The health industry has been working hard to devise means of effectively relieving the patients of their chronic knee osteoarthritis (OA). Apparently, some of the techniques the health practitioners used to propose as effective in terms of handling the knee OA menace included non-drug treatment such as exercise, weight loss, acupuncture, balneotherapy, transcutaneous electrical nerve stimulation (TENS), knee braces, sleeves as well as other devices, and canes & clutches. The above means of treatment have offered relieve of pain to many patients suffering from knee OA over the past century. Further, the health physicians also employ the use of medication as a means for relieving knee OA, which include the application of Acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs, Corticosteroid injections, Hyaluronic acid injections and risedronate (Actonel). Other techniques include the use of supplements such as avocado soybean unsaponfiables used in surgery, which include the application of joint lavage and arthroscopic debriment, ostenomy and joint-preserving surgery, and unicompartmental knee replacement methods. Other popular techniques included the use of Glucosamine, and Chndroistin sulfate that plays a huge role in relieving the pains of the patients. The techniques above do not form part of the sham treatment that also serve the same purpose of relieving knee OA temporarily. Researchers investigated the best practices that would work more effectively to relieve the pains. Cryoneurolysis works better in terms of temporarily helping the knee OA patient to relieve the pain during the chronic pains. Therefore, in adults with chronic knee pain associated with osteoarthritis, cryoneurolysis is an effective and temporarily means of reducing pain compared to sham treatment.

Cryoneurolysis is the direct use of low temperatures that reversibly kills the peripheral nerves and providing pain relief to an affected body. Contemporary technologies have led to the development of a handheld cryoneurolysis device that has small gauge needles as well as an integrated skin warmers, thus broadening the clinical application of the treatment of superficial nerves. This application further enables the treatment for pre-operative pain, chronic pains, post-surgical pains, and muscle movement disorders. The technique above has been traditionally used for over the past fifty years with little complications reported from the use of this technique. The technique also does not have any bad records as pertains to its application forthwith to the body or wound. Moreover, traditional application of this technique focused majorly on the surgical incision, even though the contemporary technical improvements allow for the percutaneous administration. The United States has approved the contemporary handheld device that administers the technique to an ailing body that is experiencing the postoperative and chronic pain status as well as spasticity. Apparently, the technique has been more effective as compared to the use of opioid and the incorporation of the Diagnostic Related Group Codes and other contemporary technological developments that include other sham treatment techniques. Apparently, acupuncture has been one of the traditional techniques used by mostly the Chinese to reduce the pain. This traditional medicine involved inserting the thin, sharp needles at particular points of the ailing body. The technique has been touted as the treatment of osteoarthritis pain for a long time. However, during a recent analysis of the 16 most randomized controlled trials conducted by Corbett et al., (2013) found the technique uncertain in treating the patients and relieving them of their pains. This means that the technique is not as reliable as it was supposed to work. Moreover, the many other randomized techniques also did not meet the criterion for an effective pain reliever as far as the age factor was concerned.

According to Radnovich et al. (2017), patients suffering from knee OA spend approximately 50% of their post-diagnosis time applying conservative and nonsurgical treatment techniques since total knee arthoplasty (TKA) is normally reserved for patients suffering from end-stage disease resulting from the limited implants as well as the associated risks and the rocketing cost of surgery. Visconsupplementation and Intra-articular (IA) corticosteroid injections can alleviate the knee OA pain despite lacking in the long-term satisfaction and relief of the technique. Moreover, the majority of these mechanisms are associated with the wrong side effects that might cause other health problems in the future.

The percutaneous use of the low temperatures of (-20oC – -10oC) to the peripheral nerves leads to the Wallerian degeneration, which disrupt the nerve structure and conduction thereof while retaining the structure elements of the same nerves. The process above allows the complete regeneration and functional recovery of the nerve. Further, the nerve axon does regenerate well alongside the previously established path before it can eventually reinnervating the sensory receptors of the body. Apparently, many scholars have shown that the use of cryoneurolysis in peripheral nerves does provide pain relief for many chronic conditions in the health management sector, despite the majority of their studies being not randomized controlled trials (RCTs). The infrapatellar branch of the saphenous nerve (IPBSN), – which is a  sensory nerve that triggers the frontal and lower parts of the knee capsule and the skin at the antero-medial knee, – becomes the primary target areas in the application of percutaneous for nerve blockade to reduce the severity of the knee pain.

Several studies have successfully examined the efficacy of the nerve blockade of the IPBSN in the treatment of post-operative knee pain when the patient is experiencing chronic pains after surgery. Trescot pioneered the proposal to target the IPBSN in conjunction with the cryoneurolysis when treating the knee pain (2003). On the other hand, Dasa contributed towards the progress by conducting the first clinical evaluation of the cryoneurolysis of the IPBSN before the TKA as a section of the multimodal pain improvements to develop the technology involved in reducing pain in post-operative (p.351).  However, Radnovich et al. (2017) upgraded the preceding studies in major ways that would lead to the best practices to relieve pain of chronic knee OA. Apparently, their study was multi-center based, randomized, sham-controlled, and double-blind trial that ran for more than six months to allow for follow-ups that would present an accurate status of the efficacy and safety of the technique to the patients. The technique was tested on the basis of the tolerability of cryoneurolysis by the patients suffering from the chronic knee OA under the trial registry. The researchers conducted the study in 17 different locations in the United States, for three years that ended in June 2016. The scholars identified a central institutional review board (IRB) which approved the study to take place through a local consent of an informed and written document from the participants who were the patients of the study as well. The research also followed all the applicable laws  and regulations that are stipulated in the International Conference on Harmonization Guideline for Good Clinical Practice, the Declaration of Helsinki, and the Code of Federal Regulations.

References

Corbett, M. S., Rice, S. J. C., Madurasinghe, V., Slack, R., Fayter, D. A., Harden, M., … Woolacott, N. F. (2013). Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: Network meta-analysis. Osteoarthritis and Cartilage, 21(9), 1290–1298. https://doi.org/10.1016/j.joca.2013.05.007

Radnovich, R., Scott, D., Patel, A. T., Olson, R., Dasa, V., Segal, N., … Metyas, S. (2017). Cryoneurolysis to treat the pain and symptoms of knee osteoarthritis: a multicenter, randomized, double-blind, sham-controlled trial. Osteoarthritis and Cartilage, 25(8), 1247–1256. https://doi.org/10.1016/j.joca.2017.03.006

Trescot, A. M. (2003). Cryoanalgesia in interventional pain management. Pain Physician, 6(3), 345–360.

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