Tuning out arthritis pain with radio energy

Known as "Coolief," the procedure can provide several months of relief from chronic arthritis pain for patients for whom surgery is not an option. It also decreases the need for a daily regimen of prescription medication and other over-the-counter pain-relieving drugs.

"We're not taking away the arthritis, just the arthritis pain," said Dr. Amin Sandeep, a pain specialist at Rush University Medical Center and chairperson of the Department of Anesthesiology at Rush Oak Park Hospital. "We're changing the wiring of the knee to interrupt the pain signal."

For several years, Rush pain medicine physicians have treated many types of chronic pain with radiofrequency (RF) ablation technology, which uses the heat from radio wave energy to temporarily neutralize specific nerves that cause chronic pain. The innovative Coolief RF technology combines cold and heat energy to extend the pain-free period much longer.

During the Coolief procedure, minimallyinvasive needles and water-cooled electrodes inserted into the knee target three nerves responsible for sending pain signals to the brain. RF energy passes through the needle and ablates (heats) nerve tissue, greatly reducing those nerves' ability to send pain signals to the brain for extended periods of time.

By also cooling the targeted area with the water-cooled electrodes, the Coolief procedure creates a treatment area that is larger than what occurs via conventional, heat-only RF treatments. That larger treatment area in turn extends the time the nerves need to resume sending pain signals.

This May, the U.S. Food and Drug Administration approved Coolief as the first RF treatment specifically to alleviate chronic knee pain due to osteoarthritis. That was based primarily on a 2016 clinical study showing that the Coolief system was safe and provided higher levels of pain relief for much longer time periods than intra-articular corticosteroids (cortisone injections). Dr. Asokumar Buvanendran, Rush's director of orthopedic anesthesia, helped lead that study, and other physicians at Rush participated in it, as did several Rush patients.

Grandmother freed from pain, able to play with grandchildren

One of those patients is Felicia McLoden. For this 65-year-old grandmother, Coolief meant nearly instant relief from the excruciating pain in her right knee that for years had made simple tasks like grocery shopping or playing with her grandchildren impossible.

"The arthritis was so bad that I could barely step down without severe pain. I thought I was going to limp for the rest of my life," McLoden said.

She felt nearly immediate relief after receiving Coolief treatment in May. "I can do things now. I don't even know what I want to do, I just know it's everything," McLoden said.

Knee osteoarthritis afflicts 20 million in U.S.

Osteoarthritis is a painful condition in which the cartilage that cushions joints loses its elasticity and wears away in places. This loss makes bones rub together, causing pain, stiffness and swelling.

According to the federal Centers for Disease Control and Prevention, 20 million people in the United States suffer from osteoarthritis of the knee, with treatments ranging from increased activity to medication to knee joint replacement surgery for the most severe cases. Each year, an estimated 700,000 of those people have knee joint replacement surgery.

While total knee joint replacement remains the best long term option for those with severe osteoarthritis of the knee, some people may not be candidates for surgery due to medical conditions such as diabetes, weight, other surgical risks, or are or are so young that a second knee replacement would be likely. "This procedure is proving to be a great option for those patients." Amin said.