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.

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.