Knee Pain

A pain management doctor’s goal is to help patients get back on their feet and stop their knee pain.

Often patients see a knee surgeon or specialist first, but they hear that surgery is what are the next steps. The best way to avoid surgery is to see a pain management specialist who understands how the knee works and can often tell what the problem is with a thorough exam.

Using a combination of MRI technology and live X-ray, the doctors at VIP Centers can visualize things they cannot see or feel.

When people are seeking out care for a knee specialist they should understand a few important things. One is to get treatment early, before it’s too late. Likewise, not treating the problem and allowing it to go on for long time can aggravate an issue.

Here are top 5 ways to avoid a knee replacement:

• Steroid or cortisone injection
• Viscosupplement knee injection
• Iovera, nerve freezing procedure for the knee
• Genicular Nerve Block for the knee
• Genicular Nerve RFA for the knee

Steroids
When steroids are injected, they are injected into the vein or the muscle. They can also be injected into the joint or the bursa. Local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure.

The patient remains awake during the procedure. With the aid of an X-ray, the doctor directs a hollow needle through the skin and into the region responsible for pain. When the needle is positioned, the anesthetic and medications are injected into the joint capsule.

The doctor will apply an anesthetic spray to numb the area where the needle will be inserted.

Cortisone shots commonly cause a temporary flare in pain and inflammation for up to 48 hours after the injection. After that, the pain and inflammation of the affected joint should decrease, and can last up to several months.

Viscosupplements

Visco-supplementation is a medical procedure during which lubricating fluid is injected into a joint. The injections we use are Hyalgan, Orthovisc, and Euflexxa.

The doctor will inject a local anesthetic into the area around the joint, so there is minimal discomfort during the procedure. Sometimes the doctor might use imaging so that they can inject into exactly the right spot. The doctor will inject the hyaluronic acid into the joint space using a needle attached to a syringe.

There can be temporary inflammation or pain for up to 48 hours after the injection, and it should then decrease.

Iovera
Cold is applied to a peripheral nerve, and the cold is at a low enough temperature that it immediately prevents the nerve from sending signals of pain. There is no damage to the surrounding tissues and structures. The iovera machine uses the principle of focused cold therapy, which is the application of low or subzero temperatures to freeze peripheral nerves. When this cold therapy is targeted at a specific area of injured areas in the body, pain relief is achieved by freezing away the nerve activity and the results are instant pain relief with no need for pain medication.

The doctor will give local anesthesia to the knees, but patients may also feel a slight tingling sensation during the procedure.

After the use of Iovera, the patient is able return to normal activities slowly per the doctor’s discretion.

Genicular Nerve Block
A genicular nerve block is the injection of a local anesthetic to block the nerves that transmits pain from the knee. The site to be injected will be numbed with a local anesthetic. An x-ray is used to ensure correct placement and positioning of the needle. Local anesthetic will be injected to numb the nerve. This will be repeated at multiple sites to block all of the genicular nerves around the knee.

This procedure is generally well tolerated with patients often requiring only a small amount of local anesthetic. Light sedation can be provided to make patients more comfortable if needed.

The patient may experience pain and some soreness in the injection site lasting a day or two. The anesthetic should give immediate relief while it may take the steroid 3-5 days to fully kick in.

Genicular Nerve RFA
The radiofrequency ablation is a longer lasting pain relief option and is meant to cut the nerve supply, so that the patient does not feel any pain. The placement of the needles being used are guided by x-ray. The area is numbed using local anaesthetic. The needles heat up the nerve to prevent the patient from feeling pain.

This procedure is generally well tolerated with patients often requiring only a small amount of local anesthetic. Light sedation can be provided to make patients more comfortable if needed.

The patient can expect some initial knee discomfort and should rest for 1-2 days afterwards. Most patients can return to normal activities in a few days and will notice marked decrease in pain and continued improvement after 3-5 days. Long-lasting pain relief is expected, but some nerves may repair themselves, so pain may return.

What are the expected results for the above treatments?

50-75% improvement each time, every patient is unique so a customized plan will be made upon your first consultation. 

Does insurance cover the treatment?
Yes. Please call our office and we can verify you coverage so you can get the care you need.

Side Effects depending on the type of treatment: 

Steroids 
Pain and swelling, skin discoloration around the injection, allergic reaction, infection.

Viscosupplementation
Warmth, pain, swelling, stiffness around the injection, trouble walking, itching or skin irritation around the knee.

Iovera
Local pain and tenderness, swelling, and bruising.

Genicular Nerve Block
Leg muscle and weakness, dizziness, mild headaches, mild discomfort at the injection site.

Genicular Nerve RFA
Pain or discomfort around the area treated, allergies or reactions to medication being used, infection, permanent nerve pain.