Cryoneurolysis for Pain Relief

Cryoneurolysis, also known as cryoablation, is a pain management technique that involves using extreme cold to temporarily block nerve conduction, leading to significant pain relief (Biel, et al., 2023). This minimally invasive procedure is gaining popularity for its effectiveness in treating certain acute and chronic pain conditions. Interestingly, cryoneurolysis is a technique that dates back thousands of years to the ancient Greeks and Egyptians (Biel, et al., 2023).

The procedure involves applying extreme cold to a specific anatomical area and the nerves that innervate it. This disrupts the conduction of pain signals to the spinal cord and brain (Biel et al., 2023). A probe cooled by liquid nitrogen or nitrous oxide creates temperatures as low as -20 to -100 degrees Celsius (Ilfeld & Finneran, 2020). The low temperatures of cryoneurolysis disrupt the nerve’s ability to transmit pain signals to the spinal cord and the brain, leading to pain relief. Unlike other forms of ablation, cryoneurolysis targets the nerve without necessarily causing permanent damage. The nerve’s ability to regenerate means that normal function can return over time, typically within a few months.

Cryoneurolysis is used to provide pain relief for various conditions, including chronic pain, post-surgical pain, neuropathic pain, and cancer pain. Chronic conditions like osteoarthritis, especially in the knee, can benefit from cryoneurolysis. Patients recovering from surgeries like total knee arthroplasties, shoulder arthroplasties, thoracotomies, and mastectomies often face considerable pain. This technique can be used intraoperatively, and multiple randomized, controlled trials have shown shorter hospitalization times and fewer opioid-related complications for patients undergoing thoracotomy (Ilfeld & Finnernan, 2020). Cryoneurolysis provides an effective solution by numbing the nerves in the affected area, facilitating a smoother recovery process (Biel et al., 2023) Conditions like postherpetic neuralgia from shingles or complex regional pain syndrome can also be treated with cryoneurolysis, offering pain relief where other treatments have failed. It is also beneficial in managing pain associated with certain cancers (Biel et al., 2023).

As a minimally invasive procedure, cryoneurolysis involves a small incision for inserting the cryoprobe, reducing the risk of complications and ensuring a quicker recovery time compared to more invasive surgical options. It allows for the precise targeting of the affected nerves, minimizing damage to surrounding tissues and reducing side effects. The use of ultrasound imaging enables precise application to specific peripheral nerves and deeper nerve structures that would be more dangerous to access otherwise (Biel et al., 2023). The temporary nature of the nerve block means normal nerve function typically returns within a few months, though repeat treatments will be necessary depending on the etiology of the patient’s pain (Biel et al., 2023). Additionally, by providing significant pain relief, cryoneurolysis can reduce the need for opioids and other pain medications, lowering the risk of dependency and side effects associated with long-term medication use (Bittman et al., 2019).

The cryoneurolysis procedure is usually performed on an outpatient basis under local anesthesia. Using imaging guidance, such as ultrasound or fluoroscopy, the physician inserts the cryoprobe near the targeted nerve (Bittman et al., 2019). The area is then cooled to the desired temperature for a specific period. Patients may experience some initial discomfort or bruising at the treatment site, but these symptoms typically resolve within a few days. Rarely, patients may have bleeding or infection. (Biel et al., 2023). Most patients can return to their normal activities within a short period (Biel et al., 2023).

Ultimately, cryoneurolysis offers a promising alternative for pain management, particularly for patients who have not found relief through traditional methods. Its ability to provide targeted, effective pain relief with minimal invasiveness and temporary effects makes it an attractive option for many affected by chronic and acute pain conditions. As research and technology continues to advance, cryoneurolysis is likely to play an increasingly important role in the field of pain management (Bittman et al., 2019).

References

Biel, Emily et al. “The applications of cryoneurolysis for acute and chronic pain management.” Pain practice : the official journal of World Institute of Pain vol. 23,2 (2023): 204-215. doi:10.1111/papr.13182

Bittman, Ross W et al. “Interventional Cryoneurolysis: What Is the Same, What Is Different, What Is New?.” Seminars in interventional radiology vol. 36,5 (2019): 374-380. doi:10.1055/s-0039-1696705

Ilfeld, Brian M, and John J Finneran. “Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain.” Anesthesiology vol. 133,5 (2020): 1127-1149. doi:10.1097/ALN.0000000000003532