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Thoughts on percutaneous cryoneurolysis for rib fracture pain?
Broke 5 ribs 18 days ago along with my shoulder. Had surgery 14 days ago to put a plate and screws for the clavicle break. Came home 11 days ago wearing a simple sling. Taking oxycodone mostly at night as it makes me feel out of it, and during the day its Tylenol and/or naproxen. I limit bed to about 11:30 pm to 7 am. During the day I’m in a chair in front of the computer and I try to walk outside a quarter mile, two or three times. I still get occasional level 8-10 pain if I make a wrong move, or even when I yawned today. That was miserable. I don't start PT until next week and already thinking about the pain. I have been reading online about freezing the nerves at the fracture to give up to 3 months relief and administered in an outpatient setting. Google “Freezing the Pain: A New Way to Treat Rib Fractures” for a video on the details. Is this widely available yet? Any thoughts on the procedure? This seems like a game changer for positive recovery outcomes.
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That sounds very similar to a procedure called radio frequency ablation (RFA) where they sort of burn the sheathing off the nerve to block pain transmission signals.
I recommend you use Tylenol with the Naproxen together and not separately as they are a potent combo together. Being so fresh off surgery I doubt anyone is going to touch you until your surgical recovery is finished. Have you had difficulty healing from broken bones in the past as your reason for researching this unusual procedure? From reading the subject matter it appears it’s used for difficult to control pain, so you’d need to fit that profile first. Also, if it’s “not widely available yet” it will most likely be out of pocket costs even if you locate someone to perform the procedure. I saw that Stanford in SF did a small trial with some success.
Pain meds work best before you have the pain. Since you're dreading PT already I also suggest you take the combo meds mentioned above before you go to PT. And consider using the oxycodone after PT if the non-narcotic meds do not significantly control your pain. Good luck and I hope you don’t need further pain control.
@jenatsky I am taking Tylenol with the Naproxen but it's only partially effective in pain control at this time, while the video by the three doctors says it's completely effective for months and simple to administer outpatient and covered by Medicare.
Actually it’s not a covered service by Medicare at this time. It has been assigned a temporary technical code that CMS will use to generate usage numbers to ascertain payment and RVU weight for this new procedure. I have attached a technical bulletin for your benefit. I would not trust what the docs said about being covered. If you end up getting this procedure done watch out for them asking you to sign an Advanced Beneficiary Notice (ABN) which states you’ll pay if the service is denied by Medicare.
FYI: CMS assigns temporary codes to many procedures when they are new in order to track usage, cost, potential payment, etc. This is how they determine if the procedure lives up to what the providers who use it say it will do. These codes are typically first submitted by the AMA to SMS for the speciality requesting the new code for the new service or procedure.
https://www.cms.gov/medicare-coverage-database/view/article.aspx
I'm just investigating at this point and don't even know if anyone in my area (Wash DC) even offers this. Nearest I found is at Yale New Haven hospital. I would post a link to the procedure but it's not letting me.