1. Cryoanalgesia Eugene Yevstratov MD 2003 http://www.ctsnet.org/home/eyevstratov "notre pain au delà de la substance"

2. Definition Cryoanalgesia is when pain is relieved by freezing the nerve fibers. Extreme cold is applied to the nerve for several minutes. The result is that the nerve temporarily stops working and can no longer transmit pain impulses. http://www.ctsnet.org/home/eyevstratov

3. The Tipe of Pain Cancer PainCancer Pain Cervical RadiculopathiesCervical Radiculopathies Chronic Pancreatic and Abdominal PainChronic Pancreatic and Abdominal Pain Facial PainFacial Pain FibromyalgiaFibromyalgia Herpes Zoster and Postherpetic NeuralgiaHerpes Zoster and Postherpetic Neuralgia Low Back Pain and Lumbar RadiculopathiesLow Back Pain and Lumbar Radiculopathies Failed Back SyndromeFailed Back Syndrome HeadachesHeadaches Myofascial Pain SyndromeMyofascial Pain Syndrome Nerve Entrapment SyndromesNerve Entrapment Syndromes Neuralgias and Peripheral MeuropathiesNeuralgias and Peripheral Meuropathies Phantom Limb PainPhantom Limb Pain Reflex Sympathetic DystrophyReflex Sympathetic Dystrophy Pelvic PainPelvic Pain Joint PainJoint Pain http://www.ctsnet.org/home/eyevstratov

4. Application Scar neuromaScar neuroma Some types of headaches caused by occipitalSome types of headaches caused by occipitalneuralgias Back pain caused by facet diseaseBack pain caused by facet disease Many other somatic pain conducted by individual peripheral nervesMany other somatic pain conducted by individual peripheral nerves http://www.ctsnet.org/home/eyevstratov

5. Pathophysiology Application of cold temperatures to nervescauses injury and impairs their ability to conduct nociceptive impulses. It based on the expansion of a compressed gas (nitrous oxide or carbon dioxide) resulting in a rapid decrease in temperature and cooling of the cryoprobe tip. Cryoanalgesia can be utilized for treating small well localized lesions of nerves, for example neuromas and entrapment neuropathies. It can be used to treat perineal pain, lower extremity pain, and facial and cranial pain. It has also been used to obtain pain relief in biomechanical pain syndromes including limbar or cervical facet syndromes and coccygodynia. http://www.ctsnet.org/home/eyevstratov

6. Possible Complications InfectionInfection Numbness of the area after the procedureNumbness of the area after the procedure BleedingBleeding http://www.ctsnet.org/home/eyevstratov

7. Equipment

8. The Physics of Cryoanalgesia The Joule-Thomson effectThe Joule-Thomson effect Absorption of heat from the surrounding tissuesAbsorption of heat from the surrounding tissues Formation of an ice ball by freezing of intracellular and extracellular waterFormation of an ice ball by freezing of intracellular and extracellular water The rapid cooling at approximately -70ºCThe rapid cooling at approximately -70ºC http://www.ctsnet.org/home/eyevstratov

9. Patient Preparation Sterile conditionsSterile conditions Kept awake in order to determine location of pain generator by palpation and/or stimulationKept awake in order to determine location of pain generator by palpation and/or stimulation Sensory stimulation thresholds are less than 0.4 mVSensory stimulation thresholds are less than 0.4 mV Motor stimulation should be 1.5 times greater than the sensory thresholdMotor stimulation should be 1.5 times greater than the sensory threshold http://www.ctsnet.org/home/eyevstratov

10. Chronic Pain Management Cryoneurolysis is "ideal" for the management of various chronic pain disordersCryoneurolysis is "ideal" for the management of various chronic pain disorders In comparison to other chemical or thermal techniques, the potential for neuroma formation or deafferentation pain is less or nonexistent.In comparison to other chemical or thermal techniques, the potential for neuroma formation or deafferentation pain is less or nonexistent. http://www.ctsnet.org/home/eyevstratov

11. Eugene Yevstratov MD http://www.ctsnet.org/home/eyevstratov