Medical devices, systems, and methods for pain management and other applications may apply cooling with at least one probe inserted through an exposed skin surface of skin. The cooling may remodel one or more target tissues so as to effect a desired change in composition of the target tissue and/or
Medical devices, systems, and methods for pain management and other applications may apply cooling with at least one probe inserted through an exposed skin surface of skin. The cooling may remodel one or more target tissues so as to effect a desired change in composition of the target tissue and/or a change in its behavior, often to interfere with transmission of pain signals along sensory nerves. Alternative embodiments may interfere with the function of motor nerves, the function of contractile muscles, and/or some other tissue included in the contractile function chain so as to inhibit muscle contraction and thereby alleviate associated pain. In some embodiments, other sources of pain such as components of the spine (optionally including herniated disks) may be treated.
대표청구항▼
1. A method for treating pain or spasm associated with a nerve of a patient, the nerve underlying a tissue, the method comprising: manually manipulating a body with a hand, the body supporting a needle, the body manipulated so as to penetrate a sharpened distal end of the needle into the tissue to t
1. A method for treating pain or spasm associated with a nerve of a patient, the nerve underlying a tissue, the method comprising: manually manipulating a body with a hand, the body supporting a needle, the body manipulated so as to penetrate a sharpened distal end of the needle into the tissue to thermally couple the needle with the nerve, wherein the body supports a cooling fluid source; wherein the needle has a lumen extending distally toward the distal end, wherein a cooling fluid supply tube extends distally within the lumen of the needle, and wherein the manipulating of the body is performed so that the cooling fluid supply tube extends distally of the skin surface; andtransmitting cooling fluid from the source to the needle so that the fluid flows through the fluid supply tube distally of the skin surface and cools the needle, and so that the needle cools the nerve sufficiently that the pain is inhibited. 2. The method of claim 1, wherein the cooling fluid comprises a cryogenic cooling fluid and further comprising vaporizing at least a portion of the cryogenic cooling fluid within the lumen of the needle so that enthalpy of vaporization cools a tissue region of the patient to a temperature in desired range so as to interfere with pain signal transmission along the nerve, the nerve comprising a sensory nerve and extending within the region. 3. The method of claim 2, wherein the region is separated from and disposed distally of the skin surface. 4. The method of claim 2, wherein the cooling fluid comprises N2O. 5. The method of claim 4, wherein the cooling fluid supply comprises a cartridge supported by the body, and wherein the cartridge contains a quantity of liquid N2O sufficient for cooling a plurality of tissue regions of the patient, and further comprising storing the liquid N2O in the cartridge at room temperature. 6. The method of claim 2, further comprising removing the needle from the body and mounting another needle to the body, manually manipulating the body so as to advance the distal end of the other needle through the skin; and transmitting cooling fluid from the cooling fluid source to another fluid supply tube within the other needle, and vaporizing at least a portion of the cryogenic cooling fluid within the lumen of the other needle so as to cool another tissue region of the patient to a temperature in the desired range. 7. The method of claim 6, wherein the size of the needle is 16 gauge or smaller. 8. The method of claim 2, wherein the cooling fluid supply tube within the needle has an outer diameter in a range between about 60 and 150 micrometers. 9. The method of claim 2, wherein the cooling of the nerve within the region to the temperature is sufficient to induce long-term inhibition of pain signal transmission along the nerve. 10. The method of claim 9, wherein the temperature is less than −19° C. and the cooling of the nerve does not induce permanent inhibition of signal transmission along the nerve. 11. A system for treating pain associated with a nerve of a patient, the nerve underlying a skin surface tissue, the system comprising: a needle having a distal end, the needle having a lumen extending distally toward the distal end;a body having an interface, the interface removably receiving the needle, the body having a handle configured for manually manipulating with a hand when the needle is on the interface so as to advance the distal end of the needle through the skin surface and into the tissue to an inserted position, the needle being thermally coupled with the nerve in the inserted position; anda cooling fluid supply tube extending distally within the lumen of the needle such that the cooling fluid supply tube extends distally of the skin surface when the needle is in the inserted position, the cooling fluid supply tube coupleable with a cooling fluid source so that cooling fluid flows from the source through the fluid supply tube distally of the skin surface and cools the needle, and so that the needle cools the nerve sufficiently that the pain is inhibited. 12. The system of claim 11, the nerve comprising a sensory nerve and extending within a tissue region of the patient, wherein the cooling fluid comprises a cryogenic cooling fluid, wherein the cooling fluid supply tube and the lumen of the needle are included in a cooling fluid flow path configured so that at least a portion of the cooling fluid vaporizes within the lumen of the needle, when the needle is in the inserted position within the tissue region and the cooling fluid flows along the cooling fluid path, such that enthalpy of vaporization cools the tissue region to a temperature in desired range to interfere with pain signal transmission along the nerve. 13. The system of claim 12, wherein the needle and cooling fluid supply tube are configured so that region is separated from and disposed distally of the skin surface. 14. The system of claim 12, further comprising the cooling fluid supply, the cooling fluid comprising N2O. 15. The system of claim 12, wherein the cooling fluid supply comprises a cartridge supported by the body, and wherein the cartridge contains a quantity of liquid N2O sufficient for cooling a plurality of tissue regions of the patient and is configured for storage of the liquid N2O in the cartridge at room temperature. 16. The system of claim 15, further comprising a plurality of needles, each of the needles removably receivable by the interface so as to facilitate sequentially removal and replacement of the needles on the body, each of the needles having an associated distal end, a lumen extending toward the distal end, and a cooling fluid supply tube, the body configured to sequentially transmit portions of the quantity of the cooling fluid from the cooling fluid source to the fluid supply tube associated with the needle received by the interface of the body so that at least a portion of the cryogenic cooling fluid vaporizes within the associated lumen of the receive needle so as to cool an associated tissue region of the patient to a temperature in the desired range. 17. The system of claim 16, wherein the size of the needles is 16 gauge or smaller. 18. The system of claim 17, wherein the cooling fluid supply tube within each needle has an outer diameter in a range between about 60 and 150 micrometers. 19. The system of claim 18, wherein the distal end of the needle comprises a sharpened distal end configured to penetrate the skin surface.
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