Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Abstract

Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from – unfortunately, there is no consensus on which treatments are “better” and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.

Wireless High-Frequency Peripheral Nerve Stimulation for Chronic Refractory Knee Pain Post-total Knee Replacement

“…There are multiple case reports of Stimwave PNS for other chronic pain syndromes [18][19][20]. However, there is not enough data to advocate the use or to comment on the placement of this device in treatment algorithms in cases of refractory, chronic pain post-TKR.…”

Platelet-rich plasma injection for symptomatic relief of disability associated with traumatic knee arthritis: a case report

“…2 Regenerative treatment in the form of intra-articular PRP and mesenchymal stem cell injections have also been included in the injection-based therapy as a potential joint remodeling approach. 3 Surgical intervention, either total or partial knee replacement, is recommended for patients with severe knee OA. Bourne et al showed that one-fifth of patients were not satisfied with the outcome of total knee arthroplasty; the artificial implant has a lifespan of only 10 to 15 years, which is not suitable for young patients.…”

“…8 A recent comprehensive consensus guideline on knee pain assigned a level 1 recommendation to safety and efficacy of intra-articular PRP for knee pain and improvement in function. 3 Studies have shown that improvement for pain and function decline starting at 6 to 9 months post-PRP injection; the optimal frequency of PRP injections remains unclear. Huang et al showed that at 12 months post-intervention, all patients had significant improvement in terms of VAC and WOMAC compared to pre-procedure.…”

“…7,10 PRP injection also shows significant pain reduction compared to intra-articular hyaluronate with moderate evidence. 3 WOMAC was used in our case report due to its disease-specific, self-administered characteristics, which help to measure pain and physical disability for people with knee and hip OA. Hmamouchi et al has suggested a 16% reduction of the total WOMAC score from baseline, which is a clinically important difference and is associated with slightly better improvement on the transition scale.…”

“…1 While multimodality is the mainstay of OA treatment, intra-articular platelet-rich plasma (PRP) injection is gaining acceptance. 2,3…”