Knee pain is one of the most common and painful ailments that can limit mobility. Injuries can result in cartilage or meniscal tears or sprains too. Obesity is another reason because of which knee pain is on the rise. Also, regular wear and tear of ligaments and tendons around the knees due to old age is another cause. These days, with reduced physical activities and sedentary lifestyles, the rate at which knees are wearing out has also become accelerated. Whatever the reason, a correct diagnosis followed by prompt treatment can help. Over the years, physiotherapy has been playing an important role in treating knee injuries. Whether to supplement the various drugs to reduce pain and inflammation or to avoid surgery, physiotherapy has helped many and its popularity is growing every day. Here are some ways that physiotherapy can help reduce pain.

Improve flexibility of tendons: The knee cap is an area where there are lot of tendons and ligaments, coordinating to enable movement. Careful exercising can ensure that the flexibility of tendons and ligaments is improved, thereby making your knee movement easier and less painful.
Improves blood supply: As we all know, proper movement requires good blood supply. Exercising with special focus on the knee ensures that blood supply is improved, and thereby the supporting ligaments and tendons function optimally.
Enhances the knee cap function: The knee cap is that portion which joins your thigh bone to your calf bones. This is prone to slip out of place, especially with arthritis and injuries. This can be painful and limit movement to a great degree. Focused exercises aimed at improving knee cap function will ensure that the knee cap has a wider range of function, and does not slip out of its socket easily.
Reduce rigidity: Once you start physiotherapy, you will feel your knees getting more flexible. The rigidity that had set in as a result of injuries and/or old age will also reduce over a period of time.
Slow down the wear and tear: When you start physiotherapy after knee damage, continuing the exercise routine, of course with expert guidance, can reduce the pace at which further damage might happen. A word of caution though. Be sure to consult an experienced physiotherapist before you begin. Exercising in a bad manner can do equal or more harm than the original injury or old age itself.

Knee Pain and Physiotherapy

It is very challenging to find operative treatments for chronic pain that offer improved daily functioning. Spinal Cord Stimulation is an excellent pain management method that can be used for patients when their neck or back pain cannot be treated by surgery or other options.

Each year more than 14,000 patients undergo the spinal cord stimulator transplant. The procedure comprises of mild electrical stimulations to the spinal cord. This modifies the nerve activity reducing the pain sensation or sensitivity that reaches the brain.

Neurostimulation therapy recommended by doctors is very effective, especially for chronic pain sufferers. The benefit of this proven therapy is that the pain experienced by the brain is minimized to a great extent. The therapy was designed only after observing how pain is managed by the brain. The therapy approved by the FDA is used to treat the pain caused due to nerve damage in the legs, arms and in the trunk. Spinal cord stimulation for chronic back and neck pain is provided to patients in pain management centers. The staff taking care of patients in these centers are specialized and trained in pain relief -how it occurs and best ways to treat it. Injections are also used to ease the pain.

How to treat back Pain?
Probably the worst pain an individual can experience is back pain, in some cases so severe that it hampers daily life. The treatment options that are used for treating back pain include electrical stimulation to the back and medication to the spine. The most common reason for spinal cord stimulation is failed back surgery. The pain related to the following conditions can also be alleviated through this therapy, scarring of the protective layers of the spinal nerves, painful inflammation and arachnoiditis.

Devices Used for Spinal Cord Stimulation
The devices used for spinal cord stimulation are available in several types but they comprise mainly of three parts. The pulse generator with a battery, a lead wire with 8-32 electrodes and a hand-held remote control that is useful in adjusting the settings of the device, and to switch it on and off. Electrical pulses are delivered to the spinal cord through the electrodes. It is very important that the procedure is carried out by doctors who specialize in pain management or by neurosurgeons.


Spinal Cord Stimulation For Chronic Back And Neck Pain!

When is your pain chronic?

Your pain is chronic if it last for more than a period of six months. Chronic pain is a long-term pain whose nature can vary from mild to excruciating, and it may trouble you either continuously or at short and regular intervals. Chronic pain is so dangerous that it does not only cause discomfort and inconvenience but also robs you entirely of your capacity to work for a long time.

Chronic pain can occur in a number of organs of the human body like head, joints, back, shoulders, neck etc. In fact, pain in any part of your body can turn into chronic pain. Here are a few symptoms that can help you identify if what you are going through is, in fact, chronic pain:

- persistent and severe body pain

- burning sensation accompanied by the body pain

- fatigue and sleeplessness

- weak immune system

- stiff and sore joints

The 4 types of chronic pain disorders that you should be aware of are:

1. Nociceptive pain

The pain that affects the soft tissues of the body such as the skin and the muscles or the organs that have sensory nerves present in them is called nociceptive pain. The sensory nerves, known as nociceptors can detect the stimuli of pain and send information to the brain and the spinal cord for interpretation. The pain could be either somatic (originating in the outer body) or visceral (originating in the internal organs).

2. Neuropathic pain

This pain is caused when the nerves stop functioning normally. It is caused due to nerve disturbances that result in pain stimuli being spontaneously transmitted to the brain and spinal cord. If you are suffering from this type of chronic pain disorder, you will feel a sharp, shooting and stabbing pain. Neuropathic pain can also be caused due to the formation of neuroma (abnormal growth of the nerve tissue).

3. Psychogenic pain

The pain that is caused by psychological disorders like depression and anxiety is known as psychogenic pain. Sometimes this pain can be accompanied by physical complications like fatigue, body pain and muscle weakness.

4. Idiopathic pain

The pain that exists even though there is no physical or psychological cause for it is known as idiopathic pain. This pain is more common in people who have suffered from a pre-existing painful disorder. Some common examples of idiopathic pain are fibromyalgia (intense pain all over the body) and tmj disorders (pain in the jaw area).

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Related Tip: Why does PAIN occur? Understand the Mechanism of Pain

Your Pain is Chronic if it Falls Under These 4 Types of Chronic Pain Disorders!

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

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?

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease, commonly called PID, is an infection of the female reproductive organs(uterus,fallopian tubules ovaries &cervix). PID is one of the most serious complications of a sexually transmitted disease in women: It can lead to irreversible damage to the uterus, ovaries, fallopian tubes, or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.

Causes

Pelvic inflammatory disease (PID) occurs when bacteria move from the vagina or cervix into the uterus, fallopian tubes, ovaries, cervix
Most cases of PID are due to the bacteria that cause chlamydia and gonorrhea. These are sexually transmitted infections (STIs). The most common way a woman develops PID is by having unprotected sex with someone who has a sexually transmitted infection.

However, bacteria may also enter the body during some surgical or office procedures, such as:

 	Childbirth
 	Endometrial biopsy
 	Insertion of an intrauterine device (IUD)
 	Miscarriage
 	Therapeutic or elective abortion

Symptoms

Signs and symptoms of pelvic inflammatory disease may include:

 	Pain in your lower abdomen and pelvis
 	Heavy vaginal discharge with an unpleasant odor
 	Irregular menstrual bleeding
 	Pain during intercourse
 	Low back pain
 	Fever, fatigue, diarrhea or vomiting
 	Painful or difficult urination

PID may cause only minor signs and symptoms or none at all. Asymptomatic PID is especially common when the infection is due to chlamydia.

Other symptoms that may occur with PID:

 	Bleeding after intercourse
 	Chills
 	Fatigue
 	Frequent or painful urination
 	Increased menstrual cramping
 	Irregular menstrual bleeding or spotting
 	Lack of appetite
 	Nausea, with or without vomiting
 	No menstruation
 	Painful sexual intercourse

Diagnosis

 	Pelvic ultrasound. This test uses sound waves to create images of your reproductive organs.
 	Endometrial biopsy. During this procedure, a small piece of your uterine lining (endometrium) is removed and tested.
 	Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Pelvic Inflammatory Disease (PID) - Causes, Symptoms & Diagnosis Of It!

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