Target: Nerves

Nonsurgical procedure eliminates knee pain.

After making the annual trek from Iowa to Florida for more than 20 years, Monica* finally gave up her snowbird status and established full-time residency in Vero Beach a few years back. Debilitating knee pain has made her stay here a little less than ideal, however.

Dr. Harold Cordner of Florida Pain Management Associates in Sebastian and Vero Beach treated Monica’s (alias) knee pain with a genicular nerve block and radiofrequency ablation.

“We do the nerve blocks first to make sure they take away enough pain so ablating the genicular nerves will provide long-lasting pain relief.” – Dr. Cordner

“Both knees are affected by osteoarthritis,” she confides. “I experienced terrible knee pain; it was the worst pain I’ve ever felt. It was a burning, aching pain that woke me up at night, and it was constant. On a scale of one to ten, my pain rated a ten on most days.

“The pain limited my activities. My family enjoys flying in our private airplane, and it got to the point where I couldn’t even get into the plane because that requires climbing up onto the wing, and I couldn’t do that anymore because my knees hurt so much.

“I also could no longer walk from my home to the beach, which is one mile to get there and one mile to get back. I knew I had to do something. I couldn’t continue to live that way.”

Over time, Monica was treated with medications, physical therapy and a series of injections into her knees. Eventually, two different orthopedic surgeons told her that because these conservative treatments failed, she should consider total knee replacement surgery.

Monica was distraught until she heard about Harold J. Cordner, MD. Dr. Cordner is board certified in pain management and anesthesiology and practices at Florida Pain Management Associates in Vero Beach and Sebastian. Dr. Cordner, Monica learned, offered the most up-to-date nonsurgical techniques for relieving his patients’ agony, and that gave her hope.

“It piqued my interest right away that Dr. Cordner was an interventional anesthesiologist,” she recalls. “I believed he might actually be able to help me. It was a stroke of luck that he was right here in Vero Beach, so I made an appointment.

“When I walked into the office at Florida Pain Management Associates, I was a patient in severe pain. Dr. Cordner was thoughtful, and he listened to me. He understood immediately what my issues were. He was able to summarize my situation quickly and come up with a treatment plan.”

Two-Phased Treatment

“When I first saw Monica, she was scheduled for arthroscopic surgery on her left knee, and her doctor told her she would probably need a total knee replacement,” reports Dr. Cordner. “She wanted to avoid both procedures. She already had several conservative treatments on both knees, including steroid injections and lubricating fluid injections.

“Initially, we talked about trying conservative measures again, and I placed injections of cortisone into both knees, which gave her relief. However, eight months later, she returned with worsening knee pain, so we discussed alternative procedures.”

The new treatment Dr. Cordner recommended for Monica was a genicular nerve block and radiofrequency ablation. The goal of this treatment is to relieve the pain in her knees by destroying their nerves.

“I was at the end of my rope because nothing else was working and my quality of life had diminished so dramatically,” shares Monica. “I agreed to have Dr. Cordner do the procedure on both of my knees.”

The treatment Dr. Cordner recommended for Monica works directly on the nerves in the knee. Dr. Cordner notes that there are different types of nerves that serve the joints, muscles, ligaments and other tissues of the body.

“There are sensory nerves, which supply sensation and transmit feeling,” he explains. “There are also motor nerves, which control function in the muscles and joints. Then there are mixed motor/sensory nerves, which have a sensory component and a motor component. The genicular nerves are the sensory nerves that supply the knee joint.

“The sensory nerves are the nerves that conduct pain signals, so they can be destroyed without causing any functional loss in the muscles or joints. The genicular nerves in the knee are the targets of the genicular nerve block and radiofrequency ablation.”

The doctor begins this treatment by performing a diagnostic nerve block. During this phase, he injects the genicular nerves with a local anesthetic. If the patient’s pain goes away, he knows those nerves are supplying enough of the painful innervation to the knee. The doctor continues by destroying the genicular nerves with the radiofrequency ablation.

“After the block, we monitor the patients and ask them to report how much relief they experience,” educates Dr. Cordner. “We do the nerve blocks first to make sure they take away enough pain so ablating the genicular nerves will provide long-lasting pain relief.

“During ablation, an insulated needle is placed on or adjacent to the target nerve, and radiofrequency waves are sent to the tip of the needle. 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.”

The nerves are not destroyed permanently, however. They grow back, but it generally takes a year or two for that to occur. Ideally, the patient will have pain relief during that time.

Dr. Cordner notes that there are two groups of patients that are good candidates for the genicular nerve block and radiofrequency ablation. The first group consists of patients such as Monica who are told they need knee replacement surgery and either refuse to have the surgery or are not good candidates for it.

“The other group of patients who are good candidates are those who have already had knee replacements and continue to have severe pain in their knees,” observes Dr. Cordner. “The problem is that the patient’s own joint tissue is no longer present. Their new knees are made of metal and plastic implants, which cannot respond to injections and other therapies.

“These patients are often told by their surgeons that the hardware looks fine and nothing more can be done for them. However, their nerves are usually still intact, so the genicular nerve block and radiofrequency ablation can help relieve their pain. This procedure offers hope for these patients.”

Dancing Legs

Dr. Cordner’s treatment gave Monica all that she hoped. Thanks to his procedure, she was able to avoid both the scheduled arthroscopic procedure and potential knee replacement surgery. She’s pleased with her condition since treatment.

“My life changed dramatically because of this procedure,” she marvels. “After two weeks, I was able to walk pain free from my home on the Intracoastal to the beach. And I’m able to get into our private plane and take rides with family members again. Now, my pain level is a zero, when it used to be a ten. I’m ready to dance!

“I’m grateful to Dr. Cordner. I’ve seen several doctors over the years, but he was the one who really had it all together.
Dr. Cordner is the most skilled pain management physician I’ve ever heard of or met.

“I think anyone considering a genicular nerve block and radiofrequency ablation should consult Dr. Cordner at Florida Pain Management Associates,” she adds. “They should get all the facts about the procedure and see how it relates to them. And I encourage them to have a complete evaluation done by Dr. Cordner. I really trust him.”

*Patient’ name withheld at their request.
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