Every chest operation carries a quiet question about what the body will remember long after the wound has closed. At the University of Missouri, a team searching for ways to ease that lingering ache without relying on opioids followed 261 lung-resection patients whose intercostal nerves had been briefly numbed by freezing cold during surgery. Two years on, roughly two-thirds were free of pain, while about a third still carried it, and the people most likely to keep hurting were women, those who had faced complications, and those still taking opioids. The study cannot yet tell whether the chill
Nerve-Freezing Pain Relief After Lung Surgery Shows Mixed Results at Two Years
About 35% of 261 patients who underwent lung resection with nerve freezing still reported pain two years later, 80% of them neuropathic.
About 35% still reported pain two years after their nerves were frozen
Mark
Start with the headline number. Roughly two in three patients had no pain at two years?
Mimi
Yes, 167 of 261, about 64%. About 35% still reported pain.
Luke
Worth saying there's no comparison group described here. We don't know how many would have been pain-free after the same surgery without freezing.
Mark
So the study can't say the freezing failed.
Mimi
Right. Dr. Klifto said it's unclear whether the results relate to cryoanalgesia or to the surgery itself.
Mark
Who was more likely to still have pain?
Mimi
Women, people with post-operative complications, and people still using opioids at the first follow-up.
Luke
Those are associations. The reporting doesn't explain why, and it doesn't say these factors cause the pain.
Mark
And the neuropathic detail?
Mimi
Of those with pain, 80% had neuropathic pain, which comes from nerve injury or malfunction. That fits a nerve-focused procedure, but the source doesn't link them.
Luke
Agreed. It's a pattern, not a verdict.
Mark
Why did Missouri care?
Mimi
Dr. Kaifi cited the state's large population struggling with opioid addiction and overdose, so alternatives matter there.
Il Polso
- A third of lung-resection patients were still hurting two years after their nerves were frozen during surgery.
- Most of the lingering pain was neuropathic, a stubborn signal born of nerve injury rather than simple tissue damage.
- Women, patients with postoperative complications, and those still on opioids at first follow-up were more likely to remain in pain.
- Researchers are racing to separate the effects of nerve cryoanalgesia from the surgery itself, while Missouri's opioid crisis presses for safer alternatives.
- The technique is still new and its long-term safety unproven, so the team is heading toward larger studies to decide who should receive it.
Every chest operation carries a quiet question about what the body will remember long after the wound has closed. At the University of Missouri, a team searching for ways to ease that lingering ache without relying on opioids followed 261 lung-resection patients whose intercostal nerves had been briefly numbed by freezing cold during surgery. Two years on, roughly two-thirds were free of pain, while about a third still carried it, and the people most likely to keep hurting were women, those who had faced complications, and those still taking opioids. The study cannot yet tell whether the chill, the cutting, or the simple passage of healing is responsible, and so the answer remains a question for further inquiry.
A chest operation can leave something behind that outlasts the scar. Because incisions pass through muscle and along nerves that run beside the ribs, some patients live with soreness, numbness, or pain for years afterward. Researchers at the University of Missouri School of Medicine have been searching for ways to manage that pain without leaning on opioids, and one method they have studied is cryoanalgesia, in which extreme cold is applied to nerves during surgery to briefly silence their pain signals.
The team followed 261 patients who received this treatment at the end of a lung resection. After two years, about 64 percent reported no pain at all, which is encouraging, but about 35 percent still did. Those who continued to hurt were more likely to be women, to have suffered complications after surgery, or to still be taking opioids at their first follow-up. Most of them, about 80 percent, had neuropathic pain, the persistent kind that stems from a damaged or malfunctioning nervous system.
The researchers are careful about what these figures prove. It is not yet clear whether the outcomes reflect the freezing or the operation itself, and the hospital, one of the first in the country to use the technique routinely in adults, regards the practice as still new. The team hopes its experience will add to the literature and deepen understanding of what happens after nerves are frozen. Their next task is to design studies that separate the effects of the cold from those of the surgery and to identify which patients benefit most.
A chest operation can leave a mark that outlasts the scar. After thoracic surgery, patients can have pain, soreness or numbness years later, because the incisions pass through muscle and through nerves running along the ribs, and that can bring damage and inflammation.
Researchers at the University of Missouri School of Medicine have been looking for ways to control that pain without leaning on opioids. One approach they have studied is cryoanalgesia: during surgery, extreme cold is applied to the nerves. The cold temporarily stops them from sending pain signals, which greatly reduces or eliminates the sensation. The open question is whether it keeps pain away over the long term for everyone.
To look at that, the team followed 261 patients at the academic health system who received cryoanalgesia at the end of a pulmonary resection, a thoracic operation in which part of the lung is removed. Two years on, 167 of them, about 64%, reported no pain. About 35% still did.
The patients who still hurt shared some characteristics. Women, people who had complications after surgery, and people still using opioids at their first follow-up visit were more likely to report pain two years later. Among all those with pain, 80% had neuropathic pain, the chronic kind caused by an injury to the nervous system or a malfunction in it.
What the numbers cannot say is why. Dr. Kevin Klifto, a co-author and resident physician, noted that it is unclear whether these results are related to the cryoanalgesia or to the surgery itself. The study did not settle that, and more research is needed to find out whether the technique prevents post-operative pain without long-term side effects, and whether it suits some patient groups better than others.
Dr. Jussuf Kaifi, another co-author, said the hospital was among the first in the country to use cryoanalgesia routinely in adults having lung surgery. Even so, the practice is still new, and the evidence on its long-term effectiveness and safety needs more exploration. The team's aim, he said, was to add its own experience to the published literature and better understand what happens to patients after their nerves are frozen.
The work also has a local backdrop. Kaifi pointed to some clinical studies suggesting that post-operative pain may raise the risk of developing chronic pain. He also noted that Missouri has a large population struggling with opioid addiction and overdose, and said that alternatives for managing pain could help patients and serve the institution's mission to save and improve lives.
Klifto is a plastics and reconstructive surgery resident at MU Health Care. Kaifi is section chief and associate professor of thoracic surgery at the Mizzou School of Medicine, holds the Margaret Proctor Mulligan Distinguished Professorship in Cancer Research, and practices as a thoracic surgeon at MU Health Care. The study, titled "Clinical predictors of pain 24 Months after intraoperative intercostal nerve Cryoanalgesia for anatomical lung resection," appeared in Surgical Oncology. Medical students Jonas McCaffrey and David Sniatkewicz are also authors.
The next step is further studies that can separate the effect of nerve freezing from the effect of the operation, and identify who benefits most.
Citazioni salienti
It's unclear whether these results were related to cryoanalgesia or the surgery itself.— Dr. Kevin Klifto, co-author and resident physician
Our goal was to add our experiences to the literature to gain a better understanding of long-term patient outcomes after freezing nerves.— Dr. Jussuf Kaifi, co-author (paraphrased)
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