Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term
pain relief in interventional
pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid
nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis,
phenol neurolysis, or surgical lesions. The application of cold to tissues creates a conduction block, similar to the effect of
local anesthetics. Long-term
pain relief from nerve freezing occurs because
ice crystals create vascular damage to the vasonervorum, which produces severe endoneural
edema. Cryoanalgesia disrupts the nerve structure and creates
wallerian degeneration, but leaves the myelin sheath and endoneurium intact. Clinical applications of cryoanalgesia extend from its use in
craniofacial pain secondary to
trigeminal neuralgia, posterior auricular
neuralgia, and
glossopharyngeal neuralgia; chest wall
pain with multiple conditions including post-
thoracotomy neuromas, persistent
pain after
rib fractures, and post herpetic
neuralgia in thoracic distribution; abdominal and
pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric
neuralgia; pudendal neuralgia;
low back pain and lower extremity
pain secondary to lumbar facet joint pathology,
pseudosciatica,
pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint
pain, cluneal
neuralgia, obturator
neuritis, and various types of
peripheral neuropathy; and upper extremity
pain secondary to suprascapular
neuritis and other conditions of
peripheral neuritis. This review describes historical concepts, physics and equipment, various clinical aspects, along with technical features, indications and
contraindications, with clinical description of multiple conditions amenable to cryoanalgesia in interventional
pain management settings.