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

Ayurveda is something which is very potent and its efficacy has been proven over the years. Arthritis is painful and has the ability to make a person feel pretty much like his or her hands are tied! However, while not much can be done to liberate a person to his or her pre-arthritis level of ease, the issue can be controlled and Ayurveda can really work wonders!

When you prefer an Ayurvedic treatment to help a person who is suffering from arthritis to experience lesser pain in his or her daily life, it is important to correct anything which may be wrong with digestion. This is because digestion, which is not optimal, leads to a situation of a build-up of ama, which is a lethal side effect of low-quality digestion.

It is believed that correcting a person s food intake will reduce the amount of ama one has in their body and as a result of the same, reduce the inflammation and the consequent pain which a patient of arthritis has to put up with on a daily basis.
If a person does not suffer from other lifestyle issues such as diabetes, making the effort to fast in accordance with the guidelines which have been set out as per the Ayurveda knowledge bank can have great benefits for the problems faced due to having arthritis.
The Magic of Ayurveda!

There is a herb known as Guggul, which is quite helpful, especially if a person is diligent about its consumption. This would mean that it be taken by him or her twice a day, along with some warm water. The dosages are small and usually range between 1 to 3 gms.
Ayurveda is a symbol of natural solutions to the health problems of people. As a result, it is only reasonable to expect a lot of the field to be centred on lifestyle habits and more so around food, as it is true, in this case at least, that we are what we eat.
In order to ease the pains of arthritis, it is very important to avoid oily food items and prefer a fruit diet such as apples, papayas and oranges. Tea, coffee and alcohol consumption should be kept to a bare minimum.
Arthritis is something which is frustrating, for sure. But, as long as a person is taking steps in the right direction, the issue will be a lot easier to deal with!

Ayurvedic Management For Arthritis!

Cervical osteoarthritis is also known as cervical spondylosis. It is a medical condition which involves changes in the joints of neck, bones and discs. This is generally caused due to the deterioration of the muscles owing to old age. With age, the cervical spine breaks down and loses all its fluids. This leads to stiffness in the spine. It occurs usually in middle aged and old aged people. This causes stiffness and severe neck pain. Corrective surgery is helpful to cure Cervical Osteoarthritis.

Symptoms of Cervical Osteoarthritis:

Pain and stiffness in the neck.
Headache which usually emerges from the neck.
Severe pain in the arms and shoulder.
Not being able to turn the head or neck fully while driving.
Muscle spasm and abnormal reflexes.
Grinding sensation or noise caused while bending the neck.
Cervical Osteoarthritis can be cured by physiotherapy in the following ways:

Heat modalities- In this method the pain and stiffness is reduced by putting heat on the affected area. This type of therapy is called heat therapy.
Neck exercise- Regular stretching and bending exercises for the neck can reduce pain and stiffness
Manipulating therapy- This form of therapy is used by massage therapists. They massage and manipulate the joints so that the muscles can function smoothly.
Hydrotherapy- This therapy involves exercising in a pool. Hydrotherapy is extremely beneficial for people having severe joint pain and stiffness.
Cervical traction- This is a common non-surgical treatment which cures pain in the neck by opening the cervical foramen (hole or passage).
Physiotherapy is the most natural and safe way of curing cervical osteoarthritis. If you are diagnosed with cervical spondylosis, you should start physiotherapy as soon as possible.

Cervical Osteoarthritis - Physiotherapy Treatment For It!!

International Childhood Cancer Day is celebrated annually on 15 February to raise awareness and to express support for children and adolescents with cancer, survivors and their families.

Why is Cancer the biggest Threat to the YOUNG in India?

There are fewer Indians who have successfully battled Cancer and have emerged successful. Yuvraj Singh, the legendary cricketer, who was diagnosed with a rare cancer at 29, survived due to an early detection. Cancer cases in India are not as many as they are in the developed world. However, due to late detection the survival rate in the country is far worse. Particularly, we are losing our youth to Cancer. Most tobacco (pan masala) related cancers and child cancers go undetected until very late.

Few cancers like cervical cancer and breast cancer which affect women of any age, are curable, however, due to lack of awareness and timely screening, many Indian women succumb to these cancers. The most common sites for cancer among men are lung, prostate, colon, rectum, stomach and liver while that among women are breast, colon, rectum, lung, cervix and stomach.

In proportion to our population, we lack the right infrastructure nationwide. esp in the northern and north eastern region, there is a dearth of good cancer facilities, where radiation, care or treatment can be given. Not even one third of cancer patients are alive beyond 5 years after their diagnosis in India, and about 71% of cancer deaths occur in patients in their prime productive years   between the ages of 30 to 69 years.

 Most Indians believe that cancer is generally incurable and that it should be kept secret from neighbors and family.  -  Dr Paul Goss, MD, Harvard University.

All these factors have contributed to a very high mortality rate. No wonder Cancer is dreaded in the country. Investment, infrastructure, lifestyles as well as mindsets need to change if we were to contain the Cancer mortality rate. While you need to watch out for early signs of cancer, here are the lifestyle changes every individual esp. all youth must adopt to avoid cancer.

Avoid Tobacco - both smoking and chewing.

Reduce alcohol intake - Save your organs from deteriorating.

Limit UV ray exposure from the sun - Keeps your skin safe.

Maintain a healthy diet - Include foods rich in Vitamins, minerals and fiber which nourish your body and build immunity.

Increase your level of fitness - Maintain a good bodyweight. Additional flab invites a host of troubles, that includes variety of cancers.

Seeking regular medical checkup or screening - This is the only way to prevent and get detected early on.

International Childhood Cancer Day - Why Cancer Is A Threat For Young?

Staying up late at night intentionally is not insomnia. If you find it difficult to fall asleep, or cannot sleep soundly for long, then it is indeed a case of insomnia. The inability to sleep can have terrible repercussions on your physical and psychological health.

A number of reasons could cause insomnia. Understanding the causes could help you identify your sleeplessness as insomnia and seek treatment right away.

What Health Issues cause Insomnia?

Here are some health problems of both the mind and body that can keep you awake  

  Stress Chronic stress and worry born out of our tense lives is a direct cause of insomnia. Long-term anxiety, panic disorders, as well as PTSD can induce sleeplessness.

  Irregular Sleep Patterns Your body would hate it if you deviate from the Circadian Rhythm   the body clock. It regulates the functions of your body, including your sleep patterns. But if you defy your body clock by sleeping at irregular hours   suppose you are staying up late to get some extra work done, or you may have opted for a night shift, or if you are experiencing a jet lag   then you will notice that when it is finally time for you to hit the bed, sleep will be elusive.

  Depression Depression is a horrific psychological disorder that makes a person lose interest in life itself. And one of the indicators of depression is loss of sleep. It is not just depression, but also other illnesses that cause psychological turbulence such as bipolar disorder and obsessive-compulsive disorders, triggering insomnia.

  Breathing Issues Sleep apnoea is a dangerous disorder that stops your breathing multiple times every night and will wake you up every time. Yet you will possibly not even remember waking up. However, this does disturb the quality of your sleep and affects your health adversely.

  Dementia Dementia is accompanied by a gradual loss of memory. But sometimes people who are suffering from dementia display anxiety, restlessness or even aggressive behaviour when it is time for them to go to bed. This is called the sundown syndrome and it might even keep them up all night.

  Pain Pain is one of the commonest reasons for losing sleep. Pain can originate due to any number of reasons   arthritis, a sprained joint, an injury, or if you are undergoing chemotherapy or radiotherapy, then it may keep you awake at night. This is actually a vicious circle because the inability to sleep will aggravate your pain. Talk to your doctor who will prescribe the appropriate pain medication.

  Parkinson s disease This disease is another reason behind insomnia. Parkinson s disease interferes with your nerve signals and this might cause disruption in your sleep.

  Menopause When a woman inches closer to her menopause, her body reduces the production of oestrogen and progesterone. This imbalance of hormones can trigger sleep loss.

How long can you go without sleeping?

There is no data on how long a human can function without sleep. The longest someone stayed awake is 11 days. Usually, the body cannot last that long without some sound shut-eye. Your brain flushes out the waste matter its cells produce during sleep. That is why even 24 hours without sleep can make your brain sluggish and disoriented. If you stay awake for more than 48 hours at a stretch, your cognitive abilities will start failing you. Sleep is instrumental to a healthy mind and body. If you are experiencing insomnia, talk to a doctor immediately or look up some remedies.

Health Problems That Keep You Awake!

If you are suffering from arthritis, it is important for you to know about how it affects your knee and other joints. Arthritis is a chronic, systematic inflammatory disease which damages your joints and connective tissues. Your knee is commonly affected by arthritis and there are three primary types of arthritis that occur in the knees. They include osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.

Types of arthritis 
The different types of arthritis affecting the knees occur due to different reasons. Osteoarthritis is a progressive condition, which wears away the joint cartilage over time. Rheumatoid arthritis is an inflammatory condition, which may occur at any age. Post-traumatic arthritis occurs after an injury is inflicted to the knee and may occur several years after a ligament injury or knee fracture.

Major symptoms

Arthritis pain may occur all of a sudden, but commonly develops slowly. In the early stages, the pain is observed in the morning after you have been inactive over the night. Pain is likely when you want to move around. Pain may be experienced even when immobile.
Periodic inflammation is a common symptom of arthritis of the knee. This happens because of the formation of bone spurs or excess fluids in your knee. The swelling gets pronounced after being inactive for a long period. The skin on your knee may look red and feel warm while you touch it. This may lead to chronic inflammation, which is very difficult to manage.
Treatment
There are several ways of treating knee arthritis. The mode of treatment depends on the severity and cause of knee arthritis. NSAIDS or nonsteroidal anti-inflammatory drugs are commonly prescribed for dealing with arthritis pain temporarily. Other medicines used for knee arthritis treatment are as follows:

Analgesics, which help in pain reduction act as good alternatives to NSAIDS.
Corticosteroids are used for reducing inflammation.
Certain DMARDs or disease-modifying antirheumatic drugs are used.
Certain injections that are used for helping with knee arthritis. They include:

Hyaluronic acid supplements, which ease the pain and inflammation by lubricating your knee joints.
Corticosteroid injections also soothe inflammation and pain.
You may also require a surgery for dealing with knee arthritis when other modes of treatment fail. The most common surgeries are as follows:

Total joint replacement, where your knee is replaced with a prosthetic made of metal, plastic or ceramic.
Osteotomy, where the knee bones are modified for controlling pressure and damage in the knees.
Arthroscopy, where an incision is made in the knee for removing damaged parts.
It is recommended for you to consult a doctor, if you experience any symptom of knee arthritis. Early treatment will prevent the condition from worsening.

Knee Pain - It May be a Sign of 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