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Pain and Spine Medicine

The Chilling Effect: Cryoneurolysis in Post-Thoracotomy Pain and Opioid-Sparing Potential

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Original Research Theater
Has Audio

    Primary Author(s)

  • Panayotis Jusakos, MD

    Resident Physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

    • Co-Author(s)

  • MR

    Marc Ross, MD

    Chair Department of physical medicine and rehabilitation
    One Brooklyn Health
    New York, New York

    • Poster Presenter(s)

  • Suha Qasem, MD

    Resident physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

Disclosure(s):
Panayotis Jusakos, MD: No financial relationships to disclose
Suha Qasem, MD: No financial relationships to disclose
Background and/or Objectives: Post-thoracotomy pain remains a significant challenge, with chronic pain syndromes leading to long-term morbidity and opioid dependence. Cryoneurolysis, a technique that induces Wallerian degeneration via controlled freezing of intercostal nerves, disrupts pain transmission by temporarily degrading axonal structures while preserving the nerve’s connective tissue framework, allowing for functional regeneration without neuroma formation. This mechanism has emerged as a promising analgesic modality. This systematic review evaluates the mechanisms, procedural efficacy, clinical outcomes, and opioid-sparing potential of cryoneurolysis for post-thoracotomy pain management.

Design: Systematic review of case reports, retrospective studies, and interventional trials.

Setting : Multi-institutional, including perioperative and outpatient pain management contexts.

Participants : Patients undergoing thoracic surgery with or without intercostal cryoneurolysis for post-thoracotomy pain management.

Interventions: This review examines intercostal cryoneurolysis techniques, including ultrasound-guided, CT-guided, and intraoperative approaches for post-thoracotomy pain management.

Main Outcome Measures: Pain reduction (visual analog scale scores), functional improvement, duration of analgesia, and opioid consumption post-procedure.

Results: Analysis of available studies suggests that cryoneurolysis significantly reduces acute and chronic post-thoracotomy pain. Intraoperative and percutaneous approaches yield sustained analgesia for 6–12 months. Ultrasound-guided and CT-guided techniques demonstrate high procedural safety with minimal complications. Compared to traditional analgesic modalities, cryoneurolysis shows a substantial reduction in opioid requirements postoperatively, potentially mitigating opioid dependence. However, heterogeneity in study designs, including differences in procedural techniques, patient selection criteria, follow-up duration, and outcome measures, limits definitive conclusions.

Conclusions: Cryoneurolysis offers a novel, opioid-sparing strategy for managing post-thoracotomy pain. By selectively ablating intercostal nerve conduction, it provides prolonged analgesia with a favorable safety profile. While preliminary evidence supports its efficacy, larger, prospective studies are needed to establish standardized protocols and long-term benefits. Its integration into multimodal pain management pathways could significantly impact postoperative recovery and opioid stewardship in thoracic surgery patients