Overview

Cryotherapy is the application of cold as a medical therapy. For chronic pain we use cryotherapy to interrupt pain signals. We do this by working out which nerves carry the pain signals, and using a cryotherapy probe to freeze these nerves.

Benefits of cryotherapy

As the freezing that is associated with cryotherapy does not cause long-term destruction of nerves, it is considered safer than procedures (such as radiofrequency denervation or chemical neurolysis) that destroy nerves.

Risks of cryotherapy

As with all procedures that involve placement of sharp, needle-like structures, there is a risk of bleeding, infection or direct injury to the nerves themselves.

In the short term, pain might get worse for a few weeks. If the area treated is very close to the skin surface, there is a risk of swelling, blistering and skin damage. Your doctor will discuss these risks with you before considering this therapy.

Other treatment options

Any possible treatment options will depend on your pain condition, and these will be discussed with you before cryotherapy is arranged. Your doctor can give you up-to-date information about the chances of this being a successful treatment for you, and any other potential treatments which could help you.

If you are not sure about having the procedure, more information can be provided. Please speak to your doctor for more information.

Preparing for cryotherapy

If you have flu, cold or cough symptoms, chest problems, diarrhoea, vomiting (being sick), or have been exposed to chickenpox, you must contact the number on your admission letter. Your treatment might need to be delayed to make it as safe as possible for you.

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

During cryotherapy

An X-ray machine (or other image guidance, such as ultrasound) will be used to make sure we insert the cryotherapy needle accurately. Not all doctors do the procedure in exactly the same way, but these things usually happen:

• We monitor your blood pressure, heart rate and oxygen levels.
• A small needle (cannula) is placed in the back of your hand.
• You'll be carefully positioned, and an antiseptic solution is used to clean the skin before the insertion of the needle.
• X-ray (or other image guidance) will be used.
• You will feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. Your doctor will warn you of this first.
• The doctor will direct the cryotherapy needle to the areas suspected to be the sources of pain.
• When the freezing process starts, you might feel pressure, tightness or a pushing sensation. If there is any discomfort or pain, let the doctor know.

Pain during cryotherapy

Local anaesthetic is used before the procedure to numb the skin. Sometimes there is discomfort or pain as the cryotherapy probe touches the deep muscles or nerves. If this happens, please tell the doctor and they will pause to make it more comfortable for you.

During the freezing process, there might be some discomfort, but this is usually mild and well tolerated.

After the procedure, there might be some discomfort at the injection site, as well as where the nerve was treated. This can last 2 to 3 weeks, but can be treated with regular painkillers that you can buy in a pharmacy or shop, if needed. Always follow the directions on the packet.

After cryotherapy

After the procedure you will be taken to a recovery area where nursing staff will monitor you. You might be helped to sit up, and your blood pressure and pulse will be checked.

You will be told when you can get dressed, and be given help to make sure that you can stand safely after the procedure.

Your pain will be assessed at rest and during activities of daily living, such as walking and moving your back. You will be given more advice when you are ready to leave hospital.

It is common for the area or limb treated to feel numb after cryotherapy. This will usually settle after a few days.

After you leave hospital

You can usually leave within a few hours after the procedure, and sometimes much sooner. This will depend on how long your doctor or nurse wants you to stay for in recovery.

Please make sure that you have made arrangements for someone to collect you after the procedure. Failure to do so will probably mean your procedure being cancelled. It is unsafe for you to drive immediately after the procedure. If you do, your motor insurance will not be valid.

Follow-up appointments

About 2 months after the procedure, you will receive an appointment for a telephone consultation with a pain management doctor or nurse. During the consultation your response to the procedure will be reviewed.