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Iovera Therapy - A Non-Opioid Treatment Option for Knee Pain Management

Featured Speaker

Clint Pakkala, NP

Clint Pakkala, NP

Clint Pakkala is a Nurse Practitioner in Orthopedics at Aspirus Keweenaw Hospital & Clinics. Clint specializes in pre- and post-operative care and treatment of patients suffering from a wide range of musculoskeletal conditions, including diseases or injuries of the bones, muscles, and joints. He sees patients in Laurium and Houghton.

About this Podcast

Nurse Practitioner, Clint Pakkala, discusses Iovera Therapy, a non-opioid treatment option for knee pain management.


Melanie Cole (Host): We’ve all heard about the opioid epidemic, but what if you could control pain without opioids and without surgery, would you try it? Of course you would. Here to tell us about that today is my guest Clint Pakkala. He’s a nurse practitioner in orthopedics at Aspirus Keweenaw Hospital. Clint, tell us about iovera treatment. What is that?

Clint Pakkala (Guest): So iovera treatment is a cryoanalgesia. It’s a new alternative that we’ve been doing for pain control, especially in the knee and arthritis pain specifically for total joint replacements. It’s indicated for knee pain in general, but most of it that we do it for is postop pain control for our knee replacements, and it’s a nonopioid, non systemic alternative to help treat this pain and it’s immediate pain relief of the nerve of the knee. No chemicals involved, no liquids, no medications, anything like that so it’s a very nice, safe procedure.

Host: That’s so cool. So is this a fairly new comfort option? Cold therapy has been around for a very long time.

Clint: Cold therapy has been around for a while yes. The iovera technology started in 2013 around in that area, but it specifically targets sensory surface nerves of the knee, so it’s very specific of where it’s targeting the pain control.

Host: So what does that mean, Clint? What does focused cold mean? And who is a candidate for this type of procedure?

Clint: So the focused area I’m talking about are two specific areas of the nerves that feed the knee. So we use landmarks or ultrasound to identify these nerves and we can specifically block the pain signals or the best terminology or analogy I can give people is you kind of unplug the electrical cord from the outlet of your wall so it stops the signal from going through, and then the nerve regenerates itself at 1 to 2 mm per day, and that takes up to about 90 days until it plugs back into the wall where you get the sensation back. And who is a candidate for it? Again, it’s indicated for anybody with knee pain, but we primarily do it for all of our total joint replacements, unless there’s a contraindication of course. So we’re treating the pain more so for postop pain.

Host: Then how is it administered? What is this like for patients?

Clint: So it’s a series of very small pokes. It’s a very small needle, and it lasts, it runs a cycle of 60 seconds and it takes anywhere from 15 minutes to half an hour. They usually can feel maybe some cooling or warmth or some tingling especially when we get right on the nerve itself, but the pain is almost immediately relieved once we are able to freeze that nerve.

Host: Pretty cool technology. Is it permanent Clint? How long does it last, and does it need to be redone very often?

Clint: No it’s not permanent. So the nerve regenerates at 1 to 2 mm per day so it can last up to 90 days post injection or post procedure. So what we’re seeing is a lot of times the procedure does not have to be repeated because by then, they’re usually out of the acute phase of the healing process, that of their knee replacement. So we’re seeing maybe on average about a week or so of opiate use post surgery, which is a very big decrease without the procedure – up to 80% less use much less narcotics post procedure. People are meeting their milestones, two, three, even four weeks earlier than without the procedure.

Host: Wow, so what about patients? What do they like about it and are there any side effects? What have you heard from them?

Clint: So I’ve only seen – so far I’ve been doing this a year, and I’ve seen really nothing but great results. I call it my hug day Friday because I get a lot of hugs from these patients. They’ve been dealing with this pain for so long and I’m able to provide them really immediate pain relief. I get some patients that are coming in, in wheelchairs, using canes, limping, and they’re really dancing out of the clinic. So some of the side effects are very minimal. It’s some of the stuff just from the procedure itself, such as poking a needle into you so you get some localized inflammation, some bruising, and really that’s about it.

Host: Can they drive themselves home after the procedure?

Clint: They sure can, yeah. There’s really no limitations post procedure. I just like them to take it easy that day and just kind of ice the sites just to get the inflammation down. The next day or so they can kind of go back to normal activities and do what they wish.

Host: Clint, do you anticipate – I do a lot of these shows, but this is really fairly new and do you anticipate this technology might become the nonnarcotic, non systemic solution of choice to manage knee pain since knee pain is such a huge problem in this country?

Clint: I agree, you know the more the word gets out, I think this is going to become more mainstream. When I first started a year ago or so, the last time I did the search, the closest that was from me doing this procedure was 3 to 4 hours away. Now there’s kind of getting a little more closer in the area, but still not as much, but with the big opioid crisis going on, this is a very safe, very effective option for pain control of the knees. They are delving into some other areas, the shoulders and for ribs to block ribs for rib fractures and such like that, but I myself have not gotten into that aspect as of yet.

Host: Well thank you for that answer. So as we wrap up Clint, what would you like listeners to know about iovera? If there’s someone that suffers from knee pain or has to have a knee replacement, what would you like them to know about asking their doctor about this procedure as opposed to opioids or certain other modalities, give us your best advice and information on this?

Clint: Yeah I would just like them to know to just inquire about it first and foremost, get educated about it and ask. It’s a very low cost. I’ve had one insurance company deny a claim in the last year, and I asked for their research and their research was looking at long term over like a 12 month period, which we know it can regenerate within 90 days so that kind of defeated that purpose. So it’s low cost, it’s very, very tolerable, and it’s very effective with really immediate pain relief and it’s very safe. Not only that, you get away from the opiates much, much sooner and then your recovery period is a lot quicker.

Host: Yeah, that’s just really a neat procedure and something for people as you say to educate themselves about and ask their providers about. Thank you so much Clint for telling us about this today. This is Aspirus Health Talk. For more information, please visit aspirus.org. I’m Melanie Cole.