Cryoneurolysis for Spasticity: Long-Lasting Relief, Candidate Criteria, and What the Evidence Shows
NeuroRehab Team
Tuesday, December 30th, 2025
Spasticity affects about 2.58 million adults in the United States. Nearly 1.07 million of these people face troublesome symptoms that disrupt their quality of life. Patients struggling with this condition can now turn to cryoneurolysis treatment. This option works better than traditional approaches and provides longer-lasting relief without the drawbacks of conventional therapies.
Cryoneurolysis stands apart from phenol and alcohol treatments. This minimally invasive procedure uses cold temperatures (between -20 and -100°C) to target peripheral nerves. The process creates controlled nerve disruption while keeping supportive structures intact. The preserved structures let nerves regenerate at a rate of 1 to 2 mm each day. The treatment costs around $500 USD, and most patients need just one session per year. Research shows that patients save 15 times more money annually compared to botulinum toxin-A treatments.
The advantages go well beyond cost savings. Patients who receive this treatment show notable improvements in their range of motion. Their reduced spasticity can last up to 11 months. The treatment works well for patients of all ages, from three-year-old children to people in their nineties. This piece looks at how cryoneurolysis works, why it’s better than traditional treatments, and what studies tell us about managing spasticity long-term.
What is Cryoneurolysis and How Does It Work?
Cryoneurolysis is a cutting-edge way to manage spasticity by using extreme cold. This treatment will give a better outcome than traditional methods because it temporarily stops nerve function while keeping the structures needed for full recovery intact.
Understanding the mechanism of nerve freezing
The treatment uses cold temperatures (between −20 and −100°C) on peripheral nerves to create a controlled second-degree nerve injury called Wallerian degeneration [1]. A doctor places a specialized cryoprobe through the skin right next to the target nerve. The device uses liquid nitrous oxide inside a closed-end probe, which makes the tip cool down faster [2]. This creates a small ice ball from the body’s own fluid around the probe tip [2].
The extreme cold stops the nerve from working by affecting both the axon and myelin sheath. This freezing leads to axonotmesis, a second-degree nerve injury in the Sunderland classification [3]. The cold temperatures block nerve signals and reduce muscle hyperactivity that causes spasticity.
The ice ball stays contained when doctors do the procedure right. There’s no risk of liquid spreading to nearby areas [4]. This precise targeting lets doctors treat only the nerves that cause problematic spasticity.
How cryoneurolysis is different from other neurolysis methods
Cryoneurolysis stands out from other spasticity treatments in several vital ways. It’s worth mentioning that unlike botulinum toxin and phenol injections, cryoneurolysis has no dose limits. Doctors can treat more muscles in one session [5]. The treatment is also safer because it avoids risks to breathing systems or liver damage that can happen with onabotulinumtoxinA and phenol injections [1].
The treatment is different from cryoablation, which uses liquid nitrogen at −195.8°C and causes permanent nerve damage. Cryoneurolysis uses temperatures that only cause temporary changes [3]. This makes it completely different from chemical methods like phenol or alcohol, which destroy tissue and cause vessel clots [5].
The iovera device works at about −88°C, which hits the perfect temperature sweet spot. This range causes temporary nerve disruption without permanent damage [6]. The temperature is just right to help patients without the risks of colder treatments.
Why it’s reversible and safe for long-term use
Cryoneurolysis can reverse because it keeps important nerve structures intact. The cold damages the axon and myelin sheath but leaves the supporting tissues—endoneurium, perineurium, and epineurium—untouched [3]. These preserved tissues create a framework for nerve regrowth, which happens at 1-2 mm daily [1].
This controlled disruption has a big advantage: effects last longer than botulinum toxin but eventually fade as nerves grow back naturally [4]. Research shows 96.75% of nerve treatments caused no pain or unusual sensations after treatment [7]. Side effects are usually mild when they happen, such as bleeding, bruising, redness, or temporary numbness [1].
Some conditions make cryoneurolysis unsafe, like cryoglobulinemia, cold urticaria, and Raynaud’s phenomenon [1]. In spite of that, most patients get relief for 3-6 months without needing surgery [2].
Patients can safely get repeated treatments because the procedure doesn’t cause permanent nerve changes or neuromas [4]. These benefits explain why medical centers worldwide now use cryoneurolysis more often to manage spasticity [5].
The Role of Diagnostic Nerve Blocks in Patient Selection
Patient selection plays a vital role in the success of cryoneurolysis treatment. Doctors use diagnostic nerve blocks (DNBs) as a screening tool to improve treatment accuracy and patient satisfaction before they start this innovative technique.
What is a diagnostic nerve block (DNB)?
A diagnostic nerve block happens when doctors inject local anesthetic near specific nerves they think cause pain or contribute to spasticity. These injections turn off the targeted nerve for approximately 4-6 hours [3]. DNBs work in two ways: they help diagnose issues and predict treatment success.
DNBs help doctors find the exact source of pain or muscle hyperactivity [3]. The targeted nerve likely causes the problem when patients feel substantial relief (usually >50% for two to six hours) after the injection [3]. When little improvement happens, doctors can rule out that nerve and look for other causes [3].
The procedure typically involves:
- Finding the target nerve using anatomical landmarks or ultrasound guidance
- Putting a small needle in the right position
- Giving local anesthetic (usually lidocaine)
- Watching how the patient responds to check if it works [3]
How DNB helps predict cryoneurolysis outcomes
Medical experts say patients should try a diagnostic nerve block before moving to cryoneurolysis [8]. This vital step shows what results to expect and helps both doctors and patients make better decisions about long-term treatments.
“You do a block first. You need to make sure people have success with the block so that they can want to have longer lasting relief and see that it’s actually efficacious,” says Dr. Levey, a specialist in the field [8]. This approach represents a transformation in patient care—patients see their potential results before choosing treatment [4].
Research shows that using DNBs to set treatment goals for spasticity leads to better results [9]. A case-control study revealed better outcomes for patients who had DNB-guided goal setting compared to those who relied only on clinical evaluation and patient needs [10].
DNBs help doctors create better nerve targeting strategies [11]. They can map which specific motor and sensory components affect spasticity and related pain [11]. This detailed mapping results in more targeted and effective cryoneurolysis treatment.
Reducible deformity vs. contracture
DNBs excel at showing the difference between reducible deformity and true contracture—knowledge that shapes treatment plans [4].
Reducible deformity means a muscle group looks short or rigid but stretches after a diagnostic nerve block [4]. This shows that spasticity (abnormal muscle tone) causes the limitation, not permanent changes. These patients often respond well to cryoneurolysis treatment.
True contracture means muscles and tendons have permanently shortened due to fibrotic changes. Temporary nerve blockade won’t improve these structural changes, which suggests cryoneurolysis alone might not help much.
French and Belgian doctors pioneered this distinction using landmark-guided anesthetic diagnostic motor nerve blocks with lidocaine, which changed how we manage spasticity [4]. Doctors now create more precise, personalized treatment plans by identifying which muscles have spasticity versus true contractures. This saves patients from unnecessary procedures.
A detailed scoping review confirms this approach works—DNBs consistently helped clinical decision-making in a variety of neurological conditions, and side effects were rare and temporary [2].
Procedure Overview: From Ultrasound to Nerve Targeting
Modern tools and techniques are vital to perform cryoneurolysis treatment with the best results. New imaging technology has improved how practitioners deliver this therapy to manage spasticity.
Ultrasound-guided cryoneurolysis explained
Ultrasound guidance has changed cryoneurolysis by letting clinicians see target nerves as they work. The technique is similar to a peripheral nerve block, but doctors position a cryoprobe next to the target nerve instead of injecting anesthetic [12].
The process starts with local anesthetic to reduce discomfort. A small introducer (14-20 gage) goes beneath the ultrasound transducer until it reaches the target nerve [12]. High-resolution ultrasound shows the nerve in cross-section, which helps place the introducer accurately without harming nearby structures [13].
The cryoneurolysis device then starts its freezing cycle. This includes 2-3 minutes of freezing and a 1-minute thaw period, repeated 2-3 times [12]. Doctors watch the probe and target nerve throughout to make sure they treat the full nerve diameter [12].
Targeting motor vs. sensorimotor nerves
Pain management was the first use of cryoneurolysis on sensory nerves, but now it treats both motor and sensorimotor nerves for spasticity [14]. Since 2018, ultrasound guidance has helped doctors target sensorimotor trunks, motor branches to specific muscles, and even nerves inside muscles [4].
Many systems use nerve stimulators at different frequencies—100 Hz for sensory and 2 Hz for motor responses [6]. This helps doctors tell the difference between sensory and motor parts, which is key in complex anatomical areas [6].
Muscle fasciculations happen right away as the nerve freezes, showing that the treatment is working [4]. Sedation clinics now help children and sensitive patients handle any temporary discomfort [4].
Use of iovera cryoneurolysis treatment devices
The iovera° system stands out among handheld devices for cryoneurolysis treatment. This FDA-cleared device uses a special “Smart Tip” probe to apply controlled cold to specific peripheral nerves [15].
Treatment takes about 30 minutes. The iovera° device creates a precise cold zone that freezes the targeted nerve and blocks pain signals immediately [15]. Nitrous oxide circulates through the system to reach temperatures of about -70°C at the probe tip [12].
Each iovera° session costs around $500 USD, and most patients need just one treatment per year [4]. The system helps with spasticity and treats various body parts including knee, hip, shoulder, foot, ankle, and spine [16].
Benefits Over Traditional Spasticity Treatments
Traditional spasticity treatments have drawbacks that cryoneurolysis helps overcome. Patients looking for alternatives to standard options need to know these benefits.
Comparison with botulinum toxin and phenol
Botulinum toxin injections are a mainstream treatment for spasticity. However, patients need repeated doses every three to four months indefinitely [17]. Doctors in Canada, France, Germany, and the United States can’t give higher doses to their patients due to strict limits. About 25% of their patients could benefit from increased dosage [5].
The problems don’t stop there. Chemical neurolysis agents like phenol and alcohol damage tissue and cause vessel thrombosis [4]. These methods lack official approval for spasticity treatment and don’t have much research to back them up [4].
No dosage limits and broader nerve targeting
Cryoneurolysis treatment stands out because it has no maximum dose limit. Doctors can treat more muscles in one session [4]. They can work on entire nerve trunks instead of just individual muscle points.
At -88°C, cryoneurolysis targets only neurons and leaves surrounding tissue intact. This makes it safer than chemical options [4]. Doctors can now treat larger sensorimotor nerve trunks that they usually avoid with chemical neurolysis.
Longer-lasting results with fewer sessions
Money-wise, cryoneurolysis saves patients a lot. The iovera device costs about $500 USD per treatment, and most patients need just one treatment yearly [4]. Botulinum toxin therapy can cost up to $36,000 per year with hospital charges [1].
Patients see their muscles relax right away with cryoneurolysis, and results last 6-12 months [5]. Fewer appointments mean less hassle and better quality of life between treatments.
Cryoneurolysis stroke applications
Stroke patients who get cryoneurolysis show less spasticity and better joint movement [17]. Almost all nerve treatments (96.75%) cause no pain or unusual sensations after the procedure [4].
This treatment works great for patients with severe spasticity who no longer respond to botulinum toxin [1]. One case study showed lasting improvement after seven months in a post-stroke patient who had multiple nerve treatments. Their pain dropped to 3/10 on the pain scale [1].
What the Research and Case Studies Show
Research and clinical case studies show compelling evidence that cryoneurolysis works to treat spasticity in patients of all types. The results verify both safety and clinical benefits of this procedure.
Better Movement and Flexibility
Clinical studies showed spasticity decreased and mobility improved after cryoneurolysis treatment. Shoulder patients had MAS score reductions of -1.0 during flexion, abduction, and external rotation at 90 days [7]. Their median ROM increased by 20.0 degrees during flexion and abduction, and 15.0 degrees in external rotation [7].
Elbow extension patients saw V1 improvements of +12.9° at 12 months [11]. Their active ROM increased by +21.3° at the same time [11]. Wrist extension benefits were similar. MAS scores dropped by a lot at 3 and 12 months (-1.0 and -1.3 respectively) [11].
Relief Lasting 6 to 12 Months or More
Cryoneurolysis offers longer-lasting benefits than traditional treatments. A case series of 10 patients showed immediate improvements that lasted 1-12 months after treatment [18]. Upper limb studies revealed significant shoulder improvement in V1, active ROM, and MAS scores that stayed stable for 12 months [11].
Some patients’ relief lasted longer with each treatment. One case study showed relief lasting 4½ months after the original treatment, 5 months after the second, and nearly 6 months after the third [19].
Safety Review of Cryoneurolysis for Spasticity Treatment
Cryoneurolysis has proven to be remarkably safe. A study of 277 nerve treatments in 113 patients found all but one of these patients had no pain or dysesthesias after treatment [3]. The reported side effects included:
- Local skin infections (cleared up within 1 month)
- Bruising or swelling (cleared up within 1 month)
- Nerve pain/dysesthesia (9 patients total; 7 in mixed sensorimotor nerves) [3]
Most patients’ discomfort went away within 3 months. Very few had symptoms that lasted longer [3].
Better Life Quality and Happy Patients
Patient feedback verifies the benefits of cryoneurolysis. Goal Attainment Scale scores went up by 13.8 points from baseline at 180 days [7]. Patient satisfaction was exceptional – seven out of eight patients gave a perfect 10/10 rating at 6 months after treatment [20].
Life quality improved beyond just symptom relief. Patients who received cryoneurolysis showed better KOOS scores (+38.8 vs +11.1 control) and SF-12 mental scores at 12 months [21]. Daily tasks became easier, especially caregiving activities like diaper changes and dressing [20].
Conclusion
Cryoneurolysis marks a major step forward in treating spasticity. It gives patients a powerful alternative to traditional treatments and addresses many limitations of conventional approaches while providing longer-lasting relief. Patients see better range of motion and reduced spasticity that usually lasts six to twelve months per treatment. This is a big deal as it means that the effects last much longer than botulinum toxin injections, which only work for three to four months.
One of the biggest advantages is that cryoneurolysis has no dosage limits like other treatments. Doctors can treat multiple muscle groups at once because there are no maximum dose restrictions. This leads to more complete care in a single session. The freezing process preserves connective tissue structures, and nerve regeneration happens naturally at 1-2 mm per day. The treatment works well and remains reversible.
Money matters make cryoneurolysis even more attractive. Most patients need just one treatment yearly at about $500 USD. This creates huge savings compared to botulinum toxin therapy, which can cost up to $36,000 annually with institutional charges. Patients get better results and save money.
The procedure’s safety record speaks volumes. Studies reveal that 96.75% of nerve treatments caused no pain or dysesthesias after the treatment period. Any side effects usually cleared up within one to three months. Patient satisfaction rates are excellent, with most giving perfect 10/10 scores six months after treatment.
A diagnostic nerve block before treatment is vital to success. This step helps doctors tell the difference between reducible deformity and true contracture. They can then identify the best candidates and create more personalized treatment plans with realistic goals.
The treatment works well in a variety of patient groups – from kids to seniors. Doctors use ultrasound guidance to target specific nerves causing problematic spasticity. While pain management for sensory nerves was its first use, modern applications now handle both motor and sensorimotor nerves effectively.
Spasticity affects millions of Americans and takes a toll on their quality of life. Cryoneurolysis offers a safe, effective, and affordable option that cuts down treatment burden while improving function. Research continues to confirm these benefits, and this treatment could become the go-to choice for patients who want long-term spasticity relief without traditional treatment limitations.
Key Takeaways
Cryoneurolysis offers a breakthrough approach to spasticity management, providing longer-lasting relief with fewer limitations than traditional treatments. Here are the essential insights for patients and healthcare providers:
• Cost-effective long-term solution: At $500 per treatment with most patients needing less than one session annually, cryoneurolysis delivers 15-fold cost savings compared to botulinum toxin therapy.
• Extended relief duration: Patients experience 6-12 months of spasticity reduction and improved range of motion, significantly longer than the 3-4 month duration of traditional treatments.
• No dosage restrictions: Unlike botulinum toxin, cryoneurolysis has no maximum dose limits, allowing treatment of multiple muscle groups in a single session.
• Reversible and safe: The procedure preserves nerve structures while temporarily disrupting function, with 96.75% of treatments showing no lasting adverse effects.
• Diagnostic nerve blocks are essential: Pre-treatment blocks help distinguish between reducible deformity and permanent contracture, ensuring optimal patient selection and realistic expectations.
When properly implemented with diagnostic nerve blocks and ultrasound guidance, cryoneurolysis represents a paradigm shift in spasticity care—offering patients sustained functional improvements with reduced treatment burden and exceptional safety profiles across all age groups.
References
[1] – https://www.archives-rrct.org/article/S2590-1095(25)00039-4/fulltext
[2] – https://pubmed.ncbi.nlm.nih.gov/41066087/
[3] – https://pubmed.ncbi.nlm.nih.gov/37104641/
[4] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11457193/
[5] – https://journals.lww.com/ajpmr/fulltext/2025/10000/measuring_the_efficacy_of_percutaneous.6.aspx
[6] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11931670/
[7] – https://www.sciencedirect.com/science/article/abs/pii/S0003999324001291
[8] – https://www.backtable.com/shows/msk/articles/cryoneurolysis-pain-management-advantages-indications-future-directions
[9] – https://www.mdpi.com/2072-6651/16/6/258
[10] – https://www.cureus.com/abstracts/1320-role-of-diagnostic-nerve-blocks-in-the-goal-oriented-treatment-of-spasticity-with-botulinum-toxin-type-a–a-case-control-study
[11] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12435237/
[12] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11801435/
[13] – https://www.nature.com/research-intelligence/nri-topic-summaries/cryoneurolysis-and-pain-management-techniques-micro-109041
[14] – https://journals.sagepub.com/doi/full/10.1177/27536351251340216
[15] – https://www.iovera.com/how-it-works
[16] – https://www.iovera.com/
[17] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11561588/
[18] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12128593/
[19] – https://journaloei.scholasticahq.com/article/92859-comprehensive-treatment-of-knee-osteoarthritis-pain-through-cryoneurolysis-a-promising-approach-for-deep-and-superficial-genicular-nerve-modulation
[20] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12264415/
[21] – https://www.mdpi.com/2075-1729/12/9/1344
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