Knee problems are very common. At their worst, they cause pain that interferes with daily activities, including walking. You may feel this pain when bending your knee, putting weight on it or all the time. However, there are treatments and pain management options that can eliminate or alleviate these problems. Pain management specialists are especially suited to help. Physician anesthesiologists who are experts in pain management are trained to evaluate and develop a treatment plan specifically for each patient.
Your knee joint is made of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is damaged, you have knee problems. These are some of the more common causes of knee pain:
- Osteoarthritis. The cartilage in the knee gradually wears away.
- Rheumatoid arthritis. The knee may become swollen and cartilage may be destroyed.
- Ligament injuries. Anterior cruciate ligament (ACL) injuries usually result from a sudden twisting motion. Injuries to the posterior cruciate ligament (PCL) are usually caused by a direct impact, like impact from a car accident or sports activities.
- Tendon injuries. These can range from inflammation to a tear, most likely from overuse in sports or from a fall.
- Cartilage injuries and disorders. Injury, overuse, muscle weakness or misalignment of the knee can soften the cartilage of the kneecap, or a blow to the knee may tear off a piece of cartilage.
- Broken kneecap. The small, round bone (patella) that sits over the front of your knee joint breaks, usually as the result of a fall or a direct blow to the knee.
Pain management is an important part of any treatment plan, both for lessening discomfort and aiding in recovery. Pain management specialists understand the full range of pain relief options and how to use these options in combination. Treatments done as part of a comprehensive, multimodal plan may help even if each treatment does not seem to make a difference when used in isolation.
Pain management specialists work with patients to help diagnose pain and treat it safely and effectively with as few side effects as possible. These treatments do not have to involve medication. In fact, pain management is generally more successful when a comprehensive approach is used, with or without medications.
You should consult with a pain management specialist if your acute (short-term) knee pain seems to be transitioning into chronic (long-term) pain. Generally, this is when the pain lasts longer than 90 days, but it could be sooner. Pain that lasts longer than expected for the condition you have is a warning sign that the pain is becoming chronic.
Pain management specialists can provide diagnosis and treatment on their own or in consultation with other health care providers. These may include your primary care physician, orthopedist, rheumatologist or physical therapist.
Orthopedists treat problems related to bones, joints, ligaments, tendons and muscles. Rheumatologists specialize in the nonsurgical treatment of arthritis and other rheumatic diseases. Physical therapists use exercises and stretches, movement training, medical massage and other hands-on techniques to help patients increase mobility, ease pain and protect against further injury.
A thorough examination is necessary for an accurate determination. The examination should include an assessment of whether the pain actually stems from the knee. Sometimes knee pain can be referred pain from another source, such as a hip injury. “Referred pain” means that an injury or disease in one part of the body is causing pain in a different location.
When making a diagnosis, your doctor will consider information that includes the following:
- Patient characteristics. Some conditions are more likely to occur in individuals with certain characteristics. For example, osteoarthritis is more frequent in older adults, and conditions associated with overuse are more frequent in people who participate in athletic activities. Obesity can also be a factor in some conditions.
- Patient history. The physician asks questions to determine potential sources of trauma, such as car accidents or sports injuries. The physician will also ask where and when you feel the pain.
- Results of a physical examination. The physician moves and probes your knee for signs of damage to the muscle, tendon or cartilage. This includes exploring the location of the pain, such as behind the knee, in front of the knee, or inside of or on top of the knee.
- Results of imaging and other tests. Sometimes X-rays, MRIs or other diagnostic tests are needed to identify structural damage or abnormalities.
The nature of your injury will guide the treatment. So will your preferences. It is best to consider the full menu of options available. These include:
- RICE (rest, ice, compression and elevation). This can work for acute pain, but treatment is different for chronic pain. For chronic pain, rest may weaken muscles that need strengthening to reduce or eliminate the pain.
- Exercise and physical therapy. Some exercises help build or stretch muscles and ease pain. You also need to know which exercises should be avoided because they could cause further damage to your knee.
- Lifestyle changes. There are changes you can make to reduce your pain. For example, maintaining a healthy weight lessens stress on your knees. You may also need to avoid activities, such as running, that exert too much force on the knees.
- Genicular nerve blocks. This treatment blocks pain signals that the genicular nerves transmit between the knee joint and the brain. This is first done with an injection of an anesthetic for short-term relief. If it is effective, the patient can get longer-term relief with a nonsurgical procedure called radiofrequency ablation. This procedure generates heat to coagulate the proteins in the nerve, which stops the pain signals.
- Peripheral nerve stimulation. A surgeon implants electrodes and a small battery pack near the peripheral nerves that transmit pain signals from the knee. The electrodes deliver a weak electrical current to the nerve (producing a tingling sensation) that tricks it into turning off pain signals to the brain. The patient controls the frequency of electrical stimulation.
- Complementary therapies. Some people find relief using massage, biofeedback, relaxation, meditation, acupuncture, yoga, or visualization.
- Medication. This includes over-the-counter remedies, such as acetaminophen and nonsteroidal anti-inflammatory drugs, and more powerful drugs like opioids. Other medications can help too, including steroids. Because opioids can be addictive, it’s important to have a qualified pain management specialist oversee your medication plan. Some caution is also required with anti-inflammatory medications and steroids, which can weaken cartilage and knee joints.
- Surgery. This is primarily used to fix structural damage. Surgery should not be the first choice, but sometimes it is the only solution. The When Seconds Count® knee surgery page provides details on options and pain management considerations.
- Regenerative therapies. Researchers continue to explore options such as plasma injections and stem cell treatments. The research is still in its early stages and is not yet conclusive.
Physician anesthesiologists are committed to patient safety and high-quality care, and have the necessary knowledge to understand and treat the entire human body.