Knee Pain Without Surgery: Cooled Radiofrequency Ablation and Regenerative Options

Marijuana is a safer drug than a typical opioid, including for musculoskeletal as well as visceral pain, and some countries now use synthetic formulations of it. It just is not approved for medical use in India yet.

For a musculoskeletal complaint, an NSAID and a muscle relaxant should not run past seven to ten days, at most two weeks. With a new patient, the first move is not intervention: a two-week medical trial is given first, against a target of at least 50% pain relief. If that trial fails to deliver it, the next step is intervention, straight away.

In India, opioids are scheduled drugs. Prescribing requires a competent doctor, meaning a pain specialist, anaesthesiologist or neurologist, not a general physician, general surgeon or ENT. For morphine and fentanyl specifically, the hospital needs a government licence to hold a set quantity, uses a special designated government form that gets stamped, and patients are required to bring back a consumption chart that is submitted to the drug controller. Tramadol, tapentadol and buprenorphine do not need that special licensing, but they still require a valid, stamped prescription from a competent doctor.

That gap exists, and it falls to drug inspectors to enforce, not to prescribing doctors. In practice it means a large number of chronic pain patients arrive in this clinic having self-medicated with over-the-counter combination painkillers for five, ten, even twenty years. This practice calls it analgesic abuse: a difficult situation created by the fact that these medicines are freely available without a prescription.

The first problem is diagnosis. Ninety per cent of doctors who are not trained for this kind of spinal pain cannot diagnose facetogenic pain. This practice groups facetogenic and discogenic pain together as axial pain, and gabapentinoids have no role in treating it, yet eight in ten axial pain patients are put on these drugs anyway, with zero results. Getting it right needs a specific history, a specific examination, and then a diagnostic block to confirm the pain is actually coming from the facet before moving to facet joint radiofrequency ablation.

For patients with advanced knee arthritis who cannot or will not have surgery, whether due to cardiac risk, age or muscle mass. It gives around 70% pain relief lasting 12 to 18 months on average.

A one-time mesenchymal stem cell implant, offered as an alternative to repeat monthly platelet-rich plasma therapy, for osteoarthritis up to grade 3.

Because injecting steroid directly into the plantar fascia can cause it to rupture. Platelet injection is used instead, typically over two to three sittings a month apart.