The Analgesic Effect of Cryotherapy on Patients Undergoing Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial

Main Article Content

Chaowat Pimratana
Kornkanok Hengsawat


Objective: To compare the degree of pain between cryotherapy and standard preoperative care in the treatment of urolithiasis with extracorporeal shock wave lithotripsy (ESWL).
Materials and Methods: A total of 180 ESWL patients were randomly assigned to experience the standard preoperative method, or additional cryotherapy (ice pack application on the ESWL site) for 10 minutes before ESWL. The primary outcome was the maximum difference of pain intensity score from baseline during ESWL and the secondary outcomes, which were analgesic consumption, pulse rate, adverse events, stone free rate, and complications that were gathered and analyzed.
Results: The maximum change in pain intensity score from baseline during ESWL in the cryotherapy group was significantly lower than in the control group (VAS score 4.0±1.9 vs. 5.2±2.7, p=0.002). The cryotherapy group showed significantly less total fentanyl consumption than the control group (85.3±22.0 mcg vs. 93.6±25.6, p=0.021). We found no significant difference in stone free rate, adverse events or complications in either group.
Conclusion: Preoperative cryotherapy using ice packs for 10 minutes can provide an effective analgesic for ESWL. Adequate pain control with cryotherapy should be an option of pain management during ESWL.


Download data is not yet available.

Article Details

How to Cite
Pimratana, C. ., & Hengsawat, K. . (2022). The Analgesic Effect of Cryotherapy on Patients Undergoing Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial. Siriraj Medical Journal, 74(2), 85–90.
Original Article


Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980 Dec 13;2(8207):1265–8.

Gupta NP, Kumar A. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status. Indian J Urol. 2008 Apr;24(2):155–8.

Huang Y, Chai S, Wang D, Li W, Zhang X. Efficacy of Eutectic Mixture of Local Anesthetics on Pain Control During Extracorporeal Shock Wave Lithotripsy: A Systematic Review and Meta-Analysis. Med Sci Monit. 2020 May 13;26:e921063-1-e921063-9.

Berwin JT, El-Husseiny T, Papatsoris AG, Hajdinjak T, Masood J, Buchholz N. Pain in extracorporeal shock wave lithotripsy. Urol Res. 2009 Apr;37(2):51–3.

Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician. 2004 Jul;7(3):395–9.

Mendell LM. Constructing and deconstructing the gate theory of pain. Pain. 2014 Feb;155(2):210–6.

Ropero Peláez FJ, Taniguchi S. The Gate Theory of Pain Revisited: Modeling Different Pain Conditions with a Parsimonious Neurocomputational Model. Neural Plast. 2016;2016:4131395.

Tedesco D, Gori D, Desai KR, Asch S, Carroll IR, Curtin C, et al. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. 2017 Oct 18;152(10):e172872.

Gorji HM, Nesami BM, Ayyasi M, Ghafari R, Yazdani J. Comparison of Ice Packs Application and Relaxation Therapy in Pain Reduction during Chest Tube Removal Following Cardiac Surgery. N Am J Med Sci. 2014 Jan;6(1):19–24.

Chumkam A, Pongrojpaw D, Chanthasenanont A, Pattaraarchachai J, Bhamarapravatana K, Suwannarurk K. Cryotherapy Reduced Postoperative Pain in Gynecologic Surgery: A Randomized

Controlled Trial. Pain Res Treat. 2019;2019:2405159. 90 Volume 74, No.2: 2022 Siriraj Medical Journal

Ravindhran B, Rajan S, Balachandran G, Mohan LN. Do Ice Packs Reduce Postoperative Midline Incision Pain, NSAID or Narcotic Use? World J Surg. 2019 Nov;43(11):2651–7.

Bovelander E, Weltings S, Rad M, van Kampen P, Pelger RCM, Roshani H. The Influence of Pain on the Outcome of Extracorporeal Shockwave Lithotripsy. Curr Urol. 2019 Mar 8;12(2):81–7.

Cannata F, Spinoglio A, Di Marco P, Luzi M, Canneti A, Ricciuti G, et al. Total intravenous anesthesia using remifentanil in extracorporeal shock wave lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial. Minerva Anestesiol. 2014 Jan;80(1):58–65.

Stocks JM, Taylor NAS, Tipton MJ, Greenleaf JE. Human physiological responses to cold exposure. Aviat Space Environ Med. 2004 May;75(5):444–57.

Thienpont E. Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty? Clin Orthop Relat Res. 2014 Nov;472(11):3417–23.

Palmieri RM, Garrison JC, Leonard JL, Edwards JE, Weltman A, Ingersoll CD. Peripheral ankle cooling and core body temperature. J Athl Train. 2006 Jun;41(2):185–8.

Vargas E Silva NCO, Rubio AL, Alfieri FM. Pain Tolerance: The Influence of Cold or Heat Therapy. J Chiropr Med. 2019 Dec; 18(4):261–9.

Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and

patient acceptable symptom state. Br J Anaesth. 2017 Mar 1;118(3):424–9.

Yayik AM, Ahiskalioglu A, Alici HA, Celik EC, Cesur S, Ahiskalioglu EO, et al. Less painful ESWL with ultrasound-guided quadratus lumborum block: a prospective randomized controlled study. Scand J Urol. 2019 Dec;53(6):411–6.

Çift A, Benlioglu C. Effect of Different Musical Types on Patient’s Relaxation, Anxiety and Pain Perception during Shock Wave Lithotripsy: A Randomized Controlled Study. Urol J. 2020 Jan 26;17(1):19–23.