written by

Richard Coursey, MD

Dr. Richard Coursey is a Vascular and Interventional Radiologist in northern Colorado

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October 8, 2019

A Physician’s Perspective: Dr. Coursey talks about genicular nerve radiofrequency ablation

Dr. Richard Coursey, Jr. speaks on his experience performing this life-altering procedure.

100 million Americans suffer from chronic pain, and knee pain is the second most common cause of chronic pain.

Typical therapies for people trying to manage their knee pain include over the counter medications, physical therapy, and then injections in their knees. When these therapies either don’t help much, or just don’t offer pain relief for long enough, patients find themselves having to learn to just deal with the daily pain, stop being physically active to avoid the pain, or go on to have a knee replacement.

While knee replacement is a very good option to treat knee pain, not everyone is a good candidate for knee replacement (too young for a knee replacement, or not medically fit to undergo a surgical procedure). Knee joint replacement is also not a guarantee that a patient will never have knee pain again. In fact, some research shows that up to 20% of patients can still experience chronic knee pain after a total knee replacement.
Newer technologies, however, are changing the way we treat knee pain, and not only are these new therapies minimally invasive, but they can be performed on an outpatient basis, in less than an hour.

Radiofrequency ablation (RFA) is a technology that has been around for decades. The basic concept is that a small needle is placed into the body in a desired area, the needle is turned on, and the needle heats up to burn or ‘zap’ a tiny problem spot. This therapy has been used to help people suffering from chronic back pain for many years, and more recently it has been used to treat chronic knee pain as well. Genicular nerve radiofrequency ablation uses RFA on the knee to achieve pain relief results.

When I first see patients in clinic about their knee pain, we review all of their history, including what has been tried in the past, what worked, and what didn’t. If the patient is a good candidate for something more than the normal treatment options described above, they are first scheduled for a ‘test injection’ where the three tiny nerves that allow the knee joint to feel pain are numbed. Patients are then instructed to go home and do things that normally would bother their knees, and to keep track of their pain levels.  If a patient gets more than a 50% pain reduction while the test injection/block is working, he/she is a good candidate for the knee RFA.

The RFA procedure is done with IV pain medication, numbing medication, and is performed just like the test injection/block, only the needles get hot this time to zap the tiny nerves. The RFA procedure usually takes between 15-20 minutes per side, start to finish. This procedure is done as an outpatient, does not require an incision, and involves almost no recovery time. Typical symptoms after treatment include mild discomfort in the areas where the needles were placed. This procedure does not affect the ability of the knee joint to move, it simply just cannot feel pain anymore.

image showing rfa procedure

Genicular nerve ablation.

50-60% of patients treated with this therapy see good relief of their pain for 9-12 months. As the small nerves that were treated start to grow back, pain will start to also return. The process by which this occurs is slightly different in every patient, changing the duration of how long a patient may get relief from this procedure. When pain returns, the procedure can be repeated.

Virtually all adult patients are candidates for this procedure if they respond to the initial test injection/block. This therapy even works to help treat chronic pain after a total knee replacement has been performed. Because no anesthesia is involved, it is safe to perform this procedure on patients in pain who are otherwise too unhealthy to undergo surgery. This procedure can also be performed steroid free, helpful to those whom are unable to tolerate steroid injections because of allergies or other health problems.

If you or a loved one have knee pain and your symptoms have not been adequately controlled, schedule a consultation with Dr. Coursey by calling 303-930-2849. Dr. Coursey performs this procedure and others to treat chronic knee pain at McKee Medical Center in Loveland, and North Colorado Medical Center in Greeley, Colorado. If you are in the Denver area you can call 720-493-3406 to schedule an appointment with Dr. Tony Brown at the RIA Interventional Suite.