The Site for Healthcare Professionals: Cryotherapy

Introduction:

Cryo-therapy is also known as Cryo-surgery or Ice-surgery. It uses cold temperature to damage tissue to treat disease.

What is Cryotherapy?

Cryotherapy means it’s the process of using high or extremely cold temperatures in order to destroy or damage the tissue by freezing those.

It helps to treat various skin diseases and also some cancer.

Substance like liquid nitrogen is used by doctors.

Cryotherapy reduces muscle pain, swelling twist in ankles or in wrists.

Principles of Cryotherapy

Lewis Hunting Reaction:

“The process of alternating vasodilation and vasoconstriction in extreme exposure to cold is called the Lewis Hunting Reaction”.

At first, vasoconstriction occurs first to reduce extremities. This is the result of the sudden decrease in the release of neurotransmitters due to local cold from the sympathetic nerves to the muscular coat of the arteriovenous anastomoses. This increases blood flow and the temperature of the fingers. Vasodilation is followed by the new phase of vasoconstriction after that the process repeats itself.

When cold is maintained for more than 15 minutes or reduced below 10 degrees Celcius, vasodilation is cold-induced after the initial time of vasoconstriction.

Cryobiology :

Cells of mammals can be destroyed by cooling to the temperature of -20 degrees Celcius. Information of ice crystals of both intracellular and extracellular begins the primary injury. The outer membrane of the cells ruptures by intracellular crystals and ice formation outside the cell which dehydrates the cellular environment which results in lethal electrolyte concentrations and changes in pH. The time cell organelles are damaged, the cell loses the ability to regulate ions which ensures cell death.

Even though liquid nitrogen, nitrous oxide, and carbon dioxide are all cryogens used in many medicines. Liquid nitrogen is the most versatile. Hence it is most commonly used. The boiling point of liquid nitrogen is -195.8 degrees Celsius. The liquid form of cryogens stored in Dewar flasks can be delivered as a spray.

Mechanism of Action:

Cryotherapy can be also known as cryosurgery. It is commonly used to treat a variety of Benign and Malignant Lesions. In Cryotherapy the mechanism of destruction is necrosis. Necrosis is the result of the freezing and Thawing of cells. Tissue injury begins with prolonged tissue cooling, metabolic disruption, ice crystal formation, and cellular rupture. Microcirculatory failure and Ischemia lead to cell death, resulting in coagulative necrosis after having.

Physical destruction procedures are effective immediately, but physiological effects which include induction of apoptosis and cytokine release and secondary necrosis produce damaging effects over several days.

The mechanism of action in cryotherapy is divided into 3 Phase as below:-

Heat transfer.
Cell Injury.
Inflammation.

a) Heat Transfer:-

There is a mechanism by which cryotherapy destroys the targeted cells. The mechanism involves the quick transfer of heat from the skin to a heat sink. Liquid nitrogen is the most commonly used cryogen, which has a boiling point of 196 degrees celsius. The rate of heat transfer depends on the temperature difference between the skin and the liquid nitrogen. In the spray cryotherapy technique, the liquid nitrogen is directly applied to the skin and the heat in the skin is transferred to the liquid nitrogen. This process results immediately. If a cryoprobe is used in the cryotherapy conduction heat transfer occurs in which the heat is transferred via the copper-metal probe.

b) Cell injury:-

Once the cell is frozen, cell injury occurs during the thaw. Ice crystals do not form until the temperature reaches –5 to -10 degrees Celsius because of hyperosmotic intracellular conditions. The water to ice transformation concentrates the extracellular solutes and leads to an osmotic gradient across the cell membrane, leads to further damage.

The tissue of epithelial cells damage maximum with rapid freezing and slow thaw and are suitable for the malignancies treatment. After rapid thaw fibroblasts produce less collagen. Hence a rapid thaw is much more suitable for the treatment of keloids or benign lesions. When a steak is defrosted from the freezer freeze damage occurs.

When fully thawed the steak juices come out which represents that the intracellular liquid that has escaped because of the damage to the cell wall. By concentrating electrolytes intracellularly low temperature also ensures maximum damage. Benign lesions need a temperature of -20 to -25 degrees Celsius, whereas malignant skin cancers require a temperature of -50 degrees Celsius.

c) Inflammation:-

Inflammation is the last response to cryotherapy which is seen as erythema and edema. Inflammation helps in cell destruction and is the response to cell death. Cryotherapy treatment causes separation of basement membrane and which may also result in blister formation.

Procedure Performed During The Cryotherapy:

Cryotherapy is performed by a well-trained radiologist in a radiology suite or in the operating room. It is an image-guided procedure. On the procedure table patient will be positioned and it is an outpatient basis procedure. Doctors will apply liquid nitrogen to the area with a spray device or cotton swab if cryotherapy is done topically.

A percutaneous procedure is performed for tumors that are deep inside the body and can be approached through the skin. A thin, needle–size applicator or cryoprobes are inserted.

Monitors are used to tracking blood pressure, heart rate, oxygen level, and pulse.
The patient will be connected to the monitors.
An intravenous(lV) line is inserted into a vein in the arm or hand of the patient by a technologist or nurse to administer a sedative.
Breathing tubes may not be required in this process.
General anesthesia is required in some patients may be.
The surface will be shaved, sterilized, and covered with a sterile drape where the applicators or cryoprobes are to be inserted.
A small skin incision is made at the site.
Through the guidance of imaging, applicators or cryoprobes will be inserted through the skin to the site of the diseased tissue.
Argon gas or liquid nitrogen is delivered once the applicators are in place.
A rapid decrease in the temperature at the tip of the probe leads to the creation of an “ice ball”.
Due to this all the water around the tip of the probe freezes.
Ultrasound, CT, or MRI are used to visualize ice balls.
lV line and applicator are removed.
Application of pressure stops the bleeding and skin will be covered with a bandage.
Here sutures are not required.

Types of Cryotherapy

1. Ice Packs:- It is the most common method of cryotherapy. There are different types of ice used in ice packs. The most common types are ice packs made with cubed, crushed, and wetted ice. It was discovered that wetted ice is better to lower surface temperature during treatment and maintaining the lower temperature during recovery. It is also more effective in lowering the intramuscular temperature during treatment.

2. Ice Spray:- A cooling effect can also be produced by icing spray for a similar effect.

3. Immersion:- Simple or whirlpool immersion.

4. Ice Massage:- slow strokes in a circular motion for 5-10 mins.

More recently whole body cryotherapy has become popular for athletes, to help aid recovery, as well as in persistent pain patients such as rheumatological conditions. More research is needed to understand the effect on the body and its relation to pain.

Benefits Of Cryotherapy

1. Helps to reduce migraine:- Cryotherapy helps in treating migraines as it cools and numbs the nerves around the neck area. By applying a neck wrap containing 2 frozen ice packs to the carotid arteries reduces migraine pain. The carotid arteries are accessible and also they are close to the carotid arteries.

2. Irritation of Numbs nerve:- Cryotherapy has been using to treat injuries of athletes. The cold can actually numb an irritated nerve.

3. Helps to treat mood disorder:- The ultra-cold temperature in whole-body cryotherapy can cause It includes the release of adrenaline, noradrenaline, and endorphins. It was actually effective in short-term treatment.

4. Reduces arthritic pain:- The whole–body cryotherapy significantly reduced pain in people with arthritis. As a result, it has also allowed for physiotherapy and occupational therapy.

5. May help treats low-rise tumors:- It can be used as a cancer treatment. It is done by freezing cancer cells and surrounding them with the help of ice crystals. It is used to treat some low-risk tumors.

6. May also help to prevent Alzheimer's disease and dementia:- It may be an effective treatment because the anti-oxidative and anti-inflammatory effects of cryotherapy could help combat the inflammatory and oxidative stress responses that occur with Alzheimer's.