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The potential for use of cryoneurolysis in chronic pain management is great. Most cryoneurolysis involves percutaneous approaches, which means that accurate identification of pain generators and probe placement is necessary.
As a modality, cryoneurolysis is "ideal" for the management of various chronic pain disorders given the cellular basis of cryoneurolysis. In comparison to other chemical or thermal techniques, the potential for neuroma formation or deafferentation pain is less or nonexistent. There is only one reported case of neuritis after cryoneurolysis.51 The neuritis occurred after an open cryoneurolysis of an intercostal nerve. It is entirely possible that the probe itself (rather than the freeze ball) could have damaged the nerve.
Prior to the performance of cryoneurolysis, pain generators must be clearly identified. Some authorities suggest a series of test blocks to determine if blocking the purported pain generators will alleviate the pain, thereby localizing and confirming the pain generator. Some authorities suggest utilization of a series of test injections (first block with lidocaine and the second with bupivacaine). Theoretically, a more prolonged analgesic response can be expected with bupivacaine in appropriate responders. In clinical practice, however, the analgesic response will often exceed the pharmacologic duration of the local anesthetic. The interpretation and explanation of this phenomenon is unclear.