Chronic knee arthritis is one of the most common diseases of as we get older and can result in pain, restricted movement, sleep disturbance, and social disability.? Non-surgical interventions, including knee joint injection with steroids or hyaluronic acids, physical therapy, knee bracing, non-steroidal anti-inflammatory drugs, pain medication, and acupuncture are often used as complementary therapies, but may not be sufficient to control chronic severe knee pain. The use of non-steroidal anti-inflammatory drugs is associated with serious side-effects, such as bleeding / gastrointestinal ulcers, stroke, and heart attack. Although surgery is generally effective for patients with advanced disease, older individuals with other medical problems may not be appropriate surgical candidates. In those cases, genicular nerve radiofrequency ablation might be a successful alternative treatment with few complications.? This procedure is reserved for patients who have not responded to more conventional chronic knee pain therapies or the more conventional therapies which carry a higher risk for the particular patient.
The knee joint sensation is supplied by the peripheral branches of various nerves, including the femoral, common peroneal, saphenous, tibial and obturator nerves. These nerve branches around the knee joint are known as the genicular nerves. Most of the genicular nerves can be easily approached by a needle technique under x-ray guidance.? Patients who have failed the more conventional treatments and who continue to suffer with significant pain could undergo a simple blockade of these nerves in the office to see if they would temporarily experience pain relief.? If the patient obtained significant temporary pain relief, they could be a candidate at a later date for radiofrequency ablation of the genicular nerves as an outpatient.
Radiofrequency ablation ( RFA) is a procedure used to provide longer term pain relief than provided by simple injections or nerve blocks. An electrical current produced by a radio wave ( hence the name radiofrequency ) is used to heat up a small area of nerve tissue through a needle by causing the tissue to vibrate.? The procedure is performed by using a needle without the need of a surgical incision.? The destruction of the nerve tissue interrupts the transmission of the painful signal from that specific area to the brain. The degree of pain relief varies. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years.? Peripheral nerves can grow back.? More than 70% of patients treated with RFA experience pain relief over the years.? Radiofrequency ablation procedures can be repeated if necessary. Patients can be sedated for the radiofrequency ablation procedures.? The patient undergoes sensory and motor stimulation for added safety before the radiofrequency ablation.? It is more desirable to have the patient conversant during the genicular nerve radiofrequency ablation. RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications.? Genicular nerve radiofrequency ablation has a slight risk of infection and bleeding at the insertion site. Some patients can experience a temporary flair up of pain after the radiofrequency ablation. This is self limiting and requires only temporary pain medication. This genicular nerve radiofrequency ablation procedure is becoming much more common over the last few years. I have performed radiofrequency ablation procedures of the facet joint nerves in the spine for decades and it has been helpful for many of our patients. We have found out in the last several years that nerves throughout the body can be treated with radiofrequency ablation for better pain control.
Arch Advanced Pain Management
James Sturm DO DABA FIPP
830 Waterbury Falls Suite 202
O’Fallon, Missouri 63368