What is Cryoablation?

Cryoablation involves freezing a specific area’s nerve with a specialized needle, which cools the tissues to approximately -70 degrees Celsius in an area of about 6-8 mm at the tip.

In Which Diseases/Conditions Is the Procedure Used?

Cryoablation can be used in various diseases affecting nerves, known as neuralgias, such as:

  • Ilioinguinal, iliohypogastric, genitofemoral, supraorbital neuralgia
  • Occipital nerve neuralgia
  • Infrapatellar saphenous nerve neuralgia
  • Pain following amputation and/or phantom pain

It can also be applied when we want to disable the innervation of a painful body part. For example, the small nerves of a joint can be selectively disabled while maintaining the limb’s full range of motion and sensation:

What Is Joint Denervation?

Joint denervation involves disabling the small nerves that supply a joint. This can be achieved using heat (radiofrequency treatment) or freezing (cryoablation). The goal of the procedure is to reduce pain.

It is important to note that this treatment does not improve the underlying condition of the joint, meaning it does not reverse degeneration. However, range of motion often improves slightly, as reduced pain allows surrounding healthy muscles to function more effectively.

When Is Joint Denervation Recommended?

This procedure is primarily used for advanced degenerative joint conditions (e.g. shoulder, hip, knee) in patients who:

  • do not wish to undergo joint replacement surgery, or
  • are not suitable candidates for surgery due to other medical conditions

It may also benefit patients who continue to experience significant pain after joint replacement.

What Are the Advantages of Cryoablation?

Cryoablation affects a larger area compared to radiofrequency treatment, which can increase its effectiveness. Additionally, pain relief typically develops faster than with radiofrequency procedures.

What to Expect During and After Cryoablation?

Before the procedure, a diagnostic nerve block is performed using a small amount of lidocaine injected near the suspected pain-transmitting nerve. This temporarily disables the nerve and helps predict the expected level of pain relief from cryoablation.

The pain-relieving effect of cryoablation is generally similar to that experienced during the diagnostic block.

The procedure is usually performed under ultrasound guidance on an outpatient basis, meaning the patient can go home the same day. Mild sedation is typically used.

The treated area may remain numb for several months.

What Happens After the Procedure?

Pain may temporarily increase after the procedure. Final results are typically evaluated after 2–3 weeks, although many patients report immediate improvement.

For post-procedural discomfort, paracetamol or non-steroidal anti-inflammatory drugs are usually sufficient.

Patients can typically return to normal activities the following day.

How Long Do the Effects Last?

The treated nerve usually regenerates within 6–12 months, at which point pain may return and the procedure can be repeated if necessary.

In some cases, pain may resolve completely, particularly if the nerve regenerates in a healthier environment (e.g. after sports-related nerve injury).

How to Prepare for Cryoablation

  • Do not eat for 6 hours before the procedure
  • You may drink water up to 2 hours before
  • If you are taking anticoagulants (blood thinners), consult your doctor about possible temporary discontinuation

Risks and Side Effects of Cryoablation

  • Numbness in the treated area (common)
  • Infection (extremely rare)
  • Persistent or temporarily increased pain (rare)
  • Bleeding (extremely rare, depending on the treated area)

Additional risks may depend on the specific treatment site and will be discussed with your doctor beforehand.

Source:

1. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain [Internet]. 2011;152(3):481–7. Available from: http://dx.doi.org/10.1016/j.pain.2010.09.029

2. Ajrawat P, Radomski L, Bhatia A, Peng P, Nath N, Gandhi R. Radiofrequency Procedures for the Treatment of Symptomatic Knee Osteoarthritis: A Systematic Review. Pain Med. 2019;1–16.

3. Pushparaj H, Hoydonckx Y, Mittal N, Peng P, Cohen SP, Cao X, et al. A systematic review and meta-analysis of radiofrequency procedures on innervation to the shoulder joint for relieving chronic pain. Eur J Pain (United Kingdom). 2021;25(5):986–1011.

4. Bone ME, Armstrong A, Bashir I, Haynes J. Thermal Radiofrequency Denervation of the Suprascapular Nerve for Chronic Shoulder Pain. Shoulder Elb. 2013;5(4):226–30.

5. Stogicza AR, Peng P. Cryoanalgesia for shoulder pain: a motor-sparing approach to rotator cuff disease. Reg Anesth Pain Med. 2022;47(9):576–80.