Prospective evaluation of cryoneurolysis Prospective evaluation of cryoneurolysis for refractory neuralgiafor refractory neuralgia

Ryan, Adam1; Grechushkin, Vadim1; Durkin, Brian2; Moore, William1

1Radiology, SUNY Stony Brook, NY2Anesthesiology, SUNY Stony Brook, NY

• Cryoneurolysis at the site of focal neuralgia statistically significantly decreased pain scores in patients with refectory neuralgia.

• Effect is usually temporary & repeat treatments are necessary in all patients

• Cryoneurolysis is a potential treatment for patients with neuralgia pain symptoms when conventional treatments fail.

ConclusionsConclusions

• Common problem with various etiologies– Postsurgical injury/neuroma formation– Post-herpetic neuralgia– Chronic radiculopathy– 15 million people on the US and Europe suffer

from chronic neuropathic pain.

Background - Neuropathic painBackground - Neuropathic pain

• Often refractory to therapy• Multidisciplinary treatment approach required

– Pharmacologics– Localized interventional procedures with

pharmacological agents – Lifestyle modification– Homeopathic approaches

Background - Neuropathic painBackground - Neuropathic pain

• Standard of care:• Often treated with multiple agents prior to any

intervention.– Anti-depressants and anti-seizure medication are first

line therapy• Often leading to cognitive side effects.

– Opioids are second line therapy. However, there is little evidence to support their use in neuropathic pain.

• Side effects: constipation, tolerance and risk of abuse.

Background - Neuropathic painBackground - Neuropathic pain

Role of Pain Management: Diagnostic injection of local anesthetic to pain

generative nerve(s)Document location of damaged nerve(s)Document effect of local therapyOrchestrate the multi-modality multi-prong

management strategy.

Background - Neuropathic painBackground - Neuropathic pain

• Prospective study• 25 patients

– Intercostal nerves (14)

– Foot/plantar neuromas (2)

– Ilioinguinal (2)

– Saphenous (4)

– Gluteal nerves (1)

– Peroneal (1)

– Digital nerve (1)

• CT or U/S guided depending on location

Nerves treated:Nerves treated:

ResultsResults

ResultsResultsAverage Pain Score SD p-value

Pre-procedure 8.9 1.8

Immediate post 0.1 0.4 < 0.001

1 week 2.8 3.1 < 0.001

1 month 3.2 3.3 < 0.001

2 months 4.2 3.2 < 0.001

3 months 4.1 3.4 < 0.001

6 months 5.3 3.5 0.003

9 months 6.0 3.5 0.04

12 months 5.6 4.4 0.07

ResultsResultsAverage Karnofsky function SD p-value

Pre-procedure 75.0 12.0

Immediate post 82.0 11.0 0.004

1 week 83.0 12.0 0.001

1 month 81.0 14.0 0.004

2 months 83.0 13.0 0.01

3 months 83.0 14.0 0.02

6 months 80.0 15.0 0.08

9 months 78.0 15.0 0.08

12 months 80.0 19.0 0.1

• Cryoneurolysis at the site of focal neuralgia statistically significantly decreased pain scores in patients with refectory neuralgia.

• Effect is usually temporary & repeat treatments are necessary in all patients

• Cryoneurolysis is a potential treatment for patients with neuralgia pain symptoms when conventional treatments fail.

• A well organized team of physicians and support staff is essential to successful patient outcomes.

ConclusionsConclusions