Rationale and Objectives
The aim of this study was to determine the effect of cryoablation on pain levels in patients with histories of post-thoracotomy pain syndrome.
Materials and Methods
Eighteen patients were included in this retrospective review. Preprocedural and immediate postprocedural pain scores were recorded, as well as several months after the procedures.
Results
The average preprocedural pain score was 7.5 ± 2.0, which decreased to 1.2 ± 1.9 immediately after the procedure. After a mean follow-up period of 51 days, the average pain score was 4.1 ± 1.7. The difference between preprocedural and postprocedural pain scores was statistically significant by Wilcoxon’s rank sum test.
Conclusion
Cryoneurolysis of the intercostal nerves statistically significantly decreased pain scores in patients with post-thoracotomy pain syndrome.
Neuropathic pain is a common problem that results from a variety of different etiologies. Prominent among these are diabetic peripheral neuropathy, postsurgical change, postherpetic neuralgia, and chronic radiculopathy . The pain that results is often refractory to therapy, requiring a multidisciplinary treatment approach including pharmacologic management, interventional procedures, and lifestyle modification . Cryotherapy for analgesia has been used since 1976 and has been shown to effective and safe . Combining this procedure with image guidance has been postulated to further reduce the risk for complications, specifically pneumothorax, when used to alleviate post-thoracotomy pain . In contrast to both medical treatment and other invasive procedures, such as neurectomy, significant pain relief is achieved acutely with cryoablation, and the recovery period is relatively brief . In the literature, cryoneurolysis has been studied mainly in the context of post-thoracotomy pain syndrome, because this is a frequently encountered problem. Most of the currently available literature focuses on intraoperative cryoablation of the intercostal nerves. There are few currently published articles on the treatment of patients with post-thoracotomy pain syndrome months or years after thoracotomy has been performed .
The aim of this retrospective study was to determine if computed tomographic (CT) cryoneurolysis is an effective method of reducing pain in patients with post-thoracotomy pain syndrome.
Methods and materials
Patient Selection
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Technique
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Pain Assessment
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Statistical Analysis
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Results
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Table 1
Preprocedural and Postprocedural Pain Scores
Time Point Mean Pain Score ∗ Range_P_ † Preprocedural 7.5 ± 2.0 3–10 Immediate postprocedural 1.2 ± 1.9 0–6 <.0001 Postprocedural 4.1 ± 1.7 0–7 .005
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Discussion
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