James Moyes has found a way to tell nerves to “shut up!” as a way of controlling pain.
Moyes, who is a physician assistant in Radiology at CommonSpirit’s Holy Cross Hospital – Davis, is one of the few providers in Utah to use a form of cryotherapy to disrupt the myelin sheath around the nerve, which prevents it from communicating pain signals to the brain. He has treated more than 100 patients with the procedure, most commonly targeting nerves that transmit pain signals from the knee.
Moyes uses a needle that is super cooled to minus 88 degrees Celcius. When placed next to the nerve, it causes an ice ball to form around the nerve, breaking down the myelin sheath and stopping pain signals without damaging surrounding structures. No substance is injected into the body – the ice ball forms merely from the presence of the cold needle and the body’s own fluid. The needle is super cooled by circulating nitrous oxide through a hand-held device called iOvera.
The myelin sheath eventually regenerates, but the cryotherapy can provide pain relief for up to three months. In some cases, the procedure re-sets the pain pathway and provides for even longer-lasting relief. For knee treatments, up to five nerves are typically treated. These nerves do not impact mobility and tend to be superficial nerves located near the patella, which is a frequent site for knee pain.
Moyes said patients are sometimes hesitant when they realize he will be inserting a needle into their knee. But he reassures them that he uses a numbing agent prior to the procedure, to minimize any discomfort from the iOvera treatment. The procedure has been helpful in individuals preparing for total knee replacement or for those who are not surgical candidates and are seeking non-narcotic options for pain relief. IOvera treatment has also been used to improve pain associated with physical therapy and can improve the post-surgical recovery process.
“This is a minimally invasive option for pain relief that does not involve narcotics, and can target painful nerves with ultrasound guidance,” Moyes said.
The procedure can also be done for other joints, including shoulders and ankles, and is approved for any pain associated with peripheral nerves.
One patient who has benefitted from the procedure is Chris Mercer of West Point. The 69-year-old has tried to stay active throughout her life. She was a catcher for the Utah State University softball team and played slow-pitch for many years after. But about a year ago, the wear and tear on her knees caught up with her. She ended up having a knee replacement on her left knee last summer. Even so, she wasn’t re-gaining the flexibility she had hoped for.
Chris loves to ride the myriad trails in West Davis County on her electric bike. But she wasn’t able to bend her knee enough to return to her passion. She was also experiencing a tremendous amount of pain. It kept her up at night and she lost 20 pounds because the pain also zapped her appetite.
Chris learned about this new procedure and in mid-October had it done. She has been free from pain since then. She’s back riding her bike, sleeping through the night and able to navigate her stairs – something that wasn’t possible before the procedure. She said she would recommend the procedure to others in a similar situation.
“I know how much relief I got,” she said.
Moyes gets great satisfaction in using this innovative therapy to help patients.
“Helping patients find physical and emotional healing through pain relief is why I come to work every day," he said. "It is so rewarding watching patients hobble into the appointment and leave with improved function or significantly reduced pain.”
