Cryoneurolysis for phantom limb pain: a systematic review.

Aims: Phantom limb pain (PLP) is a painful sensation occurring in patients around the site of an amputation. The aim of this systematic review is to evaluate the efficacy of cryoneurolysis in the management of phantom limb pain.

Materials and methods: A systematic review was performed according to the PRISMA 2020 guidelines. An initial search yielded 200 articles from four major scientific databases (PubMed, Embase, Cochrane Library, WebOfScience). Five articles met inclusion criteria, four of which underwent additional pooled statistical analysis.

Results: Pooled analysis of the included trials revealed a cumulative Cohen's d effect size of 1.55 (95% CI [0.24, 2.87]; p = 0.02; z = 2.32) for the reduction of pain on a 10-point pain scale following cryoneurolysis intervention. The remaining article that did not meet inclusion criteria for statistical analysis was a case report that reported a reduction in pain from 9/10 to 1/10 one week following intervention.

Conclusions: The large effect size demonstrated a statistically and clinically significant improvement in patient-reported pain. Additionally, patients may be able to reduce their amount of pharmaceutical pain management with successful cryoneurolysis treatment. However, these findings are limited by the small sample size and high heterogeneity between studies. Further high-quality studies should be performed to corroborate these findings.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42024543085.