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. 2024 Dec;14(12):673-680.
doi: 10.1080/17581869.2024.2441650. Epub 2024 Dec 20.

Cryoneurolysis for phantom limb pain: a systematic review

Hanna Brancaccio  1   2 , Brandon Goodwin  1   3 , John DesRochers  2 , Alec Birnbaum  2 , Uzay Cagatay  2 , Bianna Koutsenko  2 , Connor Flatley  3 , Gilbert Siu  2   4
Affiliations

Cryoneurolysis for phantom limb pain: a systematic review

Hanna Brancaccio et al. Pain Manag. 2024 Dec.

Abstract

Aims: Phantom limb pain (PLP) is a painful sensation occurring in patients around the site of an amputation. The aim of this systematic review is to evaluate the efficacy of cryoneurolysis in the management of phantom limb pain.

Materials and methods: A systematic review was performed according to the PRISMA 2020 guidelines. An initial search yielded 200 articles from four major scientific databases (PubMed, Embase, Cochrane Library, WebOfScience). Five articles met inclusion criteria, four of which underwent additional pooled statistical analysis.

Results: Pooled analysis of the included trials revealed a cumulative Cohen's d effect size of 1.55 (95% CI [0.24, 2.87]; p = 0.02; z = 2.32) for the reduction of pain on a 10-point pain scale following cryoneurolysis intervention. The remaining article that did not meet inclusion criteria for statistical analysis was a case report that reported a reduction in pain from 9/10 to 1/10 one week following intervention.

Conclusions: The large effect size demonstrated a statistically and clinically significant improvement in patient-reported pain. Additionally, patients may be able to reduce their amount of pharmaceutical pain management with successful cryoneurolysis treatment. However, these findings are limited by the small sample size and high heterogeneity between studies. Further high-quality studies should be performed to corroborate these findings.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42024543085.

Keywords: Cryoneurolysis; amputation; cryoanalgesia; cryoneuroablation; phantom limb pain.

Plain language summary

Phantom limb pain (PLP) is a challenging condition where individuals feel pain in the area where a limb has been amputated. This systematic review examined the use of cryoneurolysis, a procedure that freezes nerves to reduce pain, to manage PLP.Researchers followed PRISMA 2020 guidelines for the review, analyzing studies from major databases, including PubMed and Cochrane Library. Out of 200 initial studies, five met the criteria for inclusion, with four providing data for a combined statistical analysis. The fifth study, a case report, was analyzed separately.The analysis showed a large positive effect of cryoneurolysis on reducing PLP. On a 10-point pain scale, patients reported significant pain relief, with the pooled data showing a strong reduction in pain scores. In the case report, the patient’s pain dropped from a severe 9/10 to a mild 1/10 just one week after the treatment.The findings suggest that cryoneurolysis is an effective option for reducing PLP and may also allow patients to use less medication to manage their pain. However, the conclusions are limited by the small number of studies and differences in study methods. More high-quality research is needed to confirm these promising results.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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