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: inserting a distal end of a needle into the tissue, wherein the needle comprises an electrically conducting structure partially surrounded by an electrical insulator and
1. A method for treating pain or spasm associated with a nerve of a patient, the nerve underlying a tissue, the method comprising: inserting a distal end of a needle into the tissue, wherein the needle comprises an electrically conducting structure partially surrounded by an electrical insulator and a distal electrically conductive surface;stimulating the nerve with the electrically conductive surface of the needle to identify or verify a desired location of the nerve;positioning the needle with the nerve based on the stimulating, 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; andtransmitting cooling fluid from a cooling fluid source to the needle so that the fluid flows through the fluid supply tube and cools the needle, and so that the needle cools the nerve at the desired location such that the pain or spasm is inhibited. 2. The method of claim 1, further comprising using a stimulation or electro-myographic system coupled to the electrically conductive surface of the needle to identify or verify the desired location of the nerve. 3. 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 the desired location to a temperature in a desired range so as to interfere with pain signal transmission along the nerve, the nerve comprising a sensory nerve and extending within the desired location. 4. The method of claim 1, wherein the desired location is separated from and disposed distally of a skin surface. 5. The method of claim 4, wherein a body supports the needle and the cooling fluid source, wherein the cooling fluid source 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 5, wherein the electrical insulator comprises a lubricious coating facilitating removal of the needle from the tissue while at least a portion of the tissue is frozen, the method further comprising manually manipulating the body with the hand so as to remove the needle from the tissue while at least a portion of the tissue is frozen. 7. The method of claim 5, further comprising: removing the needle from the body and mounting another needle to the body;advancing the distal end of the other needle through the tissue;identifying another desired location of the tissue using neurostimulation by stimulating the nerve with the electrically conductive surface of the needle;positioning the needle with the nerve based on the neurostimuation; andtransmitting 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 another lumen of the other needle so as to cool another desired location of the patient to a temperature in a desired range. 8. The method of claim 1, wherein a size of the needle is 16 gauge or smaller. 9. The method of claim 1, wherein the cooling fluid supply tube within the needle has an outer diameter in a range between about 60 and 150 micrometers. 10. The method of claim 1, wherein the cooling of the nerve within the desired location to a temperature in a desired range is sufficient to induce long-term inhibition of pain signal transmission along the nerve. 11. The method of claim 10, 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. 12. A system for treating pain or spasm associated with a nerve of a patient, the nerve underlying a tissue, the system comprising: a needle having a distal end, a lumen extending distally toward the distal end, an electrically conducting structure partially surrounded by an electrical insulator and a distal electrically conductive surface, wherein the electrically conductive surface of the needle is configured for neurostimulation to identify a desired location of the nerve, wherein the distal end of the needle is inserted through a skin surface and into the tissue, the needle being positioned with the nerve at the desired location based on the neurostimulation; 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 desired location, 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 at the desired location such that the pain or spasm is inhibited. 13. The system of claim 12, wherein the electrically conductive surface of the needle comprises an electrode configured to stimulate the nerve. 14. The system of claim 12, wherein the electrically conductive surface of the needle is coupleable to a stimulation or electro-myographic system. 15. The system of claim 12, wherein the electrical insulator comprises a lubricious coating facilitating removal of the needle from the tissue while at least a portion of the tissue is frozen. 16. The system of claim 12, the nerve comprising a sensory nerve and extending within the desired location, 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 desired location and the cooling fluid flows along the cooling fluid path, such that enthalpy of vaporization cools the desired location to a temperature in a desired range to interfere with pain signal transmission along the nerve. 17. The system of claim 12, wherein the needle and cooling fluid supply tube are configured so that the desired location is separated from and disposed distally of the skin surface. 18. The system of claim 12, further comprising a body supporting the needle and the cooling fluid source comprising a cartridge, and wherein the cartridge contains a quantity of liquid N2O sufficient for cooling a plurality of desired locations and is configured for storage of the liquid N2O in the cartridge at room temperature. 19. The system of claim 18, wherein the body has an interface removably receiving the needle, further comprising a plurality of needles, each of the needles removably receivable by the interface so as to facilitate sequential 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, each of the needles having an electrically conducting structure partially surrounded by an electrical insulator such that each of the needles comprise an electrically conductive surface, the body configured to sequentially transmit portions of a 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 needle so as to cool the desired location of the patient to a temperature in a desired range. 20. The system of claim 12, wherein the size of the needle is 16 gauge or smaller. 21. The system of claim 12, wherein the cooling fluid supply tube has an outer diameter in a range between about 60 and 150 micrometers. 22. The system of claim 12, wherein the distal end of the needle comprises a sharpened distal end configured to penetrate the skin surface.
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