CRYOABLATION FOR THE TREATMENT OF NEUROMA(S)

CRYOABLATION FOR THE TREATMENT OF NEUROMA(S)


   I've been dealing with neuromas since Oct 2007 and it's now 2011.  What is a neuroma you might ask ? A neuroma is a nerve with a ball of scar tissue around it. The nerve is traumatized, for example from surgery then scar tissue forms and compresses. The errant nerve fibers grow out, like spaghetti, and twist around with the scar tissue to form a ball or nodule. These errant nerve ends cause a lot of pain. I have Arthrofibrosis, which means to form excessive scar tissue, so I have no problem forming scar tissue around nerves ,esp from multiple surgeries. 
    Most of my neuromas form along the infrapatellar branch of the saphenous nerve. The infrapatellar branch comes off the saphenous nerve on the medial side of the knee and goes across to the patella and below. My nerve pain takes on many forms. It can be an intense burning, a burning flare, intense throbbing, multiple hard needle like sticks and very sensitive to touch. Nerve pain is very hard to treat. Narcotics don't work as well, taken alone. Nerve pain is managed with a "cocktail " of meds, usually prescribed by a pain management specialist. These meds can be a combination of antidepressants, anticonvulsant meds, narcotics and hypertensive meds, various gels and lidoderm patches to name a few. Each one of these drugs works at a different receptor site in the brain or spine, to block pain. 
   Other methods of treatment include e-stim modalitiesultra sound, conductive garments , nerve decompression/resection surgeries, cryoablation, and the last resort,a spinal cord stimulator. I've tried 4 of the above. My journey thru nerve pain and the various treatment methods I've tried, are chronicled thru my thread titled, OPEN DEBRIDEMENT AND PROXIMAL Z-PLASTY
   My pain management doctor brought up the possibility of trying cryoablation to the neuromas in my knee. Cryoablation freezes the nerve into an ice ball. The procedure leaves the nerve sheath/tube intact , so if and when the nerve regenerates, it still has an intact sheath/tube to grow in. This frozen nerve will last anywhere from a couple months, to about 1 year. I read about it, but there really wasn't anything out there about people's experiences with cryoablation. Last year one of the kneegeeks went through this method of treatment for her neuroma. She briefly posted, then dropped off the site. I would like to tell my experience with cryoablation to provide firsthand account of what to expect.
   Cryoablation is a surgery, so you are prepped for surgery. This involves getting into a gown, signing permits, and getting an IV. I will receive 2 meds thru the IV. One is Fentanyl for pain and Versed to lightly sedate. You have to be awake enough to provide feedback to the Dr performing the procedure, which was my pain management doctor. I marked 10 neuromas on the medial side of my knee with surgical marker. You are wheeled to the operating room, where everyone is gowned and masked up. Sterile drapes are placed over you and you are hooked up to the heart monitor , BP monitor, O2 monitor and an O2 nasal cannula is placed in your nose. My leg was prepped with orange surgical betadine from ankle to mid thigh.
   The Dr proceeded to start with the first marked neuroma. He pushed down to feel the BB or pea sized nodule , which also elicited pain for me to say, that was the spot! He then injected a little local anesthesia to numb the area, to insert the cryo probe, which was the size of an ice pick. Once the probe hit the neuroma (ouch !) they had to run 2 stimulus tests. One was to stimulate to make sure it was not a motor nerve and then to stimulate for sensory nerve. A motor response would make my leg move and sensory , well , elicited a painful response. We were looking for that painful response. BINGO!
   Once the sensory test was done, then the cryoablation took place. The probe would then freeze the neuroma for 5-7 min, which hurt at first. I was given a dose of Fentanyl and Versed to counter the pain. Then it was turned off, for a 2-3 min thawing period, then a second cryo period began, lasting another 5 min. This procedure was repeated each time, to the other 9 neuromas, and each time, I received a dose of Fetanyl and Versed. 
   The whole procedure took 2 hours. After it was done, my leg was cleaned off and a pressure dressing of gauze pads, kerlix and ace wrap was applied. They wheeled me back to the recovery room. My vital signs were monitored for about an hour. Everything checked out OK , so after an hour I was allowed to go home. I was supposed to limit activity and ice and elevate my leg for 48 hours. I was able to walk OK . I was tired from the whole experience and slept when I got home.
   We planned on having another cryoablation a week later, because other areas to ablate would show up. I couldn't believe I was going thru it again, but I had 10 more areas to be done. I marked them all with surgical pen. Then whole process was repeated as above and lasted 2 hours.
   Aside from being sore, I enjoyed several weeks of no nerve pain in the knee. Unfortunately, the cryoablation was not able to reach the nerve pain going down my medial leg and across the top of my foot.  Just to have the pain gone for several weeks in the knee was pure heaven.
   It's now been 5 months since the cryoablation. The nerve pain has slowly returned. I am back to having monthly local anesthetic injections and blocks to the knee. My pain management Dr is trying to get the hospital to buy a cryo machine for the clinic. The one he used on my knee was brought by the rep and not to keep. I feel it was beneficial for neuromas. Most people only have 1 neuroma to ablate, not the 10-20 I had.
I highly recommend cryoablation as a method of treating painful neuromas and I would go thru it again if I was offered the chance.
Pam
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