Summary: Shoulder and hip arthritis are pretty common. These are progressive conditions, and many people living with these painful conditions stop responding to traditional drug therapy. In such cases, they have an option of joint replacement or opt for prolonged opioid treatment. However, doctors have found a safer way to overcome pain in those who cannot undergo surgery. They used a technique called cooled radiofrequency ablation to reduce pain sensation. The procedure is highly safe with almost no side effects and could significantly reduce pain in 70-80% of the patients.
Doctors have discovered a new way to provide significant pain relief to those living with chronic hip or shoulder pain due to severe arthritis. Moreover, this pain works even for those who do not report many benefits from medications. Not only that, this new technique can provide prolonged pain relief and improve joint function. Finding new ways to treat severe chronic pains like those caused by arthritis is important to reduce dependence on opioids. However, there are many issues in treating severe arthritic pain. Arthritis is a chronic and progressive condition. It means that in people diagnosed with the condition, pain keeps increasing.
In most of these patients, doctors would start treatment with non-steroidal anti-inflammatory drugs. However, as the disease progresses and pain becomes work, they have to opt for opioids in many instances. Of course, besides opioid use, there are many other treatment options, like intra-articular corticosteroid injections. Although intra-articular corticosteroid injections are safe and effective, but they often fail to provide prolonged relief, especially as the condition progresses.
Thus, for example, most people may report significant benefits lasting almost six months after the first corticosteroid injection. However, this benefit lasts barely for three months on subsequent injections. Ultimately, intra-articular injections only help for a few weeks, making them impractical to use. Joint replacement surgery is the only option for many people without optimal pain relief. However, not everyone can undergo joint replacement. For example, older adults or those living with severe health conditions cannot undergo such a major surgery. Thus, for them, high-dose opioids remain the only option. But high dose opioids are associated with many health risks.
The new technique does not involve prescribing toxic drugs and is minimally invasive. Thus, it is safe for use in various population groups. This technique is called cooled radiofrequency ablation (c-RFA). It involves inserting a needle, placing it near the sensory nerves, and using a specific radiofrequency to “knock out” these nerves. Radiofrequency cause irreversible changes in these sensory nerves, and thus these nerves stop carrying pain sensation. It does not kill the nerve cells completely but causes significantly reduced transmission. It means that some sensation is preserved, but pain transmission is significantly overcome. One can learn more about this technique here.
The study was done on 23 people. Of them, 12 had chronic shoulder pain, and another 11 had hip pain. These were people irresponsive to conventional drug therapy and intra-articular lidocaine and corticosteroid injections. This procedure is highly safe, as it did not cause any side effects. However, it resulted in significant benefits. All patients reported significantly reduced pain and improved joint function. Doctors reported an impressive 85% pain reduction in those with shoulder pain and 74% pain reduction in those with hip pain. Also, two-thirds of the participants reported significant improvement in joint function. Thus, doctors say that the method could be a safe alternative to joint replacement surgery and prolonged opioid use. In addition, it can especially help reduce the risk of opioid addiction.
Of course, this procedure is not for mild or moderate cases of arthritis. It is more like a last resort for those who cannot undergo surgery, and prescribing opioids is not an option for these people. Here it is also vital to notice that knee, shoulder, and hip arthritis account for 95% of all severe cases of arthritis. Doctors say they are still scratching the surface, as this technique may also be suitable for chronic pain caused due to other reasons. Thus, future studies need to explore its role in managing cancer pain, pain due to amputation, and trauma.
By Gurpreet Singh Padda, MD, MBA