Knee Pain and Your Options

knee pain

What can I do about knee pain?

A patient once told me to appreciate my knees because they will go out long before you’re ready!  Knee pain is very difficult to deal with as literally every other step you take can be excruciating.  Let’s talk about some options for knee pain.
First, conservative things first!  You can treat many knee pains with the anacronym RICE: Rest, Ice, Compression, and Elevation.   Don’t forget OTC meds such as Tylenol, ibuprofen, and naproxen are options depending on your medical conditions.
After conservative treatments, consider physical therapy, aqua therapy, Airrosti, and knee braces.  Many times a little therapy and support can help resolve knee pain.  Furthermore, topical creams can be used with benefit.  You can also consider CBD cream which can provide significant anti-inflammatory benefits.  

If these options don’t help, that’s where we can help!  We routinely offer multiple options for patients with knee pain including:-  steroid injections:  used for inflammation/swelling-  viscosupplementation:  used as a lubricant for the knee joint for degeneration or arthritis pain-  Radiofrequency: a higher-level procedure where the nerves that go to the knee are burned, blocking only the pain signals that come from your knee.  This procedure is a very good option for people that have tried everything else with little benefit. Amazingly, we can even provide significant benefit in patients that have had a total knee replacement but still have pain!-  Spinal Cord Stimulation: 

This is another high-level procedure where we can use electrical stimulation of nerves in the back to block pain signals.  This is another option for patients that have had surgery on their knees but still have pain.  
As you can see, we have many options to offer and want to work with you and how you want to address your pain.  Don’t give up hope!  We are here to help you get back to your life!

Candidates For A Spinal Cord Stimulation Trial

Are you wondering if you would be a good candidate for a spinal cord stimulation?

This is usually twofold:  the things you have tried before to treat your pain and your insurance company.  If you have tried conservative things, OTC meds, prescription meds, injections, and/or surgery, and still have pain, then you would be a good candidate for the trial.  Just like you don’t decide about buying a car without test driving it, you should not decide on an SCS implant until you have tried it.

This is what the trial is for, to test drive the SCS technology and see if you get good benefit.

Next, check with your insurance company, many have requirements for you to determine if you can have an SCS trial.  Finally, realize the SCS technology works better for nerve pain than other types of pain.

Talk to your doctor about what kind of pain you have and if you may be a good candidate for a spinal cord stimulation trial.

Injections During Covid-19

Dr. Moran is not doing injections during COVID-19 for many reasons.  Most importantly, many governing organizations have limited elective procedures and only allow life-saving procedures to occur until the pandemic clears.  Next, Dr. Moran wants to limit everyone’s exposure to others while we practice social distancing.  Finally, steroids will weaken your immune system and consequently increase the chance of an infection.  Dr. Moran tried to continue to serve his patients until it became too risky for each patient and his staff to continue.

Dr. Moran will resume procedures as soon as the national guidelines change and it’s safe for everyone involved.

Injections Over A Year: How Many Is Enough?

There are varying guidelines from pain organizations about how many is the appropriate number of injections.  Usually, it comes down to less than 3 steroid injections every 6 months.  Realize, many injections don’t require steroids so they would not count in these numbers.

In the end, your insurance company will determine how many steroid injections and/or procedures you can get in a twelve-month period.  Feel free to look into your insurance pain procedure policies or just ask!

Giving Injections Another Go

I already tried injections and they didn’t work.  Should I try injections again?

This is a common question. It is very similar to saying “I tried a new cell phone two years ago…why should I get a new one?  The answer: things change!  And just like phones, there are many different types of injections to consider relative to where they go, what meds are used, and the approach used to do them.  If you get an injection in the wrong place, you won’t get much benefit. This does not mean the injection failed as much as it means there are most likely other locations causing your pain that need to be addressed.  Furthermore, realize insurance companies will only let us address one thing at a time.  We have to chip away at your pain.  Much like if your car has a dead battery and is out of gas.  If I give you a new battery, your car is better, but you can’t get benefits from the new battery as you still need gas! Always discuss your lack of benefits from injections with your doctor so they can see if anything else needs to be addressed.

How do you know where to put the injection?

This is based on your symptoms, exam, imaging, and discussion about your pain.  You should make sure your pain management doctor does an exam, reviews your symptoms, and reviews your diagnostic studies before doing any procedures to optimize the potential of the procedure and your benefit.

Your Options for Lower Back Pain

back pain san antonio

If you are experiencing lower back pain, there are many different procedures that can be considered.

Just in the lumbar spine, not counting any muscles, bursas, vertebral bodies, or many other things, there are over 85 different types of procedures for the low back!  Make sure your doctor considers all of these and makes the best decision for you to treat your pain.

Considering just the low back spine:

Lumbar facet injections- 5 each side or 10

Interlaminar Epidural steroid injections: 5

Transforaminal Epidural steroid injections:  5 each side or 10

Diagnostic medial branch blocks:  5 each side or 10

Radiofrequency:  5 each side or 10

Selective nerve root blocks:  5 each side or 10

Discogram:  5 levels

Lumbar/Thoracic SCS trial/placement:  2

Dorsal Root Ganglion Stimulation:  5 each side:  10

SI joint injections: one each side or 2

SI joint diagnostic blocks:  2 sides

SI joint radiofrequency:  2 sides

Sacral Dorsal Root Ganglion stimulation: 2 each side:  4

Hip steroid injections:  2 sides

Sacrococcygeal joint injections:  1

Celiac Plexus Block:  1

Lumbar sympathetic Block: 1

Blood Thinners And Your Procedure

Did you know different blood thinners require different amounts of time to hold before a procedure?  Plavix, (clopidogrel) should be held for 7 full days before injections in your spine area, but Xarelto (rivaroxaban) should be held for only 3 days before an injection in your spine area.  And this depends on kidney and liver function.  If you are taking any blood thinners or medicines that can thin your blood, please make sure to hold them the appropriate amount of time before a procedure….otherwise, we may not be able to perform your injection.  Any questions, just ask!
 
It is a national standard to require a driver to drive you home after a procedure.  Dr. Moran follows these standards to ensure the safety of you and everyone on the roads driving.  Even if you choose not to have sedation, a driver is required because you can have weakness in your arms or legs after a procedure, and we wouldn’t want you driving in these situations.  In very rare situations, Dr. Moran will agree to do an injection and allow a patient to drive themselves home, but the patient will sign a consent saying they accept all risks and responsibilities, they will be required to provide their car keys and wait for over one hour, Dr. Moran will have to examine the patient before being released,  if you have any weakness you will not be released and may still need a driver, and the patient accepts and fully understands this is against Dr. Morans medical advice.  Dr. Moran puts the safety of his patients and the community first.  It is much easier to simply find a driver.