ArcaMax

DEAR DR. ROACH: I have bad knee arthritis. My doctor is suggesting a genicular nerve block. Is this a good idea? Will it fix the problem? -- P.O.V.

ANSWER: Chronic knee pain from osteoarthritis is a common problem in middle-aged and older adults. Before a person receives treatment, the diagnosis should be confirmed by an X-ray. First-line treatments are exercise and anti-inflammatory drugs, like naproxen (orally) or diclofenac (topically).

When first-line treatments are ineffective, there are other options. Knee injections with steroids have long been used, but recent studies cast doubt on their effectiveness and raise concern for damage to knee cartilage. Hyaluronic acid and plasma-rich platelet injections have been shown in recent trials to be only slightly better than saline injections, and they are much more expensive. Duloxetine, an antidepressant that has pain-relieving properties, is effective for some people but not everyone.

Before considering knee-replacement surgery, a nerve block or ablation of the nerves that carry pain information (there are three genicular nerves) can be attempted when an expert is available. There is significant pain relief from this procedure, although the benefit is greatest within a few weeks and generally lessens after three to four months. About half of the people who got the procedure report being "much improved" or "very much improved" afterward. It is generally safe with a low risk of side effects, and it can be repeated.

DEAR DR. ROACH: I am 81 years old and have been diagnosed by my ophthalmologist with age-related macular degeneration (the dry type). I was advised to start taking the AREDS2 eye vitamin and mineral supplement. Shortly afterward, I came across a magazine advertisement for AREDS2, which included a disclaimer from the Food and Drug Administration (in fine print, ironically) that stated the product is "not intended to diagnose, treat, cure or prevent any disease."

I'm confused. If the over-the-counter mineral supplement doesn't do any of this, then of what value is it, and why take it? The disclaimer was easy to overlook and nearly impossible to read. -- E.D.

ANSWER: You are very wise to look at the disclaimer, and I appreciate your asking me. The FDA requires this disclaimer on all supplements, even those with strong evidence that supports them. I often refer readers to this disclaimer when I am trying to give a realistic expectation of the benefit that a person can get from a supplement.

In this particular case, however, there is strong evidence that the AREDS and AREDS2 formulations of over-the-counter supplemental vitamins and minerals do slow the progression of the dry type of AMD. I agree with your ophthalmologist that it is worthwhile for you to take this formulation. I recommend the AREDS2 formulation for current or former smokers as the beta-carotene in the original AREDS formulation was associated with an increase in lung cancer risk.

I do want to emphasize that you should only take these supplements when your eye professional recommends them. They aren't of proven benefit in people who don't have AMD, nor in people with very early AMD.

There are mixed data about prostate cancer risk with vitamin E, which is in both the AREDS and AREDS2 formulations. The AREDS trials did not show any increased risk of prostate cancer with these formulations, but a 2011 trial did show a small increase in prostate cancer with the same dose of vitamin E that was used in the AREDS trials. Other studies have shown both small protection and no change in risk.

Still, because there is a potential for risk, the AREDS supplements should only be taken when prescribed by your regular doctor or eye doctor.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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