Introduction:
With the increase in orthopedic surgeries and postoperative medications, problems like drug overdoses, adverse effects of medicines, and drug dependence have also increased. Opioids (narcotics) are one of the most commonly prescribed analgesics postoperatively for effective pain management. However, the use of these drugs is majorly linked with subsequent drug dependence. Therefore, alternative pain management postoperatively has increased to avoid such conditions. These alternative methods are either used to complement conventional medicine or as an alternative to traditional medicine. The below article will discuss the various alternative pain management after orthopedic surgery in detail.
What Are the Alternative Pain Management Methods After Orthopedic Surgery?
Orthopedic surgeons use standard alternative methods: physical therapy modalities like heat/cold therapy, TENS (transcutaneous electrical nerve stimulation), acupuncture, relaxation techniques, and cognitive therapies. They are often combined with conventional medicine to treat and manage pain in patients following orthopedic surgery effectively.
1. Cryotherapy:
For decades cryotherapy has been used postoperatively to promote healing after orthopedic surgeries. Currently, the use of cryotherapy has been widely accepted as a postoperative intervention. However, its efficacy is still controversial and understudies. This modality uses the external cold application to decrease or alter the body's physiologic response to surgery by reducing pain, swelling, and inflammation. Modalities of cryotherapy include gaseous cryotherapy, continuous cryotherapy, ice packs, and cold water therapy.
The Effects of Cryotherapy:
The cold application is believed to cause extreme anesthetic effects. When applied post-surgically, it constricts the superficial cutaneous vessels to preserve the body's core heat. This results in reduced capillary permeability and hemorrhaging and reduces pain and swelling. In muscular structures, the cold application can temporarily relieve the responsiveness of the muscle spindle that is responsible for sending information to the motor nerve cells. However, some limitations of cryotherapy include nerve palsies (lack of nerve function), skin infections, and frostbite (freezing of the skin and subcutaneous tissue).
2. TENS:
Among the modalities frequently employed in physiotherapy, transcutaneous electrical nerve stimulation is commonly used. This technique uses a low-voltage current to manage pain. TENS can be used following orthopedic surgery to relieve pain by stimulating larger diameters. The unit of TENS comprises a battery-powered device that is connected to leads. These leads have sticky pads attached to the surface of the desired site of analgesia. These sticky pads are attached to the area of pain or at the pressure point. Low-voltage electrical stimulation is passed through these electrodes.
TENS work is based on the proposed spinal cord gating mechanism. These techniques function by applying electrical impulses to stimulate nerve cells, regulating the transmission of pain signals to the spinal cord and brain, and modifying the perception of pain.
The efficacy of TENS following orthopedic surgery shows mixed results based on the frequency and variation of TENS usage postoperatively. Recent studies have shown that the usage of TENS at the surgical site has reduced postoperative pain by 26.5 percent and decreased opioid consumption by 35.5 percent. However, the routine use of this technique still needs to be recommended. These approaches operate by administering electrical impulses to stimulate nerve cells, consequently regulating the transmission of pain signals to the spinal cord and brain while also modifying the perception of pain.
3. Acupuncture:
Acupuncture has been used as a standard modality for treating musculoskeletal pains. They are also used to intervene and rehabilitate various diseases and conditions. This practice originates from traditional Chinese medicine and entails the insertion of thin needles into the body to stimulate sensory nerves within the targeted area. Recent studies show that acupuncture has positive effects on reducing postoperative pain.
They have also been shown as one of the complementary therapies for managing pain postoperatively and have also reduced the usage of opioids and their adverse effects postoperatively. It is believed to stimulate the areas of the skin that comprise significant amounts of intersecting nerve endings responsible for pain perception in these areas of muscle or bones.
This, in turn, releases a chemical into the muscles, spinal cord, and brain that help in relieving pain and swelling and help achieve a feeling of general relaxation in the body.
The effects of acupuncture as a complementary medicine postoperatively are influenced by various factors like the presurgical and psychological conditions of the patient. Rarely it may cause risks like bleeding and bruising at the insertion site. And sometimes, it may lead to infection when unsterilized needles are used.
4. Continous Passive Motion (CPM):
This treatment modality uses an external motorized device to help move the joint constantly in a mechanical splint at a pre-set range of motion. This modality is generally used to prevent stiffness and improve motion content. Following orthopedic surgery, there is a greater risk of immobilization, which increases the pain post-surgically. Hence an early usage of this technique to prevent immobilization has dramatically reduced the pain. This technique comprises a machine that promotes the movement of joints without requiring the patients to exert any effort. They have also prevented scar formation and muscle shortening around the joints. However, the efficacy of this machine still needs to be determined.
5. Psychological Techniques:
Psychological techniques have been used for many years as an adjunctive treatment modality for managing pain in many patients. These include relaxation techniques, medical hypnosis (also referred to as hypnotherapy which the therapist uses mind-body intervention to focus on the patient’s problem), and guided imagery. Guided imagery is a relaxation technique that promotes creating a positive, calm visualization in the mind. Recent studies have shown psychological methods' effectiveness when combined with conventional techniques. It can effectively manage pain and promote physical and mental relaxation post-surgically. Various psychological techniques are used in orthopedic rehabilitation.
Conclusion:
Orthopedic surgeries are extensively performed nowadays to treat various conditions. Studies and research are growing in this field of medicine to explore the multiple ways to manage pain and avoid opioid dependence effectively and reduce the cost of treatment. The techniques mentioned above are alternative pain management methods following orthopedic surgery. When combined with conventional medicine, all of these techniques have been shown to improve pain management effectiveness.
