Pain can be defined as an unpleasant feeling which can be a result of tissue damage, whether real or potential. Knee pain is a common ailment that affects individuals of all ages. It is characterized as a feeling of pain, tightness, or discomfort that emanates from the region of the knee. The severity of the pain can vary, mainly depending on the onset of sudden or gradual knee pain. Unlike pain coming from the hip, the origins of pain in the inner knee or outer knee are associated with knee problems. Pain is the body’s natural response to injury or disease, and the severity of pain is no indication of the extent of damage. It is possible to have a serious injury and experience minimal pain, or the reverse is also possible, where a simple injury can cause a lot of pain. Pain is an unpleasant sensation that can restrict an individual’s mobility and ability to perform daily activities. It can lead to an individual avoiding the use of a particular body part, and as a result, muscle atrophy may occur. In some cases, pain can result in an individual overusing the body part in an attempt to work through the pain. This can cause damage to the tissues of the body. It is for these reasons that pain should be managed.
Overview of Knee Pain
Later, as discomfort decreases, a proper rehabilitation program, stretching and strengthening, and a gradual return to activity will help to prevent a recurrence of the injury.
The first step in managing knee pain is to understand its cause. This can be obtained by obtaining an X-ray of the knee joint. It is advisable to see a physician if the pain persists. A physician may prescribe rest or inactivity. This is to be followed by further treatment, dependent on the cause of the knee pain. Restrictions of activity, resting, elevation, and immobilization are all good measures for treatment. These are to be followed by an effort to reduce the pain and swelling. This can include applying an ice pack or a cold compression wrap to the injured area, or the use of an NSAID type drug to reduce inflammation. Support may be obtained through the use of knee braces or elastic tape. These measures are to facilitate a greater healing process for chronic injuries as well as to relieve pain for minor injuries.
Because of the constant weight bearing the knees are subject to, knee pain from arthritis is the most common location for pain. The knee joint is often afflicted by inflammatory types of arthritis that can cause swelling and pain. It is also one of the joints most commonly affected by osteoarthritis. The degree of pain from osteoarthritis is often correlated to the amount of activity the individual engages in, as it worsens with use. Osteoarthritis also affects young athletes who have injured their knees. These individuals develop what is referred to as post-traumatic arthritis.
Knee pain is the most common form of musculoskeletal pain and is a major cause of lost work days and a serious disability for many people. The knee is a complex joint with many components, making it vulnerable to a variety of injuries. These injuries can be the result of overuse, inadequate training (not enough stretching or strengthening), not warming up before activity, poor conditioning, or may occur suddenly, such as in a traumatic accident.
Importance of Pain Management Techniques
The bigger picture of why we need to utilize different coping techniques to control pain is to enhance our health and general prosperity. Utilizing techniques that decrease the pain will permit sufferers to practice all the more viable exercise, for example, swimming and walking, which can improve state of mind and turn away weight pick up, a typical symptom of pain and state of mind issue. Weight reduction diminishes the danger of different sorts of interminable medical issues that are either caused by or exacerbated by the weight pick up, for example, diabetes, cardiovascular malady, and hypertension.
Living with chronic pain is challenging. There are occasions when the pain dies down for a period, however it generally flares up and can interfere with everyday normal exercises, for instance, work, recreational activities and relationships with family and friends. The distress caused by uncontrolled pain can increase uneasiness, cause distress, and something irrefutable that may produce emotional maladjustment. This can be maintained a strategic distance from by working with your pain management knee pain doctor Singapore to discover the remedies that can diminish or eliminate the pain. People with pain will benefit if they understand the reasons why they hurt and what are the possible causes of their pain. They will also benefit by learning all they can about the treatments that are available for pain relief, including how to use medications safely and effectively, how to enhance the impact of pain treatments, and how to use adaptive strategies for controlling pain.
Coping Strategies Provided by Knee Pain Doctors in Singapore
In severe cases of OA, joint replacements have become more common. This is not a painful condition and it is relieved when the joint no longer hurts. However, it must be remembered that medications will not cure your condition but simply help to relieve some pain and problems temporarily. All drugs have side effects, and the effects of the drugs mentioned above should be discussed with the doctor who prescribed them.
High molecular weight injections have been developed as a treatment to delay the progression of OA. This treatment can only be prescribed by a specialist and medical officers have been advised not to begin new courses of treatment.
Cortisone injections are another form of medication used to reduce inflammation. It may seem that the knee is worse for the first 24-48 hours after the injection, but this is temporary and symptoms improve over the following weeks. Regular cortisone injections are not advisable due to the weakening effect they have on the bones and surrounding tissue.
It is also useful to distinguish between painkillers and anti-inflammatory drugs. An important point is that you should ask your doctor before taking any other medications or herbal remedies. This is because certain drugs can have strong effects on other medical conditions you may have. For example, it is advisable to avoid anti-inflammatory drugs if you suffer from asthma.
Coping strategies by knee pain doctors in Singapore can be many and varied. Listed below are a few techniques that could be used to help you cope with your knee conditions and pain. The most common form of medications for knee conditions are simple painkillers. These act to reduce the pain that you feel. There are a great many painkillers available and what works best for one person does not always work for another. Paracetamol is often the first choice. It is important to remember that no painkiller will remove the pain completely, and it is better to take them regularly for an agreed trial period, usually two weeks, with a follow-up to assess the effectiveness and side effects.
Medication Options
Pain can be managed with medication, but the use of medication as a primary treatment option has few, if any, benefits compared to exercises. Back pain can return. However, there should also be other compelling reasons for choosing exercise therapy over more passive modalities of care in managing chronic knee pain. When properly performed, exercise will generally yield better long-term relief from chronic pain than any other therapy. Exercise can be successful in preventing the onset of pain symptoms that may lead to a chronic problem. Finally, exercise is relatively inexpensive. This is especially important in today’s cost-conscious environment where consumers have much more financial responsibility for treatments rendered. With the possible exception of starting an exercise program in the presence of significant structural damage, exercise is a viable treatment option for nearly everyone with chronic knee pain. There are many healthcare providers who advocate medication as a primary treatment for knee pain. This is especially true for those providers who have little or no training in exercise therapy. But this approach is usually taken because it is the easiest and most passive form of treatment for the patient. In saying this, the use of medication for the treatment of painful symptoms, while an exercise program is being initiated, may have some benefits if the patient can tolerate it.
Physical Therapy and Exercise
Physical therapy is often a key element of a knee pain doctor’s treatment plan. The patient can be shown specific stretches and exercises to help improve range of motion and prevent the muscles in the knee from atrophying. This is critical to maintain the strength in the muscles that support the knee since they do not get an effective workout in daily activities that do not involve knee bending, i.e. cycling and swimming. It is very important that patients do the exercises that are prescribed by the therapist in order to get the maximum benefit. Often, patients will be given an exercise program to do at home. It may be helpful to do these exercises in front of a mirror to be sure that they are done correctly. Some of the exercises do not involve weight bearing and can be done in a sitting position. This can allow the patient to effectively build the strength in the muscles without risking further damage to the knee. But remember, none of the strengthening exercises are effective without the accompanying stretching exercises. These stretching exercises, if done correctly, can often have an immediate benefit. The most effective of these is the hamstring stretch. By decreasing tightness in the hamstring, less stress is put on the knee when walking, going up stairs, and with most activities in general. The less stress that is put on the knee, the slower the progression of knee osteoarthritis. This in turn will lead to a lesser degree of pain and a higher level of function for the patient.
Lifestyle Modifications
Lifestyle modification has been found to be an effective and essential part of overall treatment for people with chronic health problems. Some people believe that lifestyle modification only applies to recent health behavior changes such as increasing exercises or stopping smoking. However, health behavior is determined by the broader context of a person’s day-to-day life, influenced by the individual’s social and physical environment. People nowadays live in an environment that is not conducive to a healthy lifestyle; it is becoming more difficult to make the healthy choice the easy choice. Effective lifestyle modification will enhance self-management and reduce the onset of health conditions. Although it can be quite challenging to make changes in lifestyle, the potential benefits are indeed huge. By making small changes, some people may be able to achieve improved health, enhanced quality of life, and perhaps the capacity to live without medications or with less medication. This may also reduce the signs and symptoms of the health condition. Lifestyle modification can be achieved through a combination of self-help and individual counseling or group support sessions.
Alternative Treatments
Chondroitin sulfate is a naturally occurring substance in the body. It is a major component of cartilage – the tough, connective tissue that cushions the joints. Chondroitin sulfate is believed to help the body maintain fluid and flexibility in the joints. Glucosamine is a form of amino sugar that is believed to play a role in cartilage formation and repair. In studies to date, the most encouraging results have been seen from Glucosamine Sulfate supplements. In one study, Glucosamine Sulfate supplements were shown to reduce joint pain and stiffness in people with knee OA. An extension of this study showed a slowing of joint space narrowing in knee osteoarthritis. In another study, Chondroitin Sulfate was shown to be as effective as an NSAID in reducing knee pain and increasing function. Although more studies on Chondroitin Sulfate and Glucosamine are needed, many knee pain doctors are recommending these substances to patients as a possible alternative or in conjunction with traditional treatments. The use of Glucosamine and Chondroitin Sulfate is on the rise worldwide – in 1999, this over-the-counter remedy totaled $159 million in sales in the U.S. and it is expected to double by the end of 2003.
Supportive Care and Self-Help Techniques
A common question is whether to use ice or heat. In general, ice is used for acute pain or pain associated with swelling, and heat is used for more chronic pain. Ice massage is a convenient and effective way to get the anti-inflammatory benefits of ice on a localized area. A paper cup is filled with water and frozen. The top of the cup is then torn off, leaving an ice cylinder. With the use of a towel to catch the melting ice, the cylinder is rubbed over the affected area for 5-10 minutes. An ice pack or plastic bag filled with ice or frozen vegetables may also be used. Commercial gel packs are convenient and may be cooled in the freezer or heated in the microwave. Heat may be in the form of a hot shower, heating pad or the commercially convenient chemical heat pack. The choice of using ice or heat is largely based on patient preference.
The knee must be protected from aggravating pain and further injury. This may require reduced activity, support from a cane, or a change in footwear. A support or brace may be indicated, particularly if there is associated instability. Supportive devices should be used as needed. The best ways to protect the knee are to avoid positions or movements that aggravate the pain, use an assistive device and/or brace as needed, and modify activities as necessary.
Rest and Ice Therapy
Ice is most commonly used in the acute phase of an injury, the first 72 hours. In this phase, it is postulated that cold application minimizes edema, swelling, formation through a decrease in blood flow, vasoconstriction. Ice will also provide a numbing effect, which will decrease pain. A recent systematic review into the use of ice following total knee replacement demonstrated that it is beneficial in pain control and has led to reduced post-operative opioid consumption. A key point with ice application is to avoid direct contact of the ice with the skin. This can lead to an “ice burn”. An easy method is to wrap ice in a damp tea towel, then apply it to the knee for 15-20 minutes. This can be repeated several times a day at 2-3 hour intervals. It should be noted, however, that there are some patients who do not respond well to ice application.
Ice therapy is often used as a pain reliever. It is an analgesic, something that takes away pain. Applying an ice pack to an injured area decreases blood flow to the area. This can be helpful in decreasing swelling. When the tissue temperature has decreased due to the ice application, the tissue’s metabolic rate has also decreased. The metabolic rate will only normalize when the tissue reaches its normal temperature.
Rest is a decrease of activity, usually aiming to improve function or decrease pain. Failure to rest following an injury could slow healing and lead to further damage. Rest provides the body with the opportunity to reallocate energy that would otherwise be used for joint and muscle activity towards healing.
Assistive Devices and Braces
Knee pain can make it difficult to perform many day-to-day tasks. Assistive devices can reduce stress and strain on your knee and conserve energy. A certified orthotist is an allied health professional who is specifically trained in the skills of designing and fitting custom-made braces or orthotics. An off-the-shelf brace is a knee brace that comes already made and fitted, which you can purchase and take home the same day. Some practitioners feel that knee braces can be helpful, while others feel the evidence supporting their use is lacking. An assistive device is any tool or aid that can make doing an activity easier. A cane can take weight off of a painful knee or leg. A knee sleeve can provide some compression and warmth while still allowing a good range of motion. A custom-made foot orthotic (shoe insert) on the opposite foot can help reduce stress on the other knee by correcting an uneven gait. Either the orthotist or your physician can help determine what assistive device may be helpful and instruct you on how to obtain it.
Stress Management and Relaxation Techniques
Progressive muscle relaxation is a technique introduced by Jacobson in 1929. It is a method of reducing muscle tension to promote relaxation. Tense the muscle for 10 seconds and then suddenly release it. Next, focus on the difference between the tension and the relaxed state. Start at the muscles around the forehead and eyes and work around the whole body down to the feet. This technique will improve the awareness of muscle tension and teach a person to let go of this tension to reduce pain and stress. It can be used in combination with imagery where a person visualizes themselves in a place where they feel content and happy. This can have a positive effect in reducing mood disturbances often associated with chronic pain.
Breathing exercises are a way of altering the body’s reaction to stress by producing a calming effect. When a person is stressed, breathing becomes rapid, shallow, and erratic. This can increase the perception of pain and also lead to a feeling of dizziness or lightheadedness. By slowing down the breathing to a regular rate and focusing on taking long, deep breaths, the body can relax and the perception of pain is decreased. This can be used as a coping strategy for painful flare-ups and reduce the avoidance behavior that is often associated with fear of pain worsening. It can help to promote a more functional activity pattern and, in turn, lead to increased confidence in the knee and reduced perception of pain. Deep breathing can be practiced anywhere and at any time.
Stress is a common problem for people with chronic knee pain. Engaging in a problem-solving approach to find a solution to the pain and implementing various self-help techniques will often result in a reduction of stress. There are several relaxation techniques that can help to reduce stress. Relaxation is a state where there is a reduction in the physical and emotional arousal associated with anxiety. It is a technique that can reduce the perception of pain.
Future Developments in Knee Pain Management
The emerging therapies and technologies such as regenerative medicine, using the growth factors, stem cells and tissue engineering to repair the damaged tissue is the effort to avoid the surgery and to halt the progression of arthritis. GAPET (Guided Autologous Platelet Enhanced Therapy) injection is already showing promising results in some cases of knee OA. The other alternative using the acupuncture and neuromodulation technologies also have a great potential in managing knee pain, but still a lot of research is required to prove the effectiveness and safety profiles. This era of new technologies is full of promises, however we must make sure every step is based on the solid evidences and the comparative effectiveness with the existing treatments are well tested. The results of those research will determine the future paradigm of knee pain management. And we expect those will be a more effective treatments with less cost and less invasive techniques compared to the existing treatments. So it will benefit the patients and reduce the disease burden to the society.
In addition to those strategies and plan of actions, the above article is the outcome from the National Pain survey 2008 which was focused on establishing the pain research agenda. Knee pain research was recognised as a priority area. It is still in progress and developing, and researchers and specialists in the field always strive to find the best solution to manage and cure the pain. The revolutionary total knee replacement surgery was the advanced stages in surgical techniques, however it may not be the best solution for every patient. An effort trying to understand pain mechanisms involved in the knee and to find the best management will always result in preferred alternative to the surgery in years to come. Decoding the Human Knee – With a better understanding of how the knee works, we can design improved strategies for preventing and managing knee pain. This information is crucially lacking, and even simple pain problems can become chronic because little is known about the origin of the pain. A concerted effort to define the basic science of knee pain will be exceedingly worthwhile.
Advances in Surgical Techniques
High tibial osteotomy is a surgical procedure employed to relieve pressure on a damaged knee joint. This is predominantly used to treat early osteoarthritis. The procedure involves cutting and reshaping the tibia or fibula to shift the weight of the body off the damaged area of the knee. Though not a new procedure, recent advancements have enabled this to be a more viable option for patients, with technological improvements reducing the size of surgical wounds and internal fixation techniques. The recovery time for patients has also been reduced.
In recent times, there has been a trend towards less invasive surgical techniques. This has mainly been due to the development of arthroscopy, which is a surgical procedure in which a small camera is inserted into the affected joint via a small incision. The camera transmits images from inside the joint to a video monitor, which guides the arthroscopic surgeon in performing the necessary procedure. This technique results in less trauma to the joint, less pain, faster recovery times, and has been shown to be effective in treating many different types of knee injuries.
There has been much advancement in the treatments for knee pain, which has resulted in overall improvements in patient care. These have included the development of less invasive surgical procedures, new technologies, and a better understanding of how tissues respond to injury. This has generally led to improvements in treating soft tissue injuries in and around the knee.
Emerging Therapies and Technologies
The most significant recent advance in pharmacological management of knee pain is the increased use of COX-2 specific NSAIDs and the development of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs). COX-2 specific agents have been shown to have fewer gastrointestinal side effects than traditional NSAIDs, with one specific agent showing reduced risk of adverse cardiovascular events. Although these agents are more costly than traditional NSAIDs, this is partially offset by the cost savings from fewer gastrointestinal complications. Anti-coenzyme Q10 antibodies are emerging as a potential method for slowing progression of osteoarthritis. Corticosteroid injections and viscosupplementation have remained popular symptomatic treatments, although their effects on disease progression are unclear.
With the understanding of knee pain as a disabling condition with numerous influences, there is a growing realization of the potential benefit from multi-modal treatment that includes both pharmacological and non-pharmacological interventions. While there is a great deal of anecdotal evidence supporting the use of many non-pharmacological therapies, often there is little evidence from randomized controlled trials to substantiate their efficacies. The recent development of a NIH (USA) initiative to develop consensus statements regarding non-pharmacological treatment of common musculoskeletal conditions is a positive step that may well lead to increased research in this area.
Research and Clinical Trials
Future research surrounding knee pain management will be based on the outcomes of recent systematic reviews on the effectiveness of various techniques in managing knee pain, such as arthroscopy, viscosupplementation, and intra-articular corticosteroid injections and surgery. A recent internationally recognized systematic review on the efficacy of arthroscopic surgery in reducing pain in degenerative knee disease concluded that there are only “small and inconsequential” benefits in arthroscopy over conservative treatment or placebo in treating middle-aged and older patients with knee pain, and many knee surgeons have found this to be a turning point in the case. Word Count: 229
The most significant advance in evidence-based medicine has been the development and recognition of the importance of the pyramid in defining the level of evidence in healthcare, which places randomized controlled trials (or systematic reviews of RCTs) at the top of the hierarchy. This puts clinical trials and research at the forefront of modern medical practice and advocates the role of evidence-based medicine in the treatment of patients, rather than “clinical” opinion and anecdotal experience. Clinical trials form the basis of future management strategies for patients, and their role in improving patient outcomes and well-being is pivotal.
