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

Sleep is the most essential part of our lives because it is the time when our body gets rejuvenated and recharged. However, due to numerous reasons, quite a few individuals fail to achieve proper sleep or any sleep at all. This condition in which a person is unable to sleep at night can be termed as insomnia.

Causes of insomnia
There can be varied reasons for different people that can cause insomnia.

Unhealthy lifestyle i.e. improper sleep cycle, improper food habits, untimely naps, substance abuse etc.
Medical conditions like sinus allergies, gastrointestinal problems, endocrine problems, arthritis, asthma, neurological condition like Parkinson s disease, chronic back pain etc.
Psychological conditions like depression and anxiety
Certain medications aimed to cure other health problems
In case of the treatable medical reasons, insomnia is gone once the problem is treated. However, for people who have no idea as to why they suffer from insomnia, here are certain tips that can help in fighting it.

Lifestyle changes to cure insomnia
Starting with a significant lifestyle change can be a great way to change one s sleep cycles and get a good night s sleep.

Maintain a proper and healthy diet, with more fruits and vegetables and less carbs and fat.
Try to sleep and wake up at the same time everyday (despite the fact that you may not feel sleepy). This will train the body and regulate the body clock.
Avoid afternoon naps or any short naps during the day.
Exercise daily for at least 30 minutes.
Avoid caffeine as it has contains properties that keeps a person up for long hours.
Avoid intake of alcohol and nicotine. Although alcohol is associated with fun and partying, it is actually a depressant and causes improper sleep.
Avoid any meal right before bed time.
Tips that can help

Take a good, warm shower right before sleep.
Ask your partner to give you a nice massage before bedtime.
Restrict bed activities to sleep and sex only, nothing more.
Make a really comfortable and inviting sleep environment.
Try and get rid of all your worries before going to bed.
Reduce stress using a number of stress reduction therapies like meditation, deep breathing, progressive muscle relaxation techniques, etc.
Apart from the lifestyle changes and the tips that will help you gain a better sleep, there is another therapy, which may be useful. It is called the cognitive behavioural therapy. This therapy can give essential knowledge about sleep and help achieve normal sleep routines.

Suffering From Insomnia - 7 Lifestyle Changes You Must Do!

Knee pain is referred to as a condition when the knee joints (which are responsible for walking, running, sitting and standing along with bearing the maximum body weight for most forms of physical activities) are significantly inflamed, giving rise to a severe pain in particular areas or the entire knee joint. There might also be severe stiffness around the knee joint which might make it very difficult to function.

Knee pain might occur due to obesity, old age, different forms of arthritis, severe injury in the knee or the associated ligament or bones, knee cap dislocation, overuse of the knee joint and infections of the knee joint.

Homeopathic Treatment For Knee Pain:

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to remove the symptom of knee pain but to cure its underlying cause. As far as therapeutic medication is concerned, several well-proved medicines are available for knee pain that can be selected on the basis of cause, location, sensation, modalities and extension of the knee pain. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. The effective homeopathic remedies for knee pain are as follows :

Bryonia Alba   This homeopathic preparation is effective in curing knee pain with the symptoms of severe pain in the knee joints during walking. Pain stops when you stop walking or moving and you may also have an abnormal growth in the knee joints. If the knee pain is caused due to osteoarthritis, Bryonia Alba can prove to be a useful remedy as well.

RhusTox   If the knee pain comes with the symptoms of severe pain in damp weather, intense pain after initial movement which tends to gets better in continuous motion, a prescribed dosage of RhusTox might help in the elimination of the pain.

Colchium   The medicine is useful in treating knee pain which worsens due to movement and subsequently improves in warm weather or after getting appropriate rest.

Silicea   This preparation is useful in curing knee pain which retains the sensation of being tightly bound during all times.

Lachesis   If the knee pain is caused due to rheumatoid arthritis, Lachesis can be an effective treatment. Lachesis can also be prescribed if the pain is accompanied with an abnormal growth around the affected area.

These are just a few of the commonly used Homeopathic remedies and are mentioned only to create awareness about the effectiveness of Homeopathic medicines for Knee Pain. It is not advisable to resort to self-medication for any disease.

Treating Knee Pain With Homeopathy Treatment

Blessed are the people who can effortlessly fall asleep, especially at night. For some people, sleep appears like a distant dream that haunts them for days. Medically known as Insomnia, the disorder can take a toll on the physical and mental health of the individual affecting their personal as well as professional life to a great extent. The sleeping disorder may be temporary (Transient Insomnia) or long-lasting (Chronic that may persist for months). 

Some individuals may suffer from insomnia on and off (Intermittent Insomnia). Short-term insomnia may last for a few days or weeks and often improves on its own. Chronic insomnia needs medical attention at the earliest to avoid further aggravation and discomfort. On an average, a person needs 6-8 hours of sleep daily. In case of insomnia, a person may experience difficulties in falling asleep in spite of being tired and exhausted. Some may also not be able to enjoy a sound sleep (interrupted sleep).

Homeopathy and Insomnia
Homeopathic treatment has been a revelation in dealing with insomnia. With a holistic approach and the use of natural products and herbs, homoeopathy believes that evaluating and eliminating the underlying trigger can bring about drastic improvements in the case of insomnia. Insomnia may be an outcome of health conditions (secondary insomnia) such as diabetes, asthma, cancer, diabetes, heart disease, gastroesophageal reflux disease, Alzheimer's disease over-functioning of the thyroid. However, the trigger can be stress, anxiety, following an unhealthy sleep cycle, having the dinner late at night and retiring to bed immediately after (often termed as Primary Insomnia). The Homeopathic approach in treating insomnia involves a right mix of the homoeopathic medicines and bringing about the necessary changes in the lifestyle habits. Understanding the pattern and type is important to treat insomnia.

In the case of primary insomnia, in addition to the intake of medicines, the homoeopathic approach also emphasizes upon eliminating the lifestyle habits that triggered the sleeping disorder.

Time and again, homeopathy has stressed that there should at least be a 3 hours gap between dinner and sleep to ensure there is a better digestion of food without any incidences of acid reflux or heartburn. Avoid heavy or spicy foods for dinner. Keep the dinner light and simple.
Try to live a stress-free life. Meditation, yoga, exercise, listening to soft and light music, can play an instrumental role to keep the mind and the body calm and relaxed.
A healthy sleep cycle (sleep early, wake up early) can go a long way to reduce the incidences of insomnia, especially Transient and Intermittent.

Insomnia - Why Homeopathy Is The Best Form Of Treatment?

In today s stressful environment, more and more people are being diagnosed with psychological disorders such as insomnia and depression. Neither of the two are things which people feel lucky to possess. However, it is interesting to note that there is a link between the two conditions. Also, the problems are a lot more common than a person is likely to first think; 80% of depressed people suffer from chronic insomnia!

For a long time until recently, many people were of the opinion that most depressed people were insomniac. But that is not really correct. The two issues do overlap to a large extent, but they are different from each other. Again, that does not mean one cannot affect the other.

When a person has depression, one of the main things that he or she can experience is a lack of pleasure from the activities and happenings which occur in his or her daily life. Similarly, when a person does not get enough sleep or even just cannot sleep, he or she is quite likely to display a tendency to worry. Often, worrying sets the stage for depression to develop in the person. In fact, doctors have observed that people who do not sleep enough are more likely to undergo treatment for depression than the others.

Recent findings have concluded that when a person sleeps better, the case of depression also shows an uptick. In addition to this, the habit of sleeping well can also go quite a long way to make sure that a person does not relapse into depression. According to some sleep therapies, people who suffer from lack of sleep are advised to follow a systematic routine of getting to bed and getting out of bed. Activities including reading in bed or watching TV after going to bed must be avoided. While there are various means to help a person sleep better, the choice as to which one would suit a person in the best possible way is only best decided by the person s personal doctor. What is for sure is the fact that a person can effectively sleep to a better life!

So, it can be said that if a person wants to cure his/her depression and enjoy life being peppy, napping away is not such a bad idea after all. Having said that, everything is good only up to a certain limit!

Insomnia and Depression - Is There A Link Between Them?

Arthritis, which is quite a common ailment among people aged above 40, is painful regardless where it affects a person, be it the hands or the toes. However, the Ayurvedic field of medicine has come up with historic ways of treating the issue. Over the course of time, these methods have proved to be quite effective, and especially popular as they have no side effects. A person only needs to spend a little time to get to know how to go about using Ayurveda to cure the arthritic aches and pains, which plague daily life!


One of the best things about Ayurveda is the fact that the solutions are generally made using ingredients that are very easy to source. For example, there is a solution for arthritis, which involves mixing a cup of mustard oil with about 10 grams of camphor and then heating the combination. This oil mixture then needs to be massaged on the affected areas. Now, isn t that simple?


The common potato, long considered to be a vegetable of the masses, also finds its use in Ayurveda when it comes to treating arthritis. If you soak a few unpeeled slices of potato in a glass of water overnight and drink this water the following morning, you are sure to find an improvement in your condition quite soon. 


Additionally, there are a few other food items that are recommended in the Ayurvedic treatment. These include bitter gourd, which is not only low in calorie content, but also very high on vitamins and ginger which improves metabolism. Consuming garlic and buttermilk is also considered advantageous. 


Moreover, you may also need to make some changes to the lifestyle habits, which have been deeply ingrained. For instance, sleeping as per a regular schedule and not going to sleep very late at night has a positive impact.


As you have probably be discerned, when it comes to health, the devil is in the eating! If a person who has arthritis makes an effort to conform to a good and healthy diet, which does not contain fried or sugary food, or even those which have spices in excess, he or she will not only find the pain symptoms of arthritis reducing, but also gain a general sense of health.


As long as a person has the patience to follow the way of treating arthritis set out by Ayurveda, the benefits will truly be bountiful!

Arthritis - How Ayurveda Can Help Treat it?

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