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

Corey W Hunter, Timothy R Deer, Mark R Jones, George C Chang Chien, Ryan S D'Souza, Timothy Davis, Erica R Eldon, Michael F Esposito, Johnathan H Goree, Lissa Hewan-Lowe, Jillian A Maloney, Anthony J Mazzola, John S Michels, Annie Layno-Moses, Shachi Patel, Jeanmarie Tari, Jacqueline S Weisbein, Krista A Goulding, Anikar Chhabra, Jeffrey Hassebrock, Chris Wie, Douglas Beall, Dawood Sayed, Natalie Strand, Corey W Hunter, Timothy R Deer, Mark R Jones, George C Chang Chien, Ryan S D'Souza, Timothy Davis, Erica R Eldon, Michael F Esposito, Johnathan H Goree, Lissa Hewan-Lowe, Jillian A Maloney, Anthony J Mazzola, John S Michels, Annie Layno-Moses, Shachi Patel, Jeanmarie Tari, Jacqueline S Weisbein, Krista A Goulding, Anikar Chhabra, Jeffrey Hassebrock, Chris Wie, Douglas Beall, Dawood Sayed, Natalie Strand

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.

Keywords: ablation; dorsal root ganglion; genicular nerve; knee; knee pain; peripheral nerve stimulation; platelet-rich plasma; regenerative medicine.

Conflict of interest statement

CWH is a consultant for Abbott, Averitas, Biotronik, Boston Scientific, Mainstay, Nalu, PainTEQ, Saluda, SKK, Vivex. Funded Research by Abbott, Boston Scientific, Discgenics, Mesoblast, Saluda, TissueGene, Vivex. Grants from Saluda, PainTEQ, and Mainstay, outside the submitted work. TRD is a consultant/Research Investigator for Abbott, Avanos, Medtronic, Boston Scientific, Saluda, Nalu, Cornorloc, PainTEQ, Spinal Simplicity, Mainstay Medical, Ethos, Spinethera, SPR Therapeutic, Tissue Tech and Vertos Medical. Funded Research by Abbott, Boston Scientific, Nalu and PainTEQ. In addition, Dr TDR has a patent Abbott pending to DRG Surgical Leads and stock options from Vertos Medical, SpineThera, Saluda Medical, Nalu Medical, Cornerloc, SPR Therapeutic, PainTEQ and Spinal Simplicity; Common stock in Ethos. TD is a consultant for Abbott and Vivex. Funded Research by Discgenics, Mesoblast, TissueGene, Vivex. Research Support, OA Knee Study from Biostar, Kolon Tissuegene and Xalud, outside the submitted work. MFE is a consultant for Abbott, Boston Scientific, Flowonix, Medtronic, Nevro and Stimwave, outside the submitted work. JHG is a consultant for Abbott and Saluda, reports personal fees from Abbott, Stratus Medical, Research Support from SPR Therapeutics and Mainstay Medical, outside the submitted work. Funded Research for Saluda. SP is a consultant for Abbott. JSW is a consultant for Abbott and reports personal fees from Medtronic, Saluda, Biotronik, and SI Bone, during the conduct of the study. AC reports consultant from Arthrex and Zimmer Biomet, outside the submitted work. DB is a consultant for Discgenics, Mesoblast, Vivex, Medtronic, Spineology, Merit Medical, Johnson and Johnson, IZI, Techlamed, Peterson Enterprises, Medical Metrics, Radius Pharmaceuticals, Avanos, Boston Scientific, Sollis Pharmaceuticals, Simplify Medical, Stryker, Lenoss Medical, Spine BioPharma, Piramal, ReGelTec, Nanofuse, Spinal Simplicity, Pain Theory, Spark Biomedical, Micron Medical Corp, Bronx Medical, Smart Soft, Tissue Tech, Kahtnu Surgical, RayShield, Stayble, Thermaquil, Stratus Medical, Genesys, Abbott, Eliquence, SetBone Medical, Amber Implants, Cerapedics, Neurovasis, outside the submitted work. DS is a consultant for Boston Scientific, Neuralace, Nevro, PainTEQ, and Saluda. Funded Research by Neuralace, Nevro, PainTEQ, and Saluda. NS is a consultant for Abbott, Nimbus, Saluda, and Nevro. The authors report no other conflicts of interest in this work.

© 2022 Hunter et al.

Figures

Figure 1
Figure 1
Illustration of the innervation of the knee.

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