Is Knee Joint Pain Treatable with Neurofunctional Pain Management?

Many who experience knee joint pain will attest to the frustration that accompanies the lack of effective treatments. After the application of treatment and ingestion of drugs, patients are left with short-term relief from pain and wait for the pain to resume while the condition causing it gets worse. Many patients simply want a solution to the pain—or, to put it more simply, they want to know that knee joint pain is treatable without invasive procedures and surgeries. The short answer is that there are options to treat knee pain of various causes, but the root cause of the problem is likely to continue, and the overall condition of the knee will likely get worse while temporary relief efforts get shorter and shorter.

That is why it is critical for both patients and doctors to look beyond short-term solutions and provide sustainable therapies that directly address the source or sources of knee pain. 

Below, we will explore the common treatments prescribed for knee pain and their side effects – and we’ll look at the more valid alternatives provided by a comprehensive Neurofunctional Pain Management approach. Let’s get started.

The Importance Of Targeting The Cause Of Knee Joint Pain

Today, an estimated 25% of the US adult population suffers the consequences of chronic and acute knee pain – a percentage that accounts for nearly 6.5 million people. But despite how widespread this condition is, no two individuals will have the same experience with knee pain. 

For some, mild discomfort deriving from a minor ligament strain in the knee joint is nothing more than a temporary inconvenience that can be addressed with at-home therapies such as R.I.C.E (Rest, Ice, Compression, and Elevation). 

However, for those affected by chronic conditions such as severe trauma or degenerative joint diseases, knee pain can cause a cascade of debilitating consequences. From mobility issues and increased risk of injuries to constant pain and productivity loss, knee pain can certainly have an impact on all aspects of a person’s life. 

But when it comes down to treating long-term pain, patients often find themselves at a loss. Without having a thorough understanding of what’s causing their condition, it is often too tempting to simply rely on short-term treatments, home remedies, and over-the-counter painkillers or steroids. 

At best, these treatment options will provide short-term relief without solving the underlying cause of pain. At worst, therapies such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can lead to dependency and complications such as stroke and nerve damage. 

The sections below offer a greater understanding of why choosing short-term treatments and OTC medications to treat knee pain isn’t just inefficient – but can also be dangerous. Let’s get started.

Why NSAIDs And Home Remedies Are Not Proper Treatments

Most patients are familiar with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and Tylenol, and other over-the-counter medications that give a short window of pain relief, dull the pain and cause the patient to rely on heavier and unhealthier doses. But what else can patients with knee joint pain do to effectively treat the pain? In addition to the use of NSAIDs, other home remedy efforts include regular kneading and massaging of the knee, and regular application of ice to diminish swelling in the muscles. A patient who simply deals with the pain on their own is less likely to experience any long-term or moderate-term pain relief because all their efforts and home-use medications will get less and less effective as the knee gets worse and worse over time.

The Side Effects Of NSAID Dependency

Out of around 50 million Americans who suffer from chronic pain, 29 million use non-steroidal anti-inflammatory drugs (NSAIDs) chronically to manage their knee and joint pain. 

But while medications such as aspirin, ibuprofen, and Celebrex are widely available (often over the counter) and affordable, it is important to not underestimate the risks they pose to a patient’s health – starting with dependency. 

Developing a dependency on drugs such as ibuprofen can cause patients with knee pain to crave their medications, take more than prescribed, and develop a high tolerance to the analgesic effects that NSAIDs produce. In turn, this can create a vicious circle and cause patients to become always more reliant on drugs in every aspect of their lives. 

Below are the complications of developing a dependency on NSAIDs to treat chronic knee pain.

Gastrointestinal (GI) Bleeding

Taking high doses of NSAIDs over long periods to treat knee pain may lead to several gastrointestinal adverse effects, including lesions and bleeding. This happens because these medications cause topical injury (on the surface) of the mucosa that lines the upper, mid, and lower digestive tract. 

Additionally, according to 2005 studies, some NSAIDs such as ibuprofen can temporarily inhibit the healing function of platelets (the blood cells in charge of regenerating damaged tissue). This makes it difficult for ulcers and lesions in the GI tract to stop bleeding and begin healing. 

Among the most severe complications of GI bleeding are anemia (lack of hemoglobin and red blood cells), shock, and insufficient blood circulation. It is estimated that around 1-2% of people who take NSAIDs over long periods will develop gastrointestinal bleeding, ulcers, and lesions.

Myocardial Infarction

Non-steroidal anti-inflammatory drugs taken to ease knee pain can have a range of effects on the cardiovascular system and increase the risk of myocardial infarction (a heart attack). This is especially true in people who are already at risk of heart problems but can affect anyone. 

Some of the negative effects of NSAIDs on the cardiovascular system that might lead to a heart attack include:

• Non-steroidal anti-inflammatory drugs can inhibit the chemicals in charge of reducing the likelihood of blood clots, thus making them more likely to manifest and block arteries in the heart. 
• NSAIDs can reduce the blood flow to the kidneys, which causes the body to retain more water and salt. This, in turn, can increase blood pressure and make a myocardial infarction more likely. 

The risk of myocardial infarction increases significantly in as little as seven days of taking the drug.

Stroke

The majority of non-steroidal anti-inflammatory drugs increase the risk of stroke ( a sudden interruption of blood flow to the brain) and other cerebrovascular events. This is because these medications inhibit the functioning of prostaglandins, or the compounds responsible for widening and relaxing the blood vessels. 

In turn, this can cause vasoconstriction (the narrowing of blood vessels) which can lead to reduced blood flow to the brain. NSAIDs also promote the retention of sodium and increase blood pressure, which is an additional risk factor for strokes.

Peptic Ulcer

Peptic ulcers are lesions that occur in the lining of the stomach (gastric ulcer) or in the first part of the small intestine (duodenal ulcers). NSAIDs can lead to ulcers by causing a reduction in the levels of prostaglandin, a chemical that is essential to protect the gastric mucosa. 

In severe cases, peptic ulcers can cause gastrointestinal obstruction, stomach cancer, internal bleeding, and holes in the stomach wall. According to a study conducted in 1999, NSAID-induced peptic ulcers account for 10% to 30% of all peptic ulcers.

Acute Renal Failure

As seen above, NSAIDs reduce the blood flow to the kidneys by reducing the amount of prostaglandins secretion in the body. In turn, this can lead to a reduced ability of the kidneys to filter blood, thus causing a range of consequences, including:

• Accumulation of waste product
• Increased blood pressure
• Difficulty processing salt and water in the body
• Deterioration of the renal function

Over time, an excessive accumulation of waste in the kidneys can lead to what’s called “Acute Renal Failure”. Acute kidney injury or failure might be reversible, but it is a serious condition that requires immediate medical care. Using high doses of NSAIDs for a month or longer can increase the risk of acute kidney failure fourfold.

The Downside Of Corticosteroid Injection For Knee Joint Pain Treatment

Some doctors may rely on the use of a treatment called corticosteroid injection. The primary purpose of corticosteroid injections, much like the use of NSAIDs and ice, is to reduce inflammation. However, unlike NSAIDs and the application of ice, corticosteroids intend to provide lasting anti-inflammatory effects, which can last for several months. However, the growing consensus in conventional care is leaning in the direction of less and less corticosteroid use overall. Many reports and publications are coming out with evidence that long-term use of steroids to reduce inflammation and pain is facilitating the continued destruction of the damaged tissue causing the pain, essentially making the condition worse at the expense of short-term relief. However, one could easily see the benefits of corticosteroid injections especially due to their lasting efficacy, typically several weeks to several months of pain relief. One other benefit of corticosteroids is that they closely resemble a natural hormone produced in our bodies called cortisol, which is the source of health deterioration associated with stress. However, we must not view the injections of corticosteroids as perfectly safe and effective, even if they do resemble something that is naturally produced in our bodies. It is widely known that steroids have a litany of side effects and are often viewed as having a short-term effective use range, meaning a doctor would see steroids as a solution for a few years but not for decades.

The Side Effects Of Corticosteroid Injection

Steroids are the artificial version of hormones that are naturally produced in the human body by the adrenal glands. This family of drugs is efficient in temporarily reducing excessive inflammation, which is caused by the body as a response to injury, infection, or bacteria. In turn, steroids can reduce swelling and pain, but they won’t cure the underlying reason for knee pain.

Although today they have a wide range of uses, steroids are commonly prescribed to ease the symptoms deriving from a range of inflammatory conditions, including osteoarthritis, rheumatoid arthritis, and gout. Although they can be taken orally, corticosteroid treatments for knee pain are usually delivered in the form of intra-articular (inside the joint) injections.

According to a study conducted in 2004, steroids can successfully reduce the symptoms of arthritis for up to 2 weeks, but much higher doses are needed to ease pain in the long term. However, when taken over long periods of time, steroids can cause addiction and lead to physiological and psychological withdrawal symptoms.

Today, the rate at which steroids are prescribed for knee pain is ramping up, and around 8-14% of patients with knee osteoarthritis are likely to receive steroid injections as part of their treatment. Because of this, it is crucial for both patients and healthcare providers to understand the risk of this therapy and opt for alternative treatments.

Many patients who have used steroids for treatment, including treatment for knee pain, will either experience the numerous side effects or appreciate how the treatment with corticosteroids makes them feel. Regardless of the opinion of patients and their experiences with steroid treatment, side effects are undeniable and sometimes deadly.

Some of the most common side effects include:

Cortisone Flare

Although temporary, a cortisone flare is a common side effect of steroid injections for knee pain and can be severely debilitating for around 48 hours. A cortisone “flare” – or a sensation of intense pain in the injection site – is caused by the slow-release crystals of corticosteroids contained in the injection.

These crystals work by releasing the drug into the system over time, which helps the analgesic effect last longer. However, when injected, they can trigger temporary irritation and inflammation of the injection area.

A cortisone flare is likely to appear within a day or two of the shot and can last 2-3 days. Although inflammatory flares happen in just 1-2% of people receiving a steroid shot, over 35% of patients tend to experience post-injection pain around the knee area.

Fat Atrophy

Fat atrophy refers to the loss of fatty tissue in a certain area of the body (i.e.: the knee). As the fat mass degrades, it might leave marks such as pitting, scarring, and a sunken appearance. In severe cases, when there is a major loss of fat tissue, nearby fat mass might redistribute, which can make underlying bones and other structures more visible.

Fat atrophy due to steroid injections affects around 1% of patients, appears 1-4 months after the injection, and resolves itself in 6-30 months.

Tendon Injury

One of the most severe complications of repeated corticosteroid injections is tendon damage and ruptures. Although the mechanisms of this side effect are not well-understood, a 2016 article hypothesizes that steroids can lead to soft tissue fragmentation and cause changes in the biomechanics of the knee, such as stopping the production of collagen in the tendons.

Beyond simply injuring a tendon, steroids can also inhibit healing and repair, which is something worth considering for those whose knee pain derives from a tendon injury.

Nerve Damage

Studies conducted in 1982 have confirmed that some steroid agents commonly in use are neurotoxic – which means that they cause damage to the nerves in the peripheral nervous system (the nerves outside of the brain and spinal cord).

The damage is caused by the toxic effects of steroids on nerve fibers. Steroids can also disrupt the functioning of the blood-nerve barrier, which should keep materials from the plasma and the nerves separate.

Although steroid-induced nerve damage is sometimes reversible, you might experience motor difficulties, abnormal sensations, and changes in how your body reacts to stimuli (i.e.: you might feel pain when doing something that should be painless).

Cartilage Damage

In the knee, the cartilage plays the fundamental role of absorbing shock and friction, thus protecting bones from damage during movements. In most people with joint diseases, knee pain is caused by the degeneration of this “cushion” of soft tissue in the knee joint. 

However, if you are taking steroids to ease joint pain, you should be aware that this kind of therapy can lead to further cartilage degeneration. This happens because cortisone can prevent the release of growth factors and stop or slow down the production of new collagen (a thick fluid that makes up around 60% of the material in the cartilage).

Compromised Immune System

One of the reasons why steroids are so effective in easing knee and joint pain is that this category of drugs works by modulating the response of the immune system. In patients with inflammatory conditions such as osteoarthritis and rheumatoid arthritis, this can prevent the body from causing excessive inflammation, which can be damaging to the joint tissue. 

However, this effect can go both ways: over time, steroids reduce the volume and activity of the immune system. In healthy people, this might be a temporary side effect. In people with a suppressed or weak immune system, compromised immune functions can increase the risk of infections and complications.

In a 2019 study conducted by doctors Dara Grennan and Sheila Wang, it was confirmed that steroids “… reduce the ability of the immune system to function (immunosuppression). Patients taking steroids are not only more susceptible to infections but more likely to have severe or unusual infections.” These medical professionals continue to explain the severe side effects of steroids by comparing them to the aforementioned cortisol, your body’s primary and natural stress hormone. Grennan and Wang conclude that “… because steroids are so similar to cortisol, prolonged use of systemic steroids at higher doses can cause the adrenal glands to stop making cortisol. If the systemic steroid is stopped suddenly, this adrenal suppression and resulting lack of steroid can cause a wide range of symptoms, such as dangerously low blood pressure.” That said, knee pain is such a problem for patients and their doctors that they are willing to get on a steroid regimen to resolve the immediate pain with the understanding that a knee replacement or other surgery is the ultimate result.

The Complexities of Treating Knee Pain

We can’t forget that many other risk that there are many factors that may contribute to knee pain and that most of the treatments for knee pain only remediate inflammation, which is the driving force behind most chronic pain conditions. As we have mentioned before, many conditions contribute to chronic knee pain, including bone spurs, arthritis, dislocations, bad posture, and referred pain from the hip and back of the foot and ankle. It should then be assumed by patients seeking treatment that if these alternative risk factors apply to them, the use of NSAIDs, icing and corticosteroid injection will not be a very lasting treatment. If their risk factor for knee pain does not include inflammation of the muscles, the aforementioned anti-inflammatory treatments will do little to help the pain. It is therefore crucial that patients experiencing knee pain get an accurate diagnosis and identify the source or sources of their knee pain.

At Relatyv, our goal is to look beyond treating just the symptoms and address the root causes of knee pain. Thanks to our proprietary Neurofunctional Pain Management, we are able to provide tailored treatment programs customized to each patient’s needs. This allows patients to enjoy long-lasting relief while also taking a step towards living a life free of medications and debilitating joint conditions. 

Below is an overview of our approach to treating knee pain.

What Is Neurofunctional Pain Management?

When it comes down to addressing knee pain, looking beyond the symptoms a patient might be experiencing is key to finding a solution that isn’t only long-lasting, but also sustainable. 

Our Neurofunctional Pain Management approach does just that: it takes into account factors such as lifestyle choices, medical histories, and long-term goals to help patients live free of pain. 

Our pain management programs are entirely customized around a patient’s unique needs. Here are some of the treatments and therapies we use to provide long-lasting relief and kickstart the body’s self-healing mechanism:

• Electroanalgesia – Our MDs will deliver high-frequency pulses of electrical current to the knee area using an FDA-cleared device. The electrical current acts in the joint area by “flooding” the nervous system and preventing pain signals from reaching the brain. Additionally, electrical stimulation can trigger the production of pain-relieving hormones, such as endorphins, and improve blood circulation around the knee area, thus boosting the supply of oxygen and nutrients in the joint. 
• Viscosupplementation and hyaluronic acid injections – Viscosupplementation refers to the practice of injecting hyaluronic acid (HA) into the joint area. This thick fluid will replenish the body’s reserves of HA, thus keeping the joint lubricated and protected against friction and shock damage. 
• IV therapies – Some nutritional deficiencies can trigger or worsen knee pain. Our custom IV therapies aim to provide a renewed supply of nutrients that can reduce inflammation, support the healing of damaged tissues, and ease pain. 
• Lifestyle counseling – Even when knee pain isn’t directly caused by lifestyle choices, some factors can worsen joint conditions. For example, being obese or overweight can add stress to the knee joint, thus making the complications of arthritis more likely. At Relatyv, we maintain a holistic approach to all knee conditions, and we provide our patients with the guidelines and support needed to make better lifestyle choices for their health. 

Thanks to our expertise and availability of treatment options, we can help patients design a Neurofunctional Pain Management program that fits their medical history, lifestyle needs, and goals.

How Does Neurofunctional Pain Management Help With Knee Pain?

Regardless of the cause of knee pain, a patient’s primary concern is their ability to perform daily tasks without pain. Pain is a nervous system condition, with pain neurons referring pain to the brain and the brain interpreting that pain and creating responses. It’s a feedback loop that is supposed to be a healing mechanism, but if there is no healing occurring, then it simply becomes a negative feedback loop with the pain neurons referring to pain and the brain reacting to that pain and triggering inflammation, which causes more pain, and the cycle continues. Neurofunctional Pain Management is an effort to relieve pain while also restoring health so that the conditions causing chronic pain can be resolved as much as possible in the effort to relieve pain overall. Relatyv is the pioneering medical group bringing Neurofunctional Pain Management to the nation. The premise of Neurofunctional Pain Management is to use high pulse electrical stimulation to relieve chronic pain and to apply health restoration efforts such as specialized hydration and nutritional deficiency restoration, in combination with robust patient education and lifestyle counselling to produce a pain relief effect and a health restoration effect that will enhance the pain relief effect, making the entire pain relief process last longer for the patient and producing an enhanced quality of life that is more than just being out of pain, but being out of pain and being healthier than they were before.

Relatyv’s Knee Joint Pain Treatment

Relatyv offers a Neurofunctional Pain Management solution called Neuralgesia which is a combination of high-pulse electrical stimulation and specialized hydration therapy that fits the very definition of Neurofunctional Pain Management. Relatyv can apply this protocol to any chronic pain condition to achieve the effects of relieving pain and restoring health to magnify the patient’s quality of life. Because many chronic pain conditions are musculoskeletal-based pain problems, like bone/joint/muscle pain issues, the high pulse electrical stimulation component of Neurofunctional Pain Management is an effective therapeutic application for relieving pain. The health restoration effort may include several components depending on the patient’s specific conditions and issues, but ultimately the foundation of the patient’s health restoration is in specialized IV hydration therapy that balances and restores the nutritional deficiencies that are a primary component of chronic systemic inflammation and overall chronic pain. Relatyv can effectively treat chronic pain conditions like peripheral neuropathy and chronic knee pain using Neuralgesia treatment protocols and the overall concepts of Neurofunctional Pain Management.