Osteoarthritis is a common disorder that affects the joints in the body. It is characterized by wear and tear of the cartilage present in the bones which lead to pain and mobility issues. The disorder mostly affects the joints in the hips, spine, knees and the hands. This disorder can t be cured; the symptoms, however, can be managed.

Symptoms

The symptoms of osteoarthritis are progressive in nature and tend to worsen with time. You will experience pain in the affected joint, leading to limited mobility. Joint stiffness occurs when you wake up in the morning or when you have been inactive for a long period. You will also experience a grating-like sensation when the respective joint is being used.  

Causes

This condition occurs when the protective cartilage around the bones tend to deteriorate. The function of the cartilage is to allow the joints to move without friction. In this disorder, the surface of the affected cartilage turns rough, ultimately resulting in complete damage. This leads to loss of the protective cushion of the bone, making the bone rub on other bones. There are certain factors that make you prone to osteoarthritis, some of them are:

Aging increases the risks of this disorder.

Women are more prone to this disorder as compared to men.

Obesity puts added stress on the joints.

It might be hereditary as well.

Ayurvedic Treatment

Ayurveda is a holistic system of medicine that balances the different energies in the body to keep you healthy. Ayurveda believes in the fact that a disorder in the body occurs when there is an imbalance in the respective doshas   Vata, Pitta and Kapha. The idea is to get the doshas in order in order to get relief from the symptoms of this disorder. Osteoarthritis, or for that matter any disorder occurs due to the imbalance of the  Vata dosha . The Ayurvedic treatments for this condition is Pachkarma therapy.

Panchakarma is the elimination of doshas from the body. It is one of the peculiarities of Ayurveda. Since according to Ayurveda, disease is the result of imbalance of doshas, when the increase of dosha is in a large quantity the best way to get cured faster is expelling the doshas out. These procedures (Karmas) are five (Pancha) and hence they are described as Panchakarma i.e. five procedures. These are to be performed not only by the patient for getting them cured but even by healthy persons for maintaining the health. 

Vamana: This is the elimination of doshas by the process of emesis. This is particularly useful for diseases arising from kapha and also from pitta. Diseases like chr. bronchitis, asthma, skin diseases, allergies, herpes, diabetes, sinusitis, osteoarthritis, hyperacidity are best dealt with this procedure. The best season for doing this procedure is   Spring  or even  Autumn .
Virechana: In this procedure, loose motions are produced to eliminate the doshas. This is very useful in diseases caused by pitta dosha e.g. Hyperacidity, herpes, gulma (Type of tumor) jaundice, osteoarthritis, anemia, skin diseases etc. The best season for this procedure is  autumn .
Basti: The procedure is important for the Vata dosha mainly, but can be used for Kapha and pitta and for all sorts of diseases also. In this procedure enema with herbal decoction, oil, honey and salt is given. Since it has a direct action over the large intestine, which is the main site of Vata dosha, it acts instantaneously. The procedure is especially useful for all kinds of diseases caused by Vata Dosha e.g. back ache, arthritis, osteoarthritis, dystrophies, multiple scherosis, muscle waisting etc. The best season for this procedure is the rainy season.

Ayurveda For Osteoarthritis

At some point in life most people experience acute pain in their lower back which is extremely painful. Pain in the spine causes a lot of discomfort and disruption in the life of an individual and hence, it is always better to get it checked on time. There are patients who even wonder when they should consult a neurosurgeon or a spine surgeon for their back pain. It is advisable that a physical examination is done by a primary care physician for low back pain before consulting a spine surgeon.

Why consult a Physical care Physician First?
The main reason to consult a primary care physician at first is that he would prescribe medications for severe lower back pain. The medications could include non-narcotic pain medications such as Ultram or non-steroidal anti-inflammatory drugs such as Motrin. The physician can even refer you to a chiropractor or for physical therapy to get relief from the back pain. Mechanical means are made use of by a chiropractor mainly to alleviate the back pain of the patient.

If the patient feels better with the physical therapy or the medications prescribed by the family doctor and is able to resume normal activities, then there is no need to see a spine surgeon. It is often recommended to take good care of the back and to exercise. A combination of ergonomics, regular stretching and improved everyday posture is beneficial as it reduces the chance of causing pain in the lower back. Exercise plays a very important role and it provides the possibility of reducing the pain.

Conservative Care for Treating Lower back Pain
It is best for patients to consult a conservative care specialist if after consulting a chiropractor they do not find any reduction in their pain and they do not want to undergo spine surgery. The conservative care specialists are well-trained in rehabilitation of musculoskeletal disorders and specialize in spine care. The role of the conservative care specialist is similar to a cardiologist who specializes in treating neurological disorders.

The specialist for spine care works along with the surgeon in a spine center to treat the lower back pain. The specialist is trained in diagnostic techniques and is capable of making use of a combination of diagnostic tests as well as injection techniques such as epidural steroid injections to diagnose the source of the lower back pain in a patient. They can even advise patients whether it is appropriate to consult a spine surgeon for surgery. Surgery is done to correct the anatomical conditions and it is performed only when non-surgical treatments are not successful in alleviating the pain of the patient.

When Is The Right Time To See A Spine Surgeon?

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

One month, the injury is still healing, two months, just a little bit longer, three months? Well, you, believe it or not, it has probably become a chronic pain and is affecting every aspect of your life. Chronic pain may be a novel notion to accept but is now understood to be a disease and generally defined as pain persisting for longer than 12 weeks. Pain management in such cases is traditionally treated through prescription drugs, the other option being amputation.

This is a major cause of patients having qualms about these pills and a need for an alternative. In response to this, doctors have a new tool to help decrease the perception of pain which is a small implant placed in the back to help patients shake off the pain. This small device that could bring you back to your feet is the spinal cord stimulator.

What is spinal cord stimulation?

Theoretically, the spinal cord stimulation is a type of neurostimulation which produces an effect that interferes with the brain s ability to interpret the signal as pain by using electrical pulses. The brain, instead, experiences it as a pleasant numbing sensation. The implant is placed which takes place in two parts i.e. placing the lead device in the spine and placing the pulse generator in abdomen or buttock.

For test stimulation, the several stimulation settings are tried so that the pulse generator can be programmed using these settings. The procedure typically takes 1-2 hours and post-procedure, patients are given a handy device to control the simulations which they are to use in their day-to-day lives.

It has been observed to reduce the pain by at least 50%. However, this too has its limitations. Typical candidates are people with chronic back and limb pain who may have a failed back or disc procedure. The most common risks associated are device-related, example, unintended movement of the leads. Serious effects include hemorrhage in the epidural space or injury to a spinal cord leading to neural damage, but these are highly uncommon.

Quick facts about it

The best product which works for spinal cord stimulation is a long-lasting solution with a need to change the battery of the lead device every 9 years.
The most recommended device today is the implant because of its compact size and the device costs is quite nominal.
The quality of the product matters a lot as there are ample of cheap products available on the same lines. The same can be fitted within the body via a procedure.
The procedure conducted is also called the pain pacemaker.
Earlier, the procedure was used to conduct only in the international countries, but nowadays the implant can be done in India as well. If you are apprehensive about consuming painkillers for your chronic pain, you can explore this option with your Interventional Pain Specialist.
As it is said, lasting pain can lead to damage, hence don t wait until the damage repair has a complete null chance, rather reach out to your doctor to understand more about the concept of SCS so that you can get treated in no time. Explore the option with your "Interventional Pain Specialist".

Spinal Cord Stimulator - How Is It Beneficial In Pain Management?

How Homeopathy Can Cure Muscle and Joint Pain?

Joint and muscle pain arises when excess pressure is exerted on a particular joint or due to the wear and tear of a particular muscle. This is one area where many people face chronic pain, with symptoms such as deformity of the joints, swelling, immobility of the joints and severe joint pain. There are a lot of topical as well as oral medicines for chronic pain within conventional medicine, but it may not always be effective for all types of patients.

Homeopathy has been known to provide effective cures for many types of muscle and joint related ailments.

Let's first look at the common causes for muscle and joint pain related problems:
- Sports related injuries
- Vehicular accidents such as a car or bike accidents
- Bad postures or habits
- Other underlying physical or medical conditions

So what are the ways in which homeopathy can cure certain conditions and alleviate pain in patients?

- Arthritis: One of the most common problems that many people report is that of arthritis and rheumatoid arthritis, which causes a lot of pain in many people. In many cases, the use of Natrum Muriaticum and Bryonia has been known to allay the pain.
- Moving and shifting joint or muscle pains: Many patients have this problem where they face joint or muscle pain but instead of it being constant in one area, it moves around the body. Pulsatilla is known to effectively reduce the symptoms in these cases.
- Tennis elbow or tendon related problems: This is a common ailment, which in many cases is caused by strenuous activities, such as sports. Rhus tox has been known to be effective in such cases.
- Muscular conditions: There are many muscle-related conditions such as fibromyalgia and fibrositis among others have also been reduced after the usage of Rhus tox.

Homeopathic medicines like Medorrhinum, Ruta, Formica Rufa, Arnica, Symphytum and a few others are useful for treating such conditions, depending upon the exact symptoms and causes.

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

How Homeopathy Can Cure Muscle and Joint Pain?

Why Does Your Back Hurt?

Most of us, experience back pain due to incorrect posture or longer duration of sitting.

Sometimes you may experience back pain because of exertion - you spent the entire day doing the same kind of job or maybe you bent in a wrong manner while picking up your child. However, the actual cause of your spinal agony may not be very clear, but it pays to be aware of the possible reasons that can cause backache. It is good to consult a doctor if your back pain is consistent and recurrent.

Here are few of the causes:

1. The position of your pelvis

The pelvis consists of three bones that can shift depending on which muscles become weak or stiff. This brings about a pull in the muscle of the lower back, resulting in severe strain to this area. You should consult a physiotherapist for suggestions regarding the best exercises for strengthening your pelvic area.

2. Weak abdominal muscles

A cause of your back pain can be weak stomach muscles. Abdominal muscles play an important role in balancing out the constant bending that your back muscles perform. When you've weak abdominal muscles, your spine is not able to maintain proper balance, resulting in severe stress on the spinal column.

3. Disc injuries

Located between the bones of your spine, discs perform the function of a shock absorber. Physical injury to these padded cushions can cause them to break open, leading to a condition known as herniated disc. This can then bring about pain in the back area.

Few precautions that can be taken for a hurting back. Despite the causes, there are certain precautions that you can take, which are:

- Avoid sitting in a bad posture, that is, keep your back straight as much as you can. Pull and stretch your body in continual intervals to keep it relaxed.

- Consult the right physician instead of doing exercise that can aggravate your pain.

- Take a break from work and go for short walks, every couple of hours.

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

Why Does Your Back Hurt? + What To Do About It

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