Purpose
Cryoneuroablation,
also known as cryoanalgesia or cryoneurolysis,
is a specialized technique of anesthesia and interventional radiology,
providing long-term pain relief (1).
Lloyd et al proposed that cryonalgesia was superior to other methods of peripheral nerve destruction,
including alcohol and phenol neurolysis or surgery (2).
The application of cold to nerve creates conduction blocks,
similar to the effect of local anesthetics (3,
4,
5).
Clinical applications of cryoanalgesia in oncology extend from its use in chest wall pain after thoracic metastases,
pathologic rib fractures; post-thoracotomy pain...
Methods and materials
From January 2012 to June 2014,
32 cryoneurolysis of chest intercostal nervessecondary to carcinoma metastasis or sarcoma metastasiswere performed on 12 patients (six men,
six women; mean age: 60 years,
range: 17-79) with neurological pain and failure of third level opioid treatment.
Chest nerve roots incriminated of the pain were determined after clinical examination and confirmed by recent CT or MRI exams (Fig. 1).
Relief of pain through the use of pain treatment or medications was recorded on a 0%-100% scale (0%,
no relief; 100%...
Results
Twelve patients (mean age 60 yrs,
range : 17-79) with chronic chest pain underwent treatment as a cryoneurolysis during the period of January 2012 through June 2014.
In total,
thirty-two cryoneurolysis were performed.
Patients had two main causes for their pain: pleural metastasis or tumor infiltration of the gutter between rib and vertebra.
Meanpre-operative VASwas 6,6 out of 10 (range: 5-8) for worst pain in a 24-hour period.
The results in the time of follow-up are summerized in
Table 1.
Technical success was 100%.The number...
Conclusion
Here we propose a safe and efficacious technique with a specific protocole of freezing,
cryoprobe placement and carbodissection.
Our results show a decrease in pain free for the first month (-40% at 1 month) which allow to reduce opioids treatment and improve the living conditions.
Pain reduction is sharper during the first two weeks (from -71.4% to 42.8%).
The new increase can be explained by achieving multi metastatic patients and by disease progression itself,
which makes it difficult to accurately evaluate the EVA on the...
Personal information
Interventional Radiology,
Centre Léon Bérard - Lyon/FR
References
1- Conacher I.
Percutaneous cryotherapy for post- thoracotomy neurolgia.
Pain 1986,25:227-228
2- Lloyd JW.
B,
Glynn CJ.
Cryoanalgesia.
A new approach to Pain relief.
Lancet.
1976;2:932-934
3- Green C.
The role of cryoanalgesia for chronic thoracic pain : results of a long-term followup.
J Natl Med Assoc.
2002;94:716-720
4- Trescot A.
Cryoanalgesia in interventional pain management.
Pain physician.
2003;6:345-360
5- Myers RR,
Powzll HC,
Heckman HM et al.
Biophysical and pathological effects of cryogenicnerve lesion.
Ann Neurol 1981;10:478-485
6- Maiwand MO,
Makey AR.
Cryoanalgesia for...