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Cold Therapy for Pain Management - Types, Applications, and Contraindications

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Cold therapy refers to decreasing the tissue temperature to reduce swelling and alleviate pain. Read the below article to get an insight into cold therapy.

Written by

Dr. Deepiha. D

Medically reviewed by

Dr. Anuj Nigam

Published At November 30, 2022
Reviewed AtApril 13, 2024

Introduction:

Musculoskeletal injuries are very common and can be associated with mild to severe pain and disability. Back pain is the most common musculoskeletal pain affecting a large number of people, from young to old age. Musculoskeletal pains are managed in two ways. These include pharmacological and non-pharmacological techniques. Painkillers, anti-inflammatories, and muscle relaxants are included in the pharmacological approach. The non-pharmacological approach mainly aims to reduce pain and swelling.

What Is Cold Therapy?

Cold therapy is one of the modalities used to alleviate pain and swelling caused by musculoskeletal injuries. The process involves the use of a cold substance over the injured area to reduce the tissue temperature.

RICE (rest, ice, compression, elevation) is a simple, self-care, at-home strategy used during acute injuries and rehabilitation post-definitive treatment. The letter 'I' in the RICE method refers to cold therapy (ice). Cold therapy can also be called ice fomentation.

What Are the Types of Cold Therapy?

Sources for cold therapy are available in various forms like:

  • Crushed ice bags.

  • Over-the-counter ice packs.

  • Cold compression units.

  • Whirlpools.

  • Ice massage.

  • Coolant sprays.

  • Ice baths.

  • Topical gels or creams.

A newer and more popular option where freezing chambers are used for the whole body for a shorter period of time is called whole-body cryotherapy. People will remain in closed chambers where the temperature is reduced and frozen using liquid nitrogen.

Some other types of cold therapy include:

  • Cryo Stretching: In this, stretching of the muscles is combined with cold therapy to reduce muscle spasms.

  • Cryokinetics: Physical activity combined with cold therapy is used in case of ligament tears.

What Are the Benefits of Cold Therapy?

The benefits of cold therapy are:

  • Minimizes inflammation, sore muscles, and swelling.

  • Athletes use ice baths and other types of cold therapy to hasten recovery after physical exercise.

  • Improves immunity, and quality of sleep, and enhances one’s focus.

  • Scientists have found that exposure to cold hastens metabolism.

How Do Heat and Cold Therapies Work?

Heat therapy works in the following ways:

  • It enhances the blood flow and relaxes the muscles. It is indicated in long-term (chronic) pain.

  • The application of heat is beneficial in relieving strains and sprains, osteoarthritis (deterioration of the cartilage that cushions the ends of bones in the joints), stiffness, and chronic irritation in the tendons, relieves pain or spasms related to back or neck injury and helps warm up stiff tissues or muscles before activity.

  • Using heat and cold therapies alternatively can help minimize exercise-induced muscle pain.

Cold therapy has various physiological reactions in the injured tissues such as:

  • By reducing the temperature of the skin and muscle tissue, there is a restriction in the flow of blood to the injured site because of the blood vessel constriction reflex. This minimizes inflammation and edema.

  • Cold temperature reduces the demand for oxygen, hence, saving the tissues from hypoxic (insufficient oxygen) damage.

  • Reduced tissue temperature decreases nerve conduction (nerve activity) in both the sensory (responsible for generating various senses in the body) and motor nerves (sends signals to muscles for movement).

  • By minimizing inflammation and nerve activity and creating a numb sensation, one might experience significant relief from pain in the injured area.

What Are the Applications of Cold Therapy?

Cold therapy has been widely used during sports activities to prevent muscle cramps and relieve sports-related trauma. The following are the conditions where cold therapy can give symptomatic relief:

  • Overuse injury of the knee cap as in runner’s knee (patellofemoral pain syndrome).

  • Ligament and tendon injury (tendonitis).

  • Inflammatory and degenerative joint pain.

  • Ligament tear (sprain).

  • Sciatica (pain along the course of the sciatic nerve extending from the lower back to the legs).

  • To alleviate pain and swelling after surgeries.

  • Closed wounds during a fall.

  • Other occupational or health-related pain that one encounters in daily life, like pain in the back, legs, neck, and shoulders.

What Is the Best Way to Apply Cold Therapy?

The following are the general suggestions that need to be kept in mind while applying cold therapy:

  • It is better to wrap the ice cubes or other cold objects in a thin cloth and then apply it to the skin. The cold items should not be placed directly on the injured site, as it can harm the external skin.

  • The ice pack should be placed in an intermittent way to ease the pain and, at the same time, one must check if sensations could be felt.

  • Cold therapy should be applied for about 20 minutes many times a day (typically eight to ten times in 24 hours).

  • The cold therapy should be applied over a broad six-inch area around the site of pain. For example, cold therapy hats are available online that can help in treating headaches.

  • Cold therapy is very effective when used immediately after the injury or at least between 24 to 72 hours post-injury.

Cold therapy is an adjuvant treatment and must be combined with other therapeutic remedies like rest (avoiding physical activities), compression (applying pressure to the injured area), elevation (keeping the injured site in a raised position), medications (taking painkillers and muscle relaxants), physical therapy (hands-on care and patient education), and exercises (stretching and strengthening).

What Is the Wim Hof Method?

In the Wim Hof method, cold is applied in the form of ice baths or cold showers. By following this method, Wim Hof (founder of the Wim Hof method) is capable of standing in a container that is filled with ice cubes and can run a half marathon in the snow with bare feet. Several experiments have been conducted in recent years to understand the Wim Hof method. The results are as follows:

  • A study was conducted by Radboud University wherein both the followers of the Wim Hof method and non-followers were exposed to a pathogen and closely observed.

  • The followers of the Wim Hof method displayed fewer symptoms and increased immune response.

Further studies are being carried out to apply the effects of the Wim Hof method in areas like metabolism, stress, and inflammation.

What Are the Complications of Cold Therapy?

The complications of cold therapy are as follows:

  • Applying cold therapy for a long time can cause nerve damage resulting in loss of sensation.

  • Frozen items, kept in contact with the skin directly, can cause cold burns in the skin and the underlying tissue.

  • Cold therapy may infrequently give a stinging sensation to the skin.

  • The nitrogen vapors used in the freezing chambers may cause hypoxia conditions (oxygen deprivation), leading to unconsciousness. It is one of the significant hazards in relation to whole-body cryotherapy.

  • The extremely altered temperature may also cause eye injury.

When Is Cold Therapy Contraindicated?

There are no absolute contraindications for cold therapy. Some of the relative contraindications are:

  • Patients with cardiovascular (heart problems) and neurological disorders can avoid cold therapy until prescribed by the physician.

  • Diabetic patients have to be more careful regarding the application of cold therapy because of their changed perception of sense.

  • It is not advisable to use cold therapy on open wounds.

  • Cold therapy is not an appropriate treatment for patients with rheumatoid arthritis (a long-term inflammatory disorder that affects many joints like those in the hands and feet), Raynaud’s syndrome (a condition in which certain areas of the body feel cold and numb in certain situations), and paralysis (partial or complete loss of muscle function).

  • Cold therapy is contraindicated in deep vein thrombosis (blood clots in the veins).

  • Patients with circulatory disorders (especially poor circulation) should not use cold therapy.

  • There is no evidence to support the role of whole-body cryotherapy in relieving pain associated with migraines, fibromyalgia (widespread pain and tenderness in the muscles), multiple sclerosis (a condition in which the immune system destroys the protective covering of the nerves), and stress or anxiety-related problems.

  • Cold therapy should not be used on stiff or rigid muscles and joints.

  • Cold therapy should be avoided in cases of sensory processing disorder or nerve damage.

  • Cold therapy should be stopped if it has not provided any symptomatic relief.

  • It is better to visit a physician in case one experiences any sensory changes or persistent pain after applying cold therapy.

Conclusion:

Cold therapy is a cost-effective remedy to relieve pain and swelling. They are readily available items at the patient's convenience during an injury. A simple frozen item from a home refrigerator wrapped in a towel will serve the purpose. Even if a specified cold therapy product is unavailable, any simple means of ice fomentation will give a mild degree of relief and benefit the patient until definitive treatment is planned.

Frequently Asked Questions

1.

How Is Pain Reduced by Cold Therapy?

- The blood vessel constriction response limits the flow of blood to the wounded region, lowering the temperature of the skin and muscle tissue. Edema and inflammation go down as a consequence. 
- The demand for oxygen is decreased by cold temperatures, protecting the tissues from hypoxic injury.

2.

What Are Different Methods for Cold Therapy?

They come in a variety of formats, including: 
- Bags of crushed ice
- Ice packs sold over the counter
- Cold compression units
- Whirlpools
- Ice therapy
- Coolant sprays
- Ice packs
- Topical creams or gels
- Cryotherapy

3.

Which Is Better for Reducing Pain: Heat Therapy or Cold Therapy?

Within the first 72 hours following an accident, ice is a fantastic option since it helps to minimize swelling, which causes discomfort. On the other hand, heat assists in relaxing the muscles and easing tight joints. However, neither choice needs to be utilized for longer than 10 to 15 minutes at once.

4.

What Is Physiotherapy's Cold Therapy?

Cold treatment, also known as cryotherapy, is frequently performed while a soft tissue injury is still acute. After an injury, it entails cooling down a damaged soft tissue region with ice or a cryocuff. It is an effective procedure when combined with rest, ice, compression, and elevation.

5.

What Advantages Does Cold Treatment Offer?

There are several advantages to cold treatment, some of which are recognised and utilized often in sports science to speed up exercise recovery. Reductions in pain, blood flow, edema (fluid buildup), inflammation, muscular spasms, and metabolic demands after exercise are among the advantages investigated and acknowledged in US studies.

6.

What Is Temperature for Cold Therapy?

The use of water that is around 59 °Fahrenheit (15 °Celsius) below body temperature to cure illnesses or promote health benefits is known as "cold water treatment." Also called cold hydrotherapy. It has been a tradition for several millennia.

7.

Is Cold Treatment Beneficial for Nerve Pain?

Ice application has several advantages, including lowering skin temperature. The nerve activity is lessened. It lessens inflammation and discomfort.

8.

How Long Should Cold Treatment Be Performed?

Employ brief bursts of cold treatment many times each day. To prevent nerve, tissue, and skin damage, cold treatment should only be applied for ten to fifteen minutes at a time and not longer.

9.

How Does Cold Showers Reduce Pain?

Applications of cold water can have pain-relieving effects similar to those of local anesthetics, according to a study published in the North American Journal of Medical Sciences. The blood vessels may contract after being exposed to cold water, which may assist lessen any pain-causing swelling and edema.

10.

Do Muscles Relax During Cold Therapy?

The body produces swelling as a result of inflammation when tissue is injured, such as with sprains, strains, or recently torn muscles. This is the body's method of protecting from additional injury. When one wishes to minimize swelling, inflammation, and discomfort, applying ice is beneficial. Moreover, it might lessen excruciating muscular spasms.

11.

What Results Does Cold Treatment Have in Physiotherapy?

Cold treatment can be utilized after the first 48 hours if the inflammation persists, although it is frequently used within the first 24 to 48 hours during the acute stage of an injury to avoid additional tissue damage. After an exercise regimen, it may also be a terrific way to relieve discomfort, edema, or muscle spasms.

12.

Is Cold Treatment Effective for Arthritis?

Cold packs numb the painful region and lessen swelling and inflammation. Ice packs are particularly helpful for joint discomfort brought on by an attack of arthritis.

13.

How Often Should Cold Treatment Be Used?

Apply the ice or gel pack a few times a day for between 10 and 20 minutes. If utilizing cold treatment, check the skin frequently for feeling.

14.

Does the Cold Harm Nerves?

Like other forms of chronic pain, neuropathy frequently grows worse as the weather gets colder. When circulation deteriorates, one will experience more nerve discomfort, particularly in hands and feet.

15.

Is Sciatica Treatable with Cold Therapy?

Sciatica pain may be immediately and significantly reduced with ice treatment. Ice treatment is especially beneficial in cases of acute pain, a flare-up of chronic pain, and/or pain brought on by activity or exercise.
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Dr. Anuj Nigam
Dr. Anuj Nigam

Orthopedician and Traumatology

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