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

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.

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

Muscle sprains and ligament tears are one of the most common injuries that medical practitioners encounter on a regular basis. These injuries are painful and can also limit one s movement, needless to say. However, there are simple things that can be done as soon as the injury happens so that the impact of the injury can be reduced, the symptoms minimised, and recovery improved.

A sprain is a tear of the ligament. The ligament is responsible for connecting the tissue strands that connect the bone to the muscle. When this sprain affects the muscle or even the tendon, it is known as a strain.
Sprains are very common and can occur due to a fall, twist, or impact. Most commonly affected areas are the ankles and wrists. Sprains happen when there is a pull or a twist of the ankle or the joint. This is very common in athletes and can be caused by repetitive motions in the knees, wrists, elbows, etc.

The most common symptom is pain, swelling, limited movement, and sometimes bruising. The degree of these injuries depends on its severity. The most common ways to treat such injuries are as follows.

RICE therapy: RICE is an acronym for rest, ice, compress, and elevate. Rest the affected area immediately by stopping any further activity. Ice the area using an ice wrap, with the ice cubes wrapped in a towel or a cotton cloth. Repeat this exercise if possible for every 20 minutes. This will reduce the swelling and pain. Compress the area using a sling or a wrap. This will help in reducing the swelling. Elevate the affected area if possible above the heart. This will help control the blood flow and thereby reduce the swelling and pain.
Pain control: If there is pain that needs medication, go for the non-steroidal drugs like ibuprofen or acetaminophen. If it is a child that is injured, it is advisable to give non-aspirin ones.
Seek professional help: Most sprains can be self-limiting over a couple of days. However, it is advisable to seek medical help if there is significant pain, swelling, or numbness, open wounds or bruises, or inability to move the joint.
The doctor may decide to do the following.

Scanning or imaging to rule out any internal hard/soft tissue injury like fracture or tear
Immobilise the joint with a splint or a cast
Start physical therapy if there is severe pain and immobility
Surgical repair if there is a ligament injury
A word of caution to athletes or people who are very active physically is to go easy on the joint. In an eagerness to quickly get back to their routine, more and severe damage may be caused. This can be avoided by allowing time for complete healing.

Muscle & Ligament Sprain - Tips To Help You Deal With It!

Rotator Cuff Tear is one of the most common disabilities observed amongst adults above 40 years of age. Rotator Cuff is a group of four muscles that keep the Humerus (arm bone) attached to the socket of the Shoulder. The Rotator Cuff keeps the Shoulder Blade attached to the arm, and when there s a damage (tear) in one of these muscles, excruciating pain is felt by the patient.

Kinds of Rotator Cuff Tear-

  Partial Tear: This happens when one of the Tendons amongst the four Tendons is damaged or torn.
  Full Tear: This occurs when all the Tendons are torn; this is also called Complete Tear. Severe pain is experienced in this type of tear and surgery might be required.

Symptoms-

  A person may experience excruciating pain while performing daily tasks like Combing hair, Picking up Laundry, etc.
  Muscle weakness and stiffness on Shoulder.

Diagnosis of Rotator Cuff Tear-

  Ultrasound is used to check the internal structure of the shoulder and the damaged muscle pattern. The waves directed into the shoulder create images of the Tendons and ligaments of the shoulder. This allows the doctor to access the severity of the damage on the shoulder.
  MRI: When the doctor needs a better look at the Tendon damage, radio waves provide a better imagery than Ultrasound.

Treatment of Rotator Cuff Tear-

  RICE (Rest Ice Compression Elevation): In Case of partial rotator cuff injuries with very little damage, RICE is a good treatment option to treat temporary partial damage in the shoulder. Applying cold water and moving the hands slowly helps the muscles to get into shape.

  Injections: Non-inflammatory drugs are prescribed to the patient suffering from Full Rotator Cuff injury to deal with the pain. A Tendon tear can cause extreme pain, which might give the patient some sleepless nights. Non-inflammatory painkillers temporarily numb the shoulder, allowing the patient to sleep.

  Physical Therapies: Physical therapy is one of the most sought out treatment option. Physical therapy allows a person to recover from a rotator cuff injury through exercises and mild movements of the arms and shoulders.

  Surgery: When the injury is too severe for conventional treatment and medication, a patient might have to go through some complex surgeries.

A) Arthroscopic Tendon Repair: In this surgery, the doctor makes a small incision on the shoulders and then inserts a Laparoscope type instrument (Arthroscope) into the muscles, with a camera attached on the top. This instrument allows the surgeon to see the muscle structure and also helps in re-joining the tendons.

B) Open Tendon Repair: Arthroscopic Tendon Repair can be a bit complex, that s why an open tendon repair is preferred by most doctors. In this surgery, the surgeon makes a bigger incision and attaches the Tendons surgically. 

Conclusion-
Rotator Cuff Tears is a severe problem for the locomotion of body, but it is treatable, as long as one doesn t delay going to an experienced doctor.

Rotator Cuff Tear - Know The Treatment Options!

A Guide to Dealing with Fibromyalgia

Fibromyalgia is a chronic condition marked by constant flu-like symptoms such as fatigue, headaches, insomnia and joint pains. However, the disease has no visible symptoms. There are also no known causes for the disease. While some believe stress to be a trigger for fibromyalgia, other theories suggest that physical and emotional factors such as a prior illness lead to the onset of this disease. This leads to fibromyalgia patients being often misunderstood and misdiagnosed. Almost 80% of fibromyalgia patients are women. While the disease is not lethal, it can make daily life difficult.

The criteria for fibromyalgia were established only in the late 1900s. In addition, the symptoms of this disease present themselves differently in each patient. This makes diagnosis very difficult.

Constant pain all over the body is the most common symptom of fibromyalgia.
You may also feel constantly tired, and unable to get a restful sleep.
Some fibromyalgia patients also suffer from depression or anxiety and an irritable bowel syndrome.
Fibromyalgia patients may also feel hyper sensitive to cold or heat, and feel numbness in fingers and toes.

Fibromyalgia has no known cure, and like arthritis, treatment for this disease addresses its symptoms. Most treatment programs include a combination of drugs, physical therapy, and behavioral techniques.

Pain relievers or anti-inflammatory medication and antidepressants are the two types of drugs administered to fibromyalgia patients. However, these should not be counted on as a long-term solution, as the side effects of these medicines can cause additional problems. Therapeutic massages and chiropractic manipulations can also help ease the pain. Along with this, it is also important to rest and relax. This helps reduce stress which often triggers fibromyalgia symptoms.

To get a better night's sleep, try going to bed and getting up at the same time every day. A warm glass of milk or chamomile tea just before bedtime can also help induce sleep. As far as possible, avoid taking sleeping tablets, as the body can soon become dependent on these.

Though you may constantly feel tired, increasing the day to day activity levels can have a positive effect on your health. Consider adding low-intensity activities such as walking, cycling, yoga or dancing to your daily routine. Complement these with a well-balanced, nutritious diet that includes lots of fruits and vegetables. If you or a loved one has fibromyalgia, bad days may not be prevented. But with treatment, they can be controlled.

A Guide to Dealing with Fibromyalgia

If you suffer from rheumatoid arthritis, you may be at a high risk of developing Carpal tunnel syndrome. This is a very painful condition in which the hands and wrists are affected. The Carpal tunnel refers to a structure which is formed by the bones present in the wrist and the surrounding connective tissues, through which the nerves and tendons controlling the thumb movement pass. Carpal tunnel syndrome occurs when the connective tissues get swollen because of inflammation and the nerves passing through the tunnel are crowded and squeezed.

Ways to get relief from Carpal tunnel syndrome:

Here are some common ways by which a patient with Rheumatoid arthritis can get relief from any discomfort caused due to Carpal tunnel syndrome:

Get your Rheumatoid arthritis treated. Carpal tunnel syndrome is commonly caused because of an underlying sickness such as rheumatoid arthritis. Medicines such as disease modifying anti-rheumatic drugs are used to manage the condition and for reducing inflammation which causes carpal tunnel syndrome.
Getting enough rest is also very important. You must avoid using that hand or wrist, which has been affected for some weeks. This will allow the inflamed tissue to heal. 
You may wear a wrist splinter. A splint is suggested for resting your wrist therefore, it is kept in a neutral position. It can be worn during the day or when you are sleeping.
You can take prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. These also help in reducing the swelling of tissues within the carpal tunnel.
A Cortisone shot may also be effective for easing the carpal tunnel syndrome. These steroid injections are given directly into the carpal tunnel. You will be able to get temporary relief from pain.
A set of Carpal tunnel exercises have been developed by doctors. These are designed for stretching the wrists and for keeping them limber. You must perform these exercises on a regular basis for best results. Yoga is also effective for easing carpal tunnel syndrome. Performing regular yoga will help you to improve your wrist pain. The upper joints of the body are strengthened. 
Take breaks at work on a regular basis. By changing your position and taking short breaks, your Carpal tunnel symptoms are bound to improve. This is more essential for people who do a job where great stress is placed on the wrists. If you are into typing, you need to take breaks and stretch your wrists.
There are several alternative therapies for easing carpal tunnel syndrome, which  are being studied and researched on. They include the likes of acupuncture, chiropractic care, magnets, botox treatments and vitamin B6 supplements. 

Carpal Tunnel Syndrome - 7 Ways to Ease the Pain

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