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

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

Fibromyalgia is a disorder that causes widespread body pain along with sleep deficits, memory loss, mood problems and fatigue. Symptoms may be triggered after a surgery, physical trauma, infection, or stress. Women are much more vulnerable to this disease than men. Many people affected with fibromyalgia may have suffered from headaches, backaches, depression, anxiety, tension, temporomandibular joint 
disorders and irritable bowel syndrome. Most of these patients have undergone multiple consultation with various doctors and undergone many tests, but no diagnosis could be made. These patients are often ignored by doctors and family members as always "complaining of pain".

Symptoms of Fibromyalgia:
1.Extensive Pain- Pain related to fibromyalgia is often depicted as a dull pain that lasts for at least three months. Pain can involve any body part like back,neck, chest, arms, legs. Patients have pain in multiple areas of body and painful areas change over time.

2.Fatigue- Patients afflicted with this disorder feel tired even after sleep. Such people are reported to sleep for longer hours than normal people, but their sleep often gets disrupted due to sleep apnoea and restless leg syndrome.

3.Cognitive Difficulties- These patients find it difficult to concentrate at work and also suffer from memory deficits in daily activities.

4.Other Symptoms: These patients may also have symptoms like burning urination, urgency of urination, numbness,loss of appetite, tingling sensation,diarrhoea, constipation, tinnitus, depression etc

Diagnosis of fibromyalgia:
There are no specific test to diagnose fibromyalgia. Diagnosis is made by a doctor specialised in Pain Medicine using clinical methods based on symptoms and examination. Blood tests like Haemogram, Thyroid function test, RA Factor, ESR are done to rule out other diseases which can cause similar symptoms. 

Treatment of Fibromyalgia
1.First step in treating these patients is to accept their problem and discuss with patient and family members regarding the presence of such disease entity.

2.Lifestyle changes like active involvement in cardiovascular exercises, swimming, yoga, meditation are important to control symptoms.

3.Conventional painkillers do not work in these patients. They requires special medications prescribed by a Pain Specialist for control of symptoms.

4. Counselling of patient is beneficial for associated depression.

Are You Suffering From Body Pains ? It Could Be Fibromyalgia!!

Staying up late at night intentionally is not insomnia. If you find it difficult to fall asleep, or cannot sleep soundly for long, then it is indeed a case of insomnia. The inability to sleep can have terrible repercussions on your physical and psychological health.

A number of reasons could cause insomnia. Understanding the causes could help you identify your sleeplessness as insomnia and seek treatment right away.

What Health Issues cause Insomnia?

Here are some health problems of both the mind and body that can keep you awake  

  Stress Chronic stress and worry born out of our tense lives is a direct cause of insomnia. Long-term anxiety, panic disorders, as well as PTSD can induce sleeplessness.

  Irregular Sleep Patterns Your body would hate it if you deviate from the Circadian Rhythm   the body clock. It regulates the functions of your body, including your sleep patterns. But if you defy your body clock by sleeping at irregular hours   suppose you are staying up late to get some extra work done, or you may have opted for a night shift, or if you are experiencing a jet lag   then you will notice that when it is finally time for you to hit the bed, sleep will be elusive.

  Depression Depression is a horrific psychological disorder that makes a person lose interest in life itself. And one of the indicators of depression is loss of sleep. It is not just depression, but also other illnesses that cause psychological turbulence such as bipolar disorder and obsessive-compulsive disorders, triggering insomnia.

  Breathing Issues Sleep apnoea is a dangerous disorder that stops your breathing multiple times every night and will wake you up every time. Yet you will possibly not even remember waking up. However, this does disturb the quality of your sleep and affects your health adversely.

  Dementia Dementia is accompanied by a gradual loss of memory. But sometimes people who are suffering from dementia display anxiety, restlessness or even aggressive behaviour when it is time for them to go to bed. This is called the sundown syndrome and it might even keep them up all night.

  Pain Pain is one of the commonest reasons for losing sleep. Pain can originate due to any number of reasons   arthritis, a sprained joint, an injury, or if you are undergoing chemotherapy or radiotherapy, then it may keep you awake at night. This is actually a vicious circle because the inability to sleep will aggravate your pain. Talk to your doctor who will prescribe the appropriate pain medication.

  Parkinson s disease This disease is another reason behind insomnia. Parkinson s disease interferes with your nerve signals and this might cause disruption in your sleep.

  Menopause When a woman inches closer to her menopause, her body reduces the production of oestrogen and progesterone. This imbalance of hormones can trigger sleep loss.

How long can you go without sleeping?

There is no data on how long a human can function without sleep. The longest someone stayed awake is 11 days. Usually, the body cannot last that long without some sound shut-eye. Your brain flushes out the waste matter its cells produce during sleep. That is why even 24 hours without sleep can make your brain sluggish and disoriented. If you stay awake for more than 48 hours at a stretch, your cognitive abilities will start failing you. Sleep is instrumental to a healthy mind and body. If you are experiencing insomnia, talk to a doctor immediately or look up some remedies.

Health Problems That Keep You Awake!

4 exercises to strengthen your knees

Knee pains and pains in the joints are not restricted to a certain age group anymore. Younger people of today face this problem too. To stay active all your life and escape the severe aches associated with weakening of muscles, joint pains or arthritis, you must start now. The only way to keep your knees fine and working is to exercise. 
4 moves that help you strengthen your knees.
1. Leg lifts (inner thigh) - lie on any one side, lay your head on the arm of the side below you. Make sure this hand is straight above your head, touching the ground. Keep your legs straight, one above the other. Lift the leg on top a few inches above, hold for few seconds and bring it back. Do this for 10 times and then with the other leg, on the other side. This exercise strengthens your inner thighs, eventually strengthening the knees.
2. Hip raises: lie flat on your back, your shoulders touching the ground. Bend your legs comfortable, your feet resting firmly on the ground. Raise your hips and thighs so that from your head to feet, you form an angle. Wait in this position for about 10 seconds, lower your hip until it touches the ground. Repeat for ten counts.
3. Lunges: stand straight. Take a step ahead with your right leg. Left leg remains in its place. With your back straight, bend your knees so that both are at 90 degrees. Go back to standing position; take your right leg back to where it was. Do the same step with your left leg. Repeat both sides ten times.
4. Bent leg extensions: this is pretty easy and all that you need to do it sit on a chair comfortably, with your back straight first. Your feet firmly flat on the ground in front of you, lift the right leg straight extending to the front. Make sure your thighs stay on the chair. Bring your leg back to the original position, firmly planted on the ground. Do the same with your left leg. Repeat 10 times on both sides.
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The Only 4 Moves That Strengthen Your KNEES

Insomnia is a sleeping disorder, where an affected person suffers from sleeplessness and is unable to fall asleep or remain asleep for a long time which is required to stay healthy. Insomnia affects the functioning of the body and increases pain sensitivity of the body.

Insomnia has many cures and treatment options. Homeopathy is considered to be an important and very efficient form of medication, which treats insomnia and related sleeping disorders. Homeopathy eliminates the cause of insomnia from the roots, and both the disorders and symptoms are cured.

Here are some common homeopathic medicines, which are used to treat insomnia, along with the symptoms when they are prescribed for use:

Arnica: It is used to ease patients when they overwork physically, and is also useful tor treating insomnia caused due to jet lag.
Aconite: Aconite cures acute cases of insomnia, which results because of fear, shock, paranoia, grief or due to some bad news. Anxiety, tension and restlessness also cause insomnia, which is cured by aconite.
Arsenicum album: This homeopathic remedy treats insomnia where a patient feels sleepy during the daytime, but cannot sleep at night. Restlessness and having bad dreams are observed.
Calcarea phosphoric: This medicine treats insomniac patients who experience difficulty in waking up in the morning. The patient becomes anxious, restless and gets irritated easily and tends to avoid daily routine.
Causticum: Causticum is used in cases of insomnia where bed wetting is likely by the patient, especially during the first phase of the night. The patient develops a fear of the dark and a strong sense of justice.
Chamomilla: Used in cases of sleeplessness in babies where teething, anger or colics cause disruption in sleep. The eyes do not close completely during sleep, and the patient moans. It is also used in grown-ups who are irritable and peevish and experience fearful dreams.
Cocculus: Cocculus cures insomnia, which occurs due to over exhaustion and over strain. It prevails in people who work during night shifts and need to spend sleepless nights due to work.
Coffea: This homeopathic remedy is derived from coffee beans and provides relaxation to insomniac people. When a person gets over excited and is kept awake because of constant thoughts, coffea can calm that person and make him fall asleep.
Equisetum: This homeopathic medicine cures insomnia where the patient wets the bed while dreaming. This happens due to immature nervous functioning.
Ignatia: Ignatia treats insomnia occurring from extreme shock, grief or emotional stress. The patient becomes very moody, jerks his limbs during sleep and experiences disturbing dreams.
Homeopathy is an ideal treatment for insomnia or sleeplessness. Being natural, it works very efficiently without any side effects.

10 Best Homeopathic Medicines for Insomnia (Sleeplessness) Problem

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