PAIN MANAGEMENT TECHNIQUES FOR ORTHPEDIC PATIENTS

 I'm Dr. A. Mohan Krishna, a senior consultant Orthopedic Surgeon at Apollo Hospitals in Jubilee Hills, Hyderabad, Telangana. As an orthopedic specialist, one of the most common concerns I encounter from my patients revolves around how they can effectively manage their pain. Whether it’s a recurrent joint pain or discomfort following a surgery, effective pain management is crucial to improving quality of life and promoting faster recovery. 

In this post, I would like to share some of the pain management techniques that we, at Apollo Hospitals, recommend to our orthopedic patients.

1. *Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):* 

These are perhaps the most common class of medications prescribed for pain relief in orthopedic conditions. They not only relieve pain but also help to reduce inflammation, which is often a significant cause of discomfort in orthopedic conditions.

2. *Physical Therapy and Exercise:* 

Physical activity is a vital component of pain management. Specific exercises, guided by a trained physiotherapist, can help strengthen muscles, improve flexibility, and reduce joint pain. Remember that consistency is key here, and even a few minutes of daily exercise can make a big difference.

3. *Heat and Cold Therapy:* 

Applying heat can help to relax muscles and promote blood flow, while cold therapy can help to reduce inflammation and numb pain. These therapies can be easily done at home with a hot water bottle or ice pack.

4. *Pain-Relieving Injections:* 

In some cases, when pain is severe or not responding to other treatments, injections of corticosteroids or hyaluronic acid may be used. These injections can provide relief from pain for several months.

5. *Relaxation Techniques:* 

Techniques like deep breathing, meditation, and yoga can help to reduce stress and promote relaxation, which can in turn help to manage pain. Many of our patients find these techniques to be very beneficial, particularly when dealing with chronic pain conditions.

6. *Lifestyle Modifications:*

 Maintaining a healthy weight, eating a balanced diet, quitting smoking, and reducing alcohol consumption can all contribute to better pain management. Small changes can have a big impact on your overall health and well-being.

Remember, every patient is unique, and what works for one person might not work for another. It's important to work with your healthcare provider to develop a personalized pain management plan that suits your specific needs and condition. 

At Apollo Hospitals, we are committed to providing the best possible care to our patients. If you have any questions about pain management or any orthopedic condition, please don't hesitate to reach out to us.

Remember, you don't have to live in pain. There are many strategies and treatments available that can help you manage your pain and get back to enjoying your life.

Stay healthy,

Dr. A. Mohan Krishna,

Senior Consultant Orthopedic Surgeon,

Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana.

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome:

The carpal tunnel is the space between the bones and ligaments of the wrist through which median nerve passes. Carpal tunnel syndrome develops when the nerve becomes compressed. It is common condition of the hand that affects women more frequently than men.

The symptoms of carpal tunnel syndrome include:

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  Pins and needles or tingling sensations (Paraesthesias)

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Pain or numbness in the hand, typically worse at the night.

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Clumsiness and weakness of the hand.

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A weak grip and an impaired ability to bring the thumb across the palm to meet the other fingers.

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Pain in the wrist, forearm or shoulder.

Causes:

Any condition that narrows the carpal tunnel or produces swelling of or fluid retention by the contents of the tunnel can cause carpal tunnel syndrome. The many possible causes include

-          Hormonal changes.

-          Obesity,

-          Diabetes mellitus,

-          Rheumatoid arthritis,

-          Acromegaly – bone enlargement due to pituitary gland abnormality.

-          Under activity of thyroid (hypothyroidism)

-          Renal failure,

-          Alcoholism

-          Amyloidosis : rare condition in which abnormal proteins accumulate in tissues and organs.

-          Paget’s disease: a chronic bone disease that affects elderly people. The bones become deformed and thickened.

-          Tumors: such as lipoma (Fatty tumours), ganglions (fluid filled cysts formed in tendon), and deformities of wrist after the fractures.

-          The use of hand held vibrating tools – very rarely causes carpal tunnel syndrome.

Diagnosis:

The typical history of pain and weakness in the hands usually suggest the diagnosis of carpal tunnel syndrome, but it is important to exclude other conditions that may produce similar symptoms, such as a prolapsed cervical disc or arthritis of thumb joint.

Clinical examination:

This may reveal disturbances in sensation in the area supplied by the median nerve, wasting of the muscles at the base of thumb and poor grip.

Tinel’s sign: tapping the median nerve at the wrist may reproduce the pain and tingling of carpal tunnel syndrome in the affected person. Flexing the wrist against resistance has  a similar effect.

Imaging: an x-ray of the wrist may be used to rule out bony abnormalities, while MRI gives a clear picture of the soft tissues.

Nerve conduction studies: Nerve conduction studies are conducted to see the conduction and velocity of impulses across the median nerve. This test can be used for documentation of carpal tunnel syndrome.

Treatment:

Treat the underlying cause:

The underlying causes should be treated. For example overweight patients should be encouraged to lose some weight and patients with hypothyroidism should receive thyroid hormone replacement therapy.

Some patients recover without treatment, while others respond to rest or simple measures such as the use of wrist splint for week or so. In cases where the condition is persistent however several treatments are available.

-          Anti-inflammatory drugs: may help to relive tendon swelling and pressure on the wrist in rheumatoid arthritis.

-          Wearing night splints at night, which hold the wrist, slightly forward, may help night pain.

-          Diuretics (which increase the volume of urine) are sometimes prescribed to remove excess fluid from the body.

-          Steroid injections into the carpal may provide relief, but must be performed with utmost care. It is particularly important not to inject the median nerve itself any improvement may be temporary.

-          In persistent cases, surgery will be performed in order to reduce pressure on the large media nerve.

Surgery:

Surgery is usually advisable for persistent or worsening symptoms to prevent permanent loss of sensation and wasting of the muscles in the hand. In such cases without surgery, symptoms are likely to persist.

Surgical treatment usually involves dividing transverse carpal ligament in order to relieve the pressure on the median nerve. Freeing the nerve enables normal nerve conduction to resume. Traditionally, median nerve decompression was open surgical procedure, but also new technique of endoscopic carpal tunnel release is also being practiced.

Generally, both open and endoscopic techniques have excellent results although it may take few months for grip strength to return to normal.