Cryotherapy for Chronic Pain

Cryoanalgesia with Cryo-S Painless at Mantha’s Pain Clinic: Patient Information

• Mantha’s Pain Clinic, Barkatpura, Hyderabad, now offers cryoanalgesia using the Cryo-S Painless system from Metrium-Cryoflex (Poland).
  Image: Cryo-S Painless Machine
  Link: Metrum, Poland
  Link: Surgipartner, Importer/Distributor in India
• This state-of-the-art device represents one of the most advanced technologies available worldwide for targeted nerve cryotherapy.
• Cryoanalgesia is a minimally invasive, image-guided procedure that uses controlled freezing to temporarily interrupt pain signals from specific sensory nerves while preserving long-term nerve integrity.

What is Cryoanalgesia?

• Cryoanalgesia (also called cryoneurolysis) is a procedure in which a fine, specially designed probe is placed close to a painful sensory nerve, and the nerve is exposed to extremely cold temperatures.
• This controlled freezing temporarily disables the nerve’s ability to transmit pain.

What is the Physics Principle?

• The technique is based on the Joule–Thomson effect . When a compressed gas (such as nitrous oxide or carbon dioxide) is released into the tip of the cryoprobe, it rapidly expands.
• This sudden expansion causes a sharp drop in temperature, producing a focused ice ball around the probe tip.
• This ice ball is what creates the therapeutic nerve block.

Understanding the Nerve Structure

• A nerve is made of: Image: Peripheral nerve And mechanism of action of cryotherapy
  • Axons – the thin fibers that transmit signals
  • Schwann cells – protective cells that support axon function
  • Endoneurium, Perineurium, Epineurium – natural protective coverings of the nerve
• Cryoanalgesia selectively affects the axon (the part that carries pain signals) while keeping the protective coverings intact. Because these structures are preserved, the nerve can regenerate safely.

Mechanism of Action

• When the cryoprobe forms an ice ball around the nerve, the axon undergoes axonotmesis, involving temporary interruption of nerve conduction and Wallerian degeneration.
• The nerve then regenerates naturally at a rate of approximately 1 mm per day, allowing pain relief for several months without permanent nerve damage.

Ensuring Accurate and Safe Targeting

• Precision is essential for both effectiveness and safety.
• Ultrasound or fluoroscopy (X-ray) is used to locate the nerve accurately.
• Sensory and motor stimulation is performed before freezing to confirm that only sensory nerves are targeted. This ensures that no major motor nerves are inadvertently affected.

Expected Pain Relief

• Most patients experience 70–80% reduction in pain, and relief may last 7–8 months or longer, depending on the condition and individual healing patterns.
• As pain decreases, patients are able to move more freely, engage in daily activities with greater ease, and participate more effectively in physiotherapy and physical medicine treatments, which can further prolong and enhance the duration of pain relief beyond initial expectations.
• If pain gradually returns over time, the procedure can be safely repeated, as cryoanalgesia does not damage the long-term structure of the nerve. Many patients who benefit from the first treatment choose to undergo a repeat session when pain recurs.

At present, Conditions Treated with Cryoanalgesia at Mantha’s Pain Clinic

1. Osteoarthritis of the Knee Cryoanalgesia offers meaningful pain relief for:
   • Patients with severe osteoarthritis awaiting total knee replacement: Sometimes waiting could be due to domestic logistic reaons or the need to optimise other medical conditions.
   • Individuals with persistent postoperative knee pain
   • The knee joint receives sensory input from four key genicular nerves: 1.Superomedial, 2.Superolateral, 3.Inferomedial, 4.Inferolateral
   • The first three are safely targeted. The inferolateral nerve is avoided because of its proximity to the peroneal nerve; freezing it could risk foot drop. Image: Knee Genicular Nerves
     Image: External: Ultrasound guidance
   • Probes are placed under local anesthesia, guided by ultrasound or fluoroscopy, and each nerve is precisely frozen to reduce knee pain.
2. Occipital Headache / Occipital Neuralgia:
   • The greater and lesser occipital nerves are treated to reduce chronic headaches and scalp pain. Image: Occipital nerves
3. Frozen Shoulder:
   • Cryoanalgesia of the suprascapular nerve can significantly reduce shoulder pain and improve mobility.Image: Suprascapular nerve
4. Meralgia Paresthetica:
   • The Lateral femoral cutaneous nerve is treated for burning, tingling, or numbness over the outer thigh that commonly occurs in individuals with chronic diabetes. Image: Lateral femoral cutaneous nerve lateralfemoralcutaneousnerve
5. Postherpetic neuralgia:
   • The Relevant intercostal nerve The affected intercostal nerve can be treated to relieve the highly troubling symptoms of postherpetic neuralgia, including burning pain, tingling, and allodynia—a condition in which even light touch, such as clothing brushing the skin, causes intense pain.
     Image: Distribution of postherpetic neuralgia
6. Other suitable applications
   • Pain management: trigeminal neuralgia, cancer pain etc and many more; Neurosurgical; orthopedics; Spine surgeons; Interventional radiology

Procedure Duration and Recovery

• Cryoanalgesia is performed as a day-care, outpatient procedure.
  
• Total time in the clinic is typically up to one hour.
• Patients may walk out shortly after the procedure.
• Most can resume normal activities the same day.

Additional Information

• The procedure avoids heat, chemicals, or neurodestructive agents, making it safe and repeatable.
• There is no surgical incision—only a small needle entry point.
• Cryoanalgesia preserves nerve structure, making it safer than many other neurolytic procedures.
• Suitable for patients who cannot tolerate steroids or who prefer non-pharmacological pain management.

Acknowledgment: Prof. (Dr) G. P. Dureja Link: Delhi Pain Management Centre

• Prof. (Dr) G. P. Dureja of the Delhi Pain Management Centre deserves special acknowledgment for his more than 40 years of distinguished contributions to the field of pain medicine.
• As a pioneer in establishing one of India’s first independent pain management centres, his groundbreaking work has inspired the development of similar clinics across the country.
• Prof. Dureja’s mentorship has shaped numerous interventional pain physicians who now lead independent pain centres nationwide.
• His consistent efforts in conducting workshops and educational programs have played a pivotal role in advancing modern pain management techniques in India.
• Mantha’s Pain Clinic, supported by the guidance and training—including cryotherapy techniques—imparted by Dr. Dureja, is a proud continuation of this legacy.