Percutaneous Image-Guided Cryoablation for the Treatment of Phantom Limb Pain in Amputees: A Pilot Study

J Vasc Interv Radiol. 2017 Jan;28(1):24-34.e4. doi: 10.1016/j.jvir.2016.09.020. Epub 2016 Nov 23.

Abstract

Purpose: To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial.

Materials and methods: From January 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure.

Results: Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001).

Conclusions: Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputees* / psychology
  • Cryosurgery / adverse effects
  • Cryosurgery / methods*
  • Denervation / adverse effects
  • Denervation / methods*
  • Disability Evaluation
  • Feasibility Studies
  • Female
  • Georgia
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain Perception
  • Peripheral Nervous System / physiopathology
  • Peripheral Nervous System / surgery*
  • Phantom Limb / diagnostic imaging
  • Phantom Limb / etiology
  • Phantom Limb / physiopathology
  • Phantom Limb / surgery*
  • Pilot Projects
  • Prospective Studies
  • Surveys and Questionnaires
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography