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Ease the Suffering From Chronic Pain

Injections can help with achy joints and migraines

ON LONG HIKES and weekend trips to Chicago, Linda Kramer, 58, used every trick — from pain relievers to elastic braces and athletic tape — to baby her aching knees. “I kind of acclimated to the pain,” says the nurse, mom of four and grandmother of two from Crystal Lake, Illinois. But then she injured her shoulder, and her pain-relieving cortisone shot wore off after a few weeks: “I was ready to do more for all my painful joints.”

Kramer opted for fat injections in her shoulder and knees in the summer of 2017. “I wanted to avoid knee replacement or at least put it off as long as possible,” she notes. “So I had a procedure to clean up debris inside my knee joints and received the fat injections.” And as long as she sticks to the exercise program her doctor prescribed, she has found relief. “My shoulder works again. I can swim again. I can hike and go up and down stairs with much less pain. I can enjoy life the way I used to.”

A woman that suffers from chronic pain

Ben Baker

Fat injections have helped Linda Kramer enjoy her life again.

The procedure, called Lipogems, is one of several on the market that use small amounts of a person’s tissue to counter joint pain. Doctors extract bits of abdominal fat (or sometimes bone marrow), wash it and/or blend it, and inject it into achy joints. Small studies suggest it can ease the joint pain of mild to moderate osteoarthritis (the super-common wear and tear arthritis), but it’s not clear why or how well it works.

“Fat injections don’t create a cushion inside joints, and they don’t grow new cartilage,” explains Brian Cole, M.D., an orthopedic surgeon at Midwest Orthopaedics at Rush in Chicago, who performed Kramer’s procedure. “They can’t take the place of a knee replacement if you need one. They do reduce inflammation and improve the biochemistry of the joint so you feel better. You will likely have fewer or milder arthritis symptoms and so can be more active. We think that cells in small blood vessels in the fat are acting like pharmaceutical storehouses — secreting growth factors and anti-inflammatory proteins that improve the chemistry of the joint. Adult stem cells called mesenchymal cells may be partly responsible.”

Injectable Drug Reduces Migraines

The self-injected medicine Aimovig, approved by the FDA in May, can help reduce the number and intensity of chronic and episodic migraines. In a study of 246 people whose migraines weren’t helped by other meds, 30 percent of those who used the highest FDA-approved dose of Aimovig saw their migraine days cut in half, without the sedation, depression or weight gain caused by traditional preventive medicines.

Knee-Pain Treatment Offers Chilly Relief

A new option for the knee pain of osteoarthritis, a treatment called Coolief, deactivates pain-sensing nerves in the knee for up to a year. The process uses a water-cooled device to transmit thermal energy from a radio frequency generator—heating and cooling nerve tissue at the site of the pain. In one study of 151 people, 74 percent who had the technique, called cooled radio frequency ablation, reported a 50 percent drop in knee pain six months after treatment. In contrast, only 16 percent who got a steroid shot in the knee had that level of pain relief.

On the Horizon: Chronic pain

"Avoid inactivity. The natural temptation when something hurts is to avoid moving and exercising. Of course, you want to avoid reinjury, but inactivity is the worst thing you can do. It increases inflammation and central nervous system sensitization, followed by muscle weakness, reduced endurance and more pain when you do move — so you move less and less. Research shows that continuous, healthy movement and early physical therapy are best."

XAVIER JIMENEZpsychiatrist and medical director of the Chronic Pain Rehabilitation Program at the Cleveland Clinic

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