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

Spine surgeries are complicated and have serious repercussions if the procedure doesn t go as planned. Probing your doctor is therefore very critical to ensure a safe operation and early post-op recovery. Questions can range from the type of treatment chosen for speedy recovery to side effects. Here is a list of questions that you need to ask your spine surgeon:

1. Why is the surgery recommended?
Typically, there could be more than one treatment option for a particular problem. Your doctor should be able to tell you very precisely as to why the surgery is recommended and how it is going to address the problem.

2. Is there any non-surgical option?
Many spine related issues can be treated with medicines and physiotherapy. Ask your doctor if such options exist.

3. Explain the surgical procedure in detail
Your doctor should explain the whole surgical procedure, explaining the minute details and help will help you to understand the implications.

4. What is the duration of the surgery?
Spine surgeries do not take more than 2 hours. It, however, depends on the procedure that is being performed.

5. How will the surgery address the pain?
It is important to know the source of the pain. Exploratory surgeries are not performed on the spine. Ask your doctor how he intends to address the pain through the surgery.

6. What are the risks involved?
Risks and side effects vary from patient to patient. For instance, a person with obesity, spondylitis and smoking has greater chances of complications associated with the operation.

7. Will the doctor perform the whole procedure or he will use practicing surgeons and intern for the job?
Many senior surgeons use interns and junior surgeons to perform a minor procedure. Get a clear understanding of the role of the doctor and his assistants. It is a good idea to know the background if the surgical team who is going to perform the procedure.

8. What is the success rate of the doctor for the procedure he is going to perform?
A successful spine surgeon should be able to give you valid data on his/her success rate and the overall success rate of surgeons all across the country.

9. How many days do you need to spend in hospital?
Your hospital stay is directly related to your insurance. It is essential to get a clear picture on the same.

10. Whether a back brace is necessary after surgery?
Limiting the spine movement speed the process of healing. Most Doctors suggest braces after a spine surgery.

11. What is the time required for recovery?
The recovery greatly varies from patient to patient. What you should ask your Doctor is the expected time required for you to join your job/school.

12. Will there be any physical limitation after the operations?
Many spine surgeries require you to refrain from strenuous jobs for a while. For instance, certain surgeries require you to stay away from driving for a while. Address all these apprehensions from your doctor.

12 Questions You Must Ask Your Spine Surgeon

Radiology is a special branch of medical science that uses various techniques of imaging for the diagnosis and the treatment of several types of diseases in the body. The different types of imaging techniques used in radiology are X-rays, Computerised Tomographic scan (CT Scan), ultrasound, Magnetic Resonance Imaging (MRI) and nuclear medicine which includes Positron Emission Tomography(PET).

Role played in evaluating hip replacement
Hip replacement surgeries have become extremely common in the recent times, and radiological evaluation remains the mainstay of the overall hip replacement procedure. Thus, the role played by radiology is quite significant in such situations. All the specific anatomical landmarks and the measurements are used to make sure the placement is perfect during the hip replacement surgery. Radiological imaging helps in the assessment of the following conditions that are as discussed below.

The length of leg
The inequality in the length of the two legs is prevalent after a hip replacement surgery which can create a great deal of discomfort and inconvenience to the patients. A greater difference in the length of the two legs increases the chances of dislocation, and this is a situation where radiological evaluation plays a crucial role. With the help of radiological imaging, the length of the legs can be made almost equal.

The horizontal center of rotation
In this case, horizontal center of rotation helps in the assessment of the acetabular component of the prosthesis. This is calculated by the measurement of the distance between the center of the head of the femur and the acetabular teardrop. This distance should be bilaterally equal, and it is just not possible without the help of the imaging techniques of radiology.

Acetabular inclination
The acetabular inclination is the angle formed between the face of the cup and the transverse axis. If the angle is less, then it results in a stable hip, but the abduction is limited. On the other hand, if the angle increases then there are high chances of dislocation of the hip. Thus, with the help of radiological evaluation, proper and effective angular inclination is given which is optimum for the patient.

The stem positioning of the femur
The main aim of the stem positioning of the femur in a hip replacement surgery is placing the stem in a position which is neutral within the shaft. To get a proper idea of the positioning, the imaging techniques are of utmost importance which cannot be achieved perfectly without the imaging.

Thus, the crucial role the different techniques of radiological imaging plays during the overall procedure of a hip replacement surgery can be perceived. With the use of the different imaging techniques, the results obtained are closer to perfection.

How Radiological Evaluation Can Help In Case Of Hip Replacement?

What does neck and shoulder pain indicate?

The stabbing pain that you experience around the neck and shoulder region should never be ignored as they may indicate health problems that require medical attention. There are certain points that you need to keep in mind the if you experience prolonged pain in these areas of the body.

1. Neck injury? your neck and shoulder pain should be seen as a warning sign that you need to take a look at the neck injury you may have sustained during a rear-end automobile accident. More specifically, whiplash injuries that happen when the head experiences a sudden backward and forward jerk, straining the tissues of the neck. 

2. Pain in these areas of the body could indicate abnormalities in the vertebrae of your neck such as herniated disc, causing added pressure on the nerves of the spinal cord.

3. Your neck and shoulder pain complaint may also point towards muscle strains. Lifestyle factors like working long hours in front of laptops or desktops leave you with no time and zero energy to exercise, resulting in serious neck and shoulder pains.

4. Your neck and shoulder pain may also indicate the problem of cervical spondylosis. This is a degenerative disc disease, which is characterised by severe pain that originates from the neck and radiates till the shoulders.

5. Even heart problems, such as a heart attack can cause pain in the shoulder and the neck. When this happens, the condition is known as referred pain.

6. Adopting an improper body posture during lifting of heavy materials can induce pain in your body parts, with neck and shoulders being the most vulnerable areas.

7. You may be suffering from a condition known as rotator cuff injury in which the group of ligaments and muscles that support the shoulder get injured during lifting or playing any sport.

To avoid aggravating the pain from becoming more severe, you shouldn't ignore any ache that arises from these areas.

If you would like to consult with me privately, please click on 'consult'.

Related Tip: 6 Effective Ways to Keep Away Body Pains, esp. When Temperatures Dip

What Does Neck and Shoulder Pain Indicate?

Carpal tunnel syndrome is a painful one that is born from a strain on the median nerve, which loops through the wrist bone to connect it with the rest of the hand and fingers so as to promote motion. This condition can be a painful and debilitating one that usually starts at night, and affects the various fingers, especially the thumb and index finger. The symptoms include numbness, a tingling sensation, a weak grip, and the inability to do many tasks that involve the thumb and index finger. There are many ways of treating this condition with the help of physiotherapy, steroids and corticosteroids. There are easier ways of dealing with this issue on an everyday basis, as follows.

1. Wrist splint: it is a good idea to wear a wrist splint at night which will keep the bones and muscles stationary as the pain in this condition usually starts at night. This will also prevent further damage to the median nerve. 

2. Activity: keep your activity to a minimum to give your hand and rest, in particular, some much needed rest from the pain, numbness and tingling. Further, you need to avoid activities that cause too much pain and numbness. Also, take care to keep your thumb and wrist straight during other activities so that there is less strain on the median nerve.

3. Strength and flexibility: many times, the pain from the wrist and fingers can spread towards the arm as well. In order to prevent this and to treat the pain on a more long term basis, it is important to turn to some mild exercise which can make the area more flexible and strong. This can include wrist twists which can be done ten times for each hand. One can also try yoga to strengthen the joints in the upper body.

4. Ice pack: use an ice pack or ice compress on your wrist for ten to fifteen minutes each every few hours to help in relieving unbearable pain.

5. Anti-inflammatory medication: patients suffering from this condition can also turn to non steroid medication that will help in bringing down the inflammation. This inflammation is usually responsible to a great extent for symptoms like numbness and pain which can halt various activities. These drugs may include aspirin, ibuprofen, and even naproxen sodium. 

6. Taking breaks: one must take regular breaks at work and flex the fingers and the wrist so that the painful bending posture does not make matters worse.
 
Ensuring that you manage your everyday functioning despite carpal tunnel syndrome is a matter of balancing your activities with rest.

Easy Ways to Deal With Carpal Tunnel Syndrome

Acupressure can prove to be extremely effective if you are looking for non-medicinal solutions to treat musculoskeletal problems, such as back pain, sports injuries, arthritis, etc. Acupressure is the application of putting firm pressure on the areas on the body which are swollen, agitated or tense by massaging the acupoints (specific points in the body). Acupressure believes that relieving these areas of pressure reduces the pain.

Here are some musculoskeletal problems that can be healed by acupressure:

    Arthritis: Those who seek acupressure as an alternative treatment for pain are mostly suffering from arthritis (a disease characterised by chronic joint inflammation and cartilage degeneration). Acupressure applies pressure on the inflamed joints.
    Back pain: Back pain is a common problem that can affect anyone irrespective of his or her age. Acupressure acts to relieve the points where the muscles are too tense and helps to tone or support the muscles which have become weak with disuse.
    Chronic pain: Unrelenting pain can stem from many causes. Acupressure focuses on the pain and the pain signals when treating chronic pain. The acupoint of the pain and the nerves are gently massaged to relieve the pain.
    Fibromyalgia: Traumatic injury to the soft tissue, emotional trauma or severe illness can cause fibromyalgia. It is non-inflammatory in nature and often leads to Chronic Fatigue Syndrome (a troublesome disorder with symptoms of deep fatigue, sleeping problems, pain, etc.). Acupressure can greatly improve the fatigue and sleeplessness that fibromyalgia causes.
    Tendonitis: The tendon connects the tissue to the bone, and tendonitis is the condition when the tendon is inflamed. Acupressure helps in reducing the inflammation and easing mobility restrictions.
    Sciatica: The sciatic nerve is the longest nerve in the body, stretching from the lower spine to the back of the foot. So when this nerve is agitated, pain radiates from the lower back to the foot. This condition is called sciatica. The acupoints in sciatica are the lower back and the hip. Acupressure effectively loosens the muscles in these regions and reduces inflammation.
    Sports injuries: Strains and sprains are common sports injuries, which mostly affect athletes. Acupressure has anti-inflammatory benefits that can help heal severely injured tendons, ligaments or muscle. Acupressure also plays a huge role in restoring and retraining the body, especially if you are an athlete and play high-demand sports.
    Carpel Tunnel Syndrome: Carpal tunnel syndrome is a condition in which the pressure increases on the median nerve as it goes through the carpal tunnel, and this causes wrist pain. Acupressure involves the use of directed pressure to specific acupuncture points on the surface of the body.
    Insomnia: Insomnia is a sleep disorder. The Acupressure Points between your heel and anklebones (on both sides) have traditionally been used to relieve and prevent insomnia.
    Migraines: Acupuncture is used to effectively treat primary headaches, namely tension and migraine, which are the most common.

Acupressure: The Non Medicinal Solution to Musculoskeletal Problems

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