Chronic Knee Pain That Won’t Go Away? When Genicular Nerve Ablation May Help

Standing up from a squat. YOW!

Climbing the stairs. EEK!

Taking a few routine steps. OH COME ON!

When your knee pain becomes so bad that even the most routine motions make it flare up, it’s time to seek treatment.

Everyone’s heard of knee replacement surgery – but don’t assume that’s what you need.

There’s a less invasive therapy option available, and it may be more appropriate for your situation. Read through as we explain what genicular nerve ablation is, when you would need it, and how we get there.

Why you still have knee pain when nothing is “wrong”

Because knee arthritis is a degenerative wear-and-tear condition, meaning it gradually worsens over time. As people age (or following an injury) it is common for the cartilage in the knee to progressively break down, allowing your bones to rub against each other and causing pain, swelling, and stiffness. Anyone who has experienced knee arthritis knows that walking – especially up and down stairs – can become excruciating.

As that cartilage starts to wear down, the smooth, protective padding in the knee starts to fade. Without that important layer, the nearby sensory nerves become more sensitive. Pain signals are amplified and the brain starts interpreting normal signals as pain. So even though there appears to be no structural damage, your pain is rather unbearable.

What are genicular nerves?

Put simply, the sensory nerves that surround the knee joint. We have five of them, and each one is responsible for providing sensation to a different section of the knee. What kind of sensation? Generally, the genicular nerves transmit pain signals to the brain.

In modern interventional knee pain treatment, genicular nerves are often the target. When more conservative treatments fail to help chronic knee arthritis or post-knee replacement pain, medical professionals will turn to the genicular nerves.

Step-by-step treatment plan

Genicular nerve treatment is best administered on a step-by-step basis. Just like we don’t jump directly to knee replacement, we don’t jump to nerve ablation either. These are the progressive care options your doctor can move you through based on your body’s response to each step.

1) Conservative care

When treating chronic knee pain, we start as conservatively as possible, meaning the least invasive treatments first. At this stage, the aim is to reduce inflammation, improve joint function, and strengthen surrounding muscles.

NSAIDs (ibuprofen, naproxen) and topical anti-inflammatory gels can temporarily decrease pain to improve function, but will not address structural or nerve issues.

When thinking about treating knee pain non-medically, we must also look at lifestyle habits. Losing weight and improving your movement mechanics are two ways to organically increase your odds of avoiding surgery. Getting physical therapy to strengthen surrounding muscles and increase range of motion can attack the problem from a different angle. Reducing high-impact activities (like running or squatting) rather than fully avoiding them may produce moderate gains.

The important principle is that knee pain should be treated without a procedure for as long as possible.

2) Steroid injections

Corticosteroid injections can also temporarily reduce inflammation, but will not address the root issue. You can count on some significant pain relief within days and lasting weeks or months, but will see diminishing returns the more frequently you use this option. As with most conservative treatments, if your pain is in fact nerve-mediated, you’ll eventually wind up back at square one.

3) Diagnostic genicular nerve block

This is a test run to determine whether Step 4 will have the desired effect, but let’s not get ahead of ourselves just yet.

The primary objective of a diagnostic genicular nerve block is to temporarily block pain signals from a particular nerve set and see if the patient’s pain subsides. That’s how we identify whether that is in fact the cause of the pain.

If the diagnostic block kills at least 50% of the pain, we have our answer: it proves the pain is stemming from those specific nerves. A “successful” nerve block makes that patient a candidate for a genicular nerve ablation.

4) Genicular nerve ablation

When our diagnostic nerve block has identified the source of a patient’s knee pain, we can go ahead with a nerve ablation, which is a longer-lasting pain relief option than medication, gels, and injections.

Here’s what you should understand about genicular nerve ablation: it doesn’t fix the knee. It changes how pain is communicated. The procedure uses frequencies and heat to basically cook the target pain-transmitting nerves in order to disrupt the process of reaching the brain.

Of course, sensory nerves eventually regenerate around the two-year mark, meaning a repeat operation is typically required.

5) Knee replacement

When advanced structural damage is present and life-altering pain is recurring despite all the conservative treatments mentioned above, we turn to knee replacement.

While genicular nerve ablation targets the pain signals, a knee replacement deals with the actual knee structure, replacing damaged joint surfaces and restoring your knee’s mechanical function.

When we see bone contacting bone due to significant joint space loss, we know it’s probably time for a knee replacement.

But not all severe knee pain qualifies a patient for this surgery. Making the call depends on the primary driver of pain: is it mechanical damage or nerve sensitivity?

Am I a good candidate for genicular nerve ablation?

You’re still wondering: will genicular nerve ablation actually help me?

Here’s the question we’re asking: is your pain being driven by nerve signals that can be targeted effectively?

If you have chronic, long-lasting knee pain that hasn’t responded positively to the conservative treatments outlined above, you may be a prime candidate for genicular nerve ablation.

Here are some typical profiles of patients to be evaluated for genicular nerve procedures:

• Patients with mild, moderate, or severe knee arthritis that haven’t had success with medication or physical therapy but aren’t quite ready for surgery.
• Patients that need, but want to delay, knee replacement surgery. Often, there’s a big work or family obligation that stands in the way. Sometimes, the patient just isn’t mentally ready.
• Patients that shouldn’t have surgery. Older patients. Those with cardiovascular issues or complicated medical profiles. People that have had previous surgical complications.

If your pain source is unclear, you have an acute injury, or you have mechanical issues, you are NOT a good candidate for genicular nerve ablation.

How Hudson Pain and Spine can help

Folks in the Englewood, New Jersey area with chronic knee pain should contact Hudson Pain and Spine. Dr. Saurabh Dang, a double board-certified pain management specialist and an expert in genicular nerve treatment. He can help determine the best treatment plan for you.

If your pain lasts more than two weeks, includes radiating pain, numbness, tingling, or weakness, and limits your ability to work, sleep, or do normal activities, contact Hudson Pain and Spine to schedule a consultation.

Hudson Pain and Spine
25 Rockwood Place, Suite 335, Englewood, NJ 07631
Phone: (201) 605-9000