Our role — and what we don’t do
We are not a primary chronic-pain practice and we do not provide longitudinal pain management. We perform image-guided procedures for specific, well-defined nerve pain syndromes that have already been diagnosed by your pain management, palliative care, or surgical specialist. After your procedure and a single short-interval follow-up to confirm your response, ongoing care returns to your referring physician. We do not refill or prescribe opioid pain medication. The goal of cryoneurolysis is opioid sparing — to reduce or eliminate the need for those medications, not to add another long-term prescriber.
What is cryoneurolysis?
Cryoneurolysis uses a small probe placed near a target nerve under image guidance. The probe is cooled to subzero temperatures, which produces a controlled freeze lesion that interrupts the nerve’s ability to transmit pain signals. Sensation gradually returns over weeks to months as the nerve regenerates — but in many patients, the underlying pain pattern doesn’t return with it.
Image-guided nerve blocks deliver local anesthetic (sometimes combined with corticosteroid) directly to a target nerve. Blocks can be diagnostic — to confirm a specific nerve is the source of pain — or therapeutic, providing medium-term relief.
The nerves we most commonly treat
Image-guided cryoneurolysis is best suited to specific anatomic targets. The most common include:
- Intercostal nerves — frequently targeted for post-thoracotomy pain syndrome, chest wall pain after surgery or trauma, and intercostal neuralgia. Multiple studies report significant pain reduction with CT- or ultrasound-guided approaches.1
- Pudendal nerve — for refractory pudendal neuralgia (from trauma, surgery, or childbirth) and intractable perineal or pelvic pain related to pelvic neoplasms. CT-guided bilateral cryoneurolysis has shown sustained pain relief in published case series.2
- Celiac plexus and splanchnic nerves — for visceral abdominal pain, particularly from pancreatic cancer or other upper-abdominal malignancy. CT-guided cryoneurolysis compares favorably to chemical neurolysis, with potentially fewer side effects such as diarrhea.3
- Lumbar medial branch nerves — for chronic lumbar facet joint syndrome. Image-guided approaches have demonstrated pain score improvements, though this overlaps significantly with traditional pain management practices.
- Peripheral nerve neuromas and sensory branches — including painful neuromas in amputees (phantom limb and stump pain), the infrapatellar branch of the saphenous nerve (post-surgical knee pain), the sural nerve, and other lower- and upper-extremity sensory nerves treated for post-traumatic or post-surgical neuropathic pain.4
- Trigeminal nerve branches — applied in selected secondary trigeminal neuralgia from head and neck malignancy, typically under CT guidance.
Additional and emerging targets reported in interventional radiology practice include the obturator nerve (for hip adductor spasticity or obturator neuralgia, often in oncologic settings); dorsal thoracic nerve roots (for dorsal neuropathic pain from tumor invasion); genicular nerves (for osteoarthritic knee pain, sometimes alongside other modalities); the superior hypogastric plexus, stellate ganglion, and lumbar sympathetics (for selected pelvic pain, complex regional pain syndrome, and cancer-related sympathetically mediated pain); and the iliohypogastric, ilioinguinal, genitofemoral, and intercostobrachial nerves in postsurgical pain syndromes such as post-mastectomy and post-hernia pain.
Medical conditions that targeted nerve therapy can treat
At Florida Interventional Specialists, every targeted nerve therapy is matched to the specific source of your pain. We work closely with your referring pain management or palliative care team to deliver image-guided procedures for both common and complex pain conditions — with the goal of meaningful, opioid-sparing relief.
Conditions that may be addressed with cryoneurolysis or targeted nerve blocks — depending on the underlying diagnosis and the nerve involved — include:
Bertolotti syndrome
Buttock pain
Cancer pain
Cerebrospinal fluid (CSF) leak
Cervical dystonia
Chronic testicular pain
Coccydynia
Complex regional pain syndrome (CRPS)
Cryoneurolysis for spasticity
Endometriosis
Fibromyalgia
Foot & ankle pain
Headache & facial pain
Hiccup (intractable)
Hyperhidrosis
Intercostal neuralgia
Interstitial cystitis
Knee pain
Limb pain
Long COVID (stellate ganglion block)
Occipital neuralgia
Pelvic pain
Peripheral neuropathy
Piriformis syndrome
Post-amputation pain
Post-herniorrhaphy syndrome
Post-mastectomy pain syndrome (PMPS)
Post-surgical pain
Pudendal neuralgia
Sacroiliac (SI) joint pain
Shoulder pain
Thoracic outlet syndrome
Trigeminal neuralgia
Whether a specific condition is appropriate for cryoneurolysis or a different intervention depends on the diagnosis, the nerve involved, and a discussion with your pain or palliative care physician.
Who is a good candidate?
Cryoneurolysis is most useful when a specific nerve has been identified as the dominant source of pain — often after a positive diagnostic block performed by you and your pain physician. Patients usually have a clear underlying diagnosis (post-thoracotomy syndrome, pudendal neuralgia, post-amputation neuroma, pancreatic cancer pain, etc.) and have either tried or are not appropriate for systemic pain medications and other interventional options. The decision is always made together with your referring team.
References
- Moore W, Kolnick D, Tan J, Yu HS. CT-guided percutaneous cryoneurolysis for post-thoracotomy pain syndrome: early experience and effectiveness. Acad Radiol. 2010;17(5):603–606.
- Prologo JD, Lin RC, Williams R, Corn D. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia. Skeletal Radiol. 2015;44(5):709–714.
- Bang JY, Sutton B, Hawes RH, Varadarajulu S. EUS-guided celiac ganglion radiofrequency ablation versus celiac plexus neurolysis for palliation of pain in pancreatic cancer: a randomized controlled trial. Endoscopy. 2019;51(8):751–758.
- Prologo JD, Gilliland CA, Miller M, et al. Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study. J Vasc Interv Radiol. 2017;28(1):24–34.
Frequently asked questions
Will Florida Interventional Specialists become my primary pain doctor?
No. We are not a primary chronic-pain practice. We perform image-guided procedures for specific, well-defined nerve pain conditions that have already been diagnosed and worked up by your pain management or palliative care physician. After your procedure and a single short-interval follow-up to confirm your response, you continue under the longitudinal care of your existing pain or palliative team.
Do you prescribe or refill opioid pain medication?
No. We do not prescribe or refill opioid pain medication. Cryoneurolysis is itself an opioid-sparing intervention, and the goal is to reduce or eliminate the need for those medications. All opioid prescribing and ongoing chronic pain medication management remains with your referring pain physician.
How long does cryoneurolysis last?
Effects vary by nerve target and patient, but published series report meaningful pain relief lasting from several months to over a year. The procedure can be safely repeated when symptoms return.
Is cryoneurolysis the same as radiofrequency ablation?
Both interrupt nerve signaling, but they use opposite temperature extremes. Radiofrequency ablation uses heat; cryoneurolysis uses cold. Cryoneurolysis tends to produce a more reversible lesion with less risk of inducing a new neuropathic pain (deafferentation pain), which makes it well suited to many sensory-nerve targets.
Is the procedure painful?
The procedure is performed with local anesthesia and, when appropriate, mild sedation. Most patients describe pressure rather than pain. Mild bruising or soreness at the needle entry site is common for a few days afterward and is usually well-controlled with over-the-counter medication.
How do I get referred?
Most referrals come from pain management physicians, palliative care teams, medical and radiation oncologists, thoracic surgeons, breast surgeons, gynecologists, urologists, and orthopedic surgeons. Your referring physician identifies the nerve target and sends imaging and prior workup; we confirm candidacy and schedule the procedure.
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