A new, non-invasive knee procedure could bring some relief for patients suffering from debilitating chronic pain, for whom surgery is not an option.
The treatment, recently approved by the Food and Drug Administration, is called “cooled radio frequency ablation” and is a less drastic option for people with moderate to severe osteoarthritis pain who are not ready to have knee replacement surgery, or who have health conditions that don’t make them a good candidate for surgery.
Marketed as “Coolief”, the procedure uses radio frequency to target and mute the nerves responsible for sending pain signals from the arthritic knee to the brain. Coolief doesn’t repair arthritis in the knee, but eases the pain, helping patients go back to activities without discomfort and fewer medications.
“What we’re changing is the wiring of the knee — so we’re taking away the pain signal and interrupting it,” Dr. Amin Sandeep, a pain specialist at Rush University Medical Center in Chicago who performs the procedure, told NBC News.
One 2016 study compared Coolief to popular cortisone injections, with patients reporting greater, longer-lasting pain relief with the new treatment than injections. Coolief reduces pain for about to 6 to 12 months, depending on how fast the nerves in the knee regenerate.
Osteoarthritis can affect any joint when the cartilage wears off over time, often striking big joints like the knee, causing pain, swelling and stiffness. According to the American Academy of Orthopedic Surgeons, nearly 10 million Americans had osteoarthritis of the knee in 2010.
The three current recommended approaches for knee arthritis pain are physical therapy, non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, or the opioid painkiller tramadol.
But those didn’t help Felicia McCloden, a 65-year-old grandmother from outside of Chicago. The excruciating pain in her right knee made simple tasks like grocery shopping impossible.
“I had inflammation, swelling, and my knee was like the size of a golf ball, McCloden told NBC News. “The arthritis was so bad that I could barely step down without severe pain.”
Because she wasn’t eligible for a knee replacement she tried cortisone injections, physical therapy, medications — nothing relieved her pain.
“I thought I was going to limp for the rest of my life,” she said.
In May, McCloden underwent the Coolief treatment and the result was instant.
“I couldn’t even imagine first of all, not having the pain,” she said. “It erased all of that.”
The outpatient procedure typically takes about 40 minutes, is performed with local anesthesia and doesn’t require an incision. Instead, doctors use specialized needles that emit radio frequency waves into the knee. The cost of the treatment is between $2,000 and $4,000. Because it was just approved by the FDA in April, the treatment is not widely available yet, but pain centers across the country are beginning to offer it.
Some of the reported risks from the procedure include bleeding and infection. “Though patients have a risk of the physician hitting the wrong nerve, that is extremely rare in the hands of an experienced professional”, Amin said.
Recovery time is minimal, with most patients walking immediately after the procedure and resuming normal activities in a day or two.
For some patients with structural problems of the knee, the procedure won’t help, said pain specialist Dr. Edgar Ross, associate professor of anesthesia at Brigham and Women’s Hospital.
“But let’s say a patient is younger, instead of going for a total knee replacement early, which might have to be repeated later on, Coolief can postpone the need for the total knee replacement,” Ross told NBC News.
Coolief can be repeated if necessary, but it’s not a permanent solution. While it reduces pain, it can’t stop the progression of osteoarthritis.
“While it can delay total knee replacement, knee replacement may still eventually be necessary in a big number of patients,” said Dr. Dennis Cardone, associate professor of orthopedic surgery at NYU Langone Medical Center.
From: NBC News
Author: LAUREN DUNN and FELIX GUSSONE, MD