title: Use of ultrasound-guided cryotherapy for the management of chronic pain states.
abstract: OBJECTIVE
  To report the use of ultrasound for cyroablation of purely sensory nerves for long-term relief of pain because the use of ultrasound enhances accuracy while minimizing injury to surrounding structures.
  
  
  METHODS
  Case series of three patients with positive long-term outcomes.
  
  
  METHODS
  Outpatient Pain Management Clinic associated with a large, university affiliated, tertiary-care community hospital.
  
  
  METHODS
  3 ASA physical status 2 and 3 patients who were treated for intercostal neuralgia secondary to surgical incision or vertebral fractures.
  
  
  METHODS
  These patients had failed various medical therapies but had positive responses to diagnostic intercostal nerve blocks. They underwent lesioning of the culprit nerves (with the use of ultrasound).
  
  
  RESULTS
  Pain scores were recorded using a numeric rating scale (NRS), and were solicited preprocedurally and postprocedurally, and once again after longterm follow-up (> 2 mos). Longterm (> 2 mos) relief of symptoms from established, chronic pain conditions was achieved with cryotherapy with ultrasound guidance.
  
  
  CONCLUSIONS
  Neuro-ablative procedures using cryotherapy have been well reported. The use of ultrasound with cryotherapy facilitates direct visualization of the anatomy and aids in avoidance of vital vascular and pleural structures.
authors.affiliation: Tufts University School of Medicine, Boston, MA 02111, USA; Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA. Electronic address: neil.roy.connelly@bhs.org.
authors.forename: Neil Roy
authors.initials: NR
authors.lastname: Connelly
authors.affiliation: Tufts University School of Medicine, Boston, MA 02111, USA; Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Malik
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Madabushi
authors.affiliation: Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000601:surgery; D059408:Pain Management / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: Allodynia; Analgesia; Cryotherapy; Ultrasound-guided analgesic technique