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 spinal cord injury is a damage to the spinal cord. It s an extremely serious type of physical trauma that s likely to have a lasting and significant impact on most aspects of daily life.

The spinal cord is responsible for sending messages from the brain to all parts of the body. It also sends messages from the body to the brain. We are able to perceive pain and move our limbs because of messages sent through the spinal cord.

If the spinal cord sustains an injury, some or all of these impulses may not be able to  get through . The result is a complete or total loss of sensation and mobility below the injury. A spinal cord injury closer to the neck will typically cause paralysis throughout a larger part of the body than one in the lower back area.

Causes-

A spinal cord injury is often the result of an unpredictable accident or violent event. The following can all result in damage to the spinal cord:

a violent attack such as a stabbing or a gunshot
diving into water that s too shallow and hitting the bottom
trauma during a car accident (specifically, trauma to the face, head and neck region, back, or chest area)
falling from a significant height
head or spinal injuries during sporting events
electrical accidents
severe twisting of the middle portion of the torso
Symptoms-

Some symptoms of a spinal cord injury include:

problems walking
loss of control of the bladder or bowels
inability to move the arms or legs
feelings of spreading numbness or tingling in the extremities
unconsciousness
headache
pain, pressure, stiffness in the back or neck area
signs of shock
unnatural positioning of the head
If you suspect that someone has a back or neck injury:

Don t move the injured person   permanent paralysis and other serious complications may result
Call 911 or your local emergency medical assistance number
Keep the person still
Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck
Prevention-

Because spinal cord injuries are often due to unpredictable events, the best you can do is reduce your risk.

 Some risk-reducing measures include:

always wearing a seatbelt while in a car
wearing proper protective gear while playing sports
never diving into water unless you ve examined it first to make sure it s deep enough and free of rocks

Spinal Cord Injury - Signs, Causes & Prevention

Knee pain is something that can affect anyone - irrespective of their age. While sometimes it may be of minor importance - and can easily be handled by self-care, often, lingering pain is a manifestation of some other serious underlying problem, such as arthritis. In this case, it is imperative that you consult a doctor and take appropriate measures to combat it.

Causes :

Arthritis: The chief cause of lingering knee pain, arthritis itself can be of a number of types:
 Osteoarthritis, which is a result of deterioration of cartilages due to wear and tear
 Rheumatoid Arthritis, an inflammatory chronic disorder
 Septic Arthritis, causing pain, swelling and redness.
 Gout caused due to the development of uric acid crystals in the joints
Fractures: These are caused by the breaking up of the kneecap due to falls or collisions.
ACL Injuries: Caused due to the tearing of the anterior cruciate ligament (that connects the femur and the shinbone). Especially common in sportspersons such as footballers or basketball players.
Meniscus tears: The meniscus or the rubber-like cartilage (that acts as a shock absorber) can be torn by sudden jerks or excess pressure.

Symptoms:The major symptoms of knee pain include weakness, redness, instability, stiffness or the inability to properly straighten or move the leg. Often, a deformity is also visible, such as a bone sticking out of the leg - in which case it is advisable to consult a doctor immediately.

Possible risks :Factors which include the odds of being inflicted by knee pain and cause serious complications include :
Being overweight: This exponentially increases the stress or pressure that is applied on the knee joints - even in doing mundane tasks like walking up and down stairs.
Excessive physical activity: Some activities, such as sports apply excess stress on the knees as compared to other tasks.
Loss of muscle flexibility: Tightness or weakness in muscles causes increasing number of problems in the knees.

All About Knee Pain

A Tennis elbow is a painful condition that affects the tendons due to a condition known as tendinitis, which causes inflammation. This condition will end up restricting the free movement of the elbow and the arm due to the pain and stiffness that it causes. This is due to the fact that these tendons are the tough band of connective tissues that hold the muscles and the lower arm with the bone. Repeated gripping motions and continued tugging as well as activities like weight lifting, tennis, squash and other like carpentry, painting writing and typing, can lead to this condition.

Here are a few methods of treatment and the questions that revolve around them.

Do I have to restrict my movements: Yes, when you have tennis elbow, the very first thing you must do is to give rest to the tendons by curbing those activities that have caused the condition or those which can aggravate the pain and stiffness. Lifting heavy objects, gripping things for prolong periods, other physical pursuits like tennis and other games and more will need to stop so that you do not stretch, strain or pull the tissue.
Can I take pain killers: Yes, you can take pain killers like ibuprofen and acetaminophen in case the pain is unbearable? Always ensure that an orthopedic specialist takes a look at your arm before prescribing the medicines to you.
Is an ice compress good for this pain: You can use the RICE method for acute pain that is less than 72 hours old. For more persistent pain, you must see a doctor. The RICE method refers to Rest, Ice, Compression and Elevation. In this method, you can keep your arm elevated and give it rest. You can also use an ice compress and keep it tightly wound with an elastic bandage so as to avoid swelling.
Can I take injections for this condition: Corticosteroid injections may be used for very severe cases. This contains the cortisol hormone and can give good results in the short run.
Are there any non-invasive methods for treatment: You can try non-invasive procedures like shock wave therapy which will help in fixing the pain and promote motion gradually. This procedure is usually conducted with the help of shock waves that are passed to the skin.
Is exercising a complete no: In this case, many orthopedic surgeons and doctors will ask you to go through physiotherapy so that you can get used to movements and motion after prolonged pain. These exercises will also strengthen the muscles of the area.
Talk to your doctor if the pain is particularly debilitating and discuss surgery for the same.

Tennis Elbow Treatment - What Are The FAQs Of It?

Ankylosing spondylitis refers to a form of arthritis that affects the spinal column. This condition causes the bone vertebrae to fuse together leading to a rigid spine. Depending on the extent of the damage, this could result in mild changes or in a stooped posture. Although the cause of this disease is not known, it is said to be passed down from one generation to another through a gene called the HLA-B27. This gene is also linked to spondylitis.

Ankylosing spondylitis cannot be cured, but with treatment, the pain and stiffness associated with it can be managed. Along with medication, physical and occupational therapy is a must when treating this disease. In some cases where the disease has caused severe deformities, surgery may also be recommended. However, an early diagnosis can also help prevent significant deformity.

A physical exam and an X-ray are the key factors used to confirm a diagnosis of Ankylosing spondylitis. Some of the symptoms associated with this disorder are:

Pain and stiffness: Everyone complains of a backache at some point or the other but a persistent lower back ache could be a sign of something serious. Spondylitis often starts in the sacroiliac joints and hence the lower back, buttocks and hips are the first to be affected. Pain that lasts for more than three months should not be ignored as it could be a sign of Ankylosing spondylitis.
Bony fusion: This condition causes an abnormal growth of bones in the spinal column. This can lead to the fusing of bones in the spine. The bones of the neck, back and hips are most affected by this bone fusion. While this can affect a person s mobility it can also cause complications. For example, the fusing of the ribs to the spinal column or the breastbone can restrict the expansion of the chest while breathing.
Pain in ligaments and tendons: Apart from the bones, this condition also affects a person s tendons and ligaments attached to the bones. For example, pain in and around the heel may be caused by tendonitis.
Other symptoms: The symptoms of ankylosing spondylitis are not restricted only to the joints. Hence, it is also known as a systemic disease. Some of the other symptoms exhibited by people suffering from this condition are fever, fatigue, inflammation of the eyes and a loss of appetite. Some people may also complain of lung and heart problems. 

Ankylosing Spondylitis - How To Know You Are Suffering?

It is quite likely for you to mistake fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS) as the same condition because of the frequent overlap and similar symptoms. As a result, people with both conditions are diagnosed with only one and are treated for that. The major difference between PMS and FMS is that they need different treatment. The trigger points can be eliminated, and while MPS pain may exacerbate FMS, treating MPS can improve FMS.

About FMS and MPS

FMS is a disorder featured by musculoskeletal pain along with sleep, fatigue and mood swings. It affects the way in which your brain processes pain signals.
MPS is another chronic pain disorder in which the pain is caused in the body because of pressure on sensitive points in the muscles. It is known as referred pain.
Symptoms:
There are several symptoms of MPS which are similar to that of FMS, while there are some different symptoms as well. The common symptoms are as follows:

Soft tissue pain
Headaches or migraines
Disturbance in sleep
Problems with balance
Tinnitus or ear pain
Memory problems
Excessive sweating
Here are the symptoms which are associated with MPS only and not with FMS:

Extreme numbness
Clicking or popping joints
Reduced range of motion in the joints
Blurry and double vision
Unusual nausea
Here are some symptoms which are observed in FMS but not in the case of MPS:

Fatigue
Panic attacks
Developing allergies and sensitivities
Feeling overwhelmed because of high sensory input levels
Confusion and disorientation
Diagnosis
MPS is difficult to diagnose and treat because of referred pain. The symptoms have to be recognised and the trigger points need to be identified for detecting MPS. The trigger points are found on the basis of the symptoms. Several tests like magnetic resonance elastography (MRE) and tissue biopsy are used for MPS diagnosis. On the other hand, there are no tests or scans which can detect FMS in patients.

Treatment
There are several overlaps as well as major differences when it comes to the treatment procedures of MPS and FMS. The treatment methods which are used for both MPS and FMS are as follows:

Acupuncture
Physical therapy which may be in different forms
Tricyclic antidepressant medicine
According to studies, trigger point injections are not too effective in giving relief to fibromyalgia tender points, while non-steroidal anti-inflammatory drugs (NSAIDS) are not useful for the treatment of FMS pain as they are meant for inflammation. It is very important for you to visit a doctor if you experience any symptoms of FMS or PMS. You require proper diagnosis so that the right treatment can be undertaken.

Fibromyalgia Syndrome (FMS) & Myofascial Pain Syndrome (MPS) - Signs That Indicate It!

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