Cryoneurolysis in Patients with Refractory Chronic Peripheral Neuropathic Pain

Yoon, Jung Hwoon Edward; Grechushkin, Vadim; Chaudhry, Ammar; Bhattacharji, Priya; Durkin, Brian; Moore, William

doi:10.1016/j.jvir.2015.11.027

Cited by 40 publications

(31 citation statements)

References 20 publications

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“…184 Cryoneuroablation (also known as cryoneurolysis and cryoanalgesia) is a specialized interventional pain management technique that uses a cryoprobe to freeze sensory nerves at the source of pain and provide long-term pain relief. 185,186 Cryoneuroablation is indicated for numerous persistent and intractable painful conditions, including paroxysmal trigeminal neuralgia, chest wall pain, 187 phantom limb pain, 188 neuroma, peripheral neuropathy, 187 knee osteoarthritis, 189 and neuropathic pain caused by herpes zoster. 185,190 Radiofrequency ablation.…”

Section: Figure 12: Interventional Procedures Vary By Degree Of Complmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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Section: Figure 12: Interventional Procedures Vary By Degree Of Complmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

View full text Add to dashboard Cite

show abstract

“…15 Percutaneous cryoneurolysis has been reported in the settings of occipital neuralgia, phantom limb pain, muscle spasticity, knee pain, postoperative pain (shoulders, lower extremities, intercostal), peripheral neuropathy, inguinodynia, cancer pain, and many more. [3][4][5][6][7][8][16][17][18][19][20][21][22][23] The integration of advanced imaging guidance to the management of pain provides unique opportunities for palliation in the setting of neoplastic disease by allowing deep structures and nerves to be safely accessed and ablated percutaneously. 16 Computed tomography guidance affords additional available targeting when compared with ultrasound by negating ultrasound degrading artifacts caused by deep tissue locations, adjacent air, or bone.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Percutaneous image-guided cryoneurolysis is evolving as an effective treatment option for several historically difficult to manage pain syndromes, including those related to cancer. [3][4][5][6][7][8] The purpose of this report is to describe effect of a novel procedure involving computed tomography (CT)-guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

Prologo

Manyapu

Bercu

et al. 2020

Am J Hosp Palliat Care

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Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

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“…28 Yoon et al reported the cryoneurolysis of peripheral nerves localized with ultrasound guidance for a variety of conditions. 29 Targeted nerves included the ilioinguinal, posterior tibial, saphenous, gluteal, sural, genicular, and digital nerves (and three plantar neuromas). Patients reported a significant decrease in self-reported pain scores following the cryoablation to 12 months-demonstrating the ability to reach nerves with imaging guidance for the purposes of cryoablation.…”

Section: Introductionmentioning

confidence: 99%

Interventional Cryoneurolysis: What Is the Same, What Is Different, What Is New?

Bittman

Behbahani

Gonzalez

et al. 2019

Semin intervent Radiol

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Cryoneurolysis is the deliberate application of cold temperatures to nerves for therapeutic purposes. The idea of treating pain with this technique is thousands of years old and has evolved over time through the application of surgical techniques, nerve stimulation and/or landmark guidance, and through device development. Recent integration of the interventional radiology skill set to this space has unlocked a myriad of opportunities—primarily through a unique ability to percutaneously access deep structures in the body with accuracy and precision, and the capacity to monitor ablation zones. Understanding of the specific neurohistological process that follows targeted cryoneurolysis leads to new options for treating patients in pain without drugs and opens doors for the potential modification of a wide array of disease states.

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Cryoneurolysis in Patients with Refractory Chronic Peripheral Neuropathic Pain

Cited by 40 publications

References 20 publications

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

Interventional Cryoneurolysis: What Is the Same, What Is Different, What Is New?

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