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

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

It is important for you to know about degenerative disc disease (DDD) and spondylosis. Spondylosis is an umbrella term for spine pain, which occurs because of degenerative conditions. Spondylosis refers to several conditions. They include spinal stenosis, which is the abnormal narrowing of the spinal canal, leading to leg pain, degeneration due to DDD and degenerative arthritis or osteoarthritis involving the spine. It may also include cervical osteoarthritis or neck arthritis.


About spondylosis
Spondylosis is a common condition, which is age related. The joints and discs present in the neck are specifically affected as a result of this condition. It commonly develops on account of the wear and tear of the cartilage and bones present in the neck. This condition, in spite of being common, worsens with age. In many patients, symptoms are not observed externally, but pain and muscle spasms are experienced. 


Many people with spondylosis do not undertake treatment in spite of suffering from the symptoms and pain. In case the symptoms are prevalent over a long time and tend to worsen, you have several modes of treatment to choose from. They may include medicines, corticosteroid injections, physical therapy and even surgery in some extreme cases. 


How does DDD or spondylosis occur? 
DDD is a spinal condition. It is caused due to the breakdown of the intervertebral discs. With ageing, the spine starts to show signs of wearing and tearing. This happens on account of the discs drying out and shrinking. All these age-related changes are responsible for arthritis, spinal stenosis and disc herniation. Because of these factors, pressure is likely to fall on your nerves and spinal cords, which may further cause back pain. DDD or spondylosis also develops on account of these factors.


Treatment for DDD and spondylosis
There are various modes of treatment, which are available for you to choose from in order to get relief from the symptoms and pain associated with DDD or spondylosis. You may be prescribed typical painkiller medications, such as non- steroidal anti-inflammatory drugs or NSAIDS, muscle relaxants, epidural injections, ultrasound and massage, oral steroids, transcutaneous electrical nerve stimulation (TENS) and many more. Every mode of treatment has got its own benefits, but has its limitations as well.


If you experience any symptoms of DDD or spondylosis, you must consult a doctor immediately. Your pain management physician or doctor will be able to diagnose your condition properly and will determine the mode of treatment which will suit you best.

Degenerative Disc Disease (DDD) and Spondylosis - How You Can Get it Treated?

Out of the many muscle and bone-related conditions, arthritis is one of the most painful degenerative ailments that begins with the inflammation of the joints. This condition can be particularly debilitating as it progresses, and it is usually known to affect the elderly and aging. Yet, they are not the only victims of the condition, as many patients suffering from arthritis are young. There are various kinds of arthritis and gouty arthritis or gout is one such form.

Gout is one of the three forms of the disease and it is known to be one of the most painful kinds. The accumulation of urate crystals in the joints often leads to the inflammation of the same, which is the start point of gout. While there are many kinds of treatment and management measures available for the condition, the age old form of homeopathy is one of the most recommended.

Let us cast a glance on five of the most effective homeopathic measures for this condition. At the same time, it is important to keep in mind that these medicines must be recommended only by a qualified doctor.

Colchium: This is known as one of the best homeopathic medicines for gout and is often recommended when the most noticeable symptom includes intense pain and swelling in the big toe of either or both feet. Redness and a hot sensation in the toe may also be experienced, which may get worse at night.

Ledum Pal: This is also another very effective homeopathic medicine for gouty arthritis. This is used when the symptoms include pain that travels upwards through the legs and to the knees. In such cases, the patient may also experience shooting pains that go through the feet and affect the balls of the feet as well as the toes.

Benzoic Acid: This is one of the most well-known solutions for a number of ailments, including gouty arthritis. This is especially helpful when uric acid begins to spread an unbearable odour and makes the urine a different colour, akin to brown or any other shade close to brown and even red. This medicine is also prescribed when the joints produce a crackling sound every time the patient walks.

Antim Crudum: This medicine is usually prescribed when gout begins to affect the appetite of the patient. He or she begins to feel hungry more often and consumes more food than what he or she normally would. Pain in fingers as well as in heels can also be cured with this medicine.

Sabina: Shooting pains in the toes and heels along with other feminine problems related to urine are often symptoms of gout that are treated with this medicine.

Homeopathic Remedies For Gouty Arthritis

The shoulders are the most mobile joints in your body. Shoulder joints undergo wear and a tear over time and hence become unstable. Shoulder arthritis is one of the painful conditions affecting the shoulder joints. Arthritis not only takes a toll on the tendons and muscles, but also affects the ligaments and joints too. They usually cause symptoms such as joint pain, resulting in limited mobility.

Treatment:

Nonsurgical or Lifestyle treatments:

Take rest or avoid the activities that provoke pain or change the way of your arm movements.
Physical therapy boosts shoulder mobility.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin alleviate pain and inflammation.
Corticosteroid injections in the shoulders can also help to ease the pain and inflammation, although temporarily.
Applying moist heat or ice packs over the shoulders for about half an hour at least thrice a day brings relief.
Drugs such as methotrexate can be administered in case one is suffering from rheumatoid arthritis (a chronic disease attacking multiple joints of the body).
Dietary supplements such as chondroitin and glucosamine may help reduce pain.
Surgical treatments (if your pain results in disability and does not lessen with nonsurgical options)

Join replacement surgery or arthroplasty involves replacing the damaged parts of the shoulder with a prosthetic (artificial) joint.
Few mild forms of arthritis may be treated using the Arthroscopic procedure (minimally invasive surgery). It requires a surgeon to ease the joint pain by making small incisions to  clean out  the joint. A tiny camera fitted into the joint guides the surgeon through the surgery.
Resection arthroplasty is a method that involves the surgical removal of the bone from the collar bone and substituting it with a scar tissue to treat arthritis of particular joints.

Everything You Need To Know About Shoulder Arthritis Treatment

Gout is a type of arthritis, which can affect your joints, though usually, it causes maximum harm to your big toe. Symptoms that you are having a bout of gout include having a stiffness and swelling of the joint in question. The pain is very sudden and also causes a burning sensation. Gout is basically a recurrent type of inflammatory arthritis. However, the pain associated with gout can be remedied by ayurveda. Here are some of the best ayurvedic remedies which can be used:

1. Panchatikta ghrita guggulu: panchatikta ghrita guggulu is the most common and most widely recommended treatment for gout. However, it needs to be taken on an empty stomach. It is also worth note that it works best when teaspoons of it are taken two times a day with warm milk.

2. Kaishore guggulu: kaishore guggulu is a type of medicine, which should be accompanying panchatikta ghrita guggulu. It is usually administered after some initial relief is felt from panchatikta ghrita guggulu. Its best to consume this medicine in tablet form thrice a day.

3. Shallaki: this ayurvedic remedy is great for decreasing the pain in the joints affected. It also decreases the swelling in those joints, which have been affected by the bout of gout. Shallaki is also crucial in making sure that cartilage forms and that the blood supply to the joint which is affected by gout is still stable.

4. Ashwagandha: ashwagandha is medically known as withania somnifera. In the west, ashwagandha is popularly known as winter cherry. Also, it has a lot of therapeutic properties, which include reducing joint pains and also inflammation of muscles. This herb can also work wonders on your blood circulation.

5. Pinda taila: this is a type of oil which needs to be applied externally. Pinda taila is a very rare class of medicines which treats gout externally. Pinda taila or guduchyadi taila is administered by rubbing it on the body part affected.

Ayurveda and Gout

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