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

Plantar fasciitis is a common condition that gives rise to heel pain. A thick band of tissue runs across the bottom part of the foot and connects the heel bone to the toes. This leads to inflammation. Those who suffer from plantar fasciitis experience stabbing pain especially when you take the first few steps after waking up in the morning.

As you are up and start moving in the morning, you will feel that the pain decreases. However, after long periods of inactivity or standing in one place the pain might return.

This condition is seen to occur more commonly in runners. Additionally, people who wear improper shoes, lacking adequate support and/or are overweight stand at a greater risk of getting plantar fasciitis.

Signs of Plantar Fasciitis-

Few symptoms of plantar fasciitis include-

  Stabbing pain felt at the bottom of the heels
  Pain arising immediately after exercising but not during it

Cause of Plantar Fasciitis-

Normally, the plantar fascia (ligament tissue) can play the role of a shock absorber, mainly a bowstring that supports the arch in the foot. When tension and stress build up on the bowstring, tiny tears can start to crop up within the fascia. Constant tearing and stretching can lead the fascia to become inflamed and irritated. Many times the cause of plantar fasciitis in certain patients is not entirely clear.

What Makes You Susceptible to Plantar Fascia?

Although the condition of Plantar Fascia can arise without any bulletproof reason, there are certain factors that make you more susceptible to it. These include-

  Age - Those who are aged above 40 but below 60 are more prone to getting this condition
  Obesity - Those who are overweight will inadvertently put greater pressure on the plantar fascia
  Exercises- Certain exercises tend to put more pressure on the heels than others. These exercise types include jumping activities, long-distance running, aerobic dance and ballet dance.
  Foot Type - Those who have an arched foot or are flat-footed, or tend to walk in an abnormal manner are at a greater risk of putting pressure on the plantar fascia
  Your Job Type - Teachers and factory workers who tend to be on their feet a lot or have to walk on hard surfaces may put stress on their plantar fascia

Plantar Fasciitis is a condition that needs immediate attention because when left untreated it could develop into chronic pain and thus become a source of constant pain. In order to prevent it from hampering your daily activities ensure to change the way you walk. This will minimize the hip, knee and back problems in the future.

Plantar Fasciitis - Signs, Causes & Triggers Of It! 

Uncontrollable division of cells present in the tissue leads to the formation of a lump or mass of tissue. This mass of tissue is known as a tumor and when this condition is diagnosed in the bones of a human body, it is known as bone tumor. Most bone tumors are non-cancerous (benign) and cannot grow. However, it is still possible that the bones could be weakened and the condition could result in fractures and other such problems. The tumor replaces the normal and healthy tissue.

It is observed that cases of malignant bone tumors are much less as compared to benign tumors. Some examples of benign bone tumours include:
1. Giant Cell tumor: In this condition, the tumor affects the legs
2. Osteochondroma: This form is most common among teenagers
3. Osteoblastoma: A tumor which develops in young adults and affects the spine
4. Osteoid osteoma: A tumor that affects long bones
5. Enchondroma: Usually found in hand and feet.

As stated earlier, metastatic cancer is a form of cancer that spreads to the bone from other spots in the body. Cancers from other parts that commonly spread to the bones include breast cancer, prostate cancer and lung cancer.

It is common for bone tumors to bear no symptoms and they can only be diagnosed using an x-ray. However, a typical symptom of bone tumor is pain which:
1. Starts in the region of the bone tumor
2. Often feels achy
3. Worsens with activity

Other symptoms that might be related to bone tumors are:
1. Abnormal swelling around the bone
2. Fever
3. Limping, in rare cases

Treatment
1. Benign bone tumors can be treated by just using medications. However, the tumours might relapse even after treatment.
2. Treatment of malignant tumor might require a number of specialists. The stage of cancer plays a vital role in the treatment.

Common treatments for bone tumor are:
1. Amputation: It is the surgical removal of all or a part of the limb and is conducted only if the tumor is large.
2. Radiation therapy: High intensity X-rays are used to kill cancer cells and treat the tumors.
3. Chemotherapy: Tumor cells which have infiltrated the bloodstream are eliminated using cancer drugs.

Abnormal Swelling - Can it be a Sign of Bone Tumor

Your thyroid glands are important to the body because it produces essential hormones. However, if you suffer from hypothyroidism, your thyroid glands will not be able to produce these hormones sufficiently.

In the early stages of hypothyroidism, you will not detect any noticeable changes in your body or health. However, if you do not start treatment for the condition, you will soon start to experience symptoms, such as obesity and infertility. Joint pain is another serious symptom of hypothyroidism.

Symptoms of musculoskeletal pain related to hypothyroidism-

Hypothyroidism can lead to a range of muscular and skeletal disorders in your body. Here are some musculoskeletal symptoms you are likely to experience if you suffer from hypothyroidism.

Painful and stiff muscles, which mainly affect your hip and shoulder region

Swelling across the joints of feet and hands

Carpal tunnel syndrome, where pressure on a nerve in your wrist causes pain and tingling across the entire arm

Stiffness and pain in the joints

Treating hypothyroidism related muscle and joint pain-

Over-the-counter pain medications help deal with the pain and the swelling. However, they are a temporary solution for the discomfort. Treating hypothyroidism is the best way to reduce your pain and discomfort.

Your doctor will prescribe a levothyroxine supplement, which is a synthetic hormone. This medicine will rectify the imbalance in your hormone levels, which in turn will reduce pain in your muscles and joints. Apart from the joint pain, the medication will also lower your elevated cholesterol levels from hypothyroidism.

How to get the best results from the medication-

If you consume certain foods, supplements and medication while being on levothyroxine, the drug may not work effectively. Here is a look at some things to avoid when you are on the medication.

Excessive soy products

Excessive high-fibre diet

Foods with high iron content

Antacids that contain Aluminium hydroxide

Calcium supplements

For the best effects, you need to consume the hypothyroidism medication on an empty stomach. Your doctor will likely advise you to take the medicine first thing in the morning and then wait about an hour before having your meal. In some cases, you may need to take the drug before going to bed. However, ensure you consume the medicine at least 4 hours after the last meal for the day.

Hypothyroidism And Musculoskeletal Pain - Know More About Its Link!

Today  working  usually implies sitting at a desk from morning to evening. While this may seem more comfortable than working in the fields, sitting at a desk can trigger a host of back problems. This is because sitting in the same position all day makes the spine bend forward and lowers the efficiency of the back muscles. Working at a desk not only strains your back, but also restricts your movements to typing on a keyboard and moving a mouse. 

Once a back problem begins, it usually lasts a lifetime hence; here are a few tips to save your back.

Get yourself a good chair: Your chair is crucial to your back s health. Avoid the hard backed plastic chairs and pick a more flexible mesh backed office chair if you sit at the table for a long span of time. Ergonomic chairs may seem expensive, but are worth the expense in the long run.
Stretch your muscles: Sitting in the same position all day, puts the muscles under stress and with time can constrict the muscles. Make it appoint to stand up every 30 minutes and stretch your back and sides. Also try rotating your hips and shoulders form time to time.
Take a break: No matter how much work you have in front of you, take a break at the end of each hour. Taking even 2 minutes off out of 60 every hour can have a huge impact on your health. If you still feel guilty skip using the phone to connect with your colleague and walk over to their desks instead.
Get a pedometer: Keeping a pedometer will help you track the number of steps taken in a day. Ideally, a person should take 10,000 steps a day to stay healthy. If you sit at a desk for majority of the day, take every opportunity you can to up the count on your pedometer. Go for a walk around your office after lunch or park your car a little way off from the office to create opportunities to walk.
Take the stairs: As far as possible avoid escalators and elevators. Instead climb stairs for a quick workout. If your office is on the 20th floor, walking up may not be feasible, but you could get off the elevator on the 18th floor and walk up the remaining two floors.
Eat healthy: Lastly, pay attention to what you eat. Avoid eating at the office canteen or picking up a bite at the coffee shop and carry lunch from home. This ensures that you eat a balanced meal.

World Spine Day-6 Back Saving Tips for People Who Sit at a Desk All Day

Bone Fractures: Causes and Symptoms

'Fracture' is a medical term for a broken bone. According to an estimate, an average person has two fractures within their lifetime. When a force exerted is stronger than the bone itself, it can lead to a fracture. The risk and chance of fracture depend on your age. With age, bones tend to become brittle and, hence, a fall that would have been potentially harmless years ago can lead to a broken bone at a later age.

There are many types of bone fractures, but the main types are:

Closed fracture: A fracture in which the bone breaks but does not tear through the skin

Open fracture: Where the broken bone punctures through the skin and protrudes out. There's a greater chance of bone infection in an open fracture

Displaced fracture: In this type of fracture the bone snaps into more than two parts

Nondisplaced fracture: The bone cracks partly or wholly but it does continue to move

Some of the common signs and symptoms of a fracture are:

- Bruising and swelling of the bones
- Open fractures marked by protruding bones from the skin
- Loss of locomotive and functional ability of the injured area
- Deformity of the injured area
- Pain in the event of movement of the injured area

A fracture can be caused by a number of reasons, and they are:

- Injuries and accidents
- Falls and slips
- Wear and tear through overuse
- Sport injuries
- Fist fights and brawls
- Osteoporosis (a disease which causes bones to weaken in adults)
- Osteomalacia ( a disease caused due to softening of your bones, which is caused by a vitamin D deficiency.) Soft bones are more likely to bow and fracture than are harder, healthy bones.

Note:

Osteomalacia is not the same as osteoporosis. Osteomalacia occurs due to a defect in the bone-building process while osteoporosis develops due to a weakening of existing bones.



Bone Fractures: Causes and Symptoms

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