scholarly journals Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3344-3349
Author(s):  
Edvin Koshi ◽  
Cole W Cheney ◽  
Beau P Sperry ◽  
Aaron Conger ◽  
Zachary L McCormick
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Vastus Medialis ◽  
The Novel ◽  
Chronic Knee Pain ◽  
Numeric Rating

Abstract Background Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. Objective 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Methods Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Results Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59–100%), 82% (95% CI = 48–98%), and 9% (95% CI = 2–41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. Discussion/Conclusions These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

2021 ◽  
pp. 1-6
Author(s):  
Kun Yung Kim ◽  
Gi-Wook Kim
Keyword(s):  
Conservative Treatment ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Transcatheter Arterial Embolization ◽  
Rating Scale ◽  
Case Series ◽  
Arterial Embolization ◽  
Numeric Rating Scale ◽  
Knee Oa ◽  
Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

scholarly journals Clinical Outcome of Cooled Radiofrequency Ablation in Chronic Knee Pain Osteoarthritis: An Initial Experience from Nepal

2021 ◽  
Vol 19 (1) ◽  
pp. 175-178
Author(s):  
Anuj Jung Rayamajhi ◽  
Pawan Kumar Hamal ◽  
Rupesh Kumar Yadav ◽  
Nabin Pokhrel ◽  
Prashanta Paudel ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Pain ◽  
Ultrasound Guidance ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Chronic Knee Pain ◽  
Numerical Rating

Background: Cooled Radiofrequency ablation is a newer technique for management of chronic knee pain in osteoarthritis. The aim of the study is to evaluate the clinical outcomes in patients with chronic osteoarthritis in terms of pain scores for first six months of cooled radiofrequency ablation using ultrasound guidance. Methods: A cross-sectional study with retrospective review of database was evaluated to analyze the change in the Numerical Rating Scale from baseline scores at 1 day, 1 month and 6 months after the Cooled Radiofrequency ablation of genicular nerves around knee in patients with chronic knee osteoarthritis. Results: Median age was 71 years [ 61-73 years (IQR: 25-75)] with more female preponderance. Numerical Rating Scale (Mean ± S.D.) was significantly less at 1 day (1.87 ± 1.22), 1 month (3.03 ± 0.99) and 6 months (3.37 ± 1.098) from baseline values (6.77 ± 1.00). No soreness and numbness were noted.Conclusions: Cooled Radiofrequency using Ultrasound guidance for management of knee pain in chronic osteoarthritis is promising and reduces Numerical Rating Score significantly from baseline at 1 month and 6 months respectively.Keywords: Cooled radiofrequency ablation; genicular nerve; numeric rating scale

scholarly journals High-Voltage Intraarticular Pulsed Radiofrequency for Chronic Knee Pain Treatment: A Single-Center Retrospective Study

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E549-E558
Author(s):  
Peng Yao
Keyword(s):  
Knee Pain ◽  
High Voltage ◽  
Rating Scale ◽  
Low Voltage ◽  
Oxford Knee Score ◽  
Numeric Rating Scale ◽  
Pulsed Radiofrequency ◽  
Chronic Knee Pain ◽  
Numeric Rating

Background: Intraarticular pulsed radiofrequency (IAPRF) for the treatment of painful knee osteoarthritis (KOA) is a less invasive treatment method. It has fewer adverse effects and can quickly reduce KOA-related pain and improve knee joint dysfunction. Objectives: We compared the effectiveness of high- and low-voltage IAPRF for the treatment of chronic knee pain. Study Design: Retrospective comparative study design. Setting: This study took place at Shengjing Hospital of China Medical University. Methods: A total of 57 patients with KOA who were hospitalized between July 2018 and July 2019 were randomly allocated into the high-voltage (n = 29) and low-voltage (n = 28) IAPRF groups. IAPRF was performed under the guidance of computed tomography (CT). Numeric Rating Scale (NRS-11), Oxford Knee Score (OKS), degree of pain relief, global perceived effect, and side effects at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after the procedure were recorded and analyzed. Results: NRS-11 scores decreased significantly in both groups after the procedure, but gradually increased after the 6-month follow-up period. There was a significant difference in NRS-11 scores between the 2 groups at all follow-up periods postprocedure. OKS were similar between the 2 groups. Patients with pain relief rate 50% or greater at 1, 3, and 6 months after the procedure accounted for 72.41%, 72.41%, and 55.17% in the high-voltage group, and 46.43%, 46.43%, and 28.57% in the low-voltage group, respectively. The difference between the 2 groups was statistically significant. No significant adverse reactions were observed in the 2 groups, however, patient satisfaction in the high-voltage group was significantly higher compared with patients in the low-voltage group. Limitations: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up period. Conclusions: CT-guided high-voltage IAPRF is more beneficial in reducing knee pain and improving knee function compared with low-voltage IAPRF. In addition, patients who received high-voltage IAPRF were more satisfied with their treatment. Key words: Pulsed radiofrequency, knee osteoarthritis, intraarticular, high voltage, Oxford Knee Score, Numeric Rating Scale

scholarly journals Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: results from a prospective, multicenter, randomized, cross-over trial

2019 ◽  
Vol 44 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Tim Davis ◽  
Eric Loudermilk ◽  
Michael DePalma ◽  
Corey Hunter ◽  
David A Lindley ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Clinical Trial Registration ◽  
Provide Pain Relief ◽  
Registration Number ◽  
The Mean ◽  
Numeric Rating

Background and objectivesAs a follow-up to the 6-month report,12 this study investigated the analgesic effect of cooled radiofrequency ablation (CRFA) in patients with knee osteoarthritis (OA) 12 months postintervention and its ability to provide pain relief in patients who experienced unsatisfactory effects of intra-articular steroid injection (IAS).MethodsSeventy-eight per cent (52/67) of patients originally treated with CRFA were evaluated at 12 months, while at 6 months post-IAS, 82% (58/71) of those patients crossed over to CRFA and assessed 6 months later.ResultsAt 12 months, 65% of the original CRFA group had pain reduction ≥50%, and the mean overall drop was 4.3 points (p<0.0001) on the numeric rating scale. Seventy-five per cent reported ‘improved’ effects. The cross-over group demonstrated improvements in pain and functional capacity (p<0.0001). No unanticipated adverse events occurred.ConclusionsThis study demonstrates that analgesia following CRFA for OA knee pain could last for at least 12 months and could rescue patients who continue to experience intolerable discomfort following IAS.Clinical trial registrationThe ClinicalTrials.gov registration number for this study is NCT02343003.

scholarly journals A Prospective Randomized Comparison of the Efficacy of Ultrasound- vs FluoroscopyGuided Genicular Nerve Block for Chronic Knee Osteoarthritis

2019 ◽  
Vol 2 (22.2) ◽  
pp. 139-146
Author(s):  
Seong-Soo Choi
Keyword(s):  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Nerve Block ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Nerve Blocks ◽  
Numeric Rating

Background: Recently, genicular nerve block and radiofrequency ablation were introduced to alleviate knee pain in patients with chronic knee osteoarthritis. Both ultrasound- and fluoroscopyguided genicular nerve blocks have been used. However, whether one is superior to the other remains unknown. Objectives: The present study compares the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. Study Design: This research used a prospective randomized comparison design. Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. Methods: From July 2015 to September 2017, a randomized controlled study was performed to analyze the difference in the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. The Numeric Rating Scale (NRS-11), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Global Perceived Effect Scales (GPES), and complications were evaluated preprocedure, and 1 and 3 months after genicular nerve block. Results: A total of 80 patients were enrolled and randomly distributed to groups U (ultrasoundguided, n = 40) and F (fluoroscopy-guided, n = 40). Those who were lost to follow-up or had undergone other interventions were excluded, resulting in 31 and 30 patients in groups U and F, respectively. No differences in NRS-11 or WOMAC were observed between the 2 groups at baseline or during the follow-up period. GPES and complication rates were also similar between both groups. Limitations: We were unable to perform double-blind randomization and did not evaluate patients’ baseline emotional states. Conclusions: Pain relief, functional improvement, and safety were similar between groups receiving ultrasound- and fluoroscopy-guided genicular nerve blocks. Therefore, either of the 2 imaging devices may be utilized during a genicular nerve block for chronic knee pain relief. However, considering radiation exposure, ultrasound guidance may be superior to fluoroscopic guidance. The study protocol was approved by our institutional review board (2015-0369), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002846). This work was presented in part as D-H Kim’s MS thesis at the University of Ulsan College of Medicine (2018). Key words: Genicular nerve block, ultrasound, fluoroscopy, knee osteoarthritis, Numeric Rating Scale, The Western Ontario and McMaster Universities Osteoarthritis Index

scholarly journals Transposition of the lateral femoral cutaneous nerve

2019 ◽  
Vol 130 (2) ◽  
pp. 496-501 ◽  
Author(s):  
Amgad Hanna
Keyword(s):  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Meralgia Paresthetica ◽  
Femoral Cutaneous Nerve ◽  
Simple Decompression ◽  
Reoperation Rates ◽  
Numeric Rating

OBJECTIVEMeralgia paresthetica causes pain, burning, and loss of sensation in the anterolateral thigh. Surgical treatment traditionally involves neurolysis or neurectomy of the lateral femoral cutaneous nerve (LFCN). After studying and publishing data on the anatomical feasibility of LFCN transposition, the author presents here the first case series of patients who underwent LFCN transposition.METHODSNineteen patients with meralgia paresthetica were treated in the Department of Neurological Surgery at University of Wisconsin between 2011 and 2016; 4 patients underwent simple decompression, 5 deep decompression, and 10 medial transposition. Data were collected prospectively and analyzed retrospectively. No randomization was performed. The groups were compared in terms of pain scores (based on a numeric rating scale) and reoperation rates.RESULTSThe numeric rating scale scores dropped significantly in the deep-decompression (p = 0.148) and transposition (p < 0.0001) groups at both the 3- and 12-month follow-up. The reoperation rates were significantly lower in the deep-decompression and transposition groups (p = 0.0454) than in the medial transposition group.CONCLUSIONSBoth deep decompression and transposition of the LFCN provide better results than simple decompression. Medial transposition confers the advantage of mobilizing the nerve away from the anterior superior iliac spine, giving it a straighter and more relaxed course in a softer muscle bed.

Correlation between the Likert Scale and the Numeric Rating Scale for Evaluating Knee Pain

2011 ◽  
Vol 23 (1) ◽  
pp. 14 ◽  
Author(s):  
Choong-Hyeok Choi ◽  
Suk-Hwan Kim ◽  
Young-Seok Lee ◽  
Chang-Nam Kang
Keyword(s):  
Knee Pain ◽  
Rating Scale ◽  
Likert Scale ◽  
Numeric Rating Scale ◽  
Numeric Rating

scholarly journals Effects of Korean Medicine Treatment focusing on Acupotomy of headache: A Case Report of Four Patients

2021 ◽  
Vol 42 (3) ◽  
pp. 176-184
Author(s):  
Joohyun Lee ◽  
Hongmin Chu ◽  
Kyungho Kang ◽  
Ju-hyeon Moon ◽  
Jongchul Kim ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Attack Frequency ◽  
Headache Attack ◽  
Positive Clinical Effect ◽  
Headache Impact ◽  
Numeric Rating Scale Score ◽  
Numeric Rating

Background: The aim of this study was to report the effect of acupotomy for patients with headache. Methods: Four patients with headache were treated with acupotomy. The improvement of symptoms was evaluated by numeric rating scale(NRS), Headache impact test-6(HIT-6) and headache attack frequency. Results: The numeric rating scale score and headache attack frequency decreased throughout the treatment period. No side effects were observed during treatment. Conclusion: Acupotomy had shown a positive clinical effect in the treatment of a headache in this case series. Further studies are required for its application on various headache.

scholarly journals Cooled Radiofrequency Ablation of the Genicular Nerves for Treatment of Chronic Knee Pain

2020 ◽  
Author(s):  
Yashar Eshraghi ◽  
Roshina Khan ◽  
Omar Said ◽  
Cruz Velasco ◽  
Maged Guirguis
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Pain ◽  
Rating Scale ◽  
P Value ◽  
Pain Disability Index ◽  
Pain Disability ◽  
Pain Scores ◽  
Chronic Knee Pain ◽  
Before And After ◽  
The Mean

BackgroundChronic knee pain from conditions such as osteoarthritis (OA) is a significant problem in a growing and aging population. Cooled radiofrequency ablation (CRFA) is an emerging technique to treat chronic knee pain. There is significant literature noting the clinical outcomes of CRFA in anatomic locations including the peripheral joints and the lumbar spine. This retrospective study found significant improvements in Pain Disability Index (PDI) scores and Numerical Pain Rating Scale (NPRS) scores for patients with chronic knee pain who underwent cooled radiofrequency ablation (CRFA) therapy of the genicular nerves.ObjectivesThis retrospective study evaluated the effectiveness of CRFA in the general chronic knee pain population.Study DesignRetrospective electronic chart review.SettingOutpatient non-profit practice.MethodsAfter institutional review board approval, we reviewed the data of 205 patients who had undergone cooled radiofrequency ablation therapy of the genicular nerves at a multiple-site pain practice between December 5, 2017 and September 4, 2019. This study’s primary outcome was improvement in Pain Disability Index (PDI) scores. The secondary outcomes were pain scores, assessed by the Numerical Pain Rating Scale (NPRS), and opioid consumption, assessed by daily Morphine Equivalent Dose (MED). From the 205 patients who met inclusion criteria, there were 104 patients who had PDI scores both before and after the CRFA procedure that were collected in the appropriate time frame. For these 104 patients, the pain scores and opioid consumption before and after the CRFA procedure were also collected. The age of the 104 patients ranged from 21 to 89 years. There were 38 males and 66 females.ResultsThe mean PDI score before genicular nerve block and CRFA was 38.7, and the mean PDI score after CRFA was 26.5. After CRFA treatment, 67.38% of patients had a decrease in their PDI scores, 27.9% had no change, and 4.81% had an increase in their PDI scores. P-value <0.001 with 95% CI Median (-11, -7). The mean NPRS score before genicular nerve block and CRFA was 6.98, and the mean NPRS score after CRFA was 4.18. P-value <0.001 with 95% CI Median (-3, -2). The largest group of patients, 49% of patients, had a pain score reduction of 2.25 points, while the next largest group, 17.3% of patients, had a reduction of 0.75 points, followed by 12.5% of patients with a reduction of 3.75 points. When comparing Morphine Equivalent Dose (MED) before and after the CRFA procedure, 37.5% of patients were not on opioid medication at any time during the study; additionally, the MED did not change for the majority of patients (80.77%), while the MED decreased for 13.46% of patients and increased for 5.77% of patients. Mean MED before GNB and CRFA was 17.13 and 15.91 after CRFA. P=0.025 with 95% CI Median (0,0). No serious adverse events were reported.LimitationsRetrospective nature of the study.ConclusionsThis study demonstrates the clinical effectiveness of CRFA for the treatment of chronic knee pain by improvements in PDI scores and NPRS scores for the majority of patients. Results from this study indicate that CRFA treatment provides significant pain relief and reduces the disability caused by chronic knee pain in a patient’s daily life.

scholarly journals Effectiveness of Genicular Nerve Cooled Radiofrequency Ablation on Chronic Knee Osteoarthritis Pain

2019 ◽  
pp. 83-90
Author(s):  
Jonathan Carrier
Keyword(s):  
Statistical Analysis ◽  
Radiofrequency Ablation ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Primary Outcome ◽  
Time Points ◽  
Chronic Knee Pain ◽  
Study Population ◽  
The Mean

Background: Outside of an invasive total knee arthroplasty, the available therapies for the treatment of pain secondary to knee osteoarthritis (OA) provide marginal and short-lived symptomatic relief. Genicular nerve radiofrequency ablation (RFA) serves as an alternative treatment modality for OA-associated knee pain and disability. Objectives: To quantify the effectiveness of cooled radiofrequency ablation (C-RFA) of the genicular nerves for chronic knee pain secondary to OA. Study Design: Retrospective chart review performed using Redcap, implementing current procedural terminology codes. Setting: An academic pain management center. Methods: Study population included patients treated with C-RFA from April 2015 through June 2017. Numeric Rating Scale (NRS) data were analyzed at 3 time points: 2 weeks, 4-6 weeks, and 7-33 weeks post-RFA (extended follow-up). Primary outcome for statistical analysis was NRS and the change in NRS from baseline at each of the 3 predetermined time points. Differences between the change in NRS and the number of diagnostic blocks performed (1 vs. 2) was evaluated. Correlation between the change in NRS and patient body mass index (BMI) was calculated. Results: Pre-RFA average NRS scores were available for 47 knees from 31 individuals, which were included in the analysis. The mean NRS score decreased by 50% at 2 weeks (n = 33; P < 0.001), 55% at 4-6 weeks (n = 18; P < 0.001), and 26% at 7-33 weeks (n = 18; P = 0.009). Eight patients (12 knees) provided specific data on the total duration of relief following RFA. The mean duration was 39 weeks or approximately 9 months. There were no statistically significant differences between groups receiving 1 versus 2 diagnostic blocks at 2 weeks or 4-6 weeks post- RFA. At 7-33 weeks, those who received 1 block had a decrease in NRS of –3.1, whereas those who received 2 blocks had an increase in NRS of +0.1 (P = 0.008). There was no correlation identified between BMI and change in NRS at any time point. Limitations: This study’s retrospective design inherently leads to a higher risk of selection bias. The sample size was relatively small as a high percentage of patients were lost to follow-up. The primary outcome measure for this study was the change in mean NRS pain score, and the mean of ordinal data with a nonnormal distribution lacks validity in statistical analysis. Conclusions: In this study population, C-RFA of the genicular nerves lead to 50% or greater pain relief at 2 weeks and 4-6 weeks postintervention. A 26% pain relief was achieved at 7-33 weeks, but this did not meet the established minimal clinically important difference cutoff. Two diagnostic genicular nerve blocks did not improve the rate of treatment success when compared to a single diagnostic block. BMI does not appear to correlate with outcomes. Key words: Genicular radiofrequency ablation, genicular RFA, cooled radiofrequency ablation, chronic knee pain, knee osteoarthritis

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