Could freezing nerves beat botox for spastic shoulder pain?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Be over 18 years old. * Have a clinically and functionally stable condition. * Present spastic hemiplegia of the upper limb caused by a stroke, traumatic, or hypoxic brain event occurring more than 6 months before the study. * The paretic upper limb must present significant spastic plegia at the shoulder adductors and/or shoulder internal rotators (≥ 1+ on the Modified Ashworth Scale). * Have a Visual Analogue Scale (VAS) pain score \> 40/100 mm. * Have spasticity causing limitations in providing care. * Have the cognitive capacity to make informed decisions. A comprehensive explanation of the study will be provided orally and in writing to participants and a trusted relative of their choosing. * Maintain any medications on a stable schedule. * Accept and have access to an interdisciplinary rehabilitation program and standardized evaluation sessions throughout the study. Exclusion Criteria: * In the investigator's opinion, the subject will be exposed to unacceptable risk by participation. * Previous intervention or condition that altered the target neural anatomy of the upper limb. * Any injection (neurolytic, sclerosing, anesthesia, etc.) to the upper limb within the last 4 months. * Spasticity invasive treatment such as intrathecal baclofen during the trial. * Current enrollment in an investigational drug or device study targeting spasticity management. * Pregnancy or lactation. * Allergy or intolerance to local anesthesia/BoNT-A. * Contraindications to BoNT-A administration, such as: * Myasthenia Gravis * Eaton-Lambert syndrome * Possible drug interactions (e.g., aminoglycosides and BoNT-A) * Any local skin condition at the treatment site that may adversely affect treatment or outcomes. * Chronic medication use (prescription or over-the-counter) that, in the investigator's opinion, would affect study participation or subject safety. * Contraindications to cryoneurolysis, including: * Diagnosis of cryoglobulinemia * Paroxysmal cold hemoglobinuria * Cold urticaria * Raynaud's disease * Any form of peripheral neuropathy * Open and/or infected wounds on the affected limb * Diagnosis of concomitant progressive neurological diseases such as Amyotrophic Lateral Sclerosis. * Any reason, in the investigator's opinion, that the subject may not be suitable for study participation (e.g., history of noncompliance, drug addiction, or any related upper limb injury).