Cryotherapy in the management of paroxysmal

SUMMARY Cryotherapy for the relief of pain is widely used in many conditions. The results of 83 cryotherapy sessions in 29 patients with paroxysmal trigeminal neuralgia are reviewed over a five year period. Sixty three per cent of treated nerves, 41 % of patients were pain free over one year and there was no permanent sensory loss. Despite recent advances in treatment, trigeminal neu-ralgia remains an incapacitating condition which is difficult to treat successfully in every patient. At present it is standard practice to use carbamazepine as the first line of treatment, sometimes with the later addition of phenytoin. Even though many patients can be managed in the long term by carbamazepine, side effects are often unpleasant and quite a number of patients become intolerant. Taylor et al ' reported a 16 year follow up on 143 patients treated with car-bamazepine and found it to be effective in 99 patients (69%), but 19 of those patients later became resistant to the drug and required a variety of surgical pro-cedures. In order to avoid major surgery, numerous periph-eral techniques have been used. These have included peripheral neurectomy,2 alcohol,34 or phenol injec-tions, peripheral radiofrequency thermolysis,5 removal of jaw cysts,6 and peripheral streptomycin and lidocaine injections.7 None of the techniques appears to be curative and some may cause compli-cations such as neuromas, anaesthesia dolorosa and neurological deficits. The use of cryotherapy (cryoanalgesia) was first reported by Lloyd etal in 1976 with encouraging results. They treated 64 patients suffering from intrac-table pain, six of whom had "facial pain". Cryo-therapy was used in a variety of facial pains, including post herpetic neuralgia, atypical facial pain and par