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Cryoanalgesia Eugene Yevstratov MD 2003 "notre pain au delà de la substance" http://www.ctsnet.org/home/eyevstratov 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 The Tipe of Pain • Cancer Pain • Cervical Radiculopathies • Chronic Pancreatic and Abdominal Pain • Facial Pain • Fibromyalgia • Herpes Zoster and Postherpetic Neuralgia • Low Back Pain and Lumbar Radiculopathies • Failed Back Syndrome • Headaches • Myofascial Pain Syndrome • Nerve Entrapment Syndromes • Neuralgias and Peripheral Meuropathies • Phantom Limb Pain • Reflex Sympathetic Dystrophy • Pelvic Pain • Joint Pain http://www.ctsnet.org/home/eyevstratov Application •Scar neuroma •Some types of headaches caused by occipital neuralgias •Back pain caused by facet disease •Many other somatic pain conducted by individual peripheral nerves http://www.ctsnet.org/home/eyevstratov 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 Possible Complications •Infection •Numbness of the area after the procedure •Bleeding http://www.ctsnet.org/home/eyevstratov Equipment http://www.ctsnet.org/home/eyevstratov The Physics of Cryoanalgesia •The Joule-Thomson effect •Absorption of heat from the surrounding tissues •Formation of an ice ball by freezing of intracellular and extracellular water •The rapid cooling at approximately -70ºC http://www.ctsnet.org/home/eyevstratov Patient Preparation •Sterile conditions •Kept awake in order to determine location of pain generator by palpation and/or stimulation •Sensory stimulation thresholds are less than 0.4 mV •Motor stimulation should be 1.5 times greater than the sensory threshold http://www.ctsnet.org/home/eyevstratov Chronic Pain Management •Cryoneurolysis 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 . http://www.ctsnet.org/home/eyevstratov Eugene Yevstratov MD http://www.ctsnet.org/home/eyevstratov
