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!!

Arthritis is a disease that affects the joints, muscles and soft tissues, which cause stiffness, disability and pain. It is one of the complex conditions and has also been discovered in the remains of people living more than 500,000 years ago.

Although it is usually found in people above 50 years, in rare cases, it can affect younger generations as well. The three most common forms are osteoarthritis, fibromyalgia and rheumatoid arthritis. The symptoms of some arthritis, such as rheumatoid arthritis, include the following:

Joints turning red, warm, swollen
Painful joints
Unexplained fever
Fatigue
Weight loss
Swollen lymph glands
These symptoms typically last more than two weeks.

Few facts about arthritis
Most people, even though diagnosed with arthritis, are unaware of the following facts:

Snakes, bees, and ants: After years of treatment, some people have turned to specific natural therapies that come from snakes, bees and ants. As per a study by researchers in Brazil, bee sting venom helps reduce the symptoms of arthritis.
Gout is a form of arthritis: Repeated flare-ups, pain and swelling are the result of uric acid, built around the joints. This can be due to genetic predisposition, some diseases and consumption of excess meat, seafood, fructose-sweetened drinks or alcohol. The bunion joint that connects the big toe to the foot is often affected first in people who have gout.
Children get arthritis too: Juvenile rheumatoid arthritis is the most common amongst children and affects kids between the ages of 1 - 3 or 8 - 12 years. It strikes girls about twice as often as boys. As per a recent survey, 1 in every 250 children globally suffers from arthritis.
Injuries increase the risk of arthritis: Injured joints are prone to develop osteoarthritis (OA). People with knee injuries have six times the chance, while those with hip injuries are three times more likely to develop OA.
Climate cannot cure: People have a misconception that wet, cold climates cause arthritis rather than a warmer climate. Unfortunately, that's not the case. Orthopaedics confirmed the same frequency for both warm and cold climates. However, sore joints find warm atmosphere more soothing.
Obesity increases the risk: Excess weight is one of the primary causes of osteoarthritis, especially for weight-bearing joints like knees, and to less extended hips. But there is also a higher risk to joints like ankles, back, big toes and hands.
Animals can also develop: Not only humans but animals like dogs, cats and others can also develop osteoarthritis. The symptoms are almost the same as the ones faced by a human. It can also lead to a loss of appetite, which can cause weight loss.
Race counts: Both whites and African Americans experience arthritis at similar rates. However, blacks have higher chances of severe joint pain and limitations in activity as compared to whites.
Women are prone to arthritis: Statistics show that women have a significantly higher risk for all types of arthritis except gout. As per the Arthritis Community, Research & Evaluation Unit, women are twofold more prone to arthritis than men.

9 Amazing Facts About Arthritis!

Neck pain is fairly common among adults. It results from the soft tissues such as ligaments, muscles and tendons. It can result from spasms and muscle strain from neck problems such as disc degeneration and spinal stenosis. Be it a chronic pain or a sudden one, addressing it is important to get on with the daily office life. 

Here is a list of some quick solutions, which when followed can give considerable relief from the pain:

Computer should be at eye level: While sitting at it you must ensure that the middle of the computer screen is parallel to the eye. If it is required that you bend your neck to view the screen, then you should adjust the screen, without bending your neck. This happens most often while working with a laptop. The chair length can be adjusted to fix this problem.
Refrain from neck straining while typing: If typing requires straining the neck, it should be ensured that the same doesn t happen. This is the case while texting in a mobile. A better solution is to fix this is to take the mobile at a level which does not require the neck bend down. It will ensure that the joints and discs of the neck are not stressed.
Use headset: If the work demands longer time on the phone, instead of bending the neck it makes sense to use a headset. Practicing the chin tuck exercise can help in this case. This exercise can strengthen the soft muscles of the neck. It also maintains the alignment of the head and the shoulder.
Stay hydrated: Enough hydration is necessary to ensure spinal alignment and disc height. Hydration also takes a eases the spine and relaxes the soft muscles. A practice of adequate hydration throughout the day can help stop the degeneration of the cervical disc. While drinking water is a matter of practice, keeping a water bottle serves as a constant reminder to drink it throughout the day. Keeping an alarm after 2 hours also serves as a constant reminder to drink water.
Carrying weight: One common mistake committed by most people is to carry weight with one hand. Since the load doesn t distribute evenly, it strains the neck muscles causing pain. It should be ensured that the office briefcase or the heavy purse is carried with equal stress on both the shoulders. This will ensure a painless day at the office.
Maintaining a good posture: Poor sitting or walking posture is often the cause of neck pain. While sitting it should be ensured that the back is straight and rests in the chair once in awhile. The neck and head should fall in a line while working.

Neck Pain at Work - 6 Tips to Help You Prevent it

A spinal disk has a soft, jellylike centre (nucleus) encased in a tougher, rubbery exterior (annulus). Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the nucleus pushes out through a tear in the annulus.A herniated disk, which can occur in any part of the spine, can irritate a nearby nerve. Depending on where the herniated disk is, it can result in pain, numbness or weakness in an arm or leg. Many people have no symptoms from a herniated disk. Surgery is usually not necessary to relieve the problem.

Discs uni formally distribute the body weight. It has got three-part the disc plate, nucleus and fibrous. Because of some undue pressure at a particular part of the disc, some or all cartilage fibres rupture and the nucleus bulges out. In advanced grade, this bulged out part may compress a corresponding nerve root. Due to compression, patients may experience radiating pain in the legs.

The most common site of a disc bulge is between L4-5 and L5-S1.
Through holistic corrective programme bulged out part retracts back leaving the pressure on the nerve.
The treatment has become successful because of unique muscle spasm release techniques and spinal decompression.
The disc is 84% gelatinous with the water-absorbing property. On decompression, it swells up and bulged out part retracts back and leaves the pressure on the nerve root.
As a final result, patients get complete relief in pain in the leg and also low back pain is permanently relieved.
This is the best-known treatment to date. According to a study done at KBMS Institute, more than 85% of patients get quick and permanent relief through this Holistic Corrective Programme (HCP).

Spinal Disc Problems - Know How To Deal With Them!

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