How Effective Is Using A TENS Unit For Knee Pain?

If you have knee pain, chances are that every aspect of your life is affected by your condition – and, you are certainly not alone. 

Over a quarter of the US population today struggles with the consequences of knee pain, like reduced range of motion, unmanageable care costs, inhibited sports performance, and declining productivity. 

If the prognosis is to live with chronic pain for years to come, it is only understandable to look for alternative treatments that don’t include popping pills or surgery. So, if you’ve come across at-home TENS for knee pain, you might be wondering whether this therapy is safe and efficient. 

In this guide, you’ll learn the ins and outs of electrical stimulation for knee pain and get guidance on how to choose the best neurofunctional pain management method for your needs. Let’s dive in!

How TENS Works To Help With Knee Pain

The management of pain through electrical stimulation is a field of study that goes back thousands of years. 

However, it was only with the introduction of patient-wearable TENS units in the 1970s that transcutaneous electrical nerve stimulation became a valid pain treatment option for millions of people worldwide. 

But is TENS as effective as it is promised to be? Here’s what you need to know about how TENS works to ease knee pain.

Common Causes Of Knee Pain

To understand how TENS for knee pain works, it’s important to clarify what the root causes of this condition are. Most knee conditions derive from damaged tissue in the joint area, often caused by excessive stress, overuse, direct trauma, degenerative diseases, and risk factors such as obesity and aging.

Common knee conditions that cause acute or chronic knee pain include:

  • Sprains and strains: Torn ligaments or tendons (such as the anterior cruciate ligament or ACL) in the knee joint area can affect the knee’s stability and cause pain, swelling, and stiffness. 
  • Inflammatory conditions: Conditions such as bursitis or tendonitis arise when components of the knee joint become irritated or inflamed due to overuse or improper knee mechanics. 
  • Arthritis: Knee osteoarthritis (OA) is a degenerative disease that wears down the cartilage that cushions joint movements and safeguards bones from friction. OA is among the most common causes of knee pain, affecting 14 million people in the US, and is a major cause of disability among older people.
  • Injuries and direct trauma: Fractured bones or ruptured tendons and ligaments can cause damage to hard and soft tissues in the knee area and cause severe pain.

How TENS Encourages The Body’s Own Pain Management Mechanisms

Electrical stimulation is considered to be an efficient treatment for knee pain that allows patients to manage their discomfort without surgery or medications. Beyond the analgesic (pain-relieving) effect of this therapy, electrical stimulation also supports the regeneration of tissue in the affected area by promoting blood flow and reducing inflammation

Thanks to the widespread availability of at-home TENS, people opt for this option to take advantage of the beneficial effects of electrical stimulation. TENS devices work by delivering mild pulses of electrical current to the affected area via electrodes (sticky pads). 

The electrical impulses act by triggering the body of pain-relieving agents such as endorphins, which can counteract the feeling of pain and fatigue you might feel due to your knee condition. 

But, even more importantly, it provides a concrete example of the “Gate Control Theory of Pain”: the electrical impulses “flood” the nervous system, thus closing the “gates” pain signals used to travel between the knee and the brain. In turn, this stops you from feeling pain during treatment.

When You Should Avoid TENS

Generally, this form of therapy is considered to be safe for at-home use. 

Nonetheless, there are some contraindications worth keeping in mind. Consult your doctor before using TENS if you have one or more of the following conditions:

  • You are pregnant (especially in the early stages of pregnancy) 
  • You wear a medical implant or metal device (i.e., pacemakers or internal hearing aids)
  • You have epilepsy
  • You have an open wound or irritated skin in the knee area
  • You suffer from heart and blood conditions

If your pain has not been properly diagnosed or you have a history of cancer in the past 5 years, you should also seek the advice of a healthcare specialist. 

What To Watch Out For When Resorting To At-Home TENS

At-home TENS units are often the go-to alternative for people attempting to benefit from electrical stimulation. But while these devices are readily available over the counter or online, it’s important to be aware of the fact that not all units are FDA-approved, safe, or strong enough to ease the pain. 

If you are in doubt or looking for a more personalized treatment for your knee pain, the Neuragenex team can help.

Why People Use A TENS Unit For Knee Pain

If you have heard that electrical stimulation might benefit your knee condition and support the healing of damaged tissue, you might be getting ready to try TENS. 

But what makes this type of therapy so popular? Let’s find out together. 


Around 750,000 knee surgeries and knee replacements are performed each year, and this number is expected to rise alongside life expectancy rates and the prevalence of obesity. 

That’s where the greatest advantage of TENS comes in. At-home TENS involves nothing more than placing electrodes on the knee area and choosing the right setting. In turn, this form of therapy allows you to manage pain in the long term, and without surgical procedures or pharmaceutical treatments.


Being non-invasive and generally safe, TENS can be self-administered within the comfort of your own home and at your convenience. 

What’s more, 2019 estimations show that pharmaceutical or surgical treatments for conditions such as knee osteoarthritis cost each patient between $12,400 and $16,000, making TENS a far more affordable alternative.



The Drawbacks Of Using TENS For Knee Pain

Ultimately, at-home TENS units are widely available, which gives patients the chance to try out electrical stimulation for pain management without significant financial or lifestyle commitments. 

But choosing commercially-available TENS devices over professionally-administered treatments comes with its fair share of drawbacks. Here’s what you should be aware of.

Current And Wavelength Are Not Strong Enough

The reason why over-the-counter TENS units are safe to use at home and without any training is that these devices are only designed to deliver mild electrical pulses.

But if these limitations make them harmless, they also make them ineffective to treat severe, acute, and chronic pain.

A 2007 review that compares Conventional (mild) TENS, Acupuncture-Like TENS, and Intense TENS shows that Intense TENS is best to treat small areas (like the knee) with high-frequency electrical pulses. 

While these pulses offer powerful analgesic effects, they are just tolerable by the patient. In turn, high-frequency TENS should only be administered by a specialized professional using medical-grade devices to avoid dangerous side effects.

Does Not Address All Sources Of Knee Pain

An evaluation conducted in 2000 shows that conventional TENS and Acupuncture-Like TENS are effective methods of pain management and modulation. Nonetheless, commercially-available units might not be powerful enough to address the underlying cause of knee pain. 

This means that with a TENS device, you might be able to feel a reduction of pain during and just after the treatment (up to 24 hours). However, if you are looking to support the active regeneration of tissue and kick-start the body’s healing process, at-home TENS might simply not be enough.

May Not Be Covered By Insurance

Because of the wavelength and power limitations of at-home TENS units, they cannot be classified as true electroanalgesia (the management of pain through electrical stimulation). What’s more, over-the-counter devices are created to be safely used by anyone, regardless of training or experience. 

In turn, health insurance companies won’t cover at-home TENS for knee pain. You might be able to obtain coverage if your doctor deems this procedure “medically necessary” or as a treatment for postoperative acute pain

Even if Medicare extends to TENS, coverage is only offered by professional treatments as part of a physician’s service or in conjunction with inpatient care.



A Better Treatment Alternative For Knee Pain

A review published in 2019 estimates that patients live an average of 30 years with knee disorders such as osteoarthritis. This makes it imperative to find a treatment option that isn’t just effective, but also non-invasive and non-pharmaceutical. 

Luckily, thanks to the advances in regenerative medicine, you no longer need to choose between depending on medications for the next three decades or getting surgery.

At Neuragenex, we provide holistic neurofunctional pain management therapies for knee pain that are designed around your needs and lifestyle goals. So, you can do much more than simply ease your pain. You can restore your knee health, return to saying “yes” to your favorite activities and social events, and go back to enjoying your daily life.

Here are the methods and approaches we use to help you magnify your life:

Professionally-Administered Electroanalgesia

As we have seen above, electrical stimulation can be an excellent addition to your pain management strategy. But at-home TENS units might not deliver the results you’ve been expecting. 

That’s because although based on the same principle, commercially-available TENS units are unable to deliver the benefits of professionally-administered electroanalgesia. 

At Neuragenex, we use medical-grade FDA-approved devices to administer electroanalgesic treatments, offering long-lasting results and supporting the regeneration of damaged tissue in the knee joint.

Viscosupplementation Therapy

If your knee condition has not been responding to other treatments, viscosupplementation therapy might be an option to explore. 

Through injections of hyaluronic acid, we can help you restore the functionalities of the synovial fluid – the knee joint fluid in charge of maintaining all movements fluid, lubricated, and free of friction.

Lifestyle Counseling

Lifestyle counseling is an important component of a comprehensive, ad hoc treatment journey. That’s because a lot of your knee pain might derive from lifestyle factors, such as being overweight, performing improper movements, overusing your knees, or leading a sedentary life.

Know Your Options. Treat Your Knee Pain

At Neuragenex, we strive to provide personalized pain management strategies that are safe, non-invasive, and effective. But our overarching goal is to help you restore your body’s capabilities, improve your life and health, and support long-lasting well-being – all without medications, surgery, or chiropractic care!

Knee Joint Pain Explained: Causes, Symptoms, And Treatment Options

We can all attest to the vital importance of joint movement and flexibility, especially in the lower extremities, and there is no denying we all heavily rely on our larger joints like the knee, hip, and ankle joints to accomplish regular activities that matter to us. 

The knee joint is one of the most – if not the most – crucial joints that we use every day as we rely on our legs to accomplish even the most basic daily tasks. A healthy knee is highly flexible, permitting full range of movement in the legs. The movement is supported by the group of muscles and tendons that surround the knee, maintaining normal joint alignment.

As we age, the risk factors for knee pain increase. Flexibility may gradually decrease, reducing range of motion in the knee and making movement more rigid. If the knee joint becomes painful, the consequences of this pain can extend to the rest of our body as we accommodate the pain by walking differently or adjusting our posture and balance. Or worse, we just stop moving around altogether. Ultimately, quality of life is greatly affected by knee pain and our health continues to go downhill because of chronic knee pain.


With over 100 million Americans struggling with acute or chronic knee pain, there is little doubt that this condition is among the most widespread musculoskeletal issues in the U.S. It is important to understand “knee pain” and to understand the cascade of symptoms related to pain in the knee area. 

A lot of the complications of knee pain are directly linked to what part of the knee is injured or damaged. For example, a locking, popping, and catching sensation is common for torn ligaments, while stiffness and grinding noises are telltale signs of arthritis. 

Some of the symptoms most commonly associated with knee pain include:

  • Swelling: Swelling is a common symptom associated with knee pain and inflammation, caused by increased blood flow, fluids, and white cells that accumulate around the injured area. 
  • Stiffness: Stiffness is often a consequence of torn and overstretched ligaments, but it can also be a complication of swelling or indicate mechanical problems in the knee. 
  • Tenderness: Inflammation or tissue damage can be caused by a buildup of fluids that may extend to other parts of the knee and can press on surrounding nerves. This interferes with the ability of nerves to carry motor or sensory signals to and from the brain, thus leading to sensations of numbness, tingling, or pain. 
  • Reduced range of motion: Commonly associated with torn ligaments and tendons, degenerative joint diseases (i.e.: arthritis), and bone fractures, reduced range of motion happens when one or more components in the knee area are injured and unable to support the motion of connected muscles or bones. 
  • Instability: Instability and impaired balance are often caused by diseases and injuries that wear down ligaments and tendons. However, this can also be caused by mechanical issues and deformities. 
  • Clicking, popping, or grinding sounds: Torn knee cartilage or damaged ligaments (i.e., the anterior cruciate ligament) can cause a popping or clicking sound at the time of injury or during certain knee movements. Grinding noises are more often associated with arthritis, which wears down the “cushioning” in the joint that keeps movement lubricated. 

Visible deformities: Although rare, knee pain and injuries can cause visible deformities and bulges, such as in the case of kneecap fractures or Baker’s cysts.

Common Causes Of Knee Joint Pain

There are several other conditions that can affect knee joint health, including overuse and dislocation. The severity and location of the pain largely depends on the knee structure that is affected. The following are some of the common causes of knee joint pain:


Knee arthritis is an inflammatory joint disease that affects over 14 million people in the U.S., making it one of the leading causes of knee pain. Arthritis is currently one of the major causes of disability in the elderly in the U.S. There are several different types of arthritis, including osteoarthritis, gout, and rheumatoid arthritis. Arthritis can be caused by several factors, including overuse, degenerative diseases, excessive quantities of uric acid in the body, or autoimmune conditions. 

Over time, arthritis causes breakdown of the cartilage in the knee joint – the soft tissue in the joint that “cushions” movement and protects against friction and stress. As a result, arthritis can lead to pain, grinding sounds when moving, reduced range of motion, and, if left untreated, soft and hard tissue damage.


A dislocation occurs when the bones in the knee joint – the thigh bone (femur) and the shinbone (tibia) – shift out of place and become misaligned. The dislocation might also affect the kneecap (patella) if it gets knocked out of place. 

Knee dislocations are often a consequence of direct trauma, injury, or collisions that involve the knee. They can be extremely painful and can affect the surrounding structures (i.e., ligaments and tendons).


Repeated stress to the knee joint can lead to painful overuse injuries, such as tendinopathy or strains. For example, overuse injuries can affect the tendons and ligaments in the knee. 

You might be at greater risk of overuse knee injuries if you perform repeated movements or activities such as jumping, skiing, or cycling. Being obese or overweight might also put excessive stress on the knee when walking, standing, or jogging, thus leading to the wear and tear of soft tissue.

Bad Posture

Posture impacts how external forces such as stress and gravity affect the knee joint. Bad posture can affect how your body bears its weight, thus affecting the neck and hips, which adds unnecessary strain to certain areas of the knee. This can lead to mechanical issues, such as knee valgus (knock-knees) and knee varus (bowed legs). 

These difficulties cause stress and friction to the knee joint during certain movements, thus affecting the cartilage and bones over time. If left untreated, bad posture, misalignment, and mechanical issues can make knee movements painful and restrict the range of motion.

Diagnosing Knee Joint Pain

There are many different causes of knee pain, from overuse to dislocation. As a result, an accurate diagnosis is critical before starting any treatment to ensure the underlying cause of the pain is addressed. Healthcare providers will often complete a multitude of tests to thoroughly assess the knee before making a diagnosis. 

These include:

  • Reviewing the patient’s medical history: A patient’s medical history can offer valuable insights into the potential cause of the knee pain. Doctors often begin an examination by assessing the patient’s reported symptoms, family and medical history, and mechanism of injury. Patients might also need to provide information about symptoms other than pain, such as fever, swelling, fatigue, or unexpected weight loss. 
  • Carrying out physical examinations: Physical examinations aim to assess whether the patient has swelling, sounds or noises when moving, and stability issues. Doctors also use specific tests to determine how the pain is affecting the range of motion, strength, and whether it is causing knee locking (the inability to extend or bend the knee properly).
  • Imaging tests: To assess the accuracy of their diagnosis, healthcare providers might carry out imaging tests such as X-rays. These tests offer a clear picture of the health of bones, cartilage, ligaments, and tendons in the knee area. 

Blood tests: Blood tests might also be required to exclude causes such as autoimmune diseases.

Common Treatment Options For Knee Joint Pain

The best treatment for knee pain is often determined by a thorough assessment. However, in most cases, patients are recommended one of the treatment options below (or a combination of them):

  • At-home self-care treatments: For conditions such as a mildly sprained ligament, doctors tend to recommend conservative treatment strategies such as R.I.C.E (Rest, Ice, Compression, Elevation). These therapies work by reducing the blood flow to the injured area (which limits swelling) and preventing further injury. 
  • Physical therapy: Physical therapy helps those with knee pain caused by mechanical issues, trauma, or degenerative diseases. A physical therapist will strive to improve the range of motion and muscle strength in the knee with exercises, passive modalities, or manual therapy techniques such as massage. 
  • Over-the-counter medications: Non-steroidal anti-inflammatory medications (NSAIDs) can be used to alleviate pain caused by inflammation, such as arthritis or tendonitis
  • Surgery: Knee replacement surgeries might be required in the case of a ruptured tendon or ligament, knee fractures, infected joints, or degenerative diseases. 

Some common knee conditions, such as osteoarthritis, can affect the daily life of a patient for 30 years or more, making it of paramount importance to look beyond NSAIDs as a long-term treatment solution for knee pain. 

Regardless of the cause of the knee pain, patients can be assured that there are a range of treatment options that can help mitigate the pain, increase flexibility, and restore function in the knee.

The Drawbacks Of Common Pain Treatments

Because one of the most common reasons for knee pain is the inflammation of muscles, tendons, and ligaments, the most apparent solution is to reduce the inflammation. 

Any patient familiar with muscle soreness will know that icing the affected area can result in a temporary decrease in inflammation and pain. 

However, the natural next step for managing inflammation is NSAIDs. When these two treatment options are used in tandem, they can provide a welcome relief for patients suffering from knee pain. However, these two treatments are not without drawbacks and limitations.

The Risks Of Using NSAIDs

When it comes to the use of NSAIDs as a supplement to other forms of treatment, there are several side effects that should be considered and understood by patients. 

NSAIDs are predominantly recognized as a safe treatment option in the short term, and are therefore readily available to most of the population. In fact, NSAIDs can be helpful for a short period of time whilst undergoing other treatments, such as Neurofunctional Pain Management.

However, while these drugs can provide temporary relief, NSAIDs should not be used as a long-term treatment for pain, as the risk of developing a dependency on these drugs should not be dismissed.


The term ‘dependency’ is often associated with illicit drug use and fatal outcomes. However, dependency is also used to describe overuse of medication leading to other forms of medical distress. In fact, a dependency may not always be life-threatening, although the adverse effects can be serious enough that hospitalization is necessary. Understanding this definition can help patients mitigate their risk and identify warning signs before care becomes critical.

The mild nature of NSAIDs can lead to a stronger desire for increased quantities of drugs. In a 2020 study, Dr Sharma and associates concluded that “although NSAIDs are among the most commonly used drugs, their use is associated with a broad spectrum of side effects, which may include gastrointestinal and cardiovascular toxicity” (2020). 

There are several pros and cons of NSAIDs treatment. As we move on and explore additional treatment options for knee pain, patients should consider them objectively, recognizing both the pros and cons of each treatment. While patients may experience the positive effects of NSAIDs, they should also consider the potential side effects.

How Neuragenex Approaches Knee Joint Pain: Neurofunctional Pain Management

Neuragenex offers the best treatment for knee pain with its Neuralgesia treatment program.  Neuralgesia is the unique protocol used by Neuragenex to treat a wide range of chronic pain conditions. Neuragenex is the founding medical group that is pioneering the field of Neurofunctional Pain Management. 

Neurofunctional Pain Management is a specialized treatment program that uses high-pulse electrical stimulation in combination with specialized hydration therapy to relieve pain through multiple combined physiologic effects. Pain neuron sustained depolarization and reduced chronic systemic inflammation are two of the core components of chronic pain relief under the Neurofunctional Pain Management treatment model.

Many patients experience symptom relief after only one treatment session and report that life is markedly better after only a few weeks of the Neuralgesia treatment protocol. Neuragenex is pioneering the field of Neurofunctional Pain Management with the mission to relieve pain, restore health, and magnify the quality of life without drugs, surgery, or invasive procedures.

Get The Best Treatment For Your Knee Pain

When it comes to knee pain, treatment options with Neuragenex should be your first consideration. Understanding that you have non-surgical, non-invasive, non-pharmaceutical, and non-chiropractic treatment options will be the greatest ally in your journey of pain relief. Our vision is to be the first thought, first choice, and first step in the journey of chronic pain relief.


Is Knee Joint Pain Treatable with Neurofunctional Pain Management?

Many who experience knee joint pain will attest to the frustration that accompanies the lack of effective treatments. After the application of treatment and ingestion of drugs, patients are left with short-term relief from pain and wait for the pain to resume while the condition causing it gets worse. Many patients simply want a solution to the pain—or, to put it more simply, they want to know that knee joint pain is treatable without invasive procedures and surgeries. The short answer is that there are options to treat knee pain of various causes, but the root cause of the problem is likely to continue, and the overall condition of the knee will likely get worse while temporary relief efforts get shorter and shorter.

That is why it is critical for both patients and doctors to look beyond short-term solutions and provide sustainable therapies that directly address the source or sources of knee pain

Below, we will explore the common treatments prescribed for knee pain and their side effects – and we’ll look at the more valid alternatives provided by a comprehensive Neurofunctional Pain Management approach. Let’s get started.

The Importance Of Targeting The Cause Of Knee Joint Pain

Today, an estimated 25% of the US adult population suffers the consequences of chronic and acute knee pain – a percentage that accounts for nearly 6.5 million people. But despite how widespread this condition is, no two individuals will have the same experience with knee pain

For some, mild discomfort deriving from a minor ligament strain in the knee joint is nothing more than a temporary inconvenience that can be addressed with at-home therapies such as R.I.C.E (Rest, Ice, Compression, and Elevation). 

However, for those affected by chronic conditions such as severe trauma or degenerative joint diseases, knee pain can cause a cascade of debilitating consequences. From mobility issues and increased risk of injuries to constant pain and productivity loss, knee pain can certainly have an impact on all aspects of a person’s life. 

But when it comes down to treating long-term pain, patients often find themselves at a loss. Without having a thorough understanding of what’s causing their condition, it is often too tempting to simply rely on short-term treatments, home remedies, and over-the-counter painkillers or steroids. 

At best, these treatment options will provide short-term relief without solving the underlying cause of pain. At worst, therapies such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can lead to dependency and complications such as stroke and nerve damage. 

The sections below offer a greater understanding of why choosing short-term treatments and OTC medications to treat knee pain isn’t just inefficient – but can also be dangerous. Let’s get started.

Why NSAIDs And Home Remedies Are Not Proper Treatments

Most patients are familiar with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and Tylenol, and other over-the-counter medications that give a short window of pain relief, dull the pain and cause the patient to rely on heavier and unhealthier doses. But what else can patients with knee joint pain do to effectively treat the pain? In addition to the use of NSAIDs, other home remedy efforts include regular kneading and massaging of the knee, and regular application of ice to diminish swelling in the muscles. A patient who simply deals with the pain on their own is less likely to experience any long-term or moderate-term pain relief because all their efforts and home-use medications will get less and less effective as the knee gets worse and worse over time.

The Side Effects Of NSAID Dependency

Out of around 50 million Americans who suffer from chronic pain, 29 million use non-steroidal anti-inflammatory drugs (NSAIDs) chronically to manage their knee and joint pain. 

But while medications such as aspirin, ibuprofen, and Celebrex are widely available (often over the counter) and affordable, it is important to not underestimate the risks they pose to a patient’s health – starting with dependency. 

Developing a dependency on drugs such as ibuprofen can cause patients with knee pain to crave their medications, take more than prescribed, and develop a high tolerance to the analgesic effects that NSAIDs produce. In turn, this can create a vicious circle and cause patients to become always more reliant on drugs in every aspect of their lives. 

Below are the complications of developing a dependency on NSAIDs to treat chronic knee pain.

Gastrointestinal (GI) Bleeding

Taking high doses of NSAIDs over long periods to treat knee pain may lead to several gastrointestinal adverse effects, including lesions and bleeding. This happens because these medications cause topical injury (on the surface) of the mucosa that lines the upper, mid, and lower digestive tract. 

Additionally, according to 2005 studies, some NSAIDs such as ibuprofen can temporarily inhibit the healing function of platelets (the blood cells in charge of regenerating damaged tissue). This makes it difficult for ulcers and lesions in the GI tract to stop bleeding and begin healing. 

Among the most severe complications of GI bleeding are anemia (lack of hemoglobin and red blood cells), shock, and insufficient blood circulation. It is estimated that around 1-2% of people who take NSAIDs over long periods will develop gastrointestinal bleeding, ulcers, and lesions.

Myocardial Infarction

Non-steroidal anti-inflammatory drugs taken to ease knee pain can have a range of effects on the cardiovascular system and increase the risk of myocardial infarction (a heart attack). This is especially true in people who are already at risk of heart problems but can affect anyone. 

Some of the negative effects of NSAIDs on the cardiovascular system that might lead to a heart attack include:

  • Non-steroidal anti-inflammatory drugs can inhibit the chemicals in charge of reducing the likelihood of blood clots, thus making them more likely to manifest and block arteries in the heart. 
  • NSAIDs can reduce the blood flow to the kidneys, which causes the body to retain more water and salt. This, in turn, can increase blood pressure and make a myocardial infarction more likely. 

The risk of myocardial infarction increases significantly in as little as seven days of taking the drug.


The majority of non-steroidal anti-inflammatory drugs increase the risk of stroke ( a sudden interruption of blood flow to the brain) and other cerebrovascular events. This is because these medications inhibit the functioning of prostaglandins, or the compounds responsible for widening and relaxing the blood vessels. 

In turn, this can cause vasoconstriction (the narrowing of blood vessels) which can lead to reduced blood flow to the brain. NSAIDs also promote the retention of sodium and increase blood pressure, which is an additional risk factor for strokes.

Peptic Ulcer

Peptic ulcers are lesions that occur in the lining of the stomach (gastric ulcer) or in the first part of the small intestine (duodenal ulcers). NSAIDs can lead to ulcers by causing a reduction in the levels of prostaglandin, a chemical that is essential to protect the gastric mucosa. 

In severe cases, peptic ulcers can cause gastrointestinal obstruction, stomach cancer, internal bleeding, and holes in the stomach wall. According to a study conducted in 1999, NSAID-induced peptic ulcers account for 10% to 30% of all peptic ulcers.

Acute Renal Failure

As seen above, NSAIDs reduce the blood flow to the kidneys by reducing the amount of prostaglandins secretion in the body. In turn, this can lead to a reduced ability of the kidneys to filter blood, thus causing a range of consequences, including:

  • Accumulation of waste product
  • Increased blood pressure
  • Difficulty processing salt and water in the body
  • Deterioration of the renal function

Over time, an excessive accumulation of waste in the kidneys can lead to what’s called “Acute Renal Failure”. Acute kidney injury or failure might be reversible, but it is a serious condition that requires immediate medical care. Using high doses of NSAIDs for a month or longer can increase the risk of acute kidney failure fourfold.

The Downside Of Corticosteroid Injection For Knee Joint Pain Treatment

Some doctors may rely on the use of a treatment called corticosteroid injection. The primary purpose of corticosteroid injections, much like the use of NSAIDs and ice, is to reduce inflammation. However, unlike NSAIDs and the application of ice, corticosteroids intend to provide lasting anti-inflammatory effects, which can last for several months. However, the growing consensus in conventional care is leaning in the direction of less and less corticosteroid use overall. Many reports and publications are coming out with evidence that long-term use of steroids to reduce inflammation and pain is facilitating the continued destruction of the damaged tissue causing the pain, essentially making the condition worse at the expense of short-term relief. However, one could easily see the benefits of corticosteroid injections especially due to their lasting efficacy, typically several weeks to several months of pain relief. One other benefit of corticosteroids is that they closely resemble a natural hormone produced in our bodies called cortisol, which is the source of health deterioration associated with stress. However, we must not view the injections of corticosteroids as perfectly safe and effective, even if they do resemble something that is naturally produced in our bodies. It is widely known that steroids have a litany of side effects and are often viewed as having a short-term effective use range, meaning a doctor would see steroids as a solution for a few years but not for decades.

The Side Effects Of Corticosteroid Injection

Steroids are the artificial version of hormones that are naturally produced in the human body by the adrenal glands. This family of drugs is efficient in temporarily reducing excessive inflammation, which is caused by the body as a response to injury, infection, or bacteria. In turn, steroids can reduce swelling and pain, but they won’t cure the underlying reason for knee pain.

Although today they have a wide range of uses, steroids are commonly prescribed to ease the symptoms deriving from a range of inflammatory conditions, including osteoarthritis, rheumatoid arthritis, and gout. Although they can be taken orally, corticosteroid treatments for knee pain are usually delivered in the form of intra-articular (inside the joint) injections.

According to a study conducted in 2004, steroids can successfully reduce the symptoms of arthritis for up to 2 weeks, but much higher doses are needed to ease pain in the long term. However, when taken over long periods of time, steroids can cause addiction and lead to physiological and psychological withdrawal symptoms.

Today, the rate at which steroids are prescribed for knee pain is ramping up, and around 8-14% of patients with knee osteoarthritis are likely to receive steroid injections as part of their treatment. Because of this, it is crucial for both patients and healthcare providers to understand the risk of this therapy and opt for alternative treatments.

Many patients who have used steroids for treatment, including treatment for knee pain, will either experience the numerous side effects or appreciate how the treatment with corticosteroids makes them feel. Regardless of the opinion of patients and their experiences with steroid treatment, side effects are undeniable and sometimes deadly.

Some of the most common side effects include:

Cortisone Flare

Although temporary, a cortisone flare is a common side effect of steroid injections for knee pain and can be severely debilitating for around 48 hours. A cortisone “flare” – or a sensation of intense pain in the injection site – is caused by the slow-release crystals of corticosteroids contained in the injection.

These crystals work by releasing the drug into the system over time, which helps the analgesic effect last longer. However, when injected, they can trigger temporary irritation and inflammation of the injection area.

A cortisone flare is likely to appear within a day or two of the shot and can last 2-3 days. Although inflammatory flares happen in just 1-2% of people receiving a steroid shot, over 35% of patients tend to experience post-injection pain around the knee area.

Fat Atrophy

Fat atrophy refers to the loss of fatty tissue in a certain area of the body (i.e.: the knee). As the fat mass degrades, it might leave marks such as pitting, scarring, and a sunken appearance. In severe cases, when there is a major loss of fat tissue, nearby fat mass might redistribute, which can make underlying bones and other structures more visible.

Fat atrophy due to steroid injections affects around 1% of patients, appears 1-4 months after the injection, and resolves itself in 6-30 months.

Tendon Injury

One of the most severe complications of repeated corticosteroid injections is tendon damage and ruptures. Although the mechanisms of this side effect are not well-understood, a 2016 article hypothesizes that steroids can lead to soft tissue fragmentation and cause changes in the biomechanics of the knee, such as stopping the production of collagen in the tendons.

Beyond simply injuring a tendon, steroids can also inhibit healing and repair, which is something worth considering for those whose knee pain derives from a tendon injury.

Nerve Damage

Studies conducted in 1982 have confirmed that some steroid agents commonly in use are neurotoxic – which means that they cause damage to the nerves in the peripheral nervous system (the nerves outside of the brain and spinal cord).

The damage is caused by the toxic effects of steroids on nerve fibers. Steroids can also disrupt the functioning of the blood-nerve barrier, which should keep materials from the plasma and the nerves separate.

Although steroid-induced nerve damage is sometimes reversible, you might experience motor difficulties, abnormal sensations, and changes in how your body reacts to stimuli (i.e.: you might feel pain when doing something that should be painless).

Cartilage Damage

In the knee, the cartilage plays the fundamental role of absorbing shock and friction, thus protecting bones from damage during movements. In most people with joint diseases, knee pain is caused by the degeneration of this “cushion” of soft tissue in the knee joint. 

However, if you are taking steroids to ease joint pain, you should be aware that this kind of therapy can lead to further cartilage degeneration. This happens because cortisone can prevent the release of growth factors and stop or slow down the production of new collagen (a thick fluid that makes up around 60% of the material in the cartilage).

Compromised Immune System

One of the reasons why steroids are so effective in easing knee and joint pain is that this category of drugs works by modulating the response of the immune system. In patients with inflammatory conditions such as osteoarthritis and rheumatoid arthritis, this can prevent the body from causing excessive inflammation, which can be damaging to the joint tissue. 

However, this effect can go both ways: over time, steroids reduce the volume and activity of the immune system. In healthy people, this might be a temporary side effect. In people with a suppressed or weak immune system, compromised immune functions can increase the risk of infections and complications.

In a 2019 study conducted by doctors Dara Grennan and Sheila Wang, it was confirmed that steroids “… reduce the ability of the immune system to function (immunosuppression). Patients taking steroids are not only more susceptible to infections but more likely to have severe or unusual infections.” These medical professionals continue to explain the severe side effects of steroids by comparing them to the aforementioned cortisol, your body’s primary and natural stress hormone. Grennan and Wang conclude that “… because steroids are so similar to cortisol, prolonged use of systemic steroids at higher doses can cause the adrenal glands to stop making cortisol. If the systemic steroid is stopped suddenly, this adrenal suppression and resulting lack of steroid can cause a wide range of symptoms, such as dangerously low blood pressure.” That said, knee pain is such a problem for patients and their doctors that they are willing to get on a steroid regimen to resolve the immediate pain with the understanding that a knee replacement or other surgery is the ultimate result.

The Complexities of Treating Knee Pain

We can’t forget that many other risk that there are many factors that may contribute to knee pain and that most of the treatments for knee pain only remediate inflammation, which is the driving force behind most chronic pain conditions. As we have mentioned before, many conditions contribute to chronic knee pain, including bone spurs, arthritis, dislocations, bad posture, and referred pain from the hip and back of the foot and ankle. It should then be assumed by patients seeking treatment that if these alternative risk factors apply to them, the use of NSAIDs, icing and corticosteroid injection will not be a very lasting treatment. If their risk factor for knee pain does not include inflammation of the muscles, the aforementioned anti-inflammatory treatments will do little to help the pain. It is therefore crucial that patients experiencing knee pain get an accurate diagnosis and identify the source or sources of their knee pain.

At Neuragenex, our goal is to look beyond treating just the symptoms and address the root causes of knee pain. Thanks to our proprietary Neurofunctional Pain Management, we are able to provide tailored treatment programs customized to each patient’s needs. This allows patients to enjoy long-lasting relief while also taking a step towards living a life free of medications and debilitating joint conditions. 

Below is an overview of our approach to treating knee pain.

What Is Neurofunctional Pain Management?

When it comes down to addressing knee pain, looking beyond the symptoms a patient might be experiencing is key to finding a solution that isn’t only long-lasting, but also sustainable. 

Our Neurofunctional Pain Management approach does just that: it takes into account factors such as lifestyle choices, medical histories, and long-term goals to help patients live free of pain. 

Our pain management programs are entirely customized around a patient’s unique needs. Here are some of the treatments and therapies we use to provide long-lasting relief and kickstart the body’s self-healing mechanism:

  • Electroanalgesia – Our MDs will deliver high-frequency pulses of electrical current to the knee area using an FDA-cleared device. The electrical current acts in the joint area by “flooding” the nervous system and preventing pain signals from reaching the brain. Additionally, electrical stimulation can trigger the production of pain-relieving hormones, such as endorphins, and improve blood circulation around the knee area, thus boosting the supply of oxygen and nutrients in the joint. 
  • Viscosupplementation and hyaluronic acid injections – Viscosupplementation refers to the practice of injecting hyaluronic acid (HA) into the joint area. This thick fluid will replenish the body’s reserves of HA, thus keeping the joint lubricated and protected against friction and shock damage. 
  • IV therapies – Some nutritional deficiencies can trigger or worsen knee pain. Our custom IV therapies aim to provide a renewed supply of nutrients that can reduce inflammation, support the healing of damaged tissues, and ease pain. 
  • Lifestyle counseling – Even when knee pain isn’t directly caused by lifestyle choices, some factors can worsen joint conditions. For example, being obese or overweight can add stress to the knee joint, thus making the complications of arthritis more likely. At Neuragenex, we maintain a holistic approach to all knee conditions, and we provide our patients with the guidelines and support needed to make better lifestyle choices for their health. 

Thanks to our expertise and availability of treatment options, we can help patients design a Neurofunctional Pain Management program that fits their medical history, lifestyle needs, and goals.

How Does Neurofunctional Pain Management Help With Knee Pain?

Regardless of the cause of knee pain, a patient’s primary concern is their ability to perform daily tasks without pain. Pain is a nervous system condition, with pain neurons referring pain to the brain and the brain interpreting that pain and creating responses. It’s a feedback loop that is supposed to be a healing mechanism, but if there is no healing occurring, then it simply becomes a negative feedback loop with the pain neurons referring to pain and the brain reacting to that pain and triggering inflammation, which causes more pain, and the cycle continues. Neurofunctional Pain Management is an effort to relieve pain while also restoring health so that the conditions causing chronic pain can be resolved as much as possible in the effort to relieve pain overall. Neuragenex is the pioneering medical group bringing Neurofunctional Pain Management to the nation. The premise of Neurofunctional Pain Management is to use high pulse electrical stimulation to relieve chronic pain and to apply health restoration efforts such as specialized hydration and nutritional deficiency restoration, in combination with robust patient education and lifestyle counselling to produce a pain relief effect and a health restoration effect that will enhance the pain relief effect, making the entire pain relief process last longer for the patient and producing an enhanced quality of life that is more than just being out of pain, but being out of pain and being healthier than they were before.

Neuragenex’s Knee Joint Pain Treatment

Neuragenex offers a Neurofunctional Pain Management solution called Neuralgesia which is a combination of high-pulse electrical stimulation and specialized hydration therapy that fits the very definition of Neurofunctional Pain Management. Neuragenex can apply this protocol to any chronic pain condition to achieve the effects of relieving pain and restoring health to magnify the patient’s quality of life. Because many chronic pain conditions are musculoskeletal-based pain problems, like bone/joint/muscle pain issues, the high pulse electrical stimulation component of Neurofunctional Pain Management is an effective therapeutic application for relieving pain. The health restoration effort may include several components depending on the patient’s specific conditions and issues, but ultimately the foundation of the patient’s health restoration is in specialized IV hydration therapy that balances and restores the nutritional deficiencies that are a primary component of chronic systemic inflammation and overall chronic pain. Neuragenex can effectively treat chronic pain conditions like peripheral neuropathy and chronic knee pain using Neuralgesia treatment protocols and the overall concepts of Neurofunctional Pain Management.