Cooled Radiofrequency Ablation for Pain Relief After Total Knee Replacement

PainRelief.com Interview with:

Felix Gonzalez, M.D.
Assistant professor, Division of Musculoskeletal Imaging
Department of Radiology and Imaging Scienc
Emory University School of Medicine
Atlanta, Georgia

Dr. Gonzalez

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Total knee arthroplasty is a common procedure performed worldwide for the treatment of symptomatic knee arthritis. Unfortunately, approximately 20% of those patients develop chronic pain after the surgical intervention in the setting of no complications such as infection or hardware loosening. The reason for this is not known at this point although theories exist.

The new study focused on 21 patients who were experiencing persistent chronic pain after total knee replacement, without underlying hardware complications. The patients had all failed conservative care. They filled out clinically validated questionnaires to assess pain severity, stiffness, functional activities of daily living and use of pain medication before and after the procedure. Follow-up outcome scores were collected up to one year after the C-RFA procedure.

In the end, the study found, patients with knee arthritis reported an 70% drop in their pain ratings approximately, on average.

Study Compares PRP to Placebo For Pain Relief in Knee Arthritis

PainRelief.com Interview with:

Professor Kim Bennell FAHM
Barry Distinguished Professor | NHMRC Leadership Fellow
Dame Kate Campbell Fellow
Centre for Health Exercise and Sports Medicine
Department of Physiotherapy
Melbourne School of Health Sciences
The University of Melbourne, Victoria Australia

Prof. Bennell

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis is a common chronic painful joint condition with no cure that often leads to costly joint replacement surgery. Treatments are needed that can not only reduce symptoms but also slow structural progression of the disease in order to reduce the burden of knee OA.  There are no approved disease-modifying treatments available at present. 

Platelet-rich plasma (PRP) injections have become a widely used treatment for knee osteoarthritis (OA) in recent years despite the fact that the evidence to support their effects is limited and not of high quality. For this reason, clinical guidelines currently do not recommend PRP for the management of knee osteoarthritis.

To address this gap in knowledge, our study aimed to compare the effectiveness of PRP injections to reduce knee pain and slow loss of medial tibial cartilage volume over a 12-month period. We did this by conducting a clinical trial of 288 people with mild to moderate knee OA. The study included a placebo group where participants were injected with saline into the knee. Participants and the injecting doctors were blind as to whether PRP or saline was injected into the knee.

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Caution Should Be Taken with Hip Steroid Injections For Arthritis Pain Relief

PainRelief.com Interview with:
Kanu M. Okike, MD
Orthopedic Surgeon
The Hawaii Permanente Medical Group

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Hip corticosteroid injections are a common treatment for osteoarthritis and other hip conditions.  Recently, isolated case reports have raised the question of whether hip corticosteroid injections could be associated with rapid progression of the arthritis process – a condition known as rapidly destructive hip disease (RDHD).

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Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

PainRelief.com:  What is the background for this study?

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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Synovial Stem Cells Injected into Knee Repaired Meniscus without Tumor Formation

PainRelief.com Interview with:
Mitsuru Mizuno, DVM, Ph.D.
Assistant professor at CSCRM,
Principal investigator for this study
and Ichiro Sekiya, M.D., Ph.D..

PainRelief.com:  What is the background for this study?  What are the main findings? How are the stem cells obtained?

Response: We have developed a cell therapy for treating difficult-to-heal meniscus injury using mesenchymal stem cells (MSCs) derived from the synovium of the knee. However, trisomy 7 is often found in synovial cells obtained from patients with osteoarthritis, a disease that occurs with aging.

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Genicular Artery Embolization: A Promising Therapy for Pain Relief from Knee Arthritis

PainRelief.com Interview with:
Dr. Siddharth A. Padia, MD
Interventional Radiology
Ronald Reagan UCLA Medical Center
UCLA Santa Monica Medical Center

Dr. Padia, MD

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis (OA) of the knee can be a debilitating condition with significant impact on a person’s overall quality of life. OA has historically been considered a “wear-and-tear” disease, resulting from years of stress induced cartilage degeneration. Recent data suggests that inflammation plays a role not only in the experience of pain secondary to osteoarthritis, but is a driver of OA itself. 

Genicular artery embolization (GAE) is a minimally invasive procedure where the arteries supplying the lining of the knee are selectively catheterized during an angiogram to target abnormally increased blood flow associated with knee osteoarthritis. Injection of small, microspheres results in a reduction in arterial flow, which may in turn reduce the synovial inflammation. 


PainRelief.com: What are the main findings?

Response: 40 subjects were enrolled in this trial. Technical success was achieved in 100% of subjects. Transient skin discoloration and transient mild post-procedure knee pain were common and expected. Pain scores decreased from a 8 (out of 10) at baseline to 3/10 (63% decrease) at 12 months. Twenty-seven patients (67.5%) had greater than a 50% reduction in pain scores. 

PainRelief.com: What should readers take away from your report?

Response: Genicular artery embolization is a highly promising therapy for people with knee arthritis, who are not surgical candidates or which to defer surgery. It is the first non-surgical treatment that has shown to have a significant reduction in pain with a duration of at least one year. It is minimally invasive, and most people can resume their everyday activities the evening after their procedure. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: This was a single arm trial, in that genicular artery embolization was not compared to other treatments. Future research needs to show a comparison to other treatments or placebo in order to prove its efficacy. Additionally, long-term result (2 and 4 years) would be beneficial to show the durability of GAE over time. 

Citation:

Abstract No. 16 Genicular artery embolization for the treatment of knee osteoarthritis: final results from a prospective investigational device exemption trial
Padia, S. et al. Journal of Vascular and Interventional Radiology, Volume 32, Issue 5, S8

https://www.jvir.org/article/S1051-0443(18)31829-3/fulltext

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Fusion vs Replacement for Pain Relief from Ankle Arthritis

PainRelief.com Interview with:
Bruce J. Sangeorzan, M.D.
, Professor
Director, RR&D Center for Excellence in Limb Loss Prevention and Prosthetic Engineering
Veterans Affairs
University of Washington

PainRelief.com:  What is the background for this study?

Response: We began a series of studies in the early 2000’s when ankle replacement was limited to a few centers like our own. We knew that ankle arthrodesis– or fusion—was an effective treatment for ankle arthritis. But ankle fusion is not appropriate for some people and it also results in loss of ankle motion. There were a growing number of ankle replacements being done but little was known about their effectiveness or how long they last.

We wanted to study whether replacement and fusion were comparable for pain relief and activity and wanted to know if maintaining motion of the ankle (by using a replacement) would have an advantage without additional risk. Three studies were done involving more than 800 patients from 6 centers.

This most recent study compared two groups of patients who had similar amount of pain and activity before treatment. All of the patients had already tried non -surgical solutions such as activity modification, bracing and injections with out improvement. One group had fusion of the ankle and the other had replacement of the ankle. Patients were questioned and examined four years or more after surgery and compared to their condition before treatment.

Do NSAIDs Accelerate Progression of Knee Osteoarthritis?

PainRelief.com Interview with:
Dr Thomas Perry PhD| Postdoctoral Research Fellow
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research 
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences

Dr Thomas Perry PhD| Postdoctoral Research Fellow
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research 
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences
Dr. Perry

PainRelief.com:  What is the background for this study?

Response: Management of knee osteoarthritis (OA) is multi-factorial and routinely involves the use pharmacological interventions; with most medications aimed at alleviating painful symptoms and improving function.

Little is known of the long-term effects of such medications on the structural progression of radiographic knee OA. Through examining the relationship between pharmacological interventions and the disease pathway, this may, in turn, identify potential areas for disease-modifying treatment development.

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Hand Arthritis: Supplement Did Not Provide Pain Relief

PainRelief.com Interview with:
Xiaoqian Liu
Clinical research fellow (Wednesday/Thursday)
Rheumatology Department| Royal North Shore Hospital
Institute of Bone and Joint Research | Sydney Medical School

hand arthritis

PainRelief.com:  What is the background for this study?

Response: Hand osteoarthritis (HOA) is a prevalent joint disease, causing symptoms in up to 10% of the general adult population worldwide. Hand pain is the most common symptom in addition to functional disability and decreased quality of life. Due to the modest effects and/or potential harms, current traditional treatment such as exercise, non-inflammatories and analgesics frequently do not meet patients’ demand. More and more people are turning to complementary and alternative medicines for pain relief.

In our previous work, we identified four dietary supplements with promising treatment effects for relieving pain which are Boswellia serrata extract, curcumin, pine bark extract and methylsulfonylmethane (MSM). The hypothesis was that combining these supplements to generate an enhanced benefit for people with HOA. The aim of the RADIANT study was to investigate the efficacy and safety of a 12-week course of this supplement combination in people with painful HOA who were confirmed with the diagnosis on their hand x-ray.

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High and Low Intensity Weight Training May Reduce Pain From Knee Osteoarthritis

PainRelief.com Interview with:
Stephen P. Messier, PhD
.B. Snow Biomechanics Laboratory
Department of Health and Exercise Science
Wake Forest University
Winston-Salem, North Carolina

Stephen P. Messier, PhD .B. Snow Biomechanics Laboratory Department of Health and Exercise Science Wake Forest University Winston-Salem, North Carolina
Dr. Messier

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis and whether it may worsen symptoms.

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