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

Gout is a type of arthritis, which can affect your joints, though usually, it causes maximum harm to your big toe. Symptoms that you are having a bout of gout include having a stiffness and swelling of the joint in question. The pain is very sudden and also causes a burning sensation. Gout is basically a recurrent type of inflammatory arthritis. However, the pain associated with gout can be remedied by ayurveda. Here are some of the best ayurvedic remedies which can be used:

1. Panchatikta ghrita guggulu: panchatikta ghrita guggulu is the most common and most widely recommended treatment for gout. However, it needs to be taken on an empty stomach. It is also worth note that it works best when teaspoons of it are taken two times a day with warm milk.

2. Kaishore guggulu: kaishore guggulu is a type of medicine, which should be accompanying panchatikta ghrita guggulu. It is usually administered after some initial relief is felt from panchatikta ghrita guggulu. Its best to consume this medicine in tablet form thrice a day.

3. Shallaki: this ayurvedic remedy is great for decreasing the pain in the joints affected. It also decreases the swelling in those joints, which have been affected by the bout of gout. Shallaki is also crucial in making sure that cartilage forms and that the blood supply to the joint which is affected by gout is still stable.

4. Ashwagandha: ashwagandha is medically known as withania somnifera. In the west, ashwagandha is popularly known as winter cherry. Also, it has a lot of therapeutic properties, which include reducing joint pains and also inflammation of muscles. This herb can also work wonders on your blood circulation.

5. Pinda taila: this is a type of oil which needs to be applied externally. Pinda taila is a very rare class of medicines which treats gout externally. Pinda taila or guduchyadi taila is administered by rubbing it on the body part affected.

Ayurveda and Gout

Arthritis, which is quite a common ailment among people aged above 40, is painful regardless where it affects a person, be it the hands or the toes. However, the Ayurvedic field of medicine has come up with historic ways of treating the issue. Over the course of time, these methods have proved to be quite effective, and especially popular as they have no side effects. A person only needs to spend a little time to get to know how to go about using Ayurveda to cure the arthritic aches and pains, which plague daily life!


One of the best things about Ayurveda is the fact that the solutions are generally made using ingredients that are very easy to source. For example, there is a solution for arthritis, which involves mixing a cup of mustard oil with about 10 grams of camphor and then heating the combination. This oil mixture then needs to be massaged on the affected areas. Now, isn t that simple?


The common potato, long considered to be a vegetable of the masses, also finds its use in Ayurveda when it comes to treating arthritis. If you soak a few unpeeled slices of potato in a glass of water overnight and drink this water the following morning, you are sure to find an improvement in your condition quite soon. 


Additionally, there are a few other food items that are recommended in the Ayurvedic treatment. These include bitter gourd, which is not only low in calorie content, but also very high on vitamins and ginger which improves metabolism. Consuming garlic and buttermilk is also considered advantageous. 


Moreover, you may also need to make some changes to the lifestyle habits, which have been deeply ingrained. For instance, sleeping as per a regular schedule and not going to sleep very late at night has a positive impact.


As you have probably be discerned, when it comes to health, the devil is in the eating! If a person who has arthritis makes an effort to conform to a good and healthy diet, which does not contain fried or sugary food, or even those which have spices in excess, he or she will not only find the pain symptoms of arthritis reducing, but also gain a general sense of health.


As long as a person has the patience to follow the way of treating arthritis set out by Ayurveda, the benefits will truly be bountiful!

Arthritis - How Ayurveda Can Help Treat it?

Knee pain is a common phenomenon that plagues most of the people irrespective of their age. It can be the outcome of a torn cartilage or a ruptured ligament. Medical complications, such as infections, gout or arthritis (painful inflammation and stiffness of the joints) can also give way to knee pain. Minor knee pain can be eased by self-care remedies such as physical therapy or by putting on knee braces. However, few complications might demand surgical repair. Pain can be managed by the pain management specialists.

Tips to manage knee pain

1. Medications such as naproxen, ibuprofen and acetaminophen can be administered to help remedy knee pain.
2. You can seek relief by massaging your knees with ointments constituting of a number of agents such as capsaicin or lidocaine.
3. Keep away from your usual chores to prevent repetitive strains on the knees, thus, allowing the injury to heal as well as to stay safe from further damage.
4. Applying an ice pack in a towel can ease the inflammation and pain. But do not extend its usage for more than 20 minutes because that might harm the skin and nerves.
5. Compression bandages can inhibit fluid accumulation in the damaged tissues aiding knee alignment stability. Ensure that it is tight enough to render support to your knees without actually obstructing blood circulation.
6. To pacify the swelling, try resting your sore leg on a pillow (the idea here is to keep the affected leg elevated to reduce further pain).
7. Shed off your extra pounds as being overweight increases chances of other disorders such as osteoarthritis.
8. Go for regular work outs to enhance and maintain the flexibility of your muscles as excessively weak or abnormally tight muscles can contribute to injuries. Be smart while choosing your method of exercise based on the condition you are suffering from.

Knee Pain - 8 Effective Ways to Manage it

Causes and symptoms of knee pain

Knee pain is characterized by a feeling of pain in the knee joint caused by injury or overuse. The knee joint consists of small bone structures, the kneecap, supporting ligaments and cartilage of the knee. This joint bears the full weight of the body, which makes it very vulnerable to injury.

Causes of knee pain

Knee pain is usually caused by injuries to the knee such as exposure to a direct force on the knee, abnormal twisting of the knee or falling on your knees. Some causes of knee pain are -

Knee strains and sprains - Overworking the knee joints can damage the tissues of the knee joint resulting in knee sprains and strains

Osteoarthritis - it is condition where the protective cartilage around the kneecap is damaged, resulting in knee pain

Bursitis - Excessive movement of the knee or kneeling down for extended periods can irritate the bursa (a fluid sac below the skin above the knee joint) that causes swelling and pain, thereby giving rise to this condition

Gout - This condition is characterized by the accumulation of uric acid in crystal form around the knee joint, causing inflammation and pain

Tendon disorders - Tendons connect the muscles to the bones, and overworking the knee can cause the tendons around the knee to become sore and painful

Kneecap dislocation - Injuries may cause the kneecap to shift out of its position, this causes swelling and pain in the knee joint

Symptoms of knee pain

Severe knee pain can restrict movements such as walking or standing. The symptoms vary according to the extent of the damage suffered by the knee. Most common symptoms of knee pain are problems in climbing stairs, inability to extend the knees, limping and swelling of the knee joint. In some cases, knee pain may also cause fever.

Causes and Symptoms of Knee Pain

Inflammation and resultant pain in the joints are usually the basic tenets of arthritis. This joint disorder can be painful and often, a debilitating one. It can also make the joints stiff. There are many ways of dealing with this problem, but with ayurveda, one can get to the root cause of the ailment and its presence. This helps in taking a well rounded holistic approach towards treating it with ancient know how that revolves around herbs and other natural substances which have great medicinal value, lifestyle changes, diet, exercise and yoga, oil massages, and other methods. Arthritis is known as sandhivata in ayurvedic jargon. Read on to find out how ayurveda can help in dealing with arthritis.

Herbs: one can make use of various herbs that contain linoleic acid to help in providing lubrication to the joints so as to prevent pain and stiffness. These herbs include borage seed oil which is extracted from borage seed, evening primrose oil, blackcurrant seed oil, capsaicin, curcumin, feverfew, flaxseed oil and a standard ayurvedic concoction that combines ashwagandha, gugulla, ginger, cumin and haldi or turmeric. These substances can help in treating the joints that are suffering from the pain of arthritis.

Diet: in ayurveda, to treat ailments like arthritis, it is usually recommended that a patient should start by flushing out the body toxins from within. Diet is one of the ways in which this can be done. A detoxification diet to clean the colon would be one of the foremost ways of doing a cleanse. Further, in one's daily diet, there should be a good dose of vegetables, fruits and other juices. Also, one must have plenty of herbs and spices, which can be used to season the food. Curd should generally be avoided and garlic should be used liberally. The various properties that help in an inside out cleanse that will help the system function in a better manner so that the treatment of ailments is also effectively supported.

Exercise: in ayurveda, a certain amount of daily exercise, which spans at least 45 minutes to one hour, is a must. A pattern of healthy eating, restful sleep and exercise is what usually helps in treating ailments like arthritis. For this ailment specifically, light exercise like walking is recommended. Various yoga asanas that involve sitting, standing, balancing and lying down poses as well as restful poses will also help in treating knee, shoulder and lower back pain specifically. Also, mustard oil massages can help in reducing the pain.
These are the few ways in which ayurveda can help arthritis patients live a more normal life with minimal pain.

Ayurveda For Arthritis

Don't wait any longer, manage your Geriatric Rheumatologist online with a Lybrate doctor today

Consult for Geriatric Rheumatologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES