Use of ultrasound-guided cryotherapy for the management of chronic pain states

Study Objective: To report the use of ultrasound for cyroablation of purely sensory nerves for long-term relief of pain because the use of ultrasound enhances accuracy while minimizing injury to surrounding structures. Design: Case series of three patients with positive long-term outcomes. Setting: Outpatient Pain Management Clinic associated with a large, university affiliated, tertiary-care community hospital. Patients: 3 ASA physical status 2 and 3 patients who were treated for intercostal neuralgia secondary to surgical incision or vertebral fractures. Interventions: These patients had failed various medical therapies but had positive responses to diagnostic intercostal nerve blocks. They underwent lesioning of the culprit nerves (with the use of ultrasound). Measurements and Main Results: Pain scores were recorded using a numeric rating scale (NRS), and were solicited preprocedurally and postprocedurally, and once again after longterm follow-up (>2 mos). Longterm (>2 mos) relief of symptoms from established, chronic pain conditions was achieved with cryotherapy with ultrasound guidance. Conclusions: Neuro-ablative procedures using cryotherapy have been well reported. The use of ultrasound with cryotherapy facilitates direct visualization of the anatomy and aids in avoidance of vital vascular and pleural structures. (C) 2013 Elsevier Inc. All rights reserved.