Back pain is something that affects many people all over the world. Persistent and chronic pain seems to be one of the most common complaints. Middle back pain is back pain that is felt in the thoracic vertebrae region, which is located between the base of the neck and top of the lumbar spine. The ribs attach to a long, flat bone in the middle of the chest called the sternum and wrap around the back. In case, there is a nerve around there is squeezed, disturbed, or injured, you are likely to feel pain in different spots where the nerve goes through, for example, your arms, legs, chest and the stomach.

Some of the most common causes of middle back pain are as follows:

Middle back pain can happen as a consequence of injury or sudden damage or it can happen through strain or poor stance after some time.
The most widely recognized reason for middle back pain seems to begin from soft tissue problems or muscular irritation. These can emerge from poor stance, lack of strength, prolonged sitting in front of a computer, utilizing a heavy backpack, overuse injuries, (for example, repetitive movement), or injury, (like a whiplash damage brought about by an auto crash or as a consequence of a sports injuries).
The middle back is a moderately normal site for inflammatory, degenerative, metabolic, infective and neoplastic conditions.
Middle back pain and its dysfunctions are connected with various conditions, for example, essential and optional osteoporosis (particularly vertebral cracks and hyperkyphosis emerging from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann's infection.
Muscle strain, overuse or damage to the muscles, tendons, and discs that are backing your spine can also cause middle back pain.
Weight on the spinal nerves from specific issues, for example, a herniated disc.
A fracture in one of the vertebrae can also cause pain in this region.
Osteoarthritis created by the breakdown of ligament or cartilage that cushions the little joints in the spine.
Myofascial pain that influences the connective tissue of a muscle or gathering of muscles.
In uncommon cases, pain might be brought about by different issues, for example, gall bladder disease, cancer or an infection.
Getting hit hard in the back can also cause chronic pain.
Lift something too heavy may cause pain and a sudden pressure in this area.
A compression fracture of the vertebra can also bring about intense or chronic pain in the middle back. The injury may bring about a fracture, however in ladies over age 50 without critical injury or somebody known to have osteoporosis, an unconstrained vertebral fracture is possible.
Other contributing factors to injury include lack of strength which can be treated by a Pain Management Specialist using non-surgical methods.

Common Causes of Middle Back Pain

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

Hot and Cold therapy is one of the most popular home remedies for any kind of joint pain or muscle sprain. In some cases applying heat therapy and cold therapy alternatively, can help relieve the pain while for others only one form of therapy is necessary. To understand what to use when, one should first understand the effect of heat and cooling on the body.

Applying a heat pack or immersing the affected limb in hot water improves blood circulation and makes the muscles more flexible. Thus, it can help relax a muscle and fasten the healing of damaged tissues. On the other hand, cold therapy or cryotherapy reduces blood flow to the affected site. This helps relieve inflammation and pain caused by it. It can also make the area feel numb by reducing nerve activity temporarily.

Types of Heat Therapy
Heat therapy can be categorized as dry heat and moist heat. Dry heat involves using saunas or dry heating packs to relieve pain. This is also known as conducted heat therapy. As the name suggests, moist heat involves the use of steamed towels, hot baths and moist heating packs. This is also known as convection heat therapy. Moist heat is usually considered more effective than dry heat.

Types of Cold Therapy
Cold therapy may be applied to a part of the body or to the entire body. This includes ice packs, coolant sprays, ice baths, ice massages and whole body, cold therapy chambers.

How to use heat and cold therapy?
The sooner heat and cold therapy is given to a person, the faster they will recover from their pains. Heat therapy can be given to a person for extended periods of time but when giving cold therapy, a person should not be exposed to a cold pack or ice bath for more than 10-15 minutes. Care should also be taken no to apply ice or a frozen pack directly on the skin as it can damage the skin and nerves.

When not to use Heat Therapy?
If the injury site is swollen or bruised, cold therapy is better than heat therapy. Heat therapy should also not be applied to an open wound. People suffering from conditions such as diabetes, dermatitis, deep vein thrombosis, vascular diseases and multiple sclerosis should also avoid heat therapy as these conditions can increase the risk of burns and other such complications. Pregnant women should also consult a doctor before using a hot tub or sauna.

When not to use Cold Therapy?
Cold therapy is avoidable for treating stiff joints and muscles. People suffering from poor circulation and sensory disorders should also avoid using cold therapy without a doctor s supervision. 

Hot & Cold Therapy - How It Can Treat Pain?

Are you suffering from chronic pelvic pain? Well, then it is time to consult your doctor. Chronic pelvic pain can be the indication or symptom for other serious disorders. It is often difficult to figure out the exact cause of the pain. Chronic pelvic pain refers to the persistent pain in the pelvic region that has been lasting for over six months. Your doctor needs to carefully examine your symptoms to know the source of the pain.

Here are some of the causes that lead to chronic pelvic pain:

Endometriosis: In this disease, cells that form the lining of the uterus grow abnormally. These cells grow on organs like the ovaries, urinary bladder or rectum. Symptoms that can be accompanied with pelvic pain in Endometriosis.

Pelvic pain or cramps before or during your period
Pain during or post sex
Pain at the time you ovulate
Pain during bowel movements
Rectal bleeding during period
Pain during urination
Lower back pain
Infertility
Spotting in between periods
Bloating
Adenomyosis: This disease is similar to endometriosis. Cells lining the uterus tend to invade the uterus and muscle tissues of the uterine wall. In many cases, women with adenomyosis are devoid of any symptoms. Some of the common symptoms are:

Pain during period
Pressure on bladder or rectum
Massive periods
Long periods
Interstitial Cystitis: Women suffering from interstitial cystitis have inflammation of the urinary bladder. The inflammation is due to any infection. This affects women as a result of their aging. Symptoms:

Need to urinate very often
Discomfort during urination
Pain at the time of sex
Urinary Tract Infection
Bacteria cause urinary tract infections. This, in turn, leads to pelvic pain. Infections can affect any part of the urinary tract. It can also affect the kidneys, bladder, and urethra. Urinary tract infections are common in women mainly. Symptoms:

Pressure in lower pelvis
Pain or a burning sensation during urination
Needing to urinate frequently
Cloudy urine
Blood in urine
When to visit a doctor?
It is difficult to know and assess the right time to visit the doctor. But the pain may be very irritating. It can also lead to fatal and chronic disorders. Therefore, it is best to consult a doctor if the pain persists for a long period and doesn t vanishes with the home-based remedies or medication. The doctor may conduct lab tests, laparoscopy, or radiological tests to come to a conclusion.

Chronic Pelvic Pain - Common Causes Behind It + Related Symptoms!

Ageing is a process which is not always kind to people. One of the things which occurs along with ageing is cervical spondylosis, which causes extreme pain and stiffness of muscles. Although it may be an excruciating thing to have, it really does not mean that it cannot be treated, especially with herbal medicine.

In a lot of cases, cervical spondylosis (sometimes referred to as neck arthritis or cervical osteoarthritis) ends up being related to a neck injury that was suffered by a person and it gets progressively worse as he or she gets older. It is a condition in which there is a degradation of the joints of either two or more vertebrae.

To say that herbal remedies can go a long way when it comes to an issue such as cervical spondylosis is an understatement. Take a look at Ayurveda, the ancient, yet super effective body of medicine.

Triphla: To start with, there is triphala, which is a herb. Take triphala powder, mix it in a glass of milk and have it. Do ensure that the milk is warm as triphala may not have its intended effect, if the case is otherwise.
Gugglu: Simbananda Guggulu, which is the resin extract of the Guggulu plant, is considered an effective medicine.
Aloe vera: Aloe Vera or Kumari Saar, as referred to in the Ayurvedic terms, is known to be a wonder plant and there is a good set of reasons as to why it has earned this reputation for itself. One of the reasons is surely the potential of its juice to help with treating cervical spondylosis.
Ayurveda requires general changes in a person s diet and the way he or she lives life, as well. For this reason, when a person is looking to get rid of cervical spondylosis, it is important to stay away from eating fried food or food that is either sour or bitter. Relief from cervical spondylosis can be as easy as popping a medicine in capsule form a few times a day! 

Make sure you visit a qualified doctor before you consume any of these medicines. It is to be kept in mind that a doctor should prescribe the dosage of medicines and the duration of the treatment for cervical spondylosis and only after this is done should you undergo the treatment. Soon you can look forward to living a higher quality of life with lesser pain.

Ayurveda provides permanent cure for this ailment. The treatment includes external therapies like greeva basti, abhyangam, kizhi etc. Along with some therapeutic diet and regimen and internal medication. Therefore, cervical spondylitis is completely curable with ayurveda.

6 Ayurvedic Remedies to Treat Cervical Spondylosis (Osteoarthritis of Neck) 

Treatment of frozen shoulder varies depending on the stage it is at, and how severe is the pain and stiffness. There is no outright cure and the aim of treatment is to keep the joint as mobile as possible. The most effective treatment is that which maintains a good range of movement until the shoulder starts to heal. 

Treatment may Include the following:

1. Shoulder exercises: Regular, gentle exercise can help to keep the shoulder joint mobile. If your shoulder is very stiff, exercise may hurt, and it should only be carried out with the guidance of your doctor or physiotherapist. If you are able to, continue using your shoulder as normal saving' the shoulder can cause the muscle to waste and may make stiffness worse.
2. Painkillers: Over-the-counter painkillers such as paracetamol or prescription-only drugs such as codeine may be taken to ease pain and you should discuss this with your general physician or pharmacist.
3. Anti-inflammatory painkillers: Such as ibuprofen and diclofenac, are often prescribed to ease pain and inflammation. Any medication that you take should be discussed with your general physician or pharmacist.
4. Steroid injections into or near the shoulder joint may be effective at relieving pain and inflammation for a few weeks. However, injections are not a cure, and symptoms may return.


Treatment of frozen shoulder

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