Evolving role of cryoablation and cryoneurolysis for interventional pain management

Abstract Despite advances in pain management, pain remains a major global health challenge in both oncological and non-oncological patients. Long-term pharmacological treatment is often restricted by insufficient therapeutic benefit and adverse events, highlighting the need for alternative approaches such as image-guided pain therapies. The idea of treating pain with cold has been recognized for centuries, and today cryotherapy has emerged as a valuable minimally invasive option for pain management. Cryoablation refers to the destruction of tissue with extreme cold and has an increasing role, especially in the treatment of benign (e.g., osteoid osteoma), malignant bone (i.e., metastases), and soft tissue tumors, either with a curative or palliative intent. Cryoneurolysis is a related but distinct application, focusing either on peripheral nerve modulation or nerve destruction. Cryoneurolysis may be highly effective for the treatment of acute or chronic pain, including sympathetic neurolysis in cancer and non-cancer-related pain syndromes. The general approach in patients with tumor-related pain depends on whether the lesion itself can be ablated or not. In non-oncologic patients, cryoneurolysis of the responsible nerve is typically performed following a positive response to a diagnostic nerve block. Potential indications for cryotherapy are constantly evolving; however, evidence, especially for cryoneurolysis, is still limited and based mostly on single-center case series and retrospective studies. Standardized ablation protocols are lacking, and for the duration of cycles, most experts rely on imaging visualization and validated protocols. Equally important, successful integration of cryoablation and cryoneurolysis into daily practice requires structured workflows across different patient pathways and interdisciplinary management. Key Points Question Pain management remains a major global health challenge and an unmet need in oncological and non-oncological patients. Findings Cryotherapy, in terms of cryoablation and cryoneurolysis, is increasingly incorporated in multimodal curative and palliative pain care concepts, for treatment of acute and chronic pain syndromes. Clinical relevance Advancement and validation of standardized treatment protocols are needed to strengthen evidence and further enhance clinical implementation in interventional radiology practice and interdisciplinary patient care .