Cryoablation for Arthritis and Nerve Pain Relief

The word cryoablation is formed of two words - 'cryo' means cold and 'ablation' means removal or destruction. Cryoablation in pain management is freezing the nerves to reduce pain. This technology has undergone significant advancement over the years and has recently become available in India. It can be used for relief in a magnitude of pain conditions such as arthritis of the large joints (e.g. the knee, hip, and shoulder), cancer pain, nerve pains, etc. The primary aim of cryoablation is to deactivate the nerves transmitting the pain signals to the brain. This is achieved by freezing the nerves in a controlled fashion to temperatures as low as minus 80 degrees.

How Does it Work?

The procedure is performed using a special probe called a cryoprobe, a hollow needle through which the super-cooled gas such as nitrous oxide or carbon dioxide is delivered from a high to the low-pressure chamber. The extremely low temperatures achieved at the tip of the cryoprobe cause formation of an ice ball, freezing the nearby nerves and thereby reducing their ability to transmit pain.
The probe is guided to the correct location using ultrasound and X-ray. Gas is delivered once the probe is in the correct place. With the help of ultrasound, an ice ball can be seen forming at the tip of the probe as the temperature decreases. Once the procedure is finished, the cryoprobe is removed, and the procedure site is covered with a small bandage. This technology offers numerous advantages, including:

• Minimally invasive pain management alternative 
• Quick and lasting pain relief
• Safe procedure without the increased risk of complications
• No requirement for general anaesthesia for the day care procedure
• Less pain can translate into improved functional ability and reduced painkiller requirements and disability
• Can be easily repeated, if required

A 75-year-old woman visited the hospital with severe shoulder Arthritis. Her shoulder movements were markedly reduced to the extent that even raising her hands to drink a glass of tea or eat food was not  possible without assistance. Her mobility was limited by other medical problems, including Parkinsonism and a recent COVID-19 infection. She spent most of her day lying on her back as lying on either side was  too painful due to her shoulders. This had contributed to the development of a bed sore.

The patient underwent cryoablation of the shoulder. Post-procedure, her range of hand movements improved, and she could raise a cup of tea to her mouth and drink it on her own. Her ability to lie on her sides has also improved, and this helped in the healing of her bed sore. In another case, a 68-year-old man was admitted with complaints of severe right-sided chest, abdominal and back pain for two weeks. His pain
was like a constant bruised sensation which made lying down to sleep or turning in bed a challenge.

A CT scan of the chest showed a large right lung mass invading the surrounding structures, including the space from which the nerves exit the spine. There were numerous challenges in managing his pain, including kidney failure, and his unresponsiveness to usual painkillers. This became further challenging as soon after admission, he had a brain stroke and became disoriented. This required a change in his painkillers to ensure that they do not add to the disorientation, and this further aggravated his pain. 

The patient underwent cryoablation of the nerves being compressed by the lung mass under local anaesthesia. The procedure selectively targeted the nerves being compressed by the tumour to reduce their ability to transmit pain. After the procedure, his pain was markedly reduced. This was a big transition from having severe pain and not being able to sleep, sit or lie down to almost no pain within a span of a few hours, and he was extremely pleased.

Cryoablation can be useful in other pains, such as selective nerve pains and in young patients with arthritis pain who want to avoid or postpone joint replacement surgery.

The outpatient procedures were performed by Dr Amod Manocha, Head, Pain Management, Max Hospital, Saket