A clinical trial has demonstrated that image-guided percutaneous nerve cryoablation is feasible and safe and may represent an effective new therapy for patients with phantom pains related to limb loss. The results of the trial will be presented on Wednesday at SIR 2016.
“Until now, individuals with phantom limb pain have had few medical interventions available to them that resulted in significant reduction in their pain,” said J. David Prologo, MD, assistant professor in the division of interventional radiology at Emory University School of Medicine. “Now, with the promise of cryoablation, these individuals have a viable treatment option to target this lingering side effect of amputation — a condition that was previously largely untreatable.”
Military veterans wounded in combat and people with complex medical conditions, such as uncontrolled diabetes, constitute a significant part of the population affected by pain that seems to originate from the lost limb. Millions of people in the United States live with amputated limbs and, according to the Centers for Disease Control and Prevention, nearly 200,000 amputations occur each year.
In this study, 20 patients underwent image-guided (CT and ultrasound) cryoablation of the nerve and/or neuroma in their symptomatic residual limb that corresponded to the distribution of their symptoms. Visual Analog Scale scores and responses to a Modified Roland Morris Disability Questionnaire were documented at baseline, seven days post procedure and on day 45. Analysis of covariance (ANCOVA), with baseline scores included as covariates, was used to evaluate differences in scores over time. Before cryoablation, patients reported an average pain score of 6.4 points. By day 45, the average score was 2.4 points.
“Many of the nerves contributing to these pains are inaccessible to physicians without image guidance,” said Dr. Prologo. “With the interventional radiologist skill set, we can solve tough problems through advanced image-guided therapies, and this promising treatment can target hard-to-find nerves and help amputees dramatically improve their lives — all in an outpatient setting.”
Investigators at Emory will continue to examine the potential of this emerging intervention by tracking its effectiveness at six months after treatment and beyond. Dr. Prologo added that the group has applied for a Department of Defense grant in the hopes of benefitting the thousands of veterans who have had limbs amputated and may suffer with phantom limb pain.
Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: A pilot study
Presented during Nonvascular: Spine and other, 3–4:30 p.m. in room 215/216 of the Vancouver Convention Centre.