Is cryotherapy (cryogenic therapy) painful?

Does Cryotherapy Hurt?

Yes, cryotherapy is associated with pain and discomfort, with studies showing that it causes significantly greater pain compared to alternative treatments like curettage. 1

Pain Associated with Different Types of Cryotherapy

Local Cryotherapy (e.g., liquid nitrogen application)

• Causes significant discomfort during application and potentially afterward
• Pain is reported as a common side effect in multiple clinical guidelines
• In treatment of Bowen's disease, cryotherapy caused significantly greater pain compared to curettage 1
• For ankle sprains, there is limited evidence supporting cryotherapy's effectiveness for pain reduction 1

Specific Pain Patterns by Application

• Dermatological applications: Pain is variably reported in 12-70% of patients receiving cryotherapy for conditions like hemorrhoids 1
• Orthopedic applications: Discomfort may limit treatment of multiple lesions or areas 1
• Duration-dependent: Pain increases with longer freeze times (30 seconds vs. 20 seconds) 1

Complications Beyond Pain

• Ulceration: Observed in 25% of lesions treated with cryotherapy 1, 2
• Prolonged healing: Median healing time of 46 days (up to 90 days on lower leg) compared to 35 days with alternative treatments 1
• Foul-smelling discharge: Reported as a side effect in hemorrhoid treatment 1
• Scarring: Occurs in approximately 20% of cases 2

Comparative Pain with Different Treatment Modalities

When comparing treatment options:

• Cryotherapy causes more pain than curettage for skin lesions 1
• Photodynamic therapy (PDT) and curettage both have less discomfort overall than cryotherapy 1, 2
• For hemorrhoids, cryotherapy site was associated with prolonged pain compared to closed hemorrhoidectomy 1

Factors Affecting Pain Perception During Cryotherapy

• Location: Lower leg treatments typically cause more pain and have longer healing times 1
• Technique: Pain increases with more aggressive techniques (multiple freeze-thaw cycles vs. single cycle) 1
• Duration: Longer application times increase pain but may be necessary for adequate treatment 1

Clinical Implications

• Pain from cryotherapy may limit its use for multiple lesions or in sensitive areas 1
• When treating ankle sprains, cryotherapy alone has no proven positive influence on pain 1
• For certain conditions like Bowen's disease, alternative treatments like PDT or curettage may be preferable due to less pain and better outcomes 1, 2

Despite its pain-related limitations, cryotherapy remains a viable treatment option for certain conditions when applied appropriately, but patients should be informed about the expected discomfort and potential complications before proceeding with treatment.