iovera° for Knee Pain in Columbus, OH: What Freezing the Nerve Can Do, and What It Can’t

By Nikhil Verma, MD, board-certified, fellowship-trained interventional spine and sports medicine physician, Essential Sports and Spine Solutions, Columbus, OH

A few months ago, a family friend had her knee replaced. Before surgery, a local physician treated her with iovera°. She wasn’t my patient, so I watched this one from the sidelines. What I saw was hard to ignore: she excelled in physical therapy, and even 90 days after the procedure her pain was minimal. As someone who looks at data all day, I don’t build conclusions on one story. N equals 1. But it sent me back to the research, and the research held up.

iovera° is an FDA-cleared cryoneurolysis device. It uses precise, targeted cold to temporarily quiet the nerves that carry knee pain. In a randomized, sham-controlled trial of patients with knee osteoarthritis, pain improved significantly more than with sham at 30, 60, and 90 days. There’s no steroid, no drug, and no heat.

It also doesn’t repair the joint. It turns down the pain signal. That’s why I use it as one part of a protocol rather than on its own.

I’m an interventional spine and sports medicine physician in Central Ohio. Here’s what I actually know about it.

What is iovera°?

iovera° is a handheld device that delivers controlled cold through very small needles. It turns liquid nitrous oxide into gas and uses that to form a small, precise cold zone along short 27-gauge needles.

Nothing is injected into the joint, and nothing stays in your body. Afterward, the only things left behind are the cold treatment and the pain relief it produces.

How does iovera° work for knee pain?

The cold temporarily interrupts a nerve’s ability to send pain signals. The structure around the nerve stays intact, so over time the nerve regrows and function returns. That’s why the relief is temporary, and it’s also why the treatment is safe to repeat.

The knee’s pain signals travel through two layers of nerves. The superficial nerves, like the infrapatellar branch of the saphenous nerve, carry pain from the front and inner knee. The deeper genicular nerves carry pain from around the joint itself. I can target both layers, which lets me match the treatment to where your pain actually comes from.

Is iovera° ultrasound-guided?

In my practice, yes. Every time. The target nerves are small, and their position varies from person to person. I use ultrasound to find the nerve and watch the needle in real time, so the cold lands where it should. Many clinics do this procedure by surface landmarks alone. I don’t do blind procedures, and this one is no exception.

Does iovera° work for knee osteoarthritis?

For pain in the right patient, the evidence is encouraging.

The key study is a multicenter trial published in Osteoarthritis and Cartilage. It enrolled 180 patients at 17 sites across the United States, and patients were randomized 2:1 to real cryoneurolysis or a sham treatment. The treated group had significantly more pain improvement than the sham group at 30, 60, and 90 days. Most side effects were mild and went away within 30 days.

You should also know that the study was funded by the company that makes the device. I don’t think that erases the results, because it was randomized and sham-controlled. It is something you deserve to know.

How long does iovera° last?

In the main trial, relief held through 90 days. Among patients who were still responding at day 120, the treatment effect was still statistically significant at day 150. Many people get about three months, and some get more. Because the nerve regrows, the treatment can be repeated when the pain returns.

When I use iovera°

I use it in two situations. The first is 2 to 4 weeks before a knee replacement, so you go into surgery and rehab with less pain. In a 2025 multicenter registry study of 356 knee replacement patients, those who had cryoneurolysis before surgery had lower pain scores and used fewer opioids over the following year (24% vs. 41%).

The second is before PRP, BMAC, or MFAT. Here iovera° calms the pain first, so the biologic and the rehab that follows have a better chance to work.

iovera° vs. cortisone vs. radiofrequency ablation

Cortisone suppresses inflammation for a while, but it’s a steroid, and repeated injections into a joint that’s already wearing down are something I don’t reach for reflexively.

Genicular radiofrequency ablation (RFA) uses heat on the nerves. It usually requires diagnostic blocks first, and in my practice insurance coverage for RFA is mostly limited to Medicare.

iovera° uses cold instead of heat. It involves no steroid, and relief often starts right away. Each option has a place. The right one depends on your knee, your goals, and your timeline.

Where PRP, prolotherapy, BMAC, and MFAT fit in

iovera° quiets the pain signal. It doesn’t change what’s happening inside the joint. For that, we look at orthobiologics:

• PRP (platelet-rich plasma): your own platelets, concentrated and placed in the joint to change the biological environment.
• Prolotherapy: used to support ligaments and joint structures that have become lax or irritated.
• BMAC (bone marrow aspirate concentrate): your own bone marrow, which contains mesenchymal stem cells and signaling cells. It’s used for more advanced cases.
• MFAT (micronized adipose tissue): a small amount of your own fat, gently harvested, processed, and placed in the joint during the same visit. Fat tissue carries its own signaling and support cells, and it may also add a cushioning effect. I consider it for moderate to advanced arthritis.

iovera° has one practical advantage here: it contains no steroid. That means it doesn’t disrupt the steroid-free window I build around PRP and other biologics.

It also creates a period where your knee hurts less, so you can actually strengthen it. The injection is one piece. The protocol is the point.

Is iovera° covered by insurance?

It may not be. Coverage for cryoneurolysis of the knee varies a lot, and many plans limit or deny it. We’re happy to check your plan. Even so, I’d rather be upfront: for most people this ends up being self-pay.

Self-pay has real advantages. You don’t have to wait on prior authorization. You don’t have to go through the diagnostic block steps insurers usually require before nerve procedures. And the decision is made by you and your physician, not by a coverage policy.

Who is a good candidate?

You may be a good fit if:

• you have knee osteoarthritis pain that limits your life
• you want to avoid steroids
• you’re 2 to 4 weeks out from a knee replacement
• you’re planning PRP, BMAC, or MFAT and want to calm the pain first

iovera° isn’t right for everyone. It’s not recommended if you have a cold-sensitive condition, such as cryoglobulinemia, cold urticaria, paroxysmal cold hemoglobinuria, or Raynaud’s disease. It’s also not recommended if there’s an open or infected wound near the treatment site. If you take blood thinners, we’ll review that before treating. I evaluate the knee and look at your imaging myself before recommending anything.

iovera° for knee pain in Columbus and Central Ohio

If you’re in Columbus, Dublin, Westerville, Upper Arlington, Gahanna, or anywhere in Central Ohio and you’ve been handed the same cortisone-then-surgery script, this is the gap the practice was built to fill.

If you want to go deeper on this, the specific protocols I use, how I think about system selection, and what I tell every patient after an injection, I cover all of that in my paid newsletter, Essentials of Healing. You can find it at nikhilvermamd.substack.com.

Frequently asked questions

What is iovera° for knee pain?
It’s an FDA-cleared device that uses targeted cold to temporarily quiet the nerves that carry knee pain. There’s no drug, no steroid, and no heat involved. The nerve regrows over time, which is why the treatment can be repeated.

How long does iovera° last for the knee?
In the main clinical trial, relief lasted through 90 days, and some patients were still responding at 150 days. Most people can expect around three months. It can be repeated when the pain returns.

Does iovera° hurt?
We numb the skin first, so most people feel pressure and cold rather than sharp pain. Bruising, swelling, or a patch of numbness or tingling can happen afterward. These are usually temporary.

Do you use ultrasound for iovera°?
Yes, always. The nerves around the knee vary in position from person to person. Ultrasound lets me see the nerve and place the treatment precisely instead of estimating from the surface.

Is iovera° covered by insurance?
Coverage varies, and many plans limit or deny it. We can check your plan, but for most people it’s self-pay.

Is iovera° better than a cortisone shot?
They do different jobs. Cortisone suppresses inflammation with a steroid. iovera° interrupts the pain signal without any drug. For patients building toward PRP or other biologics, avoiding steroids matters.

Can iovera° be combined with PRP or stem cells?
Yes. I often use iovera° before PRP, BMAC, or MFAT to calm the pain first. iovera° reduces pain, and the biologic works on the joint itself. Which biologic fits depends on how advanced your arthritis is.

What is MFAT?
MFAT stands for micronized adipose tissue. It’s your own fat, harvested through a small needle, processed in the same visit, and placed where the damage is. Nothing is grown in a lab, and nothing comes from a donor. It’s one of the options I consider for more advanced knee arthritis.

Does iovera° fix arthritis?
No. It doesn’t regrow cartilage or change the structure of the joint. It changes how pain is signaled, and that can give you room to move, train, and heal.

Can I get iovera° before a knee replacement?
Yes, and it’s one of the best-supported uses. I typically treat 2 to 4 weeks before surgery. A 2025 registry study found lower pain and less opioid use during the year after surgery in patients who had it beforehand.

Who shouldn’t get iovera°?
People with cold-sensitive conditions, such as cryoglobulinemia, cold urticaria, paroxysmal cold hemoglobinuria, or Raynaud’s disease. It also isn’t recommended for anyone with an open or infected wound near the treatment site. A real evaluation comes first.

Ready to talk through whether this is right for your knee? Request an appointment at https://www.essentialsportsspine.com/request-appointment/ or call 614-626-8707.

This is for educational purposes only and does not constitute medical advice.