Chronic Joint Pain

Joint pain is extremely common. In one national survey, about one-third of adults reported having joint pain within the past 30 days.1 And while it isn’t as common as periodic pain, chronic joint pain is increasingly present in our society. An x-ray may be perfect—even a complete joint replacement may have been done—and yet a patient still suffers from pain. That’s because, exclusive of the joint itself, there is possibly nerve dysfunction or nerve damage causing that pain and which has not been addressed.

Chronic joint pain is the end result of a number of conditions ranging from arthritis, trauma, or infections. The symptoms include pain, swelling, stiffness and limited movement of the joint. In chronic joint pain, the discomfort does not improve over time, and it becomes increasingly difficult to ameliorate the pain with pain medications.

More than 100 million Americans suffer from chronic pain at a cost of around $600 billion a year in medical treatments and lost productivity, according to a report from The Institute of Medicine (IOM). The overwhelming pain, and resulting drug use and loss in wages results in financial difficulties, emotional problems and relationship challenges. Thus, there is a strong interest in finding treatments for this common problem.

Current medical dogma puts a primary emphasis on structural causes for joint pain. Such complaints lead first to physical therapy, medications, and splinting. If that fails, surgery is contemplated, which ranges from endoscopic ‘clean-outs’ and repairs, all the way to joint replacements and fusions. In most cases this progression of care leads to the resolution of the pain. But in a small fraction of joint pain patients, the symptoms never abate, despite every one of the listed modalities being employed. This leads to the labeling of the patient as “crazy” or as someone with secondary gain.* A range of circumstances can ensue; escalating doses of narcotics are often prescribed and addiction and the resultant psycho-social issues of narcotic addiction are introduced into the scenario.

However, we have found that including in the evaluation the possibility of a neural origin of the pain, and offering nerve-based treatments, has made a profound difference in the outcome and quality of life for these patients. The innervation for most of the major joints of the extremities has been documented, and strategies for interrupting the pathways that transmit the painful impulses have been devised. These joint innervations are some of the innovative techniques performed by the surgeons of The Institute for Advanced Reconstruction.

That’s where Drs. Michael Rose and Andrew Elkwood of The Institute for Advanced Reconstruction come in. Experts in nerve decompression and treatment of peripheral neuropathy, for the past decade Drs. Rose and Elkwood have performed joint denervation surgery. This surgery entails a relatively simple out-patient procedure in which the doctor cuts or removes part of the nerve– the source of the pain–often providing instant and significant pain relief. Drs. Rose and Elkwood find there is success for the majority of selected patients they have treated with this procedure.

Although relatively novel (Dr. Rose and Dr. Elkwood are among only a handful of surgeons to perform specialized techniques used for nerve decompression surgeries, such as joint denervation), this procedure has actually been in practice since the 1950s. Only recently has it become more widely utilized.

Affected joints treated are mostly knees and ankles (weight bearing and constant use exacerbates the pain in these joints), but also the wrist, shoulder or elbow can be affected.

In order to understand how this surgery works, it is helpful to understand the structure and function of nerves. Like other parts of the body, sensory nerves run throughout the joints, providing sensation (in this case, pain) to a joint’s surrounding structure. That joint pain may be caused by injury or damage to that surrounding nerve. Joint denervation surgery removes a segment of the damaged nerve in order to eliminate or disrupt the chronic pain signal to the brain.

With the relief of pain, normal function can be restored to the joint. This, in turn, allows the surrounding muscles, tendons and other structures to work more effectively, and increases range of motion and general functionality.

The ultimate result is that those who have suffered chronic pain can get back to normal life. Recent patients range from a young teenage female athlete with unresolved knee pain following surgery, to a middle-aged man with chronic ankle pain.

1An elaboration of primary and secondary gain in medical terms: https://en.wikipedia.org/wiki/Primary_and_secondary_gain



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