The knee is made up of 3 joints with complex anatomies. Knee pain can come from a variety of sources & finding the diagnosis is key. Once diagnosed, besides surgery, medications, & steroid injections, there are minimally invasive treatment options that can help reduce pain.
3 common sources of knee pain
- Osteoarthritis: the knee sustains wear & tear from daily use, causing inflammation and/or pain. The pain in turn causes protective muscle spasms above & below the knee. Osteoarthritis is more frequent in women, those who are overweight, with knee trauma, ACL tear, or low bone density. While knee replacement is the definitive solution, temporary pain relief procedures can give flexibility on scheduling the replacement surgery.
- Patellofemoral syndrome: a common condition involving pain at the interface between the kneecap and the femur. This condition is seen in athletes with muscle strength imbalance, overuse, traumatic injury, and certain knee surgeries.
- Post surgery: rarely, patients develop chronic pain even a successful knee surgery from nerves too small to avoid: infrapatellar branch of the saphenous nerve in knee replacements & skin nerves in arthroscopic surgeries. Rarely this may lead to complex regional pain syndrome (CRPS). (See “painful scar neuroma” handout)
Professionally guided active exercise is fundamental to knee pain treatment. A good option is aquatherapy in warm pool which reduces weight-bearing on the knee.
The knee responds particularly well to topical pain medications. The typical medication used is diclofenac, an anti-inflammatory, but additional medications can be used in a compounded mixture.
For knee joint pain, patients can get long-lasting relief for 3+ months at a time with a non-surgical needle procedure where the 4 small nerve endings connecting the knee joint to the brain are ablated. This out-patient procedure may be particularly helpful for patients who are not surgical candidates.
Novel therapies actively being studied
- Turmeric reduces inflammation. Some patients respond better to liquid formulation vs gel, or vice versa.
- Cabbage patch applied topically to the knee itself has been found to help reduce inflammation & pain. The mechanism of action is unclear.
- Botox injection into the knee joint reduce pain by lowering pain fiber activity, in turn reduce neurogenic inflammation.
Pain physician & PhD computational biologist @StanfordPain • Advanced pain interventions with CIPS & FIPP • Opinions mine & not medical advice