Tinnirello Andrea, Marchesini Maurizio, Mazzoleni Silvia, Santi Carola, Lo Bianco Giuliano
Anesthesia and Pain Management Unit, ASST Franciacorta, Iseo Hospital, 25049 Brescia, Italy.
Department of Anesthesia and Pain Medicine, Mater Olbia Hospital, 07026 Olbia, Italy.
Medicina (Kaunas). 2025 Jun 15;61(6):1090. doi: 10.3390/medicina61061090.
Chronic pain is a significant global health issue, with conventional treatment strategies often proving insufficient or causing undesirable side effects. Interventional pain management techniques, including neuromodulation, have gained increasing interest as alternative therapeutic options. Cryoneurolysis, a technique leveraging extreme cold to modulate pain pathways, has emerged as a promising tool in chronic pain management. However, its efficacy and role within current clinical practice remain under evaluation. : A narrative review was conducted by searching PubMed, Scopus, Embase, and Web of Science databases for studies published between 2010 and 2024 using the keywords "Cryoneurolysis", "Cryoanalgesia", "Cryoablation", and "Chronic pain." Only English-language studies were included. Studies that examined intraoperative cryoablation or lacked statistical analyses (except case reports) were excluded. : A total of 55 studies were included: 4 randomized controlled trials (RCTs), 16 retrospective studies, 4 prospective observational studies, and 31 case reports or small case series. The studies displayed significant heterogeneity in patient selection, targeted nerves, procedural protocols, and follow-up durations. While two RCTs demonstrated a significant pain reduction compared to control groups, other RCTs reported no significant improvement. Observational studies and case reports frequently report positive outcomes, with some achieving complete pain relief. Cryoneurolysis appears to be most effective in treating neuropathic pain, particularly in patients with peripheral nerve involvement. Cryoneurolysis is a safe technique for chronic pain management, which has been successfully applied, particularly for selected neuropathic pain conditions. However, the current evidence is limited by study heterogeneity and a lack of high-quality comparative trials. Further well-designed randomized studies are necessary to define its long-term efficacy and its potential role relative to other interventional pain therapies, such as radiofrequency ablation.
慢性疼痛是一个重大的全球健康问题，传统治疗策略往往效果不佳或会产生不良副作用。包括神经调节在内的介入性疼痛管理技术作为替代治疗选择，越来越受到关注。冷冻神经lysis术是一种利用极寒来调节疼痛通路的技术，已成为慢性疼痛管理中有前景的工具。然而，其在当前临床实践中的疗效和作用仍在评估中。通过在PubMed、Scopus、Embase和Web of Science数据库中搜索2010年至2024年期间发表的使用关键词“冷冻神经lysis术”、“冷冻镇痛”、“冷冻消融”和“慢性疼痛”的研究，进行了一项叙述性综述。仅纳入英文研究。排除了检查术中冷冻消融或缺乏统计分析的研究（病例报告除外）。共纳入55项研究：4项随机对照试验（RCT）、16项回顾性研究、4项前瞻性观察性研究以及31项病例报告或小病例系列。这些研究在患者选择、目标神经、操作方案和随访时长方面存在显著异质性。虽然两项RCT显示与对照组相比疼痛显著减轻，但其他RCT报告无显著改善。观察性研究和病例报告经常报告积极结果，有些实现了完全疼痛缓解。冷冻神经lysis术似乎在治疗神经性疼痛方面最有效，特别是在有外周神经受累的患者中。冷冻神经lysis术是一种用于慢性疼痛管理的安全技术，已成功应用，特别是对于选定的神经性疼痛病症。然而，目前的证据受到研究异质性和缺乏高质量对照试验的限制。需要进一步设计良好的随机研究来确定其长期疗效以及相对于其他介入性疼痛治疗（如射频消融）的潜在作用。
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