COLUMBIA, Mo. ― After thoracic surgery – any medical operation done inside the chest – patients can experience pain, soreness or numbness even years later. This is because the incisions cut through muscles and nerves on sensitive ribs, which can cause damage and inflammation.
Researchers at the University of Missouri School of Medicine have been investigating ways to treat post-operative pain without having to rely on opioid medications. They explored using cryoanalgesia during surgery -- in other words, freezing the nerves. Applying extreme cold to nerves temporarily blocks them from sending pain signals, which significantly reduces or stops pain sensations. However, this method may not prevent long-term pain relief for all patients.
"Patients that were female, had post-operative complications or continued to use opioids at the time of the first follow-up visit tended to experience pain even 2 years later," co-author and resident physician Dr. Kevin Klifto said. "In addition, 80% of those who experienced pain experienced neuropathic pain, or chronic pain caused by an injury or malfunction of the nervous system. It's unclear if these results were related to cryoanalgesia or the surgery itself."
A total of 261 patients at the academic health system received cryoanalgesia at the end of their pulmonary resection, a type of thoracic surgery where parts of the lung were removed. 167 patients, or about 64%, reported no pain after 2 years, while 35% still reported pain. More studies are needed to determine if cryoanalgesia is effective for preventing post-op pain without long-term side effects, and if it's best suited for certain populations.
"We were one of the first hospitals in the nation to use cryoanalgesia routinely in adult patients undergoing lung surgery. But the use of cryoanalgesia in surgery is still new, as current evidence of its long-term effectiveness and safety needs further exploration," co-author Dr. Jussuf Kaifi said. "Our goal was to add our experiences to the literature to gain a better understanding of what the long-term patient outcomes are after freezing nerves."
Regardless of whether cryoanalgesia is a viable method for pain management, as more people become aware of the risks associated with opioids and substance use disorders, finding alternate ways to manage pain is key as patient care evolves.
"Some clinical studies suggest that if you have post-operative pain, you may be at a higher risk for developing chronic pain," Kaifi said. "Missouri has a large population of people struggling with opioid addiction and overdose. Using pain management substitutes may help patients manage their condition and promotes our mission to save and improve lives."
Kevin Klifto, DO, PharmD is a Plastics and Reconstructive Surgery resident at MU Health Care. Jussuf Kaifi, MD, PhD is the Section Chief and an associate professor of thoracic surgery at the Mizzou School of Medicine. He also holds the Margaret Proctor Mulligan Distinguished Professorship in Cancer Research and works as a thoracic surgeon at MU Health Care.
"Clinical predictors of pain 24 Months after intraoperative intercostal nerve Cryoanalgesia for anatomical lung resection" was recently published in Surgical Oncology. In addition to Klifto and Kaifi, Mizzou study authors include medical students Jonas McCaffrey and David Sniatkewicz.
