499: Image-Guided Intercostal Cryoneurolysis for Thoracic Neuropathic Pain: Case Series

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Treatment/management

Background and Aims: Thoracic neuropathic pain, including intercostal neuralgia, post-thoracotomy pain, and post-herpetic neuralgia (PHN), may remain refractory despite pharmacotherapy. Intercostal cryoneurolysis produces temporary axonal interruption and may provide prolonged analgesia following diagnostic block confirmation. We evaluated feasibility, safety, and clinical outcomes of image-guided thoracic intercostal cryoneurolysis in a small retrospective case series.

Methods: Consecutive patients undergoing thoracic intercostal cryoneurolysis after ≥50% pain relief from diagnostic intercostal block were retrospectively reviewed. Procedures were performed under combined fluoroscopic and ultrasound guidance using standardized lesion parameters (−78°C to −80°C for 180 seconds with controlled thaw cycles). Numeric Rating Scale (NRS) scores, duration of ≥50% pain relief, medication changes, and complications were assessed through medical records and structured telephone follow-up.

Results: Five patients were included (intercostal neuralgia, PHN, post-thoracotomy pain, and chronic abdominal wall entrapment). Mean baseline NRS was 8.1. Immediate post-procedure mean NRS decreased to 2.0. At approximately 1 month, mean NRS was 4.3. Three of five patients (60%) achieved sustained ≥50% pain reduction at 1 month, with durable relief lasting 3–6 months or longer. Two patients experienced short-lived benefit (<1 month). One patient discontinued pregabalin and duloxetine following pain resolution. No pneumothorax, infection, motor deficit, or persistent neurological complications were observed.

Conclusions: In this small feasibility series, image-guided thoracic intercostal cryoneurolysis was technically feasible and not associated with major complications. A clinically meaningful signal of benefit was observed in selected patients, including elderly individuals with PHN. Response variability suggests careful phenotypic selection may be important. Prospective studies are required to better define durability and predictors of response.

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Presenting Author: Anirudh Panemangalore Pai
Submitting Author: Anirudh Panemangalore Pai

Senior Author: Gautam Das

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Gautam Das: MBBS, MD, FIAPM, FIPP - Daradia: The Pain Clinic, Kolkata, India