Cryoneurolysis in Patients with Dorsal Neuropathic Pain Secondary to Tumor Invasion

Abstract

Purpose: To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion.

Materials and methods: Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain.

Results: Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred.

Conclusions: Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.