Pain palliation can be challenging in patients with metastases to the musculoskeletal system, and conventional therapy can be less than optimal for pain management. Recent advances in technology have allowed for the addition of image-guided ablation to the armamentarium for treating musculoskeletal metastases. This article focuses on one such technique, percutaneous cryoablation, and the experiences with this technique at the authors' institution. After a brief review of the history and theory behind cryoablation, the basic technique of percutaneous cryoablation of musculoskeletal metastases is described. This is followed by a review of the cases that have been performed at the authors' institution. A discussion on the many advantages and relatively few disadvantages of this exciting new technique is then put forth. Percutaneous cryoablation is beginning to emerge as a useful method of image-guided ablation of musculoskeletal metastases. As data continue to mount on this exciting application of new technology, image-guided cryoablation of musculoskeletal metastases appears to hold much promise in the treatment of pain related to these lesions.