Prospective evaluation of cryoneurolysis for refractory neuralgia Ryan, Adam 1 ; Grechushkin, Vadim 1 ; Durkin, Brian 2 ; Moore, William 1 1 Radiology, SUNY Stony Brook, NY 2 Anesthesiology, 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. Conclusions
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 pain
Often refractory to therapy Multidisciplinary treatment approach required –Pharmacologics –Localized interventional procedures with pharmacological agents –Lifestyle modification –Homeopathic approaches Background - 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 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 therapy Orchestrate the multi-modality multi-prong management strategy. Background - 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:
Results
Results Average Pain ScoreSDp-value Pre-procedure Immediate post0.10.4< week2.83.1< month3.23.3< months4.23.2< months4.13.4< months months months
Results Average Karnofsky functionSDp-value Pre-procedure Immediate post week month months months months months months
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. Conclusions