1. 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

2. 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

3. 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

4. Often refractory to therapy Multidisciplinary treatment approach required –Pharmacologics –Localized interventional procedures with pharmacological agents –Lifestyle modification –Homeopathic approaches Background - Neuropathic pain

5. 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

6.  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

7. 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:

10. Results

11. Results Average Pain ScoreSDp-value Pre-procedure8.91.8 Immediate post0.10.4< 0.001 1 week2.83.1< 0.001 1 month3.23.3< 0.001 2 months4.23.2< 0.001 3 months4.13.4< 0.001 6 months5.33.50.003 9 months6.03.50.04 12 months5.64.40.07

12. Results Average Karnofsky functionSDp-value Pre-procedure75.012.0 Immediate post82.011.00.004 1 week83.012.00.001 1 month81.014.00.004 2 months83.013.00.01 3 months83.014.00.02 6 months80.015.00.08 9 months78.015.00.08 12 months80.019.00.1

13. 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