Cryoneurolysis with iovera° for osteoarthritis knee pain: clinical evidence and experience in pre-total knee arthroplasty and non-surgical patients

Effective pain management often relies on administering opioid-based medication, but as opioids have known side effects and can lead to misuse and abuse, alternative approaches that provide non-medicated pain relief and are more versatile hold promise for improving patient care. 

During an August Becker's Hospital Review webinar sponsored by Pacira BioSciences, Gary Schwartz, MD, co-director of Anesthesiology Associates of Boro Park and vice chair of the department of anesthesia at Maimonides Medical Center, both in Brooklyn, and Christopher Varacallo, DO, of Penn Highlands Orthopedics and Sports Medicine in DuBois, Pa., discussed best practices in the use of iovera° and its role in managing the osteoarthritis (OA) pain journey.

Three key takeaways were:

  1. Multimodal pain management is an important part of perioperative care for total joint replacement. The underlying principle of multimodal pain management is the use of pain management interventions that act at different stages of the pain pathway, allowing agents to act synergistically while requiring lower total doses of each drug. Because of its unique properties and characteristics, iovera° can be a critical component of multimodal OA pain management.

  2. Iovera° is suitable for patients with limited conventional pain management treatment options. The iovera° system is a novel, FDA-approved non-opioid treatment that alleviates pain through cryoneurolysis. Its mechanism of action provides targeted, long-lasting pain relief by delivering intense cold (up to -88°C) to a specific nerve, interrupting its ability to transmit a pain signal. The system consists of a nitrous oxide cartridge, a reusable handpiece, a charging dock and disposable smart tips equipped with needles for treating both superficial and difficult-to-target peripheral nerves. Results are felt immediately and can last up to 90 days, as the nerve regenerates over time.

    Patients who stand to benefit most from treatment with iovera° include those with knee OA pain or chronic OA, those who may be candidates for total knee arthroplasty (TKA), those who are not candidates for treatment with steroids and those who are not candidates for surgery due to modifiable risk factors, advanced age or sickness.

    "These patients were left with not a lot of alternative treatment options outside of the standard NSAIDs injections or medications. iovera° is a nice treatment option for any one of these patients," Dr. Varacallo said. He noted that iovera° is also suitable for accelerating post-surgical patients' rehabilitative recovery process, decreasing their hospital length of stay and improving their quality of life.

  3. Treatment options with iovera° allow for customizable workflow integration. The iovera° system is versatile enough that treatment can be administered by different provider types (e.g., anesthesiologists, pain management specialists, physician assistants, nurse practitioners, sports medicine physicians), in a variety of care settings (e.g., ambulatory surgery centers, post-operative PACU suites at a hospital, procedure rooms at physician offices), with an array of techniques and in different applications and configurations based on provider and patient factors.

    "Unlike a traditional radiofrequency machine that is planted on a stand and weighs 15 pounds, the iovera° system is light, easy to hold in your hand and portable," Dr. Schwartz said.

    In addition, iovera° can help address treatment gaps, such as those that occur when patients with mild knee OA progress to a moderate stage or when patients with moderate OA progress to a severe stage of the disease. "[With iovera°], you can provide a continuum of care for those patients along the full spectrum of their pain and really be a champion for their pain relief," Dr. Varacallo said.

Note: This webinar included a detailed discussion of the mechanism of action of iovera°, its method of application, comparison between iovera° and other nerve treatments, nerve treatment techniques with iovera°, the clinical studies backing the efficacy of cryoneurolysis and other important considerations that go beyond the scope of this summary.

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