Cryoneurolysis for rib fracture pain

Conventional strategies to manage pain caused by rib fracture have limits. A new alternative technique called cryoneurolysis is currently being developed. This minimally invasive procedure uses extreme cold to relieve the pain in just a few minutes.

A rib fracture occurs when one of the bones in the thoracic cage breaks or cracks. Generally caused by a hard impact, rib fracture is characterized by intense pain, which is made worse by breathing. Coughing, sneezing, yawning, laughing, and even speaking become extremely painful and unpleasant.

It is estimated that up to 59 percent of patients with traumatic rib fracture feel persistent pain for more than two months (1).

Managing that pain is especially difficult. Traditionally, treatment consists in prescribing pain relievers (analgesics) and/or opioids. But the effect of most modern analgesia is short-lived (less than 72 hours), making it necessary to repeatedly administer doses. This strategy has limits. In addition, the pain, both acute and chronic, can cause significant morbidity such as hypoventilation, pneumonia or respiratory failure.

A new alternative technique called cryoneurolysis is currently being developed to relieve rib fracture pain. This minimally invasive interventional radiology procedure has been used for decades to treat chronic pain. It could therefore be an effective solution for relieving pain after a rib fracture.

Cryoneurolysis is a minimally invasive procedure that is performed on an outpatient basis (no overnight hospital stay) under local anesthesia, by an interventional radiologist. The surgical act and an imaging exam are performed simultaneously, allowing the doctor to follow the procedure in real time thanks to the transmission of images. Patient comfort is greatly improved, and recovery is almost immediate.

Cryoneurolysis consists in applying extreme cold (-70°C) to the nerve causing the pain, in order to relieve painful symptoms. This exposure to extreme cold ablates the nerve, preventing it from sending pain signals. The nerve will regenerate over the months following the procedure.

A 2022 study observed the effect of cryoneurolysis on the intercostal nerve to treat severe intercostal neuralgia (2).

The patient initially underwent a multilevel left-sided T5–T7 intercostal nerve block, followed by percutaneous cryoneurolysis of those intercostal nerves. Two 2-minute cycles of cooling to a temperature of −70°C (nitrous oxide) were used, with 30 seconds of thawing in between. The results are unequivocal: the patient experienced 100 percent pain relief immediately after the procedure. He remained completely symptom-free more than six months after the procedure, and resumed his professional and athletic activities without restrictions.

Cryoneurolysis to treat pain following a rib fracture is a minimally invasive interventional radiology procedure. It is performed under local anesthesia by an experienced interventional radiologist using X-ray guidance, which significantly lowers the risks of this type of procedure.

Considering its favorable risk-benefit ratio, intercostal cryoneurolysis could be an effective complement to analgesia for patients presenting rib fractures for whom traditional treatment has failed. 

The cryoneurolysis procedure is performed under local anesthesia under X-ray guidance. It takes place in an interventional radiology room and is performed on an outpatient basis. The procedure only lasts around 20 minutes. It is pain-free and doesn’t leave a scar.

After administering a local anesthesia, the doctor freezes a needle which is then inserted under the patient’s skin. Guided by the X-ray images, he or she positions the needle on the damaged nerve and applies extreme cold (-70°C). Under continued X-ray guidance, several freeze/thaw cycles are performed.

This exposure to extreme cold ablates the nerve, thus preventing it from sending pain signals. The nerve will regenerate over the months following the procedure. The pain relief is immediate.