Category Archives: Pain Management

OESTEOARTHRITIS YOU NEED TO KNOW

By, Dr.K.Vijayaraghavan,MD.,FIPM(Germany)

WHAT IS OSTEOARTHRITIS?

• It is the most common type of arthritis, which can also be known as wear and tear arthritis.
• Important reason is the breakdown or damage to the cartilage between joints.
• The weight bearing joints of the hip, knee and spine are affected in majority of patients.

SYMPTOMS OF OESTEOARTHRITIS

• Knee pain
• Swelling
• Joint stiffness
• Loss of movement

Causes and Risk Factors

• Age – People above age 45 are at high risk of developing osteoarthritis. However it is mostly found in people over age of 65.
• Gender – It is more common in women above 55 years.
• Obesity – It’s the most common cause of osteoarthritis, as every kilogram puts three extra kilogram of pressure on knees.
• Injury – Joint injury pose an increased risk of developing osteoarthritis.
• Weakness of muscle – Weak thigh muscles lead to osteoarthritis knee joint pain.

Knee Joint Osteoarthritis:

       Do’s for Pain Management:

• Use knee cap supports.
• Use hot water fomentation to relieve pain.
• Wear comfortable, fitting shoes to reduce stress on joints.
• Walk regularly to keep yourself active, it helps avoid stiffness.
• Maintain a healthy weight to reduce strain and pain in your knees.

Don’ts for Pain Management:

• Don’t lift heavy weights; it puts stress on the knees.
• Don’t sit cross legged.
• Avoid prolonged activities that put strain on the knee like gardening.
• Avoid jerky movements.
• Don’t smoke. Research shows that smoking leads to joint pain along with other damaging effects.

Healthy eating for osteoarthritis :

• Fuel up on fish

Certain type of fish are packed with inflammation – fighting omega -3 fatty acids, It is recommend to take at least  3 to 4 ounces of fish twice a week. Omega 3- rich fish include salmon,tuna,mackerel and herring is ideal.

• Step up on soy

Not a fan of fish? But still want the inflammation – busting benefits of omega -3 fatty acids? Then try heart-healthy soybeans. Soybeans are also low in fat, high in proteins and fibre and an all-round good-for-you food.

• Don’t Ditch the Dairy

Low-fat dairy products, like milk, yogurt and cheese are packed with calcium and vitamin D, both found to increase bone strength. Vitamin D is essential for calcium absorption, and it has been shown to boost the immune system. If dairy doesn’t agree with you, aim for other calcium and vitamin D rich foods like leafy green vegetables.

• Go Green (Tea)

Green tea is packed with polyphenols, antioxidants believed to reduce inflammation and slows cartilage destruction. Studies also show that another antioxidant in green tea blocks the production of molecules that cause joint damage in people with Rheumatoid Arthritis(RA).

• Grab the Garlic

Studies have shown that people who regularly eat foods from the allium family – such as garlic, onion and leeks – showed fewer sign of early osteoarthritis (OA). Researchers believe that a compound found in garlic may limit cartilage damaging enzymes in human cells.

• Sink Into Some Citrus

Citric fruits – Like oranges, grapefruits and limes – are rich on vitamin C. Research shows that getting the right amount of vitamin aids in preventing inflammatory arthritis and maintaining healthy joints with osteoarthritis(OA).

• Nosh on Nuts

Nuts are rich in proteins, calcium, magnesium, zinc, vitamin E and immune – boosting alpha linolenic acid (ALA), as well as protein and fibre. They are heart-healthy and beneficial for weight loss. Try walnuts, pine nuts, pistachios and almonds.

WHAT CAUSES KNEE PAIN AND HOW TO REPAIR YOUR DAMAGED KNEE?

Dr.K.Vijayaraghavan,MD.,FIPM(Germany)

Phoenix Pain Management Centre

About 1 in 5 people live with the knee pain, which is mainly due to osteoarthritis, the wear-and-tear form of arthritis. Osteoarthritis is the most common cause of disability among adults, and it frequently appears in the knee joints. Once the disease process has started, it is difficult to reverse the joint damage — which is why it’s so important to prevent knee osteoarthritis from progressing.

The likelihood of developing knee osteoarthritis symptoms increases with each decade of your life, especially between the ages of 55 and 64, says a research.

Pain occurs when the cartilage covering the bones of the knee joint wears down. Areas where the cartilage is worn down or damaged exposes the underlying bone. The exposure of the bone allows increased stress and compression to the cartilage, and at times bone-on-bone contact during movement, which can cause pain. Because the knee is a weight-bearing joint, your activity level, and the type and duration of your activities usually have a direct impact on your symptoms. Symptoms may be worse with weight-bearing activity, such as walking while carrying a heavy object.

Symptoms of knee OA may include:

• Worsening pain during or following activity, particularly with walking, climbing up or down stairs, or moving from a sitting to standing position
• Pain or stiffness after sitting with the knee bent or straight for a prolonged period of time
• A feeling of popping, cracking, or grinding when moving the knee
• Swelling following activity
• Tenderness to touch along the knee joint
• Stiffness in knee joint especially in the morning

Osteoarthritis can be diagnosed by clinical findings and can be confirmed by X-ray and MRI.

How can it be prevented?

• Maintaining healthy weight
• Controlling your blood sugar level.
• Regular walking with proper footwear on a flat even foot path.
• Muscle strengthening exercise.
• Low impact exercises
• Managing occupational risks (Kneeling,bending,twisting,walking)
• Nutritious diet

How to treat the damaged joint?

Rest is the first line of treatment.

Ice / Heat: Applying ice or cold packs to the knee can reduce inflammation and swelling, especially after an injury. Once swelling is gone, heat may be used to help relax and loosen tissues – although ice is the primary treatment.

Using Knee Braces

Pain relievers

Weight loss: Lose weight to reduce pressure on the knees.

Knee-Injections in the Knee Joint: Potent anti-inflammatory agents can be injected inside the knee to reduce pain and inflammation. Ozone Gas can also be injected into the knee to reduce pain and inflammation. Another nonsurgical injection technique that can provide relief from knee pain is viscosupplementation. This treatment involves injecting a lubricant into the knee. The filler lubricates and adds cushioning to the joint, allowing bones to move more easily and reducing friction. It is a viable solution for mild to moderate OA.

Stem Cell / Platelet Rich Plasma (PRP) therapy: PRP therapy involves injecting platelets from the patient’s own blood to rebuild a damaged tendon or cartilage. It has been successful in not only relieving the pain, but also in jump starting the healing process. The patient’s blood is drawn and PRP cells are extracted using special PRP kits and PRP machine. The platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage. It heals the joint.

Physical therapy: Physical therapies can help you recover from the injury and decrease the pain you are experiencing. They may also include low-impact stretches and exercises that can strengthen muscles in your knee, improve stability and flexibility, and reduce pressure on the joint.

Platelet Rich Plasma (PRP) a boon for natural healing of Pain

by, Dr.K.Vijayaraghavan,MD.,FIPM (Germany)

Blood is a mixture of red blood cells, white blood cells, platelets and a solution of proteins called ‘plasma’. PRP, or ‘platelet-rich plasma’, is a concentrated solution of platelets taken from ‘autologous’ blood; in other words, from your own blood that is then injected to treat a variety of musculoskeletal disorders including cartilage defects and arthritis.

What is PRP?

There are numerous ways of preparing PRP, but, in essence, a volume of blood, ranging from 10–60 ml, depending on the process being used, is drawn from the patient. Commercially devices are available that can prepare the solution in a one- or two-stage process. Some hospitals and centres with haematology labs can produce the solution themselves using only a centrifuge. However, the most common method is to use a commercial approved PRP device, which we practise in PPMC (Phoenix Pain Management Centre). Using these approved devices gives the most clinically effective PRP concentrate.

The centrifugation process basically separates the red blood cells, white blood cells and platelets into a number of different layers. One is rich in red blood cells, another layer (the buffy coat) may be rich in platelets and white cells, and another layer will contain platelet-poor plasma.

The basic concept behind PRP centers around isolating the layer that the platelet-rich plasma, while trying to leave as many of the red and white blood cells behind as possible. However, depending on the preparation method, some products will create a platelet-rich plasma that either contains lots of white blood cells, known as ‘white blood cell enriched’, or one that is ‘white blood cell depleted’.

The issue here is that a white blood cell enriched solution will contain proteins, known as pro-inflammatory cytokines that can potentially trigger an inflammatory reaction. In other words, it may contain factors that can create inflammation in tissues, be it in the joint or in the soft tissues where the PRP is injected.

PRP has been around for many years, but it gained significant popularity in 2006, as it was used extensively in many sports injuries and gained its international clinical importance.

The use of PRP has grown significantly as it doesn’t involve steroid or and pain killers. Its completely a natural healing process. A number of PRP studies were also published around that time, and interest in research into PRP rose exponentially. Although PRP has been investigated extensively in the basic science laboratory, and numerous clinical studies have been published about its effectiveness in treating pain.

What Conditions are Treated with PRP? Is It Effective?

• Arthritis or osteoarthritis, especially those with degenerative knee cartilage
• A torn ligament or ligament sprains
• Tendonitis or tendon injuries
• A bulging or herniated disc
• Injuries due to sports or exercising (such “tennis elbow,” plantar fasciitis in runners, or common injuries affecting the rotator cuff)
• Sacroiliac problems
• Sciatica/sciatic nerve pain
• Common hand injuries experienced by younger and middle-aged adults, such as carpal tunnel syndrome, Skier’s or “Gamekeepers” thumb and “Texting thumb”
• Chronic pain in any susceptible area such as the neck, lower back, knees or shoulders.

Conclusion :

Treatment with platelet-rich plasma holds great promise. The risk associated with PRP is very minimal compared to other interventions. Its complete a natural healing process at a very cost effective price. The magic lies with using  proper approved PRP device and the doctors skills, says Dr.K.Vijayaraghavan,MD.

Living a Full Life with Fibromyalgia

Do you suffer from chronic pain, fatigue and depression? You might have fibromyalgia!!!! Fibromyalgia is nothing but a complex and often misunderstood chronic pain condition that affects mainly womens. If you’ve never heard of this condition, well you’re not the only one. In fact, one in 100 indians have never heard of fibromyalgia or consider it a disease. Dr.K.Vijayaraghavan, an  pain physician explains why the disease often goes untreated and how you can seek help if you think you might have fibromyalgia.

So, why hasn’t this condition received much attention or proper diagnosis?

According to a surveys conducted, many patients delay diagnosis and treatment because they fear that they will be perceived as “faking” the disease or simply complaining. As fibromyalgia gains more attention, now more than ever, patients can move beyond the stigma, relieve the symptoms of this condition with treatment, and lead full lives.

What are the symptoms?

Fibromyalgia is a multifaceted condition that impacts each patient differently. The disease affects patients physically, emotionally and socially, interfering with their basic daily activities, such as sleeping, exercising, and working.” Common symptoms include:

• Widespread pain
• Joint stiffness
• Debilitating fatigue
• Headaches
• Irritable bowel syndrome
• Sleep disturbance
• Cognitive symptoms, such as difficulty concentrating

On average, people living with fibromyalgia endure three years of symptoms and visit at least three different physicians before receiving an accurate diagnosis. Although fibromyalgia usually appears in patients in their 20s or 30s, the disease is found in all age groups and is most common among women.

How can I ensure a proper diagnosis?

Before visiting your physician, I recommends recording your symptoms:

• Describe what you’re feeling.
• Rate the severity of your symptoms.
• Note how frequently your symptoms occur.
• Record what you’re doing when the symptoms begin.

It is also recommended to analyse your lifestyle:

• Keep track of the medications/therapies you regularly use.
• Document your current exercise routine.
• Note how your symptoms impact your daily life.
• Talk to other people about your symptoms and concerns, including family members who can discuss your family health history.
• Conduct research to learn more about fibromyalgia and the different treatment options available.

What treatments are available?

The most important step to living an active life with fibromyalgia is finding the right physician who can develop an individualized approach to managing your symptoms. The condition can be effectively managed by exploring a range of different treatment options, such as medications, diet, Yoga, lifestyle changes and other therapies such as osteopathic manipulative treatment (OMT), a hands-on treatment used by DOs to care for pain,” explains Dr.K.Vijayaraghavan. With the support of a physician, as well as friends and family, you can live an active life with fibromyalgia.”