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Are Genicular Nerve Blocks the Answer to Your Knee Pain?



If you are seeking a breakthrough treatment in managing knee osteoarthritis pain, then you are in the right place. Today we’re going to explore the world of genicular nerve blocks. This innovative treatment offers a beacon of hope for those battling knee pain, particularly for those who cannot undergo surgery or haven't found relief with conventional methods. I’m going to discuss what genicular nerve blocks are, compare their effectiveness to other treatments like physical therapy and cortisone injections, and reveal how this cutting edge treatment can transform your daily life. 


Genicular nerve blocks are an advanced treatment for knee osteoarthritis. They provide significant relief by targeting the genicular nerves responsible for transmitting knee pain to the brain. This procedure involves injecting a local anesthetic near these nerves. The beauty of this procedure is that even though the local anesthetic’s immediate effect dissipates after a few hours, patients often experience sustained pain relief extending for several months.


There are three genicular nerves that are usually targeted at the time of the procedure. These include the superolateral genicular nerve, the superomedial genicular nerve, and the inferomedial genicular nerve. These injections are done in the office setting with ultrasound guidance and are extremely safe with very low risk of side effects or complications. 


Ok so that’s how genicular nerve blocks work, but what does the clinical trial evidence say about their effectiveness and safety? Are these innovative treatments as promising in practice as they appear in theory?


This randomized controlled trial compared genicular nerve blocks to placebo for those suffering from knee osteoarthritis. The findings revealed that participants receiving the nerve block experienced significantly greater improvements in pain and functional scores compared to those who received the placebo. However, it was noted that these beneficial effects gradually decreased over the three-month duration of the study.


And how do genicular nerve blocks compare to other treatments such as physical therapy? This study randomized over 100 patients to receive either a genicular nerve block or 10 sessions of physical therapy. After three months, both groups displayed similar improvements in pain scores.


However, by the 12 week mark, those in the genicular nerve block group demonstrated a more significant increase in walking distance. These findings indicate that while both treatments are effective in reducing pain and improving function, genicular nerve blocks may provide superior long-term benefits in terms of physical capacity for individuals with knee osteoarthritis.


Now let’s compare the nerve block to cortisone injections. This study compared a single cortisone injection to a cortisone injection plus a genicular nerve block. While participants in both groups experienced notable improvements, those who received both the cortisone injection and the genicular nerve block showed more substantial improvements across various measures. These included pain levels, functional status, and overall quality of life. The study highlights the added effectiveness of incorporating genicular nerve blocks alongside cortisone injections.


Lastly, safety is really important when we talk about medical interventions. This systematic review not only found that genicular nerve blocks are effective in reducing pain and enhancing functional abilities, but that there were no adverse effects associated with the procedure. They report that none of the nine included studies raised any safety concerns.


Ok, so after evaluating the data comparing genicular nerve blocks to other treatments like physical therapy and cortisone injections, I’d like to share my perspective on how these blocks can be integrated into a broader and more effective strategy for managing knee osteoarthritis.


Firstly, genicular nerve blocks are a very safe procedure. The majority of the studies we’ve reviewed use local anesthetics like lidocaine, which are known for their safety and minimal side effects. This makes me much more confident in recommending this procedure to my patients.


Secondly, the primary benefit of genicular nerve blocks is seen in the initial 1 to 2 months, where they significantly improve pain and function. However, it’s important to note that most studies indicate a slow and gradual return to baseline pain and function levels after about 2 to 3 months.


That’s why genicular nerve blocks are best combined with physical therapy and exercise therapy. Remember, a key aspect of treating knee osteoarthritis is both aerobic exercise and muscle strengthening exercise. And the unfortunate reality is that many people are stuck in a catch 22. They want to start exercising again but they can’t because the pain is so severe. And while you can try Advil or Aleve or Tylenol or even cortisone injections, sometimes those just don’t work well enough. 


This is where genicular nerve blocks can really be a game changer. They serve as an adjunctive treatment that can provide substantial short term pain relief which in turn enables people to engage in exercise therapy. Exercise therapy is not only one of the best long-term pain management strategies but also plays a crucial role in slowing the progression of arthritis. This is true for those with mild arthritis and even severe bone on bone arthritis. 


The one last thing to consider is insurance coverage. Procedures like genicular nerve blocks may be covered by Medicare and private insurances under specific conditions, though it’s worth noting that many PPO plans require prior authorization, which can complicate the process. You’ll want to find out from your specific insurance plan if genicular nerve blocks are a covered benefit.


Ok so with all this in mind, I do recommend genicular nerve blocks, but specifically for patients experiencing severe pain where conventional treatments have been ineffective. It’s crucial to recognize that these nerve blocks are not a cure-all solution, but rather an adjunctive treatment. They are particularly valuable for patients who are not suitable for knee surgery, those who prefer to delay surgery, or those who haven’t achieved sufficient relief from other pain management methods.


Now I also mentioned earlier that genicular nerve blocks combined with a cortisone injection leads to better outcomes. But cortisone has side effects which can damage healthy cartilage. There’s something even better than cortisone that studies show have an even greater impact in relieving arthritis symptoms. Check out this deep dive video where I’ll reveal what it is and how it can transform your quality of life.

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