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

Natural Ways To Manage Arthritis

You might be aware that there is no way that you can prevent arthritis to happen except for being car. But what you can do is delay and reduce the risk of its potential onset. If your joints are healthy now, there is no guarantee that they will always be, unless, you take good care. 

Do you know a few kinds of arthritis can be modified. They are:

1. Gout - Have a healthy, balanced diet which is low in cholesterol, alcohol and sugar. This will help you fight against the onset of gout.

2. Osteoarthritis - To modify the risk factor of osteoarthritis, it is important to maintain a healthy weight.

How to defeat arthritis?

1. Keep a check on your weight: If you are obese, you are putting more pressure on your joints and as a result, they wear out soon. By losing weight, you can make a lot of difference in your joint health.

2. Ensure good water intake: Our body is 70% water. And water is one of those things which is the most important for us. Staying hydrated is very important, even for your joints. Because when the body is dehydrated, and the body needs water, it uses the water stored in our bodies, incl the water in the cartilage.

3. Try to avoid any injury: No one really wants to get injured but it is important to be careful and cautious against injuries of any kind. The more injured your joints are, the more susceptible they are to wear and tear now, and arthritis later in life.

4. Don’t stress with physical tasks: There is a way and correct posture to do them, but many people ignore those and perform the tasks clumsily. This puts additional pressure on your joints.

5. Get Your share of Vitamin D: Vitamin D is very important for us. If your body has adequate amount of vitamin D, then you are less susceptible to arthritis. It is wise to get the levels tested and if low, a doctor consulted for proper medication.

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Pain- free Arthritis? Here’s How To Make It Happen!

Yoga is recommended for people with joint inflammation or arthritis. In the case of certain individuals with different sorts of arthritis, studies have shown that consistent yoga practice can lessen joint pain, improve flexibility of the joint and release the stress and strain to provide better rest. Yoga comes with a wide range of practices; however, for the most part, it includes adopting specific bodily postures. It also includes breathing and meditation exercises. 

Some of the yoga postures to cure arthritis are as follows:

Sun salutations: They are the perfect way to begin a day. They can be reflective and calming as you develop the strength to breathe fresh air. Stand with both feet touching, and afterwards, join your hands, palm-to-palm, and place them on your chest. Breathe out and raise your arms upward. Gradually twist backwards and extend your arms over the head. Unwind your neck and breathe in. You must keep in mind that it is one breath for every movement.
Kid's pose and child's pose plus: This is a truly gentle and simple approach to stretch the lower back. Get into the stance by dropping down onto your knees, spread your knees wide and join your toes. Place your hips back onto your feet or heels and stretch your arms forward onto the ground.
Bovine pose (cow pose): Get on all fours with your hands; keep your wrists directly under the shoulders, and spread your fingers wide. Your knees need to be at the hips' width and directly under your hips. Point your abdomen upwards, as your shoulder bones push down towards your abdomen, and tilt your pelvis up and back so that you are sitting.
Furious cat: Turn around the cow pose to do the furious cat pose. From all fours, pull your belliy in and your back arches into a back bend. Point your hips back toward your lower legs to build the space between every vertebra.
Prostrate twisting: Bending should be very useful, but if the bending or twisting brings on any pain, leave it quickly. Lie on your back, draw your knees toward your abdomen, and wrap your arms around your legs, giving yourself a little hug. Shake yourself from side-to-side or forward and backward.
Bridge pose: Lie in a straight position on the floor, twist your knees, and set your feet on the floor. Breathe out and press the inner parts of your feet and your arms into the floor. Push your tailbone up, tighten your hips, and lift them off the floor until your thighs are parallel to the floor. Keep your knees right above your heels and lift the upper part of your hips toward your stomach.

Arthritis - 6 Yoga Positions That Are Beneficial for You

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

If you are suffering from gout, you should try undergoing a homeopathic treatment. Gout is a type of arthritis and is considered to be the most painful type. It is featured by the inflammation of joints accompanied by great pain. The pain and inflammation occur because of the deposition of urate crystals in a joint. The accumulation occurs when there is excessive uric acid present in the blood.

Here are some effective homeopathic remedies for the treatment of gout:

Colchicum: This medicine is the primary homeopathic medicine for treating gout because of its effectiveness. It is mostly used in chronic cases of gout. Usually, a patient experiences extreme pain in the big toe, which is too intense to be touched. The toe and other parts which get affected become swollen, red and hot. The pain worsens in the evening and at night. Patients who require this medicine should keep away from warm weather conditions. This medicine is also used in case of increased weakness and internal cold.
Ledum Pal: This effective medicine is used in cases where the pain travels in an upwards direction from below. The pain is likely to start at the feet and gradually move upwards, affecting the knees and legs. The pain also shoots through limbs. Small joints are commonly affected. There is a sensation of decreased warmth in the joints and in the body. The patient will find it difficult to tolerate any kind of external warmth. The pain improves by cold applications. The ankle balls or big toe may be swollen.
Benzoic acid: This homeopathic medicine is used for treating gout where offensive urine is experienced. The urine becomes very offensive with a very strong odor, which can be detected from a distance. The odor is usually repulsive and the color of the urine is brown. Extreme pain is experienced in the big toe and the knees are swollen.
Antim Crudum: This is an efficient homeopathic medicine used for treating gout. It is used when a patient experiences gastric symptoms along with joint pain and inflammation. The patient may develop an increased craving for food and hence, several problems occur due to over eating. Pain is experienced in the heels and fingers.
Sabina: This homeopathic medicine is important for treating gout in women, when the patient already suffers from another female disorder. Uterine symptoms are experienced along with the basic symptoms of gout. Shooting pain is experienced in the toes and heels. The joints get swollen and look red and shiny.
Homeopathy offers a completely natural treatment for different types of gout and goes beyond just curing the symptoms. You need to consult your doctor before starting a homeopathic treatment for gout.

5 Homeopathic Remedies for Treating Gout Pain

Are you suffering from arthritis and looking for effective treatment options? Arthritis is a chronic, systematic inflammatory disease that causes damage to your joints and connective tissues. The knee is primarily affected by this condition and there are three main forms of arthritis which occur in your knees. There are several treatment options and procedures for treating arthritis. They are as follows:

Several medications are used for arthritis treatment. They are:

Analgesics: These medicines help in pain reduction but do not heal inflammation.
NSAIDS: NSAIDS or non-steroidal anti-inflammatory drugs are used for reducing inflammation and pain as a result of arthritis.
Counter-irritants: These include creams and ointments containing capsaicin or menthol. Applying these creams on the skin helps with pain relief.
DMARDS: Disease-modifying antirheumatic drugs are used in case of rheumatoid arthritis. These help in slowing down your immune system from targeting your joints.
Corticosteroids: This form of medicine includes cortisone and prednisone and helps in reducing inflammation and suppressing your immune system. These can be injected into your joint or taken orally.
Therapy
Physical therapy is beneficial for certain types of arthritis. Exercising helps in improving your range of motion, and the strength of your muscles which surrounds the affected joint. Splints and braces are prescribed in some cases.

Surgery
When all other treatment measures fail, a surgery may be required to be carried out.

Joint repair: In some cases, the surface of your joints can be realigned and smoothened in order to improve function and eliminate pain. These surgeries are arthroscopically performed via incisions made on the joint.
Joint replacement: During this surgery, your damaged joint gets removed and replaced with an artificial joint. The hip and knee joints are commonly replaced surgically.
Joint fusion: This surgical procedure is used in case of smaller joints of your body. The ends of the two bones in your joint are removed and the removed ends are locked together till they heal into one unit.
Alternative treatment options
You can also opt for certain alternative remedies for arthritis. Some of them are as follows:

Acupuncture: In this therapy, fine needles are inserted at certain points on your skin for reducing arthritis pain.
Yoga and tai chi: The movements associated with yoga and tai chi are slow and stretching in nature. These help in improving joint flexibility. Your range of motion gets improved as well.
Light massages which involve stroking and kneading of your muscles help in increasing blood flow. This warms up the affected joints, providing temporary relief from arthritis pain.

Arthritis - How to Treat It Effectively?

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