Cryoablation therapy has long been used to treat pain in cancer patients.
But now, a doctor at Emory University is trying it out on other types of nerve pain, and what he’s finding could bring pain relief to millions of amputees suffering from phantom limb pain.
We take a look at one of the first patients to try this experimental procedure.
Training the next generation of firefighters requires experience and discipline and Gene Hull has both.
What he doesn’t have is both arms. He lost the right one to cancer 10 years ago.
Hull told Ivanhoe, “I thought about my family and how it was going to affect them. I thought about my job and how it was going to affect that.”
But Gene didn’t fully consider how it would affect his quality of life. He knew is arm was gone, but his brain would sometimes forget.
“I’d be sitting in my office or teaching a class and I’d get those pains and you can imagine what it’s like getting hit by a cattle prod; that’s the only thing I can equate it to,” Hull explained.
J. David Prologo, MD, Interventional Radiologist at Emory School of Medicine in Atlanta told Ivanhoe, “Many of the nerves that we know are responsible for carrying pain symptoms are not accessible to pain doctors.”
But those nerves are accessible to interventional radiologists like Dr. Prologo who uses ‘image guiding’ to pinpoint the exact nerve that’s causing the pain. He then uses cryoablation to freeze it.
Dr. Prologo said, “So basically you got a nerve that’s sending pain signals, pain signals, pain signals and after you freeze it and then thaw it, those pain signals stop.”
Hull told Ivanhoe, “I still get those pains a little bit, but they’re nowhere near what they used to be. Now they’re just a mild discomfort.” And a mild discomfort is a welcome relief from the severe pain gene felt in his phantom limb for almost 10 years.
Dr. Prologo believes military veterans who experience phantom pain after losing a limb in combat are excellent candidates for cryoablation therapy. He is applying for a grant from the Department of Defense to fund a clinical trial at several locations around the country.
TOPIC: CRYOABLATION FOR AMPUTEES
REPORT: MB #4064
BACKGROUND: Many times after an amputation the patient has phantom limb pain. Although the limb is no longer there, the pain persists. Most commonly, phantom limb pain can feel like burning, itching, twisting or pressure. The pain can last from seconds to days; it varies from person to person. Phantom limb pain is caused by mixed signals from the brain or spinal cord. However, certain activities can activate it such as touch, urination or defecation, sexual intercourse, angina, cigarette smoking, changes in barometric pressure, herpes zoster, or exposure to cold. Studies show 60-80 percent of amputees experience phantom limb pain. Studies also show 75 percent of patients develop these pains within the first few days of surgery.
(Source: http://www.amputee-coalition.org/limb-loss-resource-center/resources-for-pain-management/managing-phantom-pain/, http://bja.oxfordjournals.org/content/87/1/107.full)
TREATMENT: Treatment for phantom limb pain uses a combination of medication and non-medication therapy. Some of the pain medications these patients may be prescribed include:
* Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs)
* Opioids (narcotic pain medications)
* Muscle relaxants
Patients may take multiple medications in combination with one another for more effectiveness. Some of the non-medication treatments include:
* Massage of the residual limb
* Use of a shrinker
* Repositioning of the residual limb by propping on a pillow or cushion
* Mirror box therapy
* TENS (transcutaneous electrical nerve stimulation)
* Virtual reality therapy
NEW TECHNOLOGY: A new study has been using cryoablation therapy, commonly used for pain in cancer patients, to treat phantom limb pain. This treatment freezes the nerve using a cryoablation probe to see the nerve. After the nerve freezes it melts, causing the signals in the nerve to stop.
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Senior Manager, Media Relations
Emory Johns Creek Hospital