Harvard Health Ad Watch: A new treatment for knee arthritis

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The TV advert guarantees ache aid for knee osteoarthritis, the supply of a lot of the 600,000 knee substitute surgical procedures carried out within the US every year. A person in a bowling alley winces with ache. He almost falls as he rolls a ball into the gutter. (Did I point out the arrow protruding of his knee?)

“Knee appearing up once more?” asks his buddy, clearly involved. When ache tablets don’t appear to assist, his buddy suggests a process known as Coolief for knee osteoarthritis.

“I had it accomplished six months in the past,” says the bowling buddy. “And the very best half is that it lasts as much as one yr.”

What’s Coolief?

Coolief is a process, not a tablet. A physician inserts electrodes by means of the pores and skin, inserting them close to nerves in a number of areas across the knee. Electrical present utilized by means of the electrodes delivers warmth to the nerve. This impairs its means to ship ache indicators to the mind.

Commonplace nerve blocks use the same methodology to dam ache indicators. However Coolief doesn’t simply warmth up the electrodes, it cools them down – a method known as “cooled radiofrequency ablation.” The thought is to ship extra power the place it’s speculated to go together with much less collateral injury.

The process is taken into account minimally invasive. Nonetheless, it requires a number of injections and x-ray steerage to make sure of the correct location. By comparability, a cortisone shot within the knee to alleviate ache is normally just one injection, and x-ray steerage is never wanted.

Does Coolief work?

Plenty of research have tried to reply this query, however the proof is iffy. In keeping with a latest evaluation of earlier analysis, the proof supporting cooled radiofrequency ablation as a dependable and long-lasting technique to relieve ache from knee osteoarthritis is kind of restricted. Many research included only some sufferers and didn’t assess response after various weeks.

Right here’s a fast rundown of among the largest and most up-to-date research:

  • A 2015 examine of 9 folks with osteoarthritis receiving cooled radiofrequency ablation reported enchancment in measures of ache and performance “past one yr,” however particular particulars, together with how many individuals improved, weren’t offered.
  • A 2017 examine of 33 folks discovered successful price of solely 35% six or extra months after therapy.
  • A 2018 examine of 151 folks in contrast cooled radiofrequency ablation to having a single cortisone shot. After six months, 74% of people that had the process reported a discount in ache by at the least half. An analogous enchancment was reported by solely 16% of these receiving a cortisone injection.

What else must you think about?

Most research discovered few or no negative effects related to the Coolief process. Even so, the producer warns of potential dangers that embody an infection, nerve injury, elevated ache — even paralysis and loss of life. Partially, this can be based mostly on experiences of cooled radiofrequency ablation in different areas of the physique.

One draw back that’s price emphasizing is price: in line with an NBC Information story about this therapy, it may price $2,000 to $4,000, and might not be coated by medical insurance.

Are the advertisements correct?

Primarily based on the 30-second TV industrial described above and a six-page on-line brochure, among the claims appear exaggerated, deceptive, or incomplete. For instance:

  • A serious advertising level of Coolief is that it lasts as much as a yr. But, proof exhibiting such long-lasting enchancment in ache, perform, and high quality of life is kind of restricted. I may discover just one printed report (the 2015 examine talked about above) that monitored handled people for a yr. It adopted solely 9 sufferers, three of whom had already had knee substitute surgical procedure. No particulars had been offered on how lengthy enhancements lasted for particular person sufferers. Additionally, the examine cited by the web advert as proof for the one-year declare really monitored sufferers for under 12 weeks. One other examine of long-term outcomes is “obtainable upon request” from the corporate advertising Coolief.
  • Some proof cited to assist utilizing Coolief for osteoarthritis of the knee comes from therapy of hip and backbone ache. One examine cited as proof of long-term profit didn’t even use cooled radiofrequency ablation — it used a regular nerve block. And lasted solely 12 weeks.
  • The net advert repeatedly reminds the reader that Coolief just isn’t an opiate, and that we’d like non-opiate choices to deal with ache given the dangers and negative effects of opiates. That’s true. However different statements aren’t true. Opioid prescriptions are not given to sufferers as a first-line therapy for continual ache. Nor has aid from osteoarthritis knee ache relied on a every day routine of prescription opioid medicine. Actually, as a result of osteoarthritis of the knee tends to have an effect on older adults who’re vulnerable to medicine negative effects, and since opiates include a number of dangers and negative effects, physicians are likely to keep away from opiates in these sufferers.
  • The net advert describes the Coolief process as “minimally invasive” and cortisone injections as “invasive.” Actually, they’re each minimally invasive.

Lastly, studying that Coolief was “cleared” by the FDA may lead you to imagine the FDA evaluated the proof and concluded this process is protected and efficient. Actually, Coolief didn’t require particular FDA approval as a result of the FDA concluded it was related sufficient to different “legally marketed” units.

The underside line

Coolief could be useful for some folks with osteoarthritis of the knee. Or it may not. Earlier than I like to recommend this costly process, I’d prefer to see extra and higher research. The advertisements are dramatic and eye-grabbing, simply as they’re meant to be (see my weblog on direct-to-consumer advertisements). Sadly, the proof supporting the advantages of this product just isn’t almost so spectacular.

If in case you have osteoarthritis of the knee, discuss to your physician about all of the choices, together with cooled radiofrequency ablation. And in case you see an arrow protruding of your knee, cease bowling and search rapid medical consideration.

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