A Letter Released to Physicians on March 8, 2008

Immediate Relief for
Chronic Knee Pain

Knee pain accounts for roughly one-third of musculoskeletal problems seen in primary care.¹ Exercise and lifestyle modification serve as the conservative treatment of choice for many, and arthroplasty solves the problem for thousands more. However, for those who are too young, too old, too frail, or otherwise not recommended for knee surgery, the private practice of Neal S. Taub, MD, ABPM&R has options that may be able to provide immediate, long-lasting relief.

One option for knee pain showing very good results at Dr. Taub’s practice is targeted neurolytic blocks using diluted phenol. Nerve blocks around the knee are most commonly thought of as a form of anesthesia and postoperative pain management for knee surgery, but practitioners should also keep this option in mind for refractory chronic knee pain. Dr. Taub finds that 70% of patients receiving neurolytic blocks for knee pain experience immediate relief even though this pain has usually proved refractory to other treatments including intra-articular corticosteroids and viscosupplementation. Pain relief from one treatment lasts two to four months. The injected nerves are not permanently damaged and typically return to normal function. Your patients may have repeated treatments as needed. Types of knee pain often appropriate for nerve block treatments include arthritis, neuromata, patellofemoral pain syndrome, saphenous nerve entrapment, and spasticity related pain and dysfunction.

In addition, Dr. Taub makes nerve blocks around the knee more effective by using ultrasound guidance. Two separate papers published just last year suggest that ultrasound guidance for peripheral nerve blocks and femoral nerve blocks works better than using anatomical landmarks and/or electrical stimulation to localize nerves.^2,3 Use of the less effective guidance techniques sometimes results in multiple attempts to place the needle correctly, patient discomfort, and patient frustration.² As with the shoulder, greater accuracy with nerve blocks around the knee improves the pain relief result.³

Call Neal S. Taub, MD, Physiatrist
for pain management & rehabilitation.

References

1. Rosenblatt RA, Cherkin DC, Schneeweiss R, Hart LG. The content of ambulatory medical care in the United States. An interspecialty comparison. N Engl J Med 1983;309:892-7.

2. Brull R, Perlas A, Chan V. Ultrasound-guided peripheral nerve blockade. Curr Pain Headache Rep. 2007 Feb; 11 (1): 25-32.

3. Casati A, Baciarello M, Di Cianni S, et al. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth. 2007 Jun; 98(6): 823-7.