Cryoanalgesia - part of interventional chronic pain management

Abstract

Cryoanalgesia, also known as cryoneuroablation or cryoneurolysis, is a specialized technique for providing pain relief in chronic neuropathic pain conditions. It is a method of relieving pain, by freezing the affected nerve branches, involved in conduction of the pain. The procedure is used for the treatment of various intractable pain conditions and involves the precise location and freezing of the nerves associated with the neuropathic pain that originates from relatively small, well localized lesions such as neuromas, entrapment neuropathies, and postoperative pain. It has also been used to obtain pain relief in biomechanical pain syndromes including lumbar or cervical facet syndromes, and coccygodynia. The most common use for cryoanalgesia for lower back pain is the long-term treatment of lumbar facet pathology. Sustained blockade of afferent impulses with cryoanalgesia may reduce plasticity (windup) in the central nervous system and lead to long lasting analgesia. Permanent blockade does not usually occur, since the affected axons regenerate. Furthermore, cryoablation avoids the complication of causing or exacerbating pain. This can occur with a neurotomy or non-pulsed thermocoagulation with radiofrequency. With cryoablation, the axons and myelin sheaths are lysed (Wallerian degeneration), but the epineurium and perineurium remain intact, which facilitates successful nerve regeneration. The affected axons are unlikely to form neuromas, often associated with traumatic, surgical, and thermal lesions that interrupt perineurium and epineurium. The contact surface area of a cryoablation probe on larger nerves provides more complete neurolysis than pulsed radio frequency procedure. Furthermore, cryoablation provides immediate analgesia in the affected area while there is a delay of up to a week with pulsed radiofrequency. [...].