Skip to main content

Advertisement

SpringerLink
Log in

Applications of Cryoneurolysis in Chronic Pain Management: a Review of the Current Literature

  • Chronic Pain Medicine (O Viswanath, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to evaluate and summarize the literature investigating cryoneurolysis in the treatment of various chronic pain pathologies.

Recent Findings

There is an increasing amount of interest in the use of cryoneurolysis in chronic pain, and various studies have investigated its use in lumbar facet joint pain, SI joint pain, post-thoracotomy syndrome, temporomandibular joint pain, chronic knee pain, phantom limb pain, neuropathic pain, and abdominal pain.

Summary

Numerous retrospective studies and a more limited number of prospective, sham-controlled prospective studies suggest the efficacy of cryoneurolysis in managing these chronic pain pathologies with a low complication rate. However, more blinded, controlled, prospective studies comparing cryoneurolysis to other techniques are needed to clarify its relative risks and advantages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015;16(8):769–80. https://doi.org/10.1016/j.jpain.2015.05.002.

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  2. D’Souza RS, Hooten WM. Neurolytic Blocks. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537360/. Accessed on 15 Aug 2023.

  3. Hsu M, Stevenson FF. Wallerian degeneration and recovery of motor nerves after multiple focused cold therapies. Muscle Nerve. 2015;51(2):268–75.

    Article  PubMed  Google Scholar 

  4. Cooper SM, Dawber RP. The history of cryosurgery. J R Soc Med. 2001;94(4):196–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345–60.

    Article  PubMed  Google Scholar 

  6. Lloyd JW, Barnard JD, Glynn CJ. Cryoanalgesia. A new approach to pain relief. Lancet. 1976;2(7992):932–4.

    Article  CAS  PubMed  Google Scholar 

  7. Barnard JD, Lloyd JW. Cryoanalgesia. Nurs Times. 1977;73:897–9.

    CAS  PubMed  Google Scholar 

  8. Barnard D. The effects of extreme cold on sensory nerves. Ann R Coll Surg Engl. 1980;62(180–187):17.

    Google Scholar 

  9. Evans PJ, Lloyd JW, Green CJ. Cryoanalgesia: the response to alterations in freeze cycle and temperature. Br J Anaesth. 1981;53:1121–6.

    Article  CAS  PubMed  Google Scholar 

  10. Finneran JJ, Ilfeld BM. Percutaneous cryoneurolysis for acute pain management: current status and future prospects. Expert Rev Med Devices. 2021;18(6):533–43. https://doi.org/10.1080/17434440.2021.

    Article  Google Scholar 

  11. Bittman RW, et al. Percutaneous Image-Guided Cryoneurolysis. Am J Roentgenol. 2018;210(2):454–65. https://doi.org/10.2214/AJR.17.18452.

    Article  Google Scholar 

  12. Chu KF, Damian ED. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer. 2014;14(3):199–208. https://doi.org/10.1038/nrc3672.

    Article  CAS  PubMed  Google Scholar 

  13. Friedman T, et al. Sonographically guided cryoneurolysis: preliminary experience and clinical outcomes. J Ultrasound Med. 2012;31(12):2025–34. https://doi.org/10.7863/jum.2012.31.12.2025.

    Article  ADS  PubMed  Google Scholar 

  14. Denny-Brown D, Adams RD. The pathology of injury to nerve induced by cold. J Neuropath Exp Neurol. 1945;4:305–23. https://doi.org/10.1097/00005072-194504040-00001.

    Article  CAS  PubMed  Google Scholar 

  15. Baust JG, et al. Mechanisms of cryoablation: clinical consequences on malignant tumors. Cryobiology. 2014;68(1):1–11. https://doi.org/10.1016/j.cryobiol.2013.11.001.

    Article  ADS  CAS  PubMed  Google Scholar 

  16. Wagner R, et al. Peripheral nerve pathology following sciatic cryoneurolysis: relationship to neuropathic behaviors in the rat. Exp Neurol. 1995;133(2):256–64. https://doi.org/10.1006/exnr.1995.1028.

    Article  CAS  PubMed  Google Scholar 

  17. Myers R, et al. Biophysical and pathological effects of cryogenic nerve lesion. Ann Neurol. 1981;10(5):478–85. https://doi.org/10.1002/ana.410100512.

    Article  CAS  PubMed  Google Scholar 

  18. Murray B. Nerve Injury. In: Aminoff MJ, Daroff RB, editors. Encyclopedia of the neurological sciences. 2nd ed. Oxford: Academic Press; 2014. p. 333–5.

    Chapter  Google Scholar 

  19. Law L, Rayi A, Derian A. Cryoanalgesia. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482123/. Accessed on 15 Aug 2023.

  20. Ilfeld BM, Gabriel RA, Trescot AM. Ultrasound-guided percutaneous cryoneurolysis for treatment of acute pain: could cryoanalgesia replace continuous peripheral nerve blocks? BJA Br J Anaesth. 2017;119(4):703–6. https://doi.org/10.1093/bja/aex142.

    Article  CAS  PubMed  Google Scholar 

  21. Ilfeld B, Gabriel R, Trescot A. Ultrasound-guided percutaneous cryoneurolysis for treatment of acute pain: could cryoanalgesia replace continuous peripheral nerve blocks? Br J Anaesth. 2017;119:709–12.

    Article  Google Scholar 

  22. • Biel E, Aroke EN, Maye J, Zhang SJ. The applications of cryoneurolysis for acute and chronic pain management. Pain Pract. 2023;23:204–15. Review of cryoneurolysis in various acute and chronic pain pathologies.

    Article  PubMed  Google Scholar 

  23. Dasa V, Lensing G, Parsons M, Harris J, Volaufova J, Bliss R. Percutaneous freezing of sensory nerves prior to total knee arthroplasty. Knee. 2016;23:523–8.

    Article  PubMed  Google Scholar 

  24. Zhou L, Craig J, Parekh N. Current concepts of neurolysis and clinical applications. J Analgesics. 2014;2:16–22.

    Article  Google Scholar 

  25. Johannesen N, Madsen G, Ahlburg P. Neurological sequelae after cryoanalgesia for thoracotomy pain relief. Ann Chir Gynaecol. 1990;79:108–9.

    CAS  PubMed  Google Scholar 

  26. Mihalko WM, et al. Cryoneurolysis before total knee arthroplasty in patients with severe osteoarthritis for reduction of postoperative pain and opioid use in a single-center randomized controlled trial. J Arthroplast. 2021;36(5):1590–8. https://doi.org/10.1016/j.arth.2020.11.013.

    Article  Google Scholar 

  27. Radnovich R, et al. Cryoneurolysis to treat the pain and symptoms of knee osteoarthritis: a multicenter, randomized, double-blind, sham-controlled trial. Osteoarthritis Cartil. 2017;25(8):1247–56. https://doi.org/10.1016/j.joca.2017.03.006.

    Article  CAS  Google Scholar 

  28. Panagopoulos A, Tsiplakos P, Katsanos K, Antzoulas P, Lakoumentas J. Cooled radiofrequency ablation versus cryoneurolysis of the genicular nerves for the symptomatic pain management in knee osteoarthritis: a study protocol of a prospective, randomized, single-blinded clinical trial. J Orthop Surg Res. 2023;18(1):295. https://doi.org/10.1186/s13018-023-03737-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Perese J, et al. Ultrasound-guided percutaneous cryoneurolysis for post-thoracotomy pain syndrome: a case report. Cureus. 2022;14(12):e32888. https://doi.org/10.7759/cureus.32888.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nelson KM, et al. Intraoperative intercostal nerve freezing to prevent postthoracotomy pain. Ann Thorac Surg. 1974;18(3):280–5. https://doi.org/10.1016/s0003-4975(10)64357-3.

    Article  CAS  PubMed  Google Scholar 

  31. Clemence J, et al. Cryoablation of intercostal nerves decreased narcotic usage after thoracic or thoracoabdominal aortic aneurysm repair. Semin Thorac Cardiovasc Surg. 2020;32(3):404–12. https://doi.org/10.1053/j.semtcvs.2020.01.008.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yang MK, et al. The effects of cryoanalgesia combined with thoracic epidural analgesia in patients undergoing thoracotomy. Anaesthesia. 2004;59(11):1073–7. https://doi.org/10.1111/j.1365-2044.2004.03896.x.

    Article  CAS  PubMed  Google Scholar 

  33. Moore W, et al. CT guided percutaneous cryoneurolysis for post thoracotomy pain syndrome: early experience and effectiveness. Acad Radiol. 2010;17(5):603–6. https://doi.org/10.1016/j.acra.2010.01.009.

    Article  PubMed  Google Scholar 

  34. Staender M, et al. Computerized tomography-guided kryorhizotomy in 76 patients with lumbar facet joint syndrome. J Neurosurg Spine. 2005;3(6):444–9. https://doi.org/10.3171/spi.2005.3.6.0444.

    Article  PubMed  Google Scholar 

  35. Bärlocher CB, et al. Kryorhizotomy: an alternative technique for lumbar medial branch rhizotomy in lumbar facet syndrome. J Neurosurg. 2003;98(1 Suppl):14–20. https://doi.org/10.3171/spi.2003.98.1.0014.

    Article  PubMed  Google Scholar 

  36. Birkenmaier C, et al. Percutaneous cryodenervation of lumbar facet joints: a prospective clinical trial. Int Orthop. 2007;31(4):525–30. https://doi.org/10.1007/s00264-006-0208-6.

    Article  CAS  PubMed  Google Scholar 

  37. Truong K, et al. Cryoneurolysis’ outcome on pain experience (COPE) in patients with low-back pain: study protocol for a single-blinded randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):458. https://doi.org/10.1186/s12891-021-04320-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Sahoo RK, et al. Cryoneurolysis of innervation to sacroiliac joints: technical description and initial results-a case series. A A Pract. 2021;15(4):e01427. https://doi.org/10.1213/XAA.0000000000001427.

    Article  PubMed  Google Scholar 

  39. Sidebottom AJ, et al. Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review. Br J Oral Maxillofac Surg. 2011;49(8):653–6. https://doi.org/10.1016/j.bjoms.2010.11.007.

    Article  CAS  PubMed  Google Scholar 

  40. Moesker AA, Karl HW, Trescot AM. Treatment of phantom limb pain by cryoneurolysis of the amputated nerve. Pain Pract. 2014;14(1):52–6.

    Article  PubMed  Google Scholar 

  41. Prologo JD, Gilliland CA, Miller M, Harkey P, Knight J, Kies D, Hawkins CM, Corn D, Monson DK, Edalat F, Dariushnia S, Brewster L. Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study. J Vasc Interv Radiol. 2017;28(1):24–34.e4.

    Article  PubMed  Google Scholar 

  42. • Ilfeld BM, Smith CR, Turan A, Mariano ER, Miller ME, Fisher RL, et al. Ultrasound-guided percutaneous cryoneurolysis to treat chronic postamputation phantom limb pain: a multicenter randomized controlled trial. Anesthesiology. 2023;138:82–97. One of the large, recent multi center randomized controlled trials investigating the use of cryoneurolysis for a specific pathology.

    Article  CAS  PubMed  Google Scholar 

  43. Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002;18(6):350–4.

    Article  PubMed  Google Scholar 

  44. Yoon JH, Grechushkin V, Chaudhry A, Bhattacharji P, Durkin B, Moore W. Cryoneurolysis in patients with refractory chronic peripheral neuropathic pain. J Vasc Interv Radiol. 2016;27:239–43.

    Article  PubMed  Google Scholar 

  45. Dalili D, Ahlawat S, Rashidi A, Belzberg AJ, Fritz J. Cryoanalgesia of the anterior femoral cutaneous nerve (AFCN) for the treatment of neuropathy-mediated anterior thigh pain: anatomy and technical description. Skelet Radiol. 2021;50(6):1227–36.

    Article  Google Scholar 

  46. Fracol ME, Dumanian GA, Janes LE, Bai J, Ko JH. Management of sural nerve neuromas with targeted muscle reinnervation. Plast Reconstr Surg Glob Open. 2020;8(1):e2545.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Rhame EE, Debonet AF, Simopoulos TT. Ultrasonographic guidance and characterization of cryoanalgesic lesions in treating a case of refractory sural neuroma. Case Rep Anesthesiol. 2011;2011:691478.

    PubMed  PubMed Central  Google Scholar 

  48. Djavaherian DM, Guthmiller KB. Occipital neuralgia. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538281/. Accessed on 15 Aug 2023.

  49. Kastler A, et al. Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia. J Neuroradiol. 2018;45(6):386–90. https://doi.org/10.1016/j.neurad.2017.11.002.

    Article  PubMed  Google Scholar 

  50. Kim CH, et al. Cryoablation for the treatment of occipital neuralgia. Pain Physician. 2015;18(3):E363–8.

    Article  PubMed  Google Scholar 

  51. Grigsby E, et al. Efficacy and safety of cryoneurolysis for treatment of chronic head pain secondary to occipital neuralgia: a pilot study. Local Reg Anesth. 2021;14(125–132):17. https://doi.org/10.2147/LRA.S324527.

    Article  Google Scholar 

  52. • Kvarstein G, et al. Cryoneurolysis for cervicogenic headache - a double blinded randomized controlled study. Scand J Pain. 2019;20(1):39–50. https://doi.org/10.1515/sjpain-2019-0086. One of the large, recent multi center randomized controlled trials investigating the use of cryoneurolysis for a specific pathology.

    Article  PubMed  Google Scholar 

  53. Mortell K, Yarmohammadi H, Brocone M, Haaga J, Nakamoto D. Percutaneous CT-guided cryoablation of the celiac plexus in the palliative treatment of pancreatic cancer. J Vasc Interv Radiol. 2014;25:817.e815.

    Google Scholar 

  54. Behbahani K, et al. Percutaneous CT-guided cryoablation of the celiac plexus: a retrospective cohort comparison with ethanol. J Vasc Interv Radiol. 2020;31(8):1216–20. https://doi.org/10.1016/j.jvir.2020.04.008.

    Article  PubMed  Google Scholar 

  55. Prologo JD, et al. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia. Skelet Radiol. 2015;44(5):709–14. https://doi.org/10.1007/s00256-014-2075-3.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY, 10029, USA

    David L. Chang & Benjamin Mirman

  2. Weill Cornell Medical College, Department of Anesthesiology, New York Presbyterian Hospital, New York, NY, USA

    Neel Mehta & Daniel Pak

Authors
  1. David L. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Mirman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neel Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Pak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed equally to the manuscript text and collaboratively reviewed the manuscript.

Corresponding author

Correspondence to David L. Chang.

Ethics declarations

Conflicts of Interest

The authors declare that they have no competing interests.

Human and Animal Rights

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, D.L., Mirman, B., Mehta, N. et al. Applications of Cryoneurolysis in Chronic Pain Management: a Review of the Current Literature. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01222-w

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11916-024-01222-w

Keywords

Search

Navigation