Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

Runner s knee is a very common problem with athletes. It is definitely not something one needs to worry about. In fact, with certain exercises, it can be prevented and if you do develop a runner s knee, it can be treated with some exercises as well. There are special sports medical practitioners who prescribe not only regular physiotherapy, but also specific exercises to deal with specific sports injuries. To fight with runner s knee pain, there are a few exercises. 

But the four most important ones are described in detail below.

Quads: For performing proper quads, all you need is a back wall for additional support. You need to hold yourself against the wall and keep your legs apart from each other. The legs should be folded in the knees. In this position, you have to move up till the knee position with a minimum of one minute hold time in the knee position. You can repeat this exercise 10 times at a stretch before moving on to the next exercise.
Hamstring: This is a fairly easier exercise than the previous one. You have to stand straight with your legs apart. Bend downwards from your hips. Relax your neck and back. Ease your head downwards as well. Keep your hands behind. Join both your hands and give it a stretch. If you think that this position is straining your neck or back a little too much, then you can simply stretch your hands without joining them.
Calves: Calves is a standard exercise that is prescribed by medical practitioners and physiotherapists for easing out the pain caused by runner s knee. You have to stand with your hand against the wall. Put your left leg forward and bend it at the knees. Stand on your right heel. Hold yourself in this position for 20 to 30 seconds before changing the legs and doing the same.
Lateral: Lateral is also one of the easiest and common forms of exercises. You have to stand with your legs directly below your hips. Then stretch your right leg apart. Without bending your knees, try to touch the toes of your right leg with the fingers of your left hand. Hold this position for 20 to 30 seconds before changing the position and performing the lateral with your left leg.
Thus, these are some of the very fundamental exercises that one should follow in order to get quick relief from the pains of a runner s knee. These exercises are very easy and help in reducing pain.

Runner's Knee - 4 Most Important Exercises for it

Myths about Total Knee Replacement

Myth#1 - Knee replacement is a surgery for old people. “I’m too young for a knee replacement.”
Fact - Candidacy for a knee replacement is not based on age, but on the person’s level of pain and immobility. Living with a painful joint that prohibits you from working or participating in normal life activities is an outdated way of thinking. Age is not necessarily a limiting factor. Often times, a patient is actually fearful about the uncertainty of surgery. Once they are able to resume many of the activities they enjoyed before the surgery, with increased mobility and with less pain, they are very happy they had the surgery. The quality of life one achieves by living without knee pain is priceless.

Myth#2 - “I should wait as long as possible to undergo knee replacement surgery” 
Fact - You don't need to suffer by waiting until the pain is intolerable. The longer life of joint replacements enables people to consider surgery earlier and at a younger age. Osteoarthritis is a degenerative disease that continues to damage the joint and delaying surgery makes both surgery and return to activity more difficult. Delaying surgery lowers a patients’ quality of life not only before the operation, but even for up to two years following surgery.

Myth#3 - “I should continue with medications as long as possible”
Fact - Medicines including painkillers just give symptomatic relief for a temporary duration and prolonged usage is riddled with serious side effects such as renal failure, peptic ulceration  etc. All these medicines are NOT curable.

Myth#4 - Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy; braces will cure my advanced arthritis and knee pain.
Fact - Till date there is NO cure for advanced knee arthritis and these alternate therapies are not backed by established scientific data. All these modalities give temporary pain relief in early to moderate arthritis for some duration only and are NOT curative. Often times, a patient who is actually fearful about the uncertainty of surgery lands up trying these in order to avoid surgery. 

Myth#5 - After a knee replacement, it takes months to recover.
Fact - Depending on the activity, most patients who undergo knee replacement are able to perform routine tasks within a few weeks. A return to rigorous activity takes only a few months. One becomes independent for himself before discharge from hospital. There’s no prolonged best rest required after the surgery.


Myth#6 - After knee replacement, I’ll have to give up some activities and sports.
Fact - You have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks. It will take a bit longer to return to more rigorous activities and contact sports. Squatting and sitting cross legged though possible but at best should be kept to minimal.

Myth#7 - Knee replacement surgery leaves a large scar that is noticeable.
Fact - Scarring is minimal compared to traditional surgery. In fact, the scar is typically only 3 to 5 inches long. As time passes, the scar will fade and become less noticeable.

Myth#8 - Knee replacement is a very painful surgery. There is lots of pain in post operative period.
Fact - With modern day pain management such as in a multimodal approach, ensures that the patient does not feel any pain in post op period and has a smooth recovery.

Myth#9 - Knee replacement is done one at a time.
Fact - Both the knees can be operated at the same time if the patient does not have significant co morbidities and is deemed fit to undergo the procedure by the doctor.

Myth#10 - The new knee lasts for 5-6 yrs. only.
Fact - With modern day precision including computer assisted knee replacement and advancement in biomaterials, the survivorship has increased considerably. Today's joint replacements last 25 years or longer and, for most people, will last a lifetime.

Myth#11 - Knee replacement cannot be done a second time.
Fact - Knee replacement can be done multiple times what is called as a revision joint replacement surgery with good survivorship.

Myth#12 - “I am obese, I cannot undergo Knee replacement surgery.”
Fact - Knee replacement can be successfully done in an obese patient though the recovery is somewhat prolonged and might require additional implants. However, patients who are morbidly obese and have restricted mobility primarily due to obesity are better off after a bariatric procedure.

Myth#13 “I have diabetes or hypertension or heart ailment, so  I cannot undergo Knee replacement surgery.”
Fact  - diabetes hypertension or heart.



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 13 Myths About Total Knee Replacement (TKR), Busted!

Problems with the arteries and veins present in the hands or legs can lead to vascular disorders. The arteries carry blood from the heart to other parts of the body in order to deliver nutrients and oxygen. The veins carry the blood back to the heart, after the nutrients have been used up. If these blood vessels of the arteries or veins become blocked or narrowed, it can lead to a vascular blockage.

A vascular blockage that occurs in the hands or legs comes under the category of Peripheral Artery Disease or PAD. These type of disorders are less common in the upper extremities of the arms or hands than in the lower extremities of legs. Few of the signs for the same are:

Pain and difficulty in movement due to decreased blood flow
Numbness or weakness of leg or fingertips
Sores on the toes or feet
If the blockage is deep, symptoms of redness, swelling, extreme pain or cramping can be experienced
Abnormal color changes in the fingertips
Ulcers or wounds that don t heal
Skin sensitivity problems when in cold temperatures
How can it be diagnosed?
The blockage can be detected by various methods namely-

Physical Examination   Your doctor may find decreased pulse at armpit, wrist or fingers, full veins, masses, wounds or gangrene.
Doppler or Ultrasound examination to determine the blood flow in the arteries and veins
MRI Scan of the affected area to pay special attention to the blood vessels
Cold Stress Test
Arteriography to show clear blood vessel details
Angiography to map blockages and narrowing of the arteries
What are the Risk Factors for Peripheral Artery Disease?
An individual is at risk for developing vascular blockages in the hands or legs if one or more of the following factors are present:

Smoking
Diabetes
Heredity Factors   A personal or family history of blood vessel disease
High blood pressure
High cholesterol
Aging   People aged above 50 years and older are more prone to vascular blockage
Can it be treated?
Treatments for vascular blockage can vary depending on the age, cause of the blockage, intensity and overall well-being.

Treatments can include:

Self-care   Reducing risk factors and making lifestyle changes to quit smoking, sedentary life or diabetes, blood pressure and cholesterol management can reverse symptoms of vascular disease.
Medications   A variety of drugs can be prescribed to lower the risk and progression of narrowing blood vessels or prevent blood clotting.
Interventional Procedures   Minimally invasive surgery like saloon angioplasty, stenting or removal of artery plaque build-up.
Surgery   If the blockage is severe, surgery may be performed to lessen the vessel narrowing, reconstruct the artery or tie it off, depending on the circumstances.

Pain in the Hands or Legs!

About 80 percent of people all across the globe experience lower back pain at some stage in their lives. It is one of the most common reasons why people miss their work and appoint a physiotherapist. But lower back pain is an ailment that can be avoided with proper knowledge and some back exercises. In case your lower back pain is not under control and you have been neglecting it, you are susceptible to acute pain, sciatica, nerve pain and pain in other regions caused from a pinched nerve. Long-term pain in the back portion can lead to permanent ailments like degenerative disc disease or spinal stenosis.

Probable causes of lower back pain
Severe pain in the lower back region can be caused due to a herniated disc, back muscle pain, ligament strain or any other non-specific pain. An individual may also suffer from lower back pain due to systemic conditions like rheumatoid arthritis, fibromyalgia or ankylosing spondylitis. Though these causes are very common in most people suffering from lower-back pain, the diagnosis varies from person to person and to ensure the best care to alleviate the pain, you must consult a responsive musculoskeletal physiotherapist.

Stages for assessing and treating lower back pain
Managing the back pain is the primary objective of physiotherapy. In reality, back pain is the final symptom that is developed and the first thing that must be addressed.

Stage I
Back pain relief: The physiotherapist is going to use different types of tools and items to help the pain subside along with the inflammation. These include electrotherapy, acupuncture, ice application, soft-tissue massage and deloading taping techniques. Sometimes the physiotherapist may also recommend an anti-inflammatory drug if the pain is intolerable.

Stage II
Restoring normal strength: With the settling of pain and inflammation, you are more susceptible to injury because though your pain has subsided, your ligaments and muscles are weak. Your doctor will aim at restoring normal motion of lumbar spine, muscle endurance and strength, proprioception, balance and walking abilities.

Stage III
Restoring full body function: Depending on your daily chores and activity, your physiotherapist will aim at restoring the function of your back portion to keep you safe while performing the chosen activities. For some, it may be taking a slow walk around the park while for others it may mean taking part in some sports activity.

Stage IV
Preventing recurrence: Your physiotherapist will rehabilitate you to prevent further occurrence of this excruciating pain by suggesting proper postures, exercise and core muscle workout.

Each of these stages are important to help you get rid of severe back pain and with daily exercise, you can regulate your body and spare yourself from recurrence of this lower back pain.

Treating Chronic Lower Back Pain

Most women get accustomed to and know the pattern of their menstrual cramps. So, when something out of this pattern happens, they know it is not normal. There are various reasons for pelvic pains not associated with menses. The following are some common causes and it is always advisable to seek medical help, which will help in right diagnosis, early intervention and reduced complications.

1. Ectopic pregnancy: If a fertilized egg has planted itself outside of the uterus or the womb, it is referred to as ectopic pregnancy. The fallopian tube is the most common place for ectopic pregnancies. There is associated pelvic pain, which is unilateral, sharp, and gradually worsens. There would also be associated bleeding which is darker than the regular bleeding. This again should be confirmed on an ultrasound and then the ectopic pregnancy removed.

2. Endometriosis: The inner thick layer of the uterus could be infected leading to severe pelvic pain, especially in women who are in their 30s, who are not able to conceive. This is often ignored, considering it as normal and it continues to progress and could even result in infertility.

3. Pelvic inflammatory disease (PID): Infections like gonorrhea or chlamydia travel up from the genital tract and reach the uterus. Infection along the entire reproductive tract can lead to severe pain. In most cases, if identified early, a course of antibiotics is all that is required to control this infection. Left untreated, it can even cause infertility.

4. Ovarian cysts: Another common cause of pelvic pain, they are quite often asymptomatic, except for occasional pelvic pain. They also disappear with no medical intervention. Sometimes, however, it may get infected or rupture and can cause severe pain. This can is an indication for medical intervention. Ultrasound may be required for diagnosis and treatment may include surgical removal.

5. Uterine fibroids: The fibroids are noncancerous growths, which can grow to a considerable size and fall short of blood supply. This may cause them to burst, which can be very painful.

6. Miscarriage: Most miscarriages occur before 13 weeks of pregnancy and the usual accompanying symptoms of bleeding are severe pelvic cramps. If you are pregnant and notice bleeding with pelvic pain, it is advisable to immediately visit a doctor. Diagnosis may require an ultrasound to confirm the miscarriage. If medications are not sufficient to remove the remnants, then a dilation and curettage may be required.

7. Non-gynecological causes: Appendicitis, urinary tract infections, hernia, lower spinal problems, irritable bowel syndrome can also cause pelvic pain. The cause should be identified and managed accordingly.

Unfortunately, most women continue to experience and suffer with chronic pelvic pain without a cause identified. A thorough internal examination can help identify the problem and treat the issue.

How to Deal with Pelvic Pain other than Menstrual Cramps

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