Fibromyalgia is a disorder that causes widespread body pain along with sleep deficits, memory loss, mood problems and fatigue. Symptoms may be triggered after a surgery, physical trauma, infection, or stress. Women are much more vulnerable to this disease than men. Many people affected with fibromyalgia may have suffered from headaches, backaches, depression, anxiety, tension, temporomandibular joint 
disorders and irritable bowel syndrome. Most of these patients have undergone multiple consultation with various doctors and undergone many tests, but no diagnosis could be made. These patients are often ignored by doctors and family members as always "complaining of pain".

Symptoms of Fibromyalgia:
1.Extensive Pain- Pain related to fibromyalgia is often depicted as a dull pain that lasts for at least three months. Pain can involve any body part like back,neck, chest, arms, legs. Patients have pain in multiple areas of body and painful areas change over time.

2.Fatigue- Patients afflicted with this disorder feel tired even after sleep. Such people are reported to sleep for longer hours than normal people, but their sleep often gets disrupted due to sleep apnoea and restless leg syndrome.

3.Cognitive Difficulties- These patients find it difficult to concentrate at work and also suffer from memory deficits in daily activities.

4.Other Symptoms: These patients may also have symptoms like burning urination, urgency of urination, numbness,loss of appetite, tingling sensation,diarrhoea, constipation, tinnitus, depression etc

Diagnosis of fibromyalgia:
There are no specific test to diagnose fibromyalgia. Diagnosis is made by a doctor specialised in Pain Medicine using clinical methods based on symptoms and examination. Blood tests like Haemogram, Thyroid function test, RA Factor, ESR are done to rule out other diseases which can cause similar symptoms. 

Treatment of Fibromyalgia
1.First step in treating these patients is to accept their problem and discuss with patient and family members regarding the presence of such disease entity.

2.Lifestyle changes like active involvement in cardiovascular exercises, swimming, yoga, meditation are important to control symptoms.

3.Conventional painkillers do not work in these patients. They requires special medications prescribed by a Pain Specialist for control of symptoms.

4. Counselling of patient is beneficial for associated depression.

Are You Suffering From Body Pains ? It Could Be Fibromyalgia!!

Sports injuries are a common problem, where various types of musculoskeletal injuries can occur during the physical activities. These injuries can either be acute or chronic in nature. In athletes, such injuries can pose as a risk to their careers, which makes it essential for the physicians to provide the most appropriate treatment. It is mandatory to provide a prompt, safe and quick treatment that can restore the athlete s preinjury level of participation in sports.

Various treatment approaches are present for treating sports injuries. The use of intra-lesion blood injection is being made for addressing the musculoskeletal injuries. An easy and minimally invasive method of using concentrated autologous growth factors in treating sports injuries is the use of platelet rich plasma (PRP). It is a fraction of the blood plasma that contains a higher concentration of platelets than normal plasma, along with growth factors.

PRP is used in the treatment of both soft tissue and bone injuries. Growth factors have a positively influencing effect on the healing process of connective tissue components.
There is a huge difference between the anatomy and functions of tendons, ligaments, muscles and joint capsules. Hence, the site of injection of PRP also varies.
The cellular tension in the tissue and the collagen structure is affected after the administration of PRP.
Use of PRP is popular in the treatment of an Achilles tendon. For injecting PRP, an ultrasound scan is done, the site of injection is accurately identified and then PRP is administered.
Proper location of the site of injury and deciding the accurate injection zone prior to the injection of PRP makes it easier to facilitate treatment and eliminate discomfort.
Administration of PRP should be considered secondary to physical therapy and other conservative means of treatment.
Enthesopathy is a discomfort in the area where the attachment of tendons, ligaments and the articular capsule is present. The use of PRP is increasing in the treatment of this condition. It has an inflammatory nature and presents as epicondylitis or capsulitis.
Studies have proved that PRP is an effective alternative to injection of steroids for an anti-inflammatory effect. Steroids majorly provide only symptomatic relief, whereas PRP is more definitive.
PRP has also found an increased use in the area of surgical procedures of knees. It is used to increase the efficiency of the healing grafts placed in the knee during reconstructive surgeries.
For treatment of bone injuries, use of PRP has shown an improved quality and rate of bone healing. Even in cases of an infected injury, PRP aids in healing efficiently.
No known side effects or complications after use of PRP have been observed, which makes it a sought after option in management of sports injuries.


Platelet Rich Plasma In Sports Injuries

A broken bone or a crack in the commonly known as a fracture. Any bone in the arm can be broken, but common areas for fractures in the arm is wrist, specifically the distal radius, forearm bones (radius and ulna), elbow, humerus and shoulder. 

What causes fracture in bones?

Fall: Falling an outstretched hand or elbow is the most common cause of a broken arm.
Sports injuries: Direct blows and injuries on the field or court are a common cause of all types of arm fractures.
Significant trauma: Any of your arm bones can break during a car accident, bike accident or other direct trauma.
Abuse: In children, a broken arm may be the result of child abuse.
How to identify?

An audible snap or cracking sound may be your first indication you've broken an arm.

Signs and symptoms include:

Severe pain, which may increase with movement
Swelling
Bruising
Deformity, such as a bent arm or wrist
Inability to turn your arm from palm up to palm down or vice versa
When to see a doctor?

If you have enough pain in your arm that you can't use it normally, see a doctor right away and do the same for your child. Delay in diagnosis and treatment of a broken arm, especially for children who heal faster than adults do, can lead to poor healing and deformity.

Fracture In Upper Limb Bones - 4 Things That Can Cause It

The medical term used to describe a broken wrist is wrist fracture. The fracture might be in the 10 bones, which make up the wrist or in the radius. Some fractures can be serious while others may be tiny. The serious fractures make the bone unstable and these might require surgeries to cure. Open fracture is when the bone breaks and it breaks through the skin. This might cause an infection to the wounded area.

Causes
The most basic cause of a wrist fracture is injury. Any fall on your outstretched hand and you might have to nurse a fractured wrist. This type of fracture is common among sportsmen. If you are suffering from osteoporosis, then you have a high risk of getting a wrist fracture. Traumatic accidents may also cause severe wrist fractures.

Symptoms
The symptoms of a wrist fracture can be extremely painful. The pain escalates whenever you try to move your wrist or flex it, even if you are just flexing your fingers. Sometimes your hand or arm may even become extremely numb when you fracture the wrist. The muscles in the area become tender and swell up. It is almost impossible to move the wrist after it gets fractured. The fracture causes the wrist or rather the hand to appear deformed. The area around the fracture might even get bruise and a fractured wrist also affects the blood flow in the area. You might even injure your ligaments, tendons, muscles or nerves.

Diagnosis
To confirm and check the level of severity, you are generally asked to get an X-ray done. In order to get a more detailed look at the fracture, you might have to undergo CT or MRI scans as well. Usually to treat a fracture, you will have to wear a splint and move your hand as least as possible. But keep moving you're your fingers otherwise they might get stiff. Your doctor will inform you from when you will be able to move your wrist. Until then try to keep your movements to the minimal.

Causes and Symptoms of Wrist Fracture

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

Restless leg syndrome is a condition where the nervous supply to the lower legs (and sometimes hands) is affected. The person has a constant urge to move the legs due to the tingly sensation or the pins and needles sensation and so this condition is called as restless legs syndrome (RLS). It is almost never a standalone condition and is often associated with other nervous system conditions.
It is a progressive condition and aggravates with time. The patient may experience episodes of this disease. Most people might experience this problem at night due to which a lot of patients complain of disturbed sleep and restlessness while sleeping.

While there is no permanent solution to this condition, there are various home remedies and techniques which can help control the condition. Read on to know more.

Trigger agents: Some people are able to identify triggers like caffeine or chocolate which induce the condition. The first step would then be to avoid using these, especially before sleeping.
Exercise: Any form of exercise, which gives a good workout for the leg muscles is recommended. This could range from a 30-minute brisk walk to stretches depending on the person s overall health status. This is known to induce a good sleep, reduce muscle tension and relax the mood. Choose yoga, gym, cycling, or any form which suits your overall health and schedule.
Massages:Hot or cold massages, often used alternately, can help in relaxing the muscles. This also helps in reducing tension and improving overall sleep. The ideal time for the massage is the evening so that RLS does not affect during nighttime.
Diet: A diet rich in vitamins and minerals can prove to be helpful. This is because proper muscle and nerve function requires various minerals like zinc, potassium, calcium, sodium, etc. Diet rich in these helps in improving muscle and nerve function and thereby control RLS.
Sleep pattern: Sound sleep practices like having an early dinner, a quiet room free of digital media, optimal temperature, and relaxing ambience helps in a better sleep. This has shown to reduce the incidence of RLS and evidence of sound sleep.
Medications: RLS can also cause mild to moderate pain in the affected legs, and so pain killers can be used once in a while if the pain is not bearable. These should be used only rarely and continued use can lead to stomach ulcers and bleeding. The above mentioned nonmedical methods should be tried before trying medications. Anticonvulsants have been used to control RLS if pain killers alone are not adequate. In more severe cases, antiparkinson drugs are used with great success.

Restless Leg Syndrome - How It Can Be Controlled?

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Dr. Rajiv Mehta

Dr. Deepankar Das

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