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Pain management: Nerve freezing technique can work wonders

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Dr Amod Manocha

With improving survival rates in various types of cancers there is enhanced emphasis on reducing suffering and improving quality of life. Pain is a major issue in cancer patients with newer, refined, innovative techniques being introduced to provide relief. Cryoablation is one such option which has undergone significant advancement over the years andhas recently become available in India.

The primary aim of cryoablation techniques in pain management is to deactivate the nerves transmitting pain signals by freezing these nerves in a controlled manner to temperatures dipping as low as minus 80(-80) degrees.

The procedure is performed using a special probe called cryoprobe, which is guided to the correct location using ultrasound and x-ray imaging.  Cryoprobe is a hollow needle through which super-cooled gas such as nitrous oxide or carbon dioxide is delivered once the probe is in the correct position. The extremely low temperatures achieved at the tip of the cryoprobe cause formation of an ice ball, which can be visualised with the help of ultrasound. This freezes the nearby nerves and thereby reducing pain.

Cryoablation as a procedure can be quite useful in a range of chronic pain conditions including nerve and cancer pain. Similar was the case with 68-year-oldmale cancer patient (Ramakant, name changed) who was admitted to the hospital with complains of severe right sided chest, abdominal and back pain for the last two weeks.

The patient described his severe pain as a constant bruised sensation which made lying down to sleep or turning in bed a major challenge. A CT scan of his chest showed a large right lung mass invading into the space from which the nerves exit the spine. Reliving Ramakant’s pain was quite challenging as he had end stage renal failure and most painkillers were ineffective or produced side effects. The challenges in managing his pain further escalated when he became disoriented following a brain stroke after admission.

He underwent cryoablation of the nerves which were compressed by the lung mass. Making use of theultra sound and X-ray guidance, the nerves being compressed by the tumor were selectively identified and targeted. Post cryoablation treatment there was a marked reduction in pain. It was a big transition from having severe pain and not being able to sleep or lie down to almost no pain within a span of few hours.

Cryoablation technology being minimally invasive pain relieving alternative does not involve any cuts or incisions. It is a safe, day care procedure with the potential of providing quick and lasting pain relief.  Less pain can translate into improved functional ability, reduced painkiller requirements and reduced disability. Besides, it can be easily repeated without any added side effects.

Other than cancer pain, cryoablation procedure can be quite useful in managing joint arthritis pain, specially for young patients who wish to avoid or postpone joint replacement surgery.

(The author is Head f Pain Management Department, Max Hospital, Saket)


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