Slides - Society Of Interventional Radiology

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Prospective evaluation of cryoneurolysis
for refractory neuralgia
Ryan, Adam1; Grechushkin, Vadim1; Durkin,
Brian2; Moore, William1
1Radiology,
SUNY Stony Brook, NY
2Anesthesiology, SUNY Stony Brook, NY
Conclusions
• Cryoneurolysis at the site of focal neuralgia
statistically significantly decreased pain scores
in patients with refectory neuralgia.
• Effect is usually temporary & repeat treatments
are necessary in all patients
• Cryoneurolysis is a potential treatment for
patients with neuralgia pain symptoms when
conventional treatments fail.
Background - Neuropathic pain
• Common problem with various etiologies
– Postsurgical injury/neuroma formation
– Post-herpetic neuralgia
– Chronic radiculopathy
– 15 million people on the US and Europe suffer
from chronic neuropathic pain.
Background - Neuropathic pain
• Often refractory to therapy
• Multidisciplinary treatment approach required
– Pharmacologics
– Localized interventional procedures with
pharmacological agents
– Lifestyle modification
– Homeopathic approaches
Background - Neuropathic pain
• Standard of care:
• Often treated with multiple agents prior to any
intervention.
– Anti-depressants and anti-seizure medication are first
line therapy
• Often leading to cognitive side effects.
– Opioids are second line therapy. However, there is
little evidence to support their use in neuropathic pain.
• Side effects: constipation, tolerance and risk of abuse.
Background - Neuropathic pain
 Role of Pain Management:
 Diagnostic injection of local anesthetic to pain
generative nerve(s)
 Document location of damaged nerve(s)
 Document effect of local therapy
 Orchestrate the multi-modality multi-prong
management strategy.
Nerves treated:
• Prospective study
• 25 patients
– Intercostal nerves (14)
– Foot/plantar neuromas (2)
– Ilioinguinal (2)
– Saphenous (4)
– Gluteal nerves (1)
– Peroneal (1)
– Digital nerve (1)
• CT or U/S guided depending on location
Results
Results
Average Pain Score
SD
p-value
Pre-procedure
8.9
1.8
Immediate post
0.1
0.4
< 0.001
1 week
2.8
3.1
< 0.001
1 month
3.2
3.3
< 0.001
2 months
4.2
3.2
< 0.001
3 months
4.1
3.4
< 0.001
6 months
5.3
3.5
0.003
9 months
6.0
3.5
0.04
12 months
5.6
4.4
0.07
Results
Average Karnofsky function
SD
p-value
Pre-procedure
75.0
12.0
Immediate post
82.0
11.0
0.004
1 week
83.0
12.0
0.001
1 month
81.0
14.0
0.004
2 months
83.0
13.0
0.01
3 months
83.0
14.0
0.02
6 months
80.0
15.0
0.08
9 months
78.0
15.0
0.08
12 months
80.0
19.0
0.1
Conclusions
• Cryoneurolysis at the site of focal neuralgia statistically
significantly decreased pain scores in patients with
refectory neuralgia.
• Effect is usually temporary & repeat treatments are
necessary in all patients
• Cryoneurolysis is a potential treatment for patients
with neuralgia pain symptoms when conventional
treatments fail.
• A well organized team of physicians and support staff
is essential to successful patient outcomes.
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