Cryotherapy has been used to reduce chronic pain for many years due in part to its ease of use, affordability, and simplicity.
Twenty-five studies (22 randomized controlled trials, one prospective analysis, 1 one-group pretest/posttest study, and one case–control study) were included after the literature search. Cryotherapy applications show promise in reducing chronic pain associated with various chronic diseases including those of rheumatic and degenerative origin. Cryotherapy appears to be a safe therapy in carefully selected patients, with only minimal adverse effects reported in the literature (1)
Whole-body cryotherapy (WBC) involves a large chamber, creating cold by either combining cooled nitrogen with oxygen and injecting it into the chamber or by circulating nitrogen within the chamber walls (2).
Physicians and physical therapists today still commonly prescribe cryotherapy as a way to reduce chronic aches and pains, especially due to the ease of use, simplicity, and low cost of this kind of therapy (1)
Chronic inflammation can contribute to constant pain by chemical and mechanical stimulation of pain receptors and free nerve endings (3), which commonly occurs in autoimmune disease such as rheumatoid arthritis, ankylosing spondylitis, and multiple sclerosis, this is also witnessed in persons with musculoskeletal ailments such as lower back pain, shoulder pain and pain after surgery of hip, knee and shoulder replacement/s. Thus, there is a strong interest in using cryotherapy to reduce this inflammation in these chronic pain syndromes and to reduce the subsequent pain associated.
Edema and cytokines are key inflammatory markers used to assess the effects of treatments on inflammation. Edema is a cardinal sign of inflammation, caused by vascular changes and increased permeability that allows fluid to enter the extravascular space. The increased pressure in this space often leads to mechanical stimulation and pain production (3). Cryotherapy is thought to decrease swelling (4) by a combination of decreasing vascular permeability (5) and reducing both arterial and soft tissue blood flow to the affected areas (6).
Studies have suggested that cryotherapy decreases inflammation by decreasing pro-inflammatory cytokine TNF-α (7, 8, 9) increasing anti-inflammatory cytokine IL-10 and contrary to expectations, increasing pro-inflammatory cytokine IL-6. However, new evidence suggests that IL-6 may also possess anti-inflammatory properties (10, 11).
Nerve Transmission in Pain Fibers
Another proposed mechanism of cryotherapy is reducing nerve transmission velocity in pain fibers(12), which may be a way that cryotherapy induces an analgesic effect and pain relief. Previous literature concluded that cryotherapy significantly reduced both motor and sensory nerve conduction velocity (13) Algalfy and George found decreased nerve conduction velocity at the site of cryotherapy application, as well as increased pain threshold and tolerance. Of note, the effect on pain threshold and tolerance also extended distally to an area beyond the site of application, but supplied by the same nerve (14).
Chronic pain is a crucial aspect in the management of many chronic diseases as it can have a profound effect on the function of the associated body parts and may significantly hinder a patient’s daily life. Cryotherapy has been around and used for the management of chronic pain for decades, dating back to the time of Hippocrates and still being commonly prescribed by physicians and physical therapists today.
According to the research, the mechanism behind this pain reduction is thought to occur through the reduction of inflammation and edema, oxidative stress, and nerve conduction velocity in pain fibers. In regard to patients with rheumatic diseas
es such as, rheumatoid arthritis, and musculoskeletal ailments such as lower back pain, cryotherapy shows promising results. Whole-body cryotherapy demonstrated a reduction in both pain and disease activity, with temperatures of at least − 110 °C having the best results.
A point of conjecture though is everyone is different so the prescription of management of cryotherapy will be different for each particular person. Some may only need one or two sessions initially to reduce pain and inflammation with maintenance sessions periodically such as weekly or monthly.
1. Garcia, C., Karri, J., Zacharias, N.A. et al. Use of Cryotherapy for Managing Chronic Pain: An Evidence-Based Narrative. Pain Ther (2020). https://doi.org/10.1007/s40122-020-00225-w
2. Bouzigon R, Grappe F, Ravier G, Dugue B. Whole- and partial-body cryostimulation/cryotherapy: current technologies and practical applications. J Therm Biol. 2016;61:67–81.
3. Behrens BJ, Beinert H. Physical agents: theory and practice. 3rd ed. Philadelphia: F. A. Davis Company; 2014.
4. Stöckle U, Hoffmann R, Schütz M, Von Fournier C, Südkamp NP, Haas N. Fastest reduction of posttraumatic edema: continuous cryotherapy or intermittent impulse compression? Foot Ankle Int. 1997.
5. Deal DN, Tipton J, Rosencrance E, Curl WW, Smith TL. Ice reduces edema: a study of microvascular permeability in rats. J Bone Jt Surg Ser A. 2002;84:1573–8.
6. Ho SSW, Coel MN, Kagawa R, Richardson AB. The effects of ice on blood flow and bone metabolism in knees. Am J Sports Med. 1994.
7. Ziemann E, Olek RA, Kujach S, et al. Five-day whole-body cryostimulation, blood inflammatory markers, and performance in high-ranking professional tennis players. J Athl Train. 2012;47:664–72.Return to ref 11 in article PubMed PubMed Central Article Google Scholar
8. Gizińska M, Rutkowski R, Romanowski W, Lewandowski J, Straburzyńska-Lupa A. Effects of whole-body cryotherapy in comparison with other physical modalities used with kinesitherapy in rheumatoid arthritis. Biomed Res Int. 2015;2015:1–7.
9. Jastrząbek R, Straburzyńska-Lupa A, Rutkowski R, Romanowski W. Effects of different local cryotherapies on systemic levels of TNF-α, IL-6, and clinical parameters in active rheumatoid arthritis. Rheumatol Int. 2013.
10. Scheller J, Chalaris A, Schmidt-Arras D, Rose-John S. The pro- and anti-inflammatory properties of the cytokine interleukin-6. Biochim Biophys Acta Mol Cell Res. 2011;1813:878–88.Return to ref 17 in article
11. Pedersen BK. The anti-inflammatory effect of exercise: Its role in diabetes and cardiovascular disease control. Essays Biochem. 2006
12. Chanliongo PM. Cold (cryo) therapy. In: Lennard
TA, Walkowski S, Singla AK, Vivian DG, editors. Pain procedures in clinical practice. Philadelphia: El
sevier; 2011. p. 555–8
13. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med. 2007;41:365–9.
14. Srivastava A, Srivastava A. Oxidative stress-mediated human diseases. In: Maur
ya PK, Chandra P, editors. Oxidative stress: diagnostic methods and applications in medical science. Springer: Singapore; 2017. p. 1