Advancements in Pain Management: Cryoneurolysis vs Radiofrequency Ablation

iovera cryoneurolysis was reported in a company press release to produce greater pain reduction than radiofrequency ablation at 180 and 360 days. That finding is based on a small, unblinded single‑center randomized pilot.

Cryoneurolysis uses focused cold to interrupt nociceptive signaling in a defined peripheral nerve segment without thermal coagulation, producing a reversible axonotmesis while preserving the surrounding connective matrix. Radiofrequency ablation uses heat to denature nerve fibers and adjacent tissue, creating a more permanent neurolytic lesion. The tissue‑sparing, regenerative mechanism of cryoneurolysis plausibly explains both immediate analgesia and longer‑term patterns of recurrence, supporting an expectation of sustained—but time‑limited—relief in selected patients.

The press release describes an unblinded, single‑center randomized pilot of 30 adults with facet‑mediated chronic low back pain, with pain scores at 180 and 360 days as primary endpoints. Reported group differences favored cryoneurolysis: pain at day 180 (3.1 vs. 5.4, p=0.01) and day 360 (3.0 vs. 6.1, p=0.01), and fewer additional spine injections after 180 days (45.5% vs. 75%). Functional status was assessed with the Oswestry Disability Index (ODI) as a secondary outcome. Taken together, these numerical effects show notable between‑group separation in a pilot context but remain preliminary pending larger, multicenter confirmation.

Functional outcomes favored cryoneurolysis through 12 months: day‑360 ODI was 10.1 versus 20.6 for radiofrequency ablation (p=0.002), a between‑group difference that meets commonly cited minimal clinically important difference thresholds for the ODI. The magnitude of ODI improvement, together with the pain reductions, suggests clinically meaningful gains in activity and role function for the cryoneurolysis arm—findings that, if replicated, could translate into measurable improvements in daily function and quality of life.

Safety data over 12 months were reported as favorable, with no treatment‑related adverse events in either arm and procedural tolerability described as acceptable. Expected minor, transient local effects—bruising, swelling, altered sensation, or skin changes—are noted as device‑related possibilities. The study’s limitations (unblinded assessment, a short device tip restricting enrollment to lower‑BMI patients, and small sample size) temper generalizability; the apparent safety profile therefore requires confirmation in larger, more diverse cohorts.

Clinically, these pilot results could influence device selection and patient triage for facet‑mediated chronic low back pain by adding a non‑drug, tissue‑sparing procedural option.