Cryoneurolysis in Peripheral Neuropathic Pain
Neuropathic pain is a growing problem as the population ages and the prevalence of diabetes increases. Multiple methods of have been employed to treat neuropathic pain, including medical therapies, local anesthetics, and more invasive procedures such as spinal cord stimulators and neurolysis. Investigators from SUNY Stony Brook evaluated the use of ultrasound guided cryotherapy in this difficult patient population. Patients were selected based on inclusion criteria such as: failure of a first or second line therapy, evaluation by a pain physician before initiating therapy, and a history of response to nerve blocks. Exclusion criteria included an inability to participate in follow up assessments of pain levels. In total, 22 patients underwent ablation and were followed at 1 week and 1, 3, 6, 9, and 12 month intervals. Of these patients, 11 required repeat cryoneurolysis within 12 months of the initial procedure. The average pain score before treatment was 8.3 +/- 1.9. Pain scores after treatment were 2.3 +/- 2.5 at 1 month, 3.2+/- 2.5 at 3 months, 4.7 +/- 2.7 at 6 months, and 5.1 +/- 3.7 at 12 months. In addition to these findings, the study concluded that the regeneration of the treated nerve was related to ablation time. For example, authors found that 1 minute of ablation time corresponded to 1 month of time for nerve regeneration.
This study presents cryotherapy as an effective and safe alternative to other treatment methods for neuropathic pain. This technique provides statistically significant pain relief for the patients at every time point examined. Additional studies will be required for further evaluation of this technique, including future prospective studies to determine optimal ablation time and treatment intervals. Although the study is limited by sample size, number of ablations during the evaluation period, and concomitant pain management therapy, the results are quite promising given the positive response to therapy and the superior safety profile of cryoneurolysis compared to alternative invasive therapies for the treatment of neuropathic pain.
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Yoon JHE, Grechushkin V, Chaudry A, Bhattacharji P, Durkin B, Moore W. Cryoneurolysis in Patients with Refractory Chronic Peripheral Neuropathic Pain. J Vac Interv Radiol 2016; 27:239-243.
Brian Gardner, MD
VIR Pathway Resident at University of Virginia