Cryoneurolysis for Stroke Survivors: What It Is, What It Treats, How Well It Works, and What to Expect
- Kristian Doyle
- Sep 4
- 4 min read
Updated: Sep 4
Quick Takeaways
What it is: Cryoneurolysis uses a very cold probe placed next to a nerve to temporarily interrupt its signals. The cold creates a controlled, reversible injury. The nerve regrows over weeks to months.
Why it matters for stroke survivors: It is being studied for muscle overactivity (spasticity) and spasticity-related pain when therapy, oral medicines, or botulinum toxin injections are not enough. Evidence is early but promising.
How long it lasts: Pain relief and tone reduction can start right away and may last for months, though this varies from person to person. Repeat treatments are possible.
Safety: Most side effects are mild, like soreness or bruising. A 2023 safety review reported more than 96% of nerve treatments had no lasting pain beyond the procedure period. Serious complications are rare.
Insurance: The device used in the U.S. (iovera°) is FDA-cleared for pain relief, not specifically for stroke spasticity. Insurance coverage for stroke-related spasticity is inconsistent. Out-of-pocket costs are common.
How Cryoneurolysis Works
Doctors use ultrasound and a nerve stimulator to find the nerve causing the problem. A thin probe is placed through the skin next to that nerve. When the probe is activated, compressed gas forms a small ice ball at the tip, cooling the nerve to very low temperatures. This temporarily stops the nerve from carrying signals, which reduces spasticity or pain.
Over time, the nerve heals and regrows, which means the effect wears off but the procedure can be repeated. Treatments usually take 30–60 minutes, depending on how many nerves are involved.
What Symptoms It May Help After Stroke
Cryoneurolysis is mainly used for focal spasticity patterns otherwise known as tight muscles that interfere with care or mobility. Examples include:
Shoulder tightness that makes dressing or hygiene difficult
Elbow flexor spasticity that limits reach
Painful clenched fist or wrist flexor tightness
Foot and ankle postures that interfere with walking or shoe wear
A “test block” with local anesthetic is usually done first. If relaxing the nerve temporarily improves comfort or function, cryoneurolysis may be a good option.
How Effective Is It?
The science is still developing, but early results are encouraging:
Small studies and case series show improved comfort, easier care, and sometimes better walking ability after treatment.
Durability: Benefits can last several months, and in some people nearly a year. Nerves eventually recover, so repeat treatments may be needed.
Safety: Across published reports, most side effects are mild, such as temporary pain, bruising, or numbness. Persistent problems are uncommon.
Large clinical trials specific to stroke survivors are still in progress.
How It Compares to Other Options
Botulinum toxin (BoNT) injections: The most studied option for focal spasticity. Effects last about 3 months. Cryoneurolysis may be considered when BoNT doesn’t meet goals or causes side effects.
Phenol injections: A chemical method of nerve blocking. Effective but can be uncomfortable and sometimes causes sensory side effects. Cryoneurolysis uses cold instead of chemicals.
Surgery or intrathecal baclofen pumps: Options for severe, widespread spasticity. These are higher-risk and usually considered only after less invasive treatments. Cryoneurolysis is minimally invasive and repeatable.
Who Might Be a Candidate
You may be a candidate if you have:
Focal spasticity that affects care, comfort, or movement despite therapy and (usually) botulinum toxin
A positive response to a diagnostic nerve block
Clear goals, such as easier dressing, less pain during stretching, improved brace use, or fewer spasms during transfers
People with certain cold-related conditions (Raynaud syndrome, cryoglobulinemia, cold urticaria) are generally not good candidates.
What to Expect During Treatment
Diagnostic nerve block: Your team tests the nerve with local anesthetic to confirm that targeting it will help.
Preparation: The area is cleaned and numbed.
Placement: Using ultrasound, the probe is positioned next to the nerve.
Freezing cycles: Each freeze lasts about 1–2 minutes. One to three cycles may be used.
Immediate check: Your movement or tone is re-evaluated right after treatment.
Aftercare: Some soreness or numbness is common for a few days. Therapy usually resumes quickly to reinforce the new range of motion.
How Long It Lasts
Relief often lasts several months and sometimes longer. Repeat treatments can restore the effect as the nerve regenerates. Duration depends on the nerve treated, the severity of spasticity, and your rehabilitation goals.
Costs and Insurance Coverage
FDA status: The iovera° device is cleared for pain conditions (like knee osteoarthritis), not specifically for spasticity. Use for stroke is considered off-label.
Insurance: Coverage is inconsistent. Many insurers consider it investigational, so prior authorization is common and denials are possible.
Costs: In 2025, reported equipment costs are about $500 per session, not including professional and facility fees. Some clinics list cash prices between $800 and $1,000 per treatment. Actual out-of-pocket costs vary widely.
Questions to Ask Your Clinician
Which nerve are you targeting, and what did the test block show?
What specific improvements do you expect (e.g., easier hygiene, less pain, better walking)?
What are the common side effects in your experience?
How will therapy be adjusted after the procedure?
If the benefit fades, how soon can we repeat treatment?
The Bottom Line
Cryoneurolysis is a minimally invasive, repeatable option for focal spasticity and spasticity-related pain after stroke. Early results are promising, but the science is still catching up. If you consider this treatment, make sure you have:
A successful diagnostic nerve block first
Clear, realistic goals
A rehabilitation plan to reinforce the gains right after the procedure
This approach may help with comfort, mobility, and care tasks when other treatments are not enough.
Disclaimer
This article is for informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician, rehabilitation specialist, or another qualified healthcare provider with any questions you may have about cryoneurolysis or other stroke treatments. Never disregard or delay seeking medical advice because of something you have read here.
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