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

Pain in the joints continues to bug mankind till this very day. There are different types of joint pains, which might occur all of a sudden, with no signs of receding. The most common of them all are arthritis, tennis elbow, frozen shoulder, back pain and repetitive muscular strain. These joint pains are sometimes impossible to diagnose properly by the regular modes of diagnosis. In those cases, resorting to the homeopathic mode of medication might be a good idea as it is a medication based on treating the actual cause of the disease and sustained use might result in complete remission of the pain.

Some commonly used homeopathic medications for pain in the joints are as follows:
1. Rhus Tox: This is the most commonly used in homeopathic preparation for severe joint pains, the symptoms of which include severe pain after relaxation, pain triggered by slightly wet weather and pain after walking or running for a long time.

2. Arnica Montana: When the symptoms are pain in every joint of the body resulting in body aches and pertaining injuries due to accidents, Arnica Montana serves as the perfect medication.

3. Actea Spicata: This medicine is primarily used as a remedy for pains in the small joints of the hands. The symptoms for which the medication can be implemented are rheumatoid arthritis in the joints of the finger and swollen wrists after usage of the hand.

4. Colchium: This medicine can be used in case of Rheumatoid Arthritis (inflammatory and chronic form of arthritis).

5. Bryonia Alba: This medication can work wonders if the symptoms include severe pain in the knee joints while walking, severe swollen joints and osteoarthritis (affects the flexible tissues present at the bone ends).

However, it is always advisable to take medication as prescribed by your doctor, as the potency and frequency can only be decided by your doctor.

Homeopathic Treatment for Pain in the Joints

The knee is the largest joint in the human body and is a complex structure formed of bone, muscle and cartilage. Development of pain in the knees can be caused by numerous factors such as aging, injuries, diseases, dietary deficiencies, etc.

Arthritis is the most common cause of knee pain and usually affects the elderly and aged. It occurs due to an inflammation of the joint and causes pain, swelling, redness and inflexibility of the knees.

What are the factors that determine treatment method?

Diagnosis for knee pain varies from patient to patient as each case is different and must be approached differently. Some of the factors that determine the treatment method are as follows:

- Cause of the problem
- Nature and intensity of pain
- Age of the patient
- Medical history of the patient
- Diet and lifestyle of the patient

There are a number of different types of arthritis which can affect the knees in different ways and, consequently, require different types of treatment methods.

What are the various treatment methods for knee pain?

1. Conventional Remedies - These are used in case of conditions that are not too severe or chronic. It includes keeping on bed rest, using an ice pack, taking a painkiller and anti-inflammatory medicines, wearing knee braces, etc.

2. Physical Therapy - There are many stretching and strengthening exercise routines that help alleviate knee pain and treat the condition. Recovery is achieved by making the muscles around the knees stronger and increasing stability and flexibility.

3. Injections to the Knees - A number of anti-inflammatory substances and supplements, as well as lubricants, can be injected into the knee joint which helps reduce pain and makes the joint more supple.

4. Stem Cell Therapy - This involves drawing platelets from the patient's blood and injecting it into the knee joint for repairing damage caused to ligaments, tendons or cartilage.

5. Surgery - Surgical procedures for treating knee pain include partial or complete knee replacements.



What kind of treatment does your knee pain require?

Knee pain: causes and tips to manage knee pain

The knee is the largest joint of the body and is made up of upper and lower bones that are separated by two discs known as menisci. While minor knee pain may be experienced by many people, it should be handled with medical intervention when it becomes a serious and debilitating problem. Sudden injury or injury due to overuse as well as myriad conditions that affect the joints and muscles can bring about knee pain. Underlying conditions like osteoporosis or arthritis, which affect the bones and joints, can also cause knee pain. The symptoms include painful swelling and stiffness as well as severe discomfort. Let us learn more about the causes of knee pain and the ways in which it can be managed-

Injury: exercise and sports injuries are one of the most common causes that can be the start of acute knee pain, as well as chronic condition. These kinds of injuries can affect the ligaments and cartilage which leads to severe pain. The pain can even affect the way one functions in one's daily life. Knee ligament injuries can also cause this kind of pain. These ligaments are bands of tissues that connect the thigh bone with the lower leg bones. Sprains and tears in the acl or pcl are common in sports injuries, and may even require surgery in many cases. Knee cartilage tears can also take place in the hard yet flexible cartilage of the knee which can affect the meniscus around the knee. This condition may also require surgery.

Arthritis: this condition can affect the knees specifically and is one of the most common types of arthritis. This is a chronic condition which gets progressively worse over time and may even require surgery. Stiffness and inflammation are common symptoms. Rheumatoid arthritis is also a degenerative auto-immune disease that can affect the knees and cause knee pain. Furthermore, post traumatic arthritis can also be experienced after an injury. Osteoarthritis is another common condition that leads to knee pain. It basically occurs due to wear and tear of the knees over a prolonged period and is usually experienced by patients over the age of 50.

Managing knee pain: while pain medication and anti-inflammatory drugs may be prescribed for most cases, along with surgery in the long run, it is also possible to manage knee pain with the help of better lifestyle choices like regular knee and muscle strengthening exercises as well as rest - rest, ice, compression and elevation. These methods can help in relieving inflammation and pain. But very severe cases will require medical intervention, so it is imperative to get in touch with your doctor if the condition does not improve.

Knee Pain: Causes and Tips to Manage Knee Pain

Calcium is known for its role in maintaining the bone health, from keeping your teeth stronger to normal functioning of the cells.  But there are various factors, which lead to a deficiency of calcium in the human body and paves the way for several complications.

Here are the top three signs that indicate you are suffering from calcium deficiency.

Difficulty in sleeping: Sleep is essential for your bone health and calcium is directly associated with your sleep cycle. The level of calcium in your bones rises and falls when you are asleep and it reaches its peak when you are in deep slumber. This indicates that when you are unable to sleep properly, it is a warning sign of calcium deficiency. There are various researches that have confirmed, that by increasing the level of calcium, it is possible to restore the normal sleep cycle of an individual. This is also related to the role that calcium plays in the production of a sleep hormone called melatonin. When the calcium content in the body is really low, this hormone is not produced, thus, making it difficult for a person to sleep.
Difficulty in losing extra pounds: Yet another frustrating aspect of any individual s life is the inability to shed off excess pounds. This issue is also linked with the lack of calcium supply in the body. The calcium that s stored in the cells assists in the processing and storage of fat. So the fat cells with high calcium content burn faster, making you lose weight. Thus, if you have trouble losing weight in spite of having a well-regulated diet and regular workout, it s a sign that you are suffering from low calcium.
Paresthesia: Though this ailment is not much heard of, it could be a sign of calcium deficiency. Paresthesia is a nervous disorder, which causes tingling sensation, tremors, numbness and loss of sensitivity. It could also lead to poor concentration, amnesia, confusion, hearing impairment, twitches and other physical as well as neurological impairment. This is because low calcium in the blood is connected with the health of your nerves.
The deficiency of calcium can manifest itself in different intensity, ranging from the non-existent to minimal to severe levels. Chronic calcium deficiency can lead to life-threatening diseases like rickets, osteopenia, and even osteoporosis. Therefore, you shouldn t ignore these signs and consult an expert without delay.

Calcium Deficiency - 3 Signs You are Suffering from it

Simple exercises for relief from knee pain

A lot of people suffer from knee pain, some hereditary, some due to injuries and some due to other reasons. Whatever be the reasons, the pain is very bothersome. 

Try the following exercises regularly to get relief from knee pain.

1. Leg lifts - sit straight on a chair with your feet firmly on the ground. Lift the leg for which the knee pains, until it is parallel to the ground. Hold for a couple of seconds and bring back to the initial position. Do 10 reps every day.

2. Knee bending - sit on a chair and keep a stool of same height as the chair in front of you. Place your knee on the stool, knee slightly bent. Slowly, straighten your leg and hold in the straight position for a couple of seconds before you release. Do 10 reps.

3. Leg straightening - stand straight and place the foot on a low platform. Bend down, place both your palms on the knee and slowly push it down until your leg is straight. Push only as far as it doesn't hurt too much. Hold for a few seconds and release.

4. Stretching - sit upright. Bring your leg towards your chest by bending the knee and keeping your hand above the ankle. Push your heel towards your buttocks. Release after a couple of seconds.

5. Chair pulling - stand straight near a door keeping your feet apart (shoulder-width), in front of a chair. Hold the knob of the door and slowly, sit back on the chair. Feel the pull in the muscles and go back to previous position after 2-3 seconds. Repeat.

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5 Only Exercises For Easy Relief From Knee Pain

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