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Purpose <p>To develop expert consensus recommendations for patient selection and procedural techniques in cryoneurolysis for chronic pain management using a Delphi process.</p> Materials and Methods <p>A panel of 22 international interventionists participated in a two-round Delphi process. Participants rated 42 statements on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Consensus was predefined as ≥ 75% of ratings ≥ 7. Descriptive statistics (n, mean ± SD, % ≥ 7) were calculated.</p> Results <p>High agreement supported cryoneurolysis for localized chronic pain refractory to conservative therapies (mean 8.55 ± 0.60; 100% ≥ 7) and cases with identifiable peripheral nerve targets (8.45 ± 0.74; 100% ≥ 7). Imaging guidance was deemed essential for nerve identification and probe placement (8.91 ± 0.29; 100% ≥ 7). The panel endorsed individualized freeze–thaw cycles to achieve Sunderland II injury (8.27 ± 0.83; 91% ≥ 7) and emphasized thorough patient education (9.0 ± 0.0; 100% ≥ 7). Experts recommended repeat cryoneurolysis within weeks if initial response was incomplete (8.64 ± 0.65; 100% ≥ 7) and alternative therapies after two unsuccessful sessions (8.36 ± 0.73; 95% ≥ 7). No consensus was reached on restricting treatment to a single anatomical region (5.82 ± 2.91; 50% ≥ 7) or routine prophylactic antibiotics (6.27 ± 2.57; 54% ≥ 7).</p> Conclusion <p>This Delphi study establishes expert-derived consensus standards for cryoneurolysis, highlighting careful patient selection, mandatory imaging guidance, and flexible freeze protocols while identifying areas requiring further research.</p> Graphical Abstract <p></p>

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Interventional Management of Pain with Cryoneurolysis: Expert Consensus Recommendations for Standardizing Patient Selection and Techniques Based on Delphi Process

  • 期刊论文

  • 发表日期：

    2025年12月28日

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  • Francois H. Cornelis,
  • Neil J. Resnick,
  • Matthias Barral,
  • Salem Bauones,
  • Jan Fritz,
  • Jeffrey P. Guenette,
  • Jack W. Jennings,
  • Adrian Kastler,
  • Alexis Kelekis,
  • Alexa Levey,
  • Raul Garcia Marcos,
  • Marwan Moussa,
  • Evangelos Petsatodis,
  • Uei Pua,
  • Vijay Ramalingam,
  • Leo Razakamanantsoa,
  • Alan A. Sag,
  • Nicolas Stacoffe,
  • Sean Tutton,
  • Steven Yevich,
  • J. David Prologo,
  • Dimitrios Filippiadis

摘要

Purpose

To develop expert consensus recommendations for patient selection and procedural techniques in cryoneurolysis for chronic pain management using a Delphi process.

Materials and Methods

A panel of 22 international interventionists participated in a two-round Delphi process. Participants rated 42 statements on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Consensus was predefined as ≥ 75% of ratings ≥ 7. Descriptive statistics (n, mean ± SD, % ≥ 7) were calculated.

Results

High agreement supported cryoneurolysis for localized chronic pain refractory to conservative therapies (mean 8.55 ± 0.60; 100% ≥ 7) and cases with identifiable peripheral nerve targets (8.45 ± 0.74; 100% ≥ 7). Imaging guidance was deemed essential for nerve identification and probe placement (8.91 ± 0.29; 100% ≥ 7). The panel endorsed individualized freeze–thaw cycles to achieve Sunderland II injury (8.27 ± 0.83; 91% ≥ 7) and emphasized thorough patient education (9.0 ± 0.0; 100% ≥ 7). Experts recommended repeat cryoneurolysis within weeks if initial response was incomplete (8.64 ± 0.65; 100% ≥ 7) and alternative therapies after two unsuccessful sessions (8.36 ± 0.73; 95% ≥ 7). No consensus was reached on restricting treatment to a single anatomical region (5.82 ± 2.91; 50% ≥ 7) or routine prophylactic antibiotics (6.27 ± 2.57; 54% ≥ 7).

Conclusion

This Delphi study establishes expert-derived consensus standards for cryoneurolysis, highlighting careful patient selection, mandatory imaging guidance, and flexible freeze protocols while identifying areas requiring further research.

Graphical Abstract