By Alexander Germanis
Acommon misconception in any age of history is that medical knowledge has reached some imagined pinnacle. But as experience has shown, that is hardly ever the case. From the barber-surgeons of the medieval period to the incredibly improved anatomical research of the renaissance, there are always those laboring in the medical science who understand there is always more to learn — there is always room for improvement.
In the modern era of medicine, even ailments such as osteoarthritis of the knee are still being researched and new techniques are being explored in order to combat the pain.
As described in the first part of this series, knee osteoarthritis is the most common disease of the advanced age. Causing more than just a restriction of movement or a disturbance of sleep, the pain can also be debilitating. Afflicting primarily the elderly, osteoarthritis can even start in the young, depending on their lifestyle. Sports injuries, heavy labor and repetitive motions can all bring early onset.
Although it is understood that a deterioration of the cartilage in the knee is to blame for the arthritic condition, the pain receptors — the nerves — in the knee are still being studied. Dr. Ricardo Vallejo of Millennium Pain Center in Bloomington is a firm proponent of unending research in order to better understand this painful condition and how to combat it.
In a study outlined in The Journal of Pain in 2011, a Korean doctor by the name of Ji-Won Choi, “reported the use of a minimally invasive technique that could alleviate pain by ablation of the sensory nerves to the knee,” Dr. Vallejo explains. “Many people embraced this therapy despite the fact there were no other studies.”
“As soon as this article was published and without really looking in detail, [many doctors] started doing this treatment for everyone. That happened everywhere in the world,” the doctor continues. “By the beginning of 2013, everybody was very discouraged because the results were not the ones reported in this study.”
One of the reasons for the lackluster results, Dr. Vallejo says, was because the anatomical knowledge of the knee upon which these studies were based, was from 1948.
This is why continued research is always necessary in medicine. In a series of anatomical dissections in more than 20 specimens, Dr. Vallejo and his colleagues, in collaboration with Rush University, “identified that there were not just three sensation nerves in the knee as they are originally described,” he says. “We observed there are at least five nerves that are important. And we did locate four of them in specific areas, which will improve the position of our technique for ablation of the knee pain.”
With more research, the doctors have also come to “recognize there is a huge variability in the location of the nerves in the knee. That variation goes from patient to patient and also between knee to knee,” Dr. Vallejo adds. “So, you can have a nerve in one knee that is in a completely different location in the other knee, more so if you have degeneration of the knee over time.”
“We are, right now, finishing a study where we are comparing the ultrasound locations of these nerves with the X-ray locations, and all of this is done in order to improve the outcomes of our patients.”
Still wary of jumping in with both feet, the doctors continue to modify the technique first described by Dr. Choi, based on their anatomical findings. “After we improved on the landmarks initially reported,” Dr. Vallejo says, “we got a grant where we were able to offer these new treatment options for our patients.”
“The study is ongoing,” the doctor adds, stressing that only by remaining vigilant in their pursuit of perfection can they achieve the best results for their patients.
Next month: part three of “Knee Osteoarthritis and Its Treatments.”
For information about this new technique to fight the pain of knee osteoarthritis, contact Millennium Pain Center at 309-662-4321, www.millenniumpaincenter.com. The office is located at 1015 S. Mercer Avenue in Bloomington. The practice provides the most advanced and comprehensive pain management for a wide variety of conditions. Drs Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America.