Cryoneurolysis

A New, Drug-Free and Immediate-Relief Option

For patients living with spasticity-related pain, performing daily activities can be uncomfortable, challenging or even impossible. Until recently, the only treatment options available in Greater Houston were oral medications, with the potential for significant side effects, or neurolytic injections that can take days or weeks to become effective.

This drug-free, immediate-relief pain therapy for spasticity was performed for the first time in the United States in December 2022 and is now available to patients at TIRR Memorial Hermann. Sheng Li, MD, PhD, director of NeuroRehabilitation Research Lab, director Stroke Rehabilitation and Recovery Research and attending physician who is board certified in PM&R and Brain Injury Medicine and affiliated with TIRR Memorial Hermann performs the procedure. TIRR Memorial Hermann is the only location conducting cryoneurolysis treatment for spasticity pain in Greater Houston, and it also is one of only a few hospitals in the nation to treat spasticity with this procedure.

Spasticity and Pain

Pain is a common occurrence with spasticity. Patients often experience pain when a spastic muscle is stretched and moved, or when it bears weight. Even simple activities, like changing positions or moving from the bed to a chair or toilet, can cause pain.

The effects of spasticity can vary between patients, with some facing only mild muscle-tightening pain or discomfort, while others live with debilitating pain that prevents them from performing daily activities and basic self-care.

Cryotherapy treatments, used for a variety of conditions for many years, have recently been shown to be effective for pain relief in patients suffering from spasticity.

During cryoneurolysis, a cryoprobe is inserted through the skin and placed against the targeted nerve. The cryotherapy device then delivers liquid nitrous oxide within a closed-end probe, causing the temperature at the tip of the cryoprobe to drop rapidly.

A small ice ball, created from the body’s own fluid, forms around the probe tip and disrupts a localized area of the nerve. For pain or spasticity, the temperature of the probe tip is typically between -600 and -880C, resulting in a long-lasting nerve block. No medication is injected into the body.

Once the nerve block is achieved the ice ball melts from the patient’s own body temperature, and the probe is removed, nearly 2 minutes. Cryoneurolysis provides approximately three to six months of pain relief and relaxation of spastic muscles until the nerve regenerates.

Spasticity Facts

Risks of Untreated Spasticity

Patients with mild pain may not need treatment beyond stretching or physical therapy. For those with moderate or severe spasticity, leaving the condition in an uncontrolled state can lead to a range of complications, including:

• Joint dislocation
• Joint contractures
• Bone fractures
• Bedsores (if the pain is immobilizing)
• Abnormal gait
• Abnormal posture
• Difficulty performing daily hygiene tasks (which may lead to infection)

Patients who suffer from spasticity-related pain can benefit from cryoneurolysis. We treat patients with spasticity-related pain stemming from a variety of conditions, including:

• Stroke
• Traumatic brain injury
• Spinal cord injury
• Multiple sclerosis
• Cerebral palsy
• Brain tumor

Other Spasticity Treatment Options

Cryoneurolysis offers significant benefits over other treatment protocols. In addition to therapy, bracing or casting, patients may be currently treating spasticity pain with any of the following:

Oral Medications

These are often prescribed, but may have substantial side effects including weakness and drowsiness. Because of these systemic effects, oral medications may not be good options for brain-injury patients.

Botox Injections

Botox is frequently used for spasticity management by relaxing spastic muscles. Patients require injections every three or four months, and pain relief and muscle relaxation usually does not begin until about three days to one week after each injection.

Phenol Neurolysis

Although not FDA-approved, phenol neurolysis is commonly used for spasticity management. Phenol is injected into the targeted nerve, under ultrasound guidance, delivering chemicals to the nerve which causes nerve damage and results in a nerve block. Although the muscle relaxation usually lasts about four to six months, there is a risk of neuropathic pain and systemic toxicity from the injection.

Intrathecal Baclofen Therapy (ITB)

This surgical procedure involves implanting a pump in the abdomen that releases medication (baclofen) into the intrathecal space to treat spasticity. While it can be effective for pain relief and muscle relaxation, it also is an invasive procedure that is not appropriate for all patients.

• Drug free
• Immediate, long-lasting, localized pain relief and muscle relaxation
• Lower risk and fewer side effects than other treatment options

The results of cryoneurolysis for spasticity pain vary between patients. Some areas of the body are likely to relax more completely than others. Patients may also experience different levels of pain relief, and may have different lengths of time needed between injections.

Many patients experience no side effects.

Some may experience mild or moderate injection-site pain or discomfort. Patients may also experience a quivering sensation, during the treatment, while the ice ball is forming–but describe it as only mildly uncomfortable.

Memorial Hermann is the only health system in Houston - and one of only a few nationwide - to provide this cutting-edge treatment option for spasticity pain. Our affiliated physicians are among the first to provide this immediate, drug-free pain relief for people struggling with daily functioning.

Spasticity-related pain often requires a multidisciplinary care team. Depending on each patient’s needs, our integrated approach may include physiatrists, neurologists, neurosurgeons, orthopedic surgeons, physical therapists, occupational therapists or speech therapists.

To learn more about cryoneurolysis or to refer a patient, please contact (800) 44-REHAB (73422).