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 Comparative Effectiveness of Papaya Leaf Stew (Carica Papaya Linn) With Turmeric Acid (Curcuma Domestica Val-Tamarindus Indica) Against Primary Dysmenorrhea

2018 ◽  
Vol 1 (2) ◽  
pp. 120-127
Author(s):  
Yunita Liana
Keyword(s):  
Young Women ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Average Score ◽  
Control Group ◽  
P Value ◽  
Primary Dysmenorrhea ◽  
Control Group Design ◽  
Before And After ◽  
The Mean

Young women often feel primary dysmenorrhoea because the hormonal cycles experienced are not stable, this can disrupt the concentration and activity of young women. The principle of back to nature is increasingly popular today, the side effects of chemical drugs can cause new problems, it is one of the driving force of the development of traditional medicine. Papaya leaves contain Vitamin E which can reduce dysmenorrhea. In addition, turmeric acids also contain curcumine and anthocyanins that inhibit cyclooxygenase, thereby reducing the occurrence of inflammation during uterine contractions. The aim of this research is to know the effectiveness of papaya leaf stew with acidic turmeric to primary dysmenorrhea. Type of Research is an experimental study with a Pretest-Posttest Control Group Design design. The sample is 30 people. The research was conducted on December 27, 2017 s.d February 24, 2018 at SMP Negeri 46 Palembang. Instrument to measure pain Numeric Rating Scale. The statistical test used by Wilcoxon and Mann Whitney U. Average score of pain before papaya leaves stem 5.40 ± 0.73 while the mean score of pain after given turmeric acid 5.33 ± 0.61 The mean score of pain after being given papaya leaves stew 3.60 ± 0.91 while the mean score of pain after given turmeric acid 4.06 ± 0.79. There was a difference of mean score of dysmenorrhea pain before and after given papaya leaf stem p value = 0.000. There is difference of mean score of dysmenorrhea pain before and after given turmeric acid p value = 0,002. There was no difference of mean score of dysmenorrhea pain before and after given papaya leaf sting and turmeric acid p value = 0,217. The decoction of papaya leaf and turmeric acid have the same effectiveness in reducing primary dysmenorrhea pain.

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.

scholarly journals Correlations between Ratings of Pain, Disability and Impairment in Chronic Whiplash-Associated Disorder

1997 ◽  
Vol 2 (4) ◽  
pp. 207-213 ◽  
Author(s):  
Howard Vernon
Keyword(s):  
Rating Scale ◽  
Neck Disability Index ◽  
Physical Impairment ◽  
P Value ◽  
Pain Disability ◽  
Pain Scores ◽  
Disability Rating ◽  
Chronic Whiplash ◽  
Neck Disability ◽  
Whiplash Associated Disorder

OBJECTIVE: To investigate the level of correlation among pain, disability and physical impairment scores in chronic whiplash-associated disorder patients.SUBJECTS: Adults with chronic whiplash-associated disorder referred for secondary independent assessment.METHODS: Forty-four subjects (16 males, 28 females) were included in the sample. Self-rated pain was measured on a five-point verbal rating scale. Self-rated disability was measured using the Neck Disability Index (NDI) and the Disability Rating Index (DRI). Physical impairment was measured as active cervical ranges of motion obtained with a cap goniometer. Descriptive statistics were reported and Pearson product moment correlations were obtained with the P value at 0.01.RESULTS: Mean ± SD age of the subjects was 36.4±8.7 years. Mean duration of complaint was 15.2±12.3 months. Mean pain score out of 5 was 2.5±1.2. Mean NDI and DRI scores were 23.2±9.3 out of 50 and 21.6±9.1 out of 48, respectively. These scores correlated very highly (r=0.89, P=0.0001). The average reduction of ranges of motion compared with published norms was approximately 25%. The correlations among ranges of motion, NDI, DRI and pain scores ranged from -0.32 to -0.66 (P<0.05 to P=0.0001). Age and duration of complaint correlated poorly with ranges of motion.CONCLUSIONS: The self-ratings of pain and disability obtained from these chronic whiplash-associated disorder sufferers appear to be consistent with, and correlate reasonably well with, levels of physical impairment. Physical impairment ratings do not appear to correlate well with duration, which suggests that factors related to pain and physical impairment may play an important role in the development of chronicity in whiplash-associated disorder.

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 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

scholarly journals Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

2022 ◽  
Vol 2 (2) ◽  
pp. 253-257
Author(s):  
Aidyl Fitrisyah ◽  
Stevanus Eliansyah Handrawan ◽  
Nurlaili Maya Ramadhanty
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Rating Scale ◽  
Womac Score ◽  
Assessment Tools ◽  
Chronic Knee Pain ◽  
Total Knee

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.  

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.

The response to radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints

2018 ◽  
Vol 18 (4) ◽  
pp. 747-753
Author(s):  
Olav Rohof ◽  
Chee Kean Chen
Keyword(s):  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Controlled Trial ◽  
Case Series ◽  
Interventional Treatment ◽  
Medial Branch ◽  
Pain Disability Index ◽  
The Mean ◽  
Facet Joint Pain

AbstractBackground and aimsThe evidence for interventional treatment of thoracic facet joint pain remains limited. This is partly due to inconsistency of the path of thoracic medial branches and a lower incidence of thoracic facet pain among spine pain patients. The purpose of this study is to evaluate the efficacy of bipolar radiofrequency (RF) neurotomy of medial branches for treating chronic thoracic facet joint pain.MethodsThis is a retrospective record review of all patients diagnosed to have thoracic facet pain with diagnostic block and subsequently treated with bipolar RF neurotomy of medial branch between January 2012 and December 2015. The outcome measures were mean changes in Numeral Rating Scale (NRS) and Pain Disability Index (PDI).ResultsThere were 71 patients with complete data available for analysis. The mean age of the patients was 57.9±11.2 years. The mean duration of pain was 23±10.5 months. The majority of patients (82%) had pain reduction of more than 50% at 12 months after bipolar RF neurotomy. The NRS decreased significantly from baseline of 7.75±1.25 to 2.86±1.53 at 3 months and 2.82±1.29 at 12 months post-procedure (p<0.001.p<0.001, respectively). The PDI improved significantly from 40.92±12.22 to 24.15±9.79,p<0.05). There were no serious adverse effects or complications of the procedure reported in this study.ConclusionsBipolar RF neurotomy of thoracic medial branch is associated with a significant reduction in thoracic facet joint pain. The promising findings from this case series merit further assessment with prospective, randomized controlled trial which will produce a more reliable and accurate finding for its clinical applications.

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.

Sign in / Sign up

Export Citation Format

Share Document