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COOLIEF: Non-Narcotic, Non-Surgical Procedure for Pain Management

Pain management is a challenge, especially given the current opioid epidemic. Corey Johnson, Certified Registered Nurse Anesthetist, discusses COOLIEF, a non-narcotic, non-surgical procedure for pain management.
COOLIEF:  Non-Narcotic, Non-Surgical Procedure for Pain Management
Corey Johnson, CRNA
Corey Johnson, CRNA received his Bachelor's degree in nursing in 2000 from Oregon Health and Sciences University.  His experience includes working as a critical care nurse for eight years at Providence St. Vincent Medical Center in Portland for eight years.  He graduated in 2010 with a Masters in Anesthesiology Education from Gonzaga University in Spokane, WA.  Corey joined the United States Army Reserve in 2001 and has been mobilized to Fairbanks Alaska and most recently to Kosovo.  Corey joined Pullman Anesthesia Associates in 2010 and has been providing anesthesia and pain management at Pullman Regional Hospital since that time. He is married to Kathy and has three adult children and two grandchildren.  In his free time, he enjoys spending time with family, gardening, and many outdoor activities.

Learn more about Corey Johnson, CRNA

Bill Klaproth (Host): If you have chronic knee or hip pain, a procedure known as radio frequency ablation or RFA can be used to block the pain. Here to talk with us about the COOLIEF Radiofrequency Ablation procedure is Corey Johnson, Certified Registered Nurse Anesthetist with Pullman Anesthesia Associates. Corey thanks for your time. So, what is the COOLIEF Radiofrequency Ablation procedure?

Corey Johnson, CRNA (Guest): Great, yeah, thank you. The radiofrequency ablation procedure is a process where we target sensory nerves of the knee and hip and so nerves – small nerves that come out of the knee and hip joint that send pain signals to the spine and brain. And the radiofrequency ablation procedure is we introduce a probe that creates heat around these nerves that disrupts the pain signals to the spine and brain which relieves the pain symptoms, reducing the need for other medications or further procedures.

Host: So, Corey how is the procedure performed?

Corey: Yeah so, the introduction of these probes is a bit uncomfortable and so it does require patients to go under a deep sedation, similar to a sedation that someone might have for a colonoscopy or another minor procedure. And at that point, once the patient is comfortably napping; we go ahead and use fluoroscopy or x-ray to identify the anatomical landmarks that indicate where these sensory nerves come out of the knee. We use a little local anesthetic after we mark all those sites, introduce some 17-guage or fairly decent sized introducer cannulas at those sites, all under x-ray guidance. Once they are in place, we go ahead and put the radiofrequency probe into the cannula at each site. We use electrical stimulation to test for motor nerve involvement and so, obviously we don’t want to do any ablation to any of the motor nerves that create movement in the leg. We want to focus strictly on the sensory nerves. So, we test each of those sites for motor nerve involvement and once we have determined that they are negative for motor nerve involvement; then we use some local anesthetic at each site. The probe is inserted, again, the placement is checked by x-ray and we begin the ablation process. The ablation process itself takes about two and a half minutes at each site. The radiofrequencies create a temperature of 80 centigrade which is 176 degrees Fahrenheit. So, a fairly good temperature that creates that disruption of the nerve so that it can no longer transmit those pain signals. And after all four sites, there are three sites above the knee joint and one site below the knee joint; once all four of those have been ablated; the cannulas are removed, local anesthetic is injected into those sites and a bandage is placed and you are taken back to the room where you started.

Host: So, how long does this last? What is the average length of pain relief? Does it go to work automatically, or do you have something you can turn it up or turn it down? How does this work?

Corey: Sure. There is no implanted device that is adjustable. This is – once the procedure is complete; most people leave or wake up without pain in their knee. The pain is gone. The peak results of the pain relief – it takes approximately three weeks for us to determine the peak of pain reduction we get from the ablation. But, like I said, people typically leave the hospital without pain in their knee. And that continues over a three-week period to where we determine well this about the spot we are going to be. The statistics are that people get 50-67% reduction in their pain symptoms and that reduction in pain symptoms lasts anywhere from six months to eighteen months. Now that’s on a Bell curve and so some people have a little less, some people may have a little bit more. But most people under the Bell curve get anywhere from six to eighteen months of pain relief from this. The nerves themselves will regenerate and those pain symptoms will return and so this is not a permanent pain relief solution; but it does last for a significant length of time and allows people to reduce their pain medicines they may be taking or become more active and go back to the things they enjoy doing.

Host: And can you do the procedure again? Is this something you would do every six to eighteen months for a period of years? Or is this a one time or two time attempt to give the person some pain relief or like you say they can exercise and kind of through physical therapy, get themselves out of this situation?

Corey: Yeah, so, this can be done over and over again multiple times. There’s not necessarily a limit to the amount of times that we would do this. Now if it was – any procedure that we do is not 100% effective and so, if somebody didn’t get the results that they were looking for or didn’t find results from their procedure at all; that would be an indication that we probably wouldn’t go ahead and do this again. But anyone else that is finding results with this that would prefer to continue with this therapy versus some other definitive therapy, whether that’s surgery or something else; it’s something we could do over and over again.

Host: So, it seems like there are unique features of RFA. One being this is nonnarcotic as people are looking for nonopioid solutions.

Corey: Yeah. This procedure is useful for patients in a lot of different circumstances. And so, you have patients that have advanced arthritis at an early age where surgeons are reluctant to place artificial knees at a young age because they have a life expectancy as well. And so patients who are younger than the age that an orthopedic surgeon would be willing to place an artificial knee or hip; we can provide pain control, reducing or completely eliminating the need for opioids and extending their activities of daily living, extending their hobbies, and the things that they enjoy doing as they get to a point where they can have a knee or hip replacement. Secondly, it can be used for a patient who just is not ready to go through a hip or knee replacement at this time. They prefer to wait, but the pain is significant enough that it’s limiting the things that they enjoy doing. It can be used for patients who are preparing for a total knee or a total hip replacement. So, we could perform the COOLIEF Radiofrequency Ablation. The patient is able to perform physical therapy before their procedure, strengthening the muscles of the knee or hip, then they undergo the hip or knee replacement and then they are able to participate more aggressively with their physical therapy after the total joint replacement, potentially reducing the length of recovery.

And then lastly, there’s a percentage of patients who continue with chronic pain after having a total joint. It’s a small percentage but there is a percentage that continue with chronic pain after those joints are replaced and this is an opportunity for them to get pain relief, reducing their need for opioids or other medications, giving them more access to enjoyment and the activities they enjoy doing.

Host: Clearly, there are benefits. Pain relief, improved functionality and more. So, would someone need a doctor’s referral for this?

Corey: Typically, we receive a doctor’s referral. We like to have a referral from an orthopedic surgeon. They are the experts in kind of giving a patient all of the different options after reviewing their x-rays and their examinations, whether that be surgery or physical therapy or injections or a COOLIEF Radiofrequency Ablation. We receive referrals from primary care providers. We have gotten referrals from physician assistants and advanced practice nurses. Oftentimes, we will go ahead and do a consult with these patients and then we have a side consult that we have with the orthopedic surgeons that we work with, just to make sure that we are not missing something that may be offered to these patients by an orthopedic surgeon before we move forward with the ablation. The biggest thing is that we want to make sure the patients have been thoroughly examined and given all the options, so they have the best opportunity for the best choice in their care.

Host: And then who performs the procedure and where is it generally performed?

Corey: Oh, great question. So, currently at Pullman Regional Hospital and our Procedural Pain Management Clinic we are currently performing these in the operating room. It is not necessary for them to be performed in the operating room. We can perform them in a clean procedure room. And in the future, we will be moving them into a clean procedure room. But at this point, there are done in the operating room. Myself and others at Pullman Anesthesia Associates perform the actual procedure of COOLIEF Radiofrequency Ablation. One of our partners within the group will perform the anesthetic, the sedation that’s required for the procedure to be done and so it requires two anesthesia providers, one to do the anesthesia and one to perform the procedure to safely have you resting comfortably while we do the procedure.

Host: That sounds good. Well, Corey really interesting and thank you so much for your time today. For more information on the COOLIEF Radiofrequency Ablation procedure please visit, that’s This is the Health Podcast from Pullman Regional. I’m Bill Klaproth. Thanks for listening.