Coolief™ Relief That Lasts

New technique targets pain-generating knee nerves

There was no trauma Carol Eisenhour, 82, could remember that initiated the intense knee pain she lived with for many years. Over time, her knees continued to deteriorate and her pain worsened. She generally struggled with both joints, but recently, one especially gave her trouble.

Photo by Nerissa Johnson.

Without knee pain, Carol can play with her dog, Ruby.

“I had a lot of pain in my left knee,” she states. “It was a constant, aching pain. It was terrible, and it bothered me when I walked. I can tolerate pain pretty well, but this rated a good eight out of ten.”
Carol’s knee pain continued to increase, and she was diagnosed with severe osteoarthritis in both knees. Osteoarthritis develops when the cushioning cartilage in a joint deteriorates, leaving the bones to rub together, causing swelling and pain. It is the common wear-and-tear arthritis that often occurs as a person ages. She knew she needed help with her pain.
“My pain progressed to the point where I needed to see someone,” shares Carol.
“I had my knees replaced about four years ago. I was hoping to feel like I used to before I had any pain, and I did for a while. But about a year ago, the pain in my knees came back.”
Carol was referred to Harold J. Cordner, MD, who is board certified in pain management and anesthesiology. His practice, Florida Pain Management Associates in Sebastian, uses the most advanced techniques and technologies to diagnose and treat patients’ agonizing pain.
“Dr. Cordner is a pain management specialist, and that’s exactly what I needed. I thought he was very knowledgeable and professional.”
“Carol had bilateral knee replacements in 2013,” confirms Dr. Cordner. “But like many patients I see in my practice, she continued to have severe pain, even after getting the new joints.
“When Carol had her knee replacement surgery, there were no treatment options to relieve the pain. After a total knee replacement, there is no joint left where you can inject anything to give relief.”
Dr. Cordner stays abreast of the latest advancements in pain management. He has introduced a new procedure that can be used to help patients with knee or hip pain.
“Now, we have the ability to perform genicular nerve blocks and radiofrequency ablation,” he elaborates. “Patients who have had joint replacements but continue to have severe pain afterward, like Carol, and those who are not candidates for surgery due to health issues or other reasons are ideal candidates for this pain-relieving technique.”

Block Before Ablation

“There are nerves that innervate joints, muscles, ligaments and pretty much every structure in the body,” explains
Dr. Cordner. “There are sensory nerves, which transmit feeling and pain. There are motor nerves, which control function. There are also mixed nerves, which have a sensory component and a motor component.
“Fortunately, we were able to isolate genicular nerves in a cadaver dissection. Genicular nerves are sensory nerves that innervate the knee joint. We also were able to isolate sensory nerves to the hip joint.
“A sensory nerve does not control motor function, and can be ablated, or destroyed using heat, because it won’t cause any weakness, dysfunction or muscle atrophy. Weakness in the joints or muscles can occur when you heat or ablate a motor or mixed motor-sensory nerve. We avoid those problems by performing a genicular sensory nerve block and Coolief ablation.”

“My knees feel like they’re supposed to feel. My pain used to be an eight. I don’t have any pain at all in my knees now.” – Carol

Before the ablation, Dr. Cordner performs a diagnostic nerve block. He injects the genicular nerves with a local anesthetic. If the patient’s pain goes away, the doctor knows those nerves are generating the pain. Once identified, the doctor destroys the offending nerves by ablating them with radiofrequency energy.
“If the patients do not get good relief from the block, then burning those nerves will not give them much pain relief,” informs Dr. Cordner. “We do the blocks first to make sure it takes away enough pain so ablating the genicular nerves will provide long-lasting pain relief.”
The relief obtained using the genicular nerve technique can last from six months to several years, sometimes longer.
“Dr. Cordner did procedures on my knees that blocked the nerves until the pain was gone,” describes Carol. “In order for him to know if he had the right nerves blocked, I couldn’t take anything for pain. He kept doing what he was doing until the pain went away.”
To increase the effects of genicular nerve ablation, Dr. Cordner uses an advanced, cooled radiofrequency technology. This technology has several benefits over traditional radiofrequency methods.
“In traditional radiofrequency, the needle is placed on or adjacent to the nerve, and radiofrequency waves are sent to the tip of the needle,” educates the doctor. “The needle itself doesn’t heat up. The tissue surrounding it heats up, similar to what a microwave does. If the needle is sitting on top of a nerve, it heats up the nerve, and it dies due to the heat.
“With Coolief cooled radiofrequency, water is sent through the needle, which cools the needle and the adjacent tissue. This enables the treatment area to be dramatically larger, which does two things. First, there is a higher likelihood the energy will affect the nerve rather than the surrounding tissue. It also makes the radiofrequency results last longer because with a larger treatment area, it takes longer for the nerves to grow back.”

Complete Relief

After having failed knee replacement surgeries and living for years with excruciating pain, Carol is thrilled with the results of her genicular nerve procedures. While this time she struggled most with her left knee, she’s had both knees treated by Dr. Cordner. She can’t believe the difference in how her knees feel since the treatments.
“My knees feel like they’re supposed to feel,” she reports. “My pain used to be an eight. I don’t have any pain at all in my knees now. And I have full function with my knees.”
Carol is happy she found Dr. Cordner and Florida Pain Management Associates. They were able to do what the joint replacements could not: give her full mobility and complete pain relief. She’s glad to know the doctor is there if she needs him.
“I highly recommend Dr. Cordner,” she says. “I love him because he took care of my problem. If I ever need to go back for pain management, I will definitely go back to him. But I think I’m taken care of for now!”

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