They are also helpful in providing relief during the acute attacks.

How does it work?
The most common form of electrotherapy is known as TENS, which stands for transcutaneous electrical nerve stimulation. The area to be treated is cleansed with spirit and then small sticky pads are applied through which the electricity is passed. A hand-held device is used, through which electrical impulses are passed to the skin, which stimulates the nerve cells to provide relief from pain. It causes a vibrating and tingling sensation in the treated area. It is believed that it blocks the nerve impulses and therefore provides pain relief. Another theory states that they promote the release of endorphins which are natural painkillers; it is also very effective in case of migraine and sciatica and neck pain where the chronic pain is coupled with acute spurts.

With narcotic painkillers having various side effects, techniques like electrotherapy are gaining popularity. A small catch also is that it does not work for everybody and in most people with back pain, fibromyalgia, and migraines, requires repeat sessions for relief. The cost of each session also needs to be considered against the extent of relief achieved. However, for those whom it works, it is a very good technique for chronic pain control.

Electrotherapy - How It Can Help In Managing Pain?

A pain in the neck or back can restrict movements and hamper your lifestyle. These are both common pains that may or may not be a symptom of a more serious illness. Neck pain can be caused by a number of factors including stress, whiplash, inflammatory infections, mechanical disorders and metabolic disorders. The main causes for a backache are vertebral column diseases, spinal cord infections, abnormal posture, heavy lifting etc.

Homeopathy is one of the most holistic forms of treatment that can be used to treat pain in the neck or back. Homeopathic treatment has no side effects and is based on individual mental and physical symptoms showcased. Homeopathy do not address the pain itself but treats the underlying cause thus ensuring that it does not recur. Some common homeopathic remedies for neck pain and backaches are:

1. Calcarea flour: this is used to treat pains that arise from the hardening of cervical glands. Such pain tends to deteriorate in cold weather and worsens when the patient is lying down. Heat can be soothing to such backaches and neck pains.

2. Bryonia: this is used typically to treat backaches that are worsened by any movement and for a stiff back. This sort of back ache is often relieved by resting or lying on a hard surface.

3. Arnica: arnica is an excellent remedy for pains that follow an injury. When it comes to backaches and neck pains it can be used to treat soreness and straining of ligaments. It is also beneficial against the feeling of being bruised.

4. Fluoric acid: this can be used to treat rigidity and a feeling of stiffness around the nape of the neck. Such pain is often associated with numbness of the neck and forearm.

5. Hypericum: this is a useful homeopathic remedy for compressed injuries and nerve pain. It can be used to treat back aches caused by disc compression, canal stenosis, myelopathy and radiculopathy. Hypericum can also be used to treat jerking muscles.

6. Kali carb: if your back feels weak and you experience sharp pains, kali carb may be help alleviate your pain. Such pain is usually associated with a burning sensation and causes excessive sweating. Kali carb is also suited to treating backaches during pregnancy.

Along with medication, try maintaining a good posture to help reduce neck pains and backaches. Avoid lifting heavy weights and travelling long distances. Applying hot and cold packs over the area can also help reduce the intensity of the pain.

Treating Backache and Neck Pain With Homeopathy Medicines

The causes and symptoms of chronic lower back pain

Lower back pain is characterized by a feeling of pain around the lumbar region (curve of the back connecting the upper back and glutes- muscles in the buttock that are responsible for thigh movement) caused by muscle or ligament injury. The spinal area is most likely to be affected by lower pain as it may impair routine activities like walking and standing. Any lower back pain that lasts for more than ninety days can be considered as chronic.

Causes of lower back pain

There are plenty of causes for lower back pain. Anything that exposes the lumbar area of the spine to a level of stress beyond its capacity can cause lower back pain. These causes are-

1. Disorders of the discs

The spinal area in the lower back comprises of small bones called the vertebra, which are connected to each other by pieces of cartilage known as discs. These discs act as shock absorbers, and when exposed to excessive shock can cause the disc to bulge, resulting in herniated discs. Wear and tear of the discs can also occur.

2. Spinal stenosis

Spinal stenosis occurs when the area around the spine becomes narrow. It may affect the nerves surrounding the lower back, resulting in pain.

3. Wear and tear of the joints and ligaments

Normal wear and tear of the joints and ligaments cause difficulties in holding the spine in its proper position and this progresses with age. This may cause a vertebra to slide over another and affect the nerve endings, giving rise to pain.

Symptoms of lower back pain

The symptoms of lower back pain are usually a dull or excruciating pain in the lower back. It can also affect other parts of the body such as the hips and the legs. In case of severe pain, simple activities like walking, bending and sitting will be impaired.



The Causes and Symptoms of Chronic Lower Back Pain

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