[ 1 ]
Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy.
Ernst E, Fialka V
J Pain Symptom Manage 1994 Jan ; 9(1) : 56-9
Among the physical treatments to reduce pain, ice has had its place for many years. Experience tells us that ice has a strong short-term analgesic effect in many painful conditions, particularly those related to the musculoskeletal system.
Serial applications may also be helpful. The scientific evidence from clinical trials is, however, fragmentary. This applies both for acute and serial cold-induced analgesia.
The mechanisms by which cryotherapy might elevate pain threshold include an antinociceptive effect on the gate control system, a decrease in nerve conduction, reduction in muscle spasms, and prevention of edema after injury. ?
It is concluded that ice may be useful for a variety of musculoskeletal pains, yet the evidence for its efficacy should be established more convincingly.
PMID: 8169463, Ul: 94223144
[ 4 ]
Nursing approaches to nonpharmacological pain control
Int J Murs Stud 1990; 27(1): 1-5
A combination of pharmacological and nonpharmacological methods of pain control probably yield the most effective pain relief for the patient.
The nurse may make a significant contribution to pain control by being able to offer a variety of nonpharmacological methods of pain relief that the patient may use in combination with the more traditional methods of analgesia or local anesthesia.
Recent research supports some of the older methods of nonpharmacological pain control such as distraction, especially humor; relaxation using the patient’s own memory of peaceful events; and cutaneous stimulation, especially use of cold.
Cutaneous stimulation may even be effectively used at sites other than the site of pain. Specific examples of these techniques are presented.
PMID: 2179151, Ul: 90186074
[ 6 ]
Pain relief using cutaneous modalities, positioning and movement
McCaffery M, Wolff M
Hosp J 1992 ; 8(1-2): 121-53
Positioning, movement, and certain cutaneous modalities may be easily used by all caregivers, including the family, to bring comfort and pain relief to terminally ill patients with pain. For such patients, these techniques are most appropriately used in addition to pharmacologic control of pain. Patients themselves may use some of the cutaneous modalities with minimal assistance from others, thereby promoting a sense of independence. Other techniques may be performed by family and friends, providing them with the assurance that they are assisting a loved one. The techniques presented here can be readily used in the home or hospital setting and are relatively low risk, simple, and inexpensive. This paper presents specific guidelines for patients and caregivers in relation to the use of superficial massage, superficial heat and cold, menthol application to skin, transcutaneous electrical nerve stimulation (TENS), positioning, and movement. Because of their simplicity and ease of use, these techniques tend to be overlooked. However, taking the time to introduce these techniques to patients and families often results in a significant contribution to the comfort of the dying patient. PMID: 1286847, Ul: 93162587
[ 8 ]
Pain control after surgery : a patient’s guide, Agency for Health Care Policy and Research
Decubitus 1992 Nov;5Ç6):50-2
What is pain?
Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body’s way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body.
Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells, most sense pain and the fewest sense cold.
When there is an injury to your body – in this case surgery – these tiny cells send messages along nerves into your spinal cord and then up to your brain.
Pain medicine blocks these messages or reduces their effect on your brain. Sometimes pain may be just a nuisance, like a mild headache. At other times, such as after an operation, pain that doesn’t go away – even after you take pain medicine – may be a signal that there is a problem.
After your operation, your nurses and doctors will ask you about your pain because they want you to be comfortable, but also because they want to know if something is wrong. Be sure to tell your doctors and nurses when you have pain.
PMID: 1489516, Ul: 93143859
[ 10 ]
The effects of extreme cold on sensory nerves.
Ann R Coll Surg Engl 1980 May;62(3):180-7
The effects of extreme cold on sensory nerves are discussed and a clinical application of these effects is proposed.
The structural changes observed following the freezing of sensory nerves in the rat are described and correlated with the clinical results in patients with chronic facial pain treated by cryogenic peripheral nerve blockade.
It is suggested that this technique offers features which are not shown by any other method for interrupting peripheral pain pathways and provides a useful alternative to existing methods of treatment for chronic pain.
[ 11 ]
Simple and fast to use
- The ALKANTIS compresses can be prepared in advance in order to be ‘ready to use��� according to the needs of the department.
- The ALKANTIS compresses can be stored for several months in the freezer.
- Simple and fast to use in 4 stages:
Non infectious Medical Waste or Infectious Medical Waste if contaminated
1 – Break the sachet of water laid flat with a slight sharp impact with the hand,
2 – Wait for the compress to absorb the water,
3 – Place in the freezer for a minimum of 90’,
4 – Remove from the peelable packaging for immediate application,
5 – Dispose of after use.
[ 12 ]
Analgesic effect of vibration and cooling on pain induced by intraneural electrical stimulation
Bini G, Cruccu G, Hagbarth KE, Schady W, Torebjork E
Pain 1984 Mar; 18(3): 239-48
Psychophysical experiments were carried out on 16 human subjects to determine how low intensity mechanical and thermal skin stimuli interfere with the sensation of pain. Moderate or intense pain was induced by low frequency (2 Hz) electrical stimulation within cutaneous fascicles of the median nerve at wrist level, and vibration, pressure, cooling or warming were applied for short periods (usually 20 to 60 sec) within or outside the skin area to which the pain was projected.
Vibration within the area of projected pain reduced the sensation of pain more efficiently than vibration outside that area. Moderate pain was sometimes completely inhibited but intense pain was only moderately reduced.
Pressure and cooling produced some pain relief whereas (mild) warming had an ambiguous effect. The painful input is derived from stimulation of fibres in the nerve trunk, and not from peripheral nociceptors.
The pain suppressing effects of vibration and cooling are not explicable in terms of lowered excitability of the nociceptive nerve endings in the skin. Instead, the results indicate that activity in low threshold mechanoreceptive and cold sensitive units suppresses pain at central (probably segmental) levels.
[ 13 ]
Validation of cutaneous stimulation interventions for pain management.
Mobily PR, Herr KA, Nicholson AC
University of lowa, Collège of Nursing, lowa City 52242.
Int J Nurs Stud 1994 Dec; 31(6): 533-44
The purpose of this study was to identify validate specific activities considered important in the implementation of selected cutaneous stimulation pain management interventions including-heat and cold application, massage and Transcutaneous Electrical Nerve Stimulation (TENS).
A two-round Delphi survey was completed by nurses selected for their expertise in pain management. Data were analysed using a modification of Fehring’s diagnostic content validity method. Consistently high scores were obtained by the raters for each intervention and activity, with most activities perceived as critical to the intervention.
From this process, a list of activities for each cutaneous stimulation intervention evolved that are applicable to educatiCn, clinical practice and clinical nursing research.
PMID: 7896516, Ul: 95204124
[ 14 ]
Cold and cryotherapy. A review of the literature on general principles and practical applications
[Article in German]
Kerschan-Schindl K, Uher EM, Zauner-Dungl A, Fialka-Moser V
Universitätsklinik für Physikalische Medizin und Rehabilitation, Wien.
Acta Med Aus-triaca 1998; 25(3): 73-8
Cryotherapy increases the threshold of pain and induces physiological changes.
lt influences hemodynamics (reduction of skin- and muscle temperature through vasoconstriction), 200-101 vcemetabolism (reduction of ischemia due to hypoxia), and neural control (reduction of nerve conduction velocity and muscle tone).
Cryotherapy is indicated mainly in locomotor system related pain. Such pain can be induced by degenerative changes, postoperatively, and during mobilisation of contracted joints.
Cryotherapy may be used as short term therapy (less than 15 min) as well as long term therapy (more than 20 min).
For maximal efficacy the intensity of application as well as the application medium must be considered. Due to biorhythm, cold application seems to be more effective in the afternoon.
Publication Types:200-310 pdf
PMID: 9816398, UI: 99033186
[ 15 ]
Cryotherapy diminishes the inflammatory reaction to trauma and reduces edemahematoma formation and pain.
During the rehabilitation period, cold applicationnables the patient to develop strength and mobility in an injured area, with minimal inflammation and discomfort.
Heat potentiates the body’s inflammatory reaction to trauma and results in increased discomfort.
Cryotherapy should be used initially and heat should be reserved for improving mobility and absorbing hematomas after all inflammation has subsided.
[ 16 ]
Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases-pilot study.
[Article in German]
Metzger D, Zwingmann C, Protz W, Jackel WH
Hochrhein-Institut für Rehabilitationsforschung, Department für Epidemiologie und Sozialmedizin, Bad Sackingen.
Cryotherapy as a whole-body cold therapy (with cold air cooled by addition of nitrogen blown on the patients in an open cabin) for treatment of inflammatory rheumatic diseases already started in Bad Sackingen in 1986.
In 1996, anew cold chamber (this time a closed chamber without any addition of nitrogen) based on compressor technology was introduced. 100-105 pdfThe aim of our study was to test whether significant pain relief could be achieved by means of this cold therapy. Furthermore, we were interested in the practicability and acceptance of this new technique. Well-being during the treatment application and pain level were assessed using verbal and numerical rating scales.
The sample consisted of 120 consecutive patients (75% women, age: 30-67 yrs, M = 52.6 yrs). These patients were suffering from primary fibromyalgia (40.7%), rheumatoid arthritis (17.3%), chronic low back pain (16.4%), ankylosingspondylitis (10.9%),osteoarthritis (9.1%), secondary fibromyalgia (3.6%) and other autoimmune diseases (l .8%) (mean duration of symptoms: 4 yrs).
The patients were treated 2.5 minutes on average in the main chamber (mean temperature: -105 degrees C).
The patients’ statements concerning their pain level were analysed by means of analyses of variance with repeated measures and paired-sample t-tests. RESULTS: The pain level after application of the cold therapy decreases significantly. The pain reduction last about 90 minutes. The initial pain level decreases during the whole time of treatment, no significant improvement, though, can be shown from the middle let the end of the four-weeks treatment.
According to the results of our study, there is evidence that the whole-body cold therapy generates important short-term effects and somewhat weaker effects over the treatment period as a whole. 210-260 pdfShort-term pain reduction facilitates intensive application of physiotherapy and Occupation Therapy.
The treatment procedure is practicable and ail in ail well tolerated. From the patients’ point of view, whole-body cold therapy is an essential part of the rehabilitation program.
PMID: 10832164, Ul: 20291627
[ 17 ]
Reduction of pain-related behaviours with either cold or heat treatment in an animal model of acute arthritis
Sluka KA, Christy MR, Peterson WL, Rudd SL, Troy SM
Physical Therapy Graduate Program, College of Medicine, The University of lowa,
lowa City 52242-1008, USA.
Arch Phys Med Rehabil 1999 Ma r; 80(3): 313-7
OBJECTIVE: To assess -the effects of heat and cold on quantifiable pain behaviours in an animal model of arthritis that minimizes the motivational affective component of pain.
DESIGN: The effects of superficial heat (40 degrees C) and cold (4 degrees C) on pain behaviours in rats with knee joint inflammation were tested before and after induction of inflammation and after treatment with heat or cold.
SUBJECTS: Joint inflammation was induced in male Sprague-Dawley rats by intra-articular injection of the knee joint with 3% kaolin and 3% carrageenan.
MAIN OUTCOME MEASURES: Withdrawal latency to heat applied to the paw (PWL) assessed secondary hyperalgesia; 100-105 dumpsspontaneous pain behaviours assessed degree of weight bearing/ guarding; and joint circumference assessed joint swelling.
RESULTS: Cold treatment of the inflamed knee joint significantly reversed the PWL immediately after treatment dp = .003) without affecting spontaneous pain behaviours or joint circumference. In contrast,210-260 pdf heat treatment produced a small but significant decrease in spontaneous pain behaviours (p = .03) without affecting PWL or jint circumference.
CONCLUSION: Acute arthritic pain can be treated with either superficial heat for reducing guarding or with cold for reducing pain or hyperalgesia outside the injury site.
PMID: 10084440, UI: 99181931
[ 18 ]
Physiotherapy methods of relieving pain
Moncur C, Shields MN
Baillieres Clin Rheumatol 1987 April 1 (1):183-93
Management of pain in the person with arthritis requires interdisciplinary team work with the patient being the final manager. lt is important that any health care provider perceive the patient as a person who happens to have arthritis–not as ‘an arthritic’. Defining a person by one’s disease process is dehumanising.
The patient has the same aspirations as anyone who is able-bodied–to be free from disease. While the patient may know that a cure is not imminent, there is still the hope for one. Therefore, as the patient comes for physiotherapy, there may be a hidden wish that the moist packs, TENS, or therapeutic pool will be curative.
lt is important that the patient understand that no equipment in the physiotherapy department has curative powers. This will help avoid unnecessary dependency behaviours on the part of the patient. Careful instruction and supervision of the patient by the physiotherapist, in concert with reinforcement from the physician, can prepare the patient to apply heat, cold or a variety of treatments at home. Although the patient is given the responsibility for this part of his care, periodic follow-up and reassessment should be completed to determine changes in his physiological, psychological, and functional status.
Physiotherapists who have a clear understanding of the physical treatment of pain associated with the rheumatic diseases can be a valuable asset to medical care.
PMID: 3334214, UI: 89249421
[ 19 ]
The influence of heat and cold on the pain threshold in rheumatoid arthritis
Cupkovic B, Vitulic V, Babic-Naglic D, DurrigT. T
Department of Rheumatology and Rehabilitation, University Hospital, Rebro,
Z Rheumatol 1993 Sep-Oct; 52(5): 289-91
Superficial heat and cold are commonly used therapeutic methods in patients with rheumatoid arthritis. Both procedures have analgesic effect. In r0 inpatients with rheumatoid arthritis the pain threshold was measured before and after warm bath and ice massage. Rheumatoid patients had significantly lower pain threshold compared to the healthy subjects in normal circumstances.
Heat and cold remarkably raise the pain threshold right after the application.300-075 pdf The pain threshold is also raised 10 and 30 min after cryotherapy, but not after the warm bath. Between investigated groups there were no statistically significant differences in the pain threshold values in any observed time.
We consider that both methods have a reasonable place in the therapy of rheumatoid arthritis.
Randomised controlled trial
PMID: 8259720, UI: 94082526
[ 20 ]
Treating arthritis with locally applied heat or cold
Oosterveld FG, Rasker JJ
Department of Rheumatology, Hospital Medisch Spectrum Twente, The Netherlands.
Semin Arthritis Rheum 1994 0ct;24(2):82-90
The scientific for the treatment of arthritis with locally applied heat or cold is reviewed. Experimental studies in vitro, in animals, in healthy subjects, and in patients are considered.
Results of investigations of the effects of locally applied heat or cold on the deeper tissues of joints and on joint temperature in patients are not consistent. In general, locally applied heat increases and locally applied cold decreases the temperature of the skin, superficial and deeper tissues, and joint cavity. Most studies’ dealing with the effects of heat and cold on pain, joint stiffness, grip strength, and joint function in inflamed joints report beneficial effects. In vitro studies show that higher temperatures increase the breakdown of articular cartilage and tissues that contain collagen.
Therefore, one goal of physical therapy should be to decrease intra-articular temperature in actively inflamed arthritic joints.
PMID: 7839157, UI: 95141086
[ 21 ]
New perspectives on osteoarthritis
Division of Rheumatology and Clinical Immunology, Department of Medicine,
University of Pitbsburgh School of Medicine, Pennsylvania 15213, USA.
Am J Med 1996 Feb 26;100ÇZA):10S-15S
Osteoarthritis (OA) is the most common rheumatologic disease, afflicting tens of millions of U.S. citizens. lt is not an inevitable consequence of aging; rather, it is a degene ative process acquired because of metabolic, mechanical, genetic, and other influences.
lt is characterized by progressive loss of cartilage and bony overgrowth. Because cartilage is not innervated, the pain of OA arises from secondary effects, such as joint capsule distension, stretching of periosteal nerve endings, and, possibly, synovial inflammation.
Psychologic factors, including stress and depression, may influence the perception of pain by OA patients. The risk of OA apparently is not increased by normal joint use, but persons who participate in competitive sports or who play with abnormal or injured joints are at increased risk. Obesity increases OA risk, and weight loss has been found to decrease it. Some forms of premature OA appear to be inherited. The objective diagnosis of OA is mode on the basis of radiography.
However, many individuals with radiographic evidence of OA are asymptomatic in the affected joint. It is essential to ensure that pain in the affected joint, is attributable to OA and not another cause. The management of OA should include physical medicine measures such as heat or cold therapy and often neglected environmental measures, such as reducing chair height and using shoe orthotics.
Therapeutic exercise is beneficial for many patients and includes an initial warm-up with range of motion, muscle strengthening, and aerobic activity (such as swimming). A major question in the pharmacologic management of OA is whether nonsteroidal anti-inflammatory drugs (NSAIDs) are superior to analgesics in terms of symptomatic relief; studios indicate that they are not. The question is relevant because of the adverse effects of NSAID use, particularly in the elderly population.
PMID: 8604721, UI: 96199291
[ 22 ]
Cryotherapy in osteoporosis
[Article in Polish]
Pol Merkuriusz Lek 1998 Oct; 5(28): 222-4
Cryotherapy is use of temperature lower than -100 degrees C onto body surface, for 2-3 minutes, in aim to cause physiological reactions for cold and to use such adapting reactions. Organism’s positive response to cryotherapy supports treatment of basic disease and facilitates kinesitherapy. 200-105 pdfLow temperature may be obtained by use of air flow cooled with liquid nitrogen; this could be applied either locally, over chosen part of the body, or generally, over the whole body, in cryosauna or in cryochamber.
The most efficiently is applying cryotherapy twice a day, with at least 3 hours interval. Kinesitherapy is necessarily used after each cryotherapy session. Whole treatment takes 2 to6 weeks, depending on patient’s needs.
Cryotherapy reduces pain and swellings, causes skeletal muscles relaxation and increase of their force, also, motion range in treated joints increases. Thus, cryotherapy seems to fulfil ail necessary conditions for rehabilitation in osteoporosis. Cryotherapy represents numerous advantages: it takes short time for applying,300-101 pdf being well tolerated by patient, also patient’s status improves quickly. In addition, contraindications against cryotherapy are rare.
All this makes cryotherapy a method for a broad use in prophylactics and treatment of osteoporosis.
PMID: 10101448. UI: 99201664
[ 23 ]
Combination of cold and compression after knee surgery. A prospective randomised study.
Schröder D, Passier HH
Sportklinik, Stuttgart, Germany.
Knee Surg Sports Traumatol Arthrose 1994; 2(3): 158-65
The objective of this study was to investigate the effect of continuous long-term application of a combined cooling and compression system (Cryo/Cuff, Aircast Inc., Summit, New Jersey, USA) on postoperative swelling, range of motion ÇROM), pain, consumption of analgesics, and return of function after anterior cruciate ligament (ACL) reconstruction.
We compared the cold-compression system with traditional ice therapy. There were 44 patients in the series (aged 15-40 years) who were randomly assigned to a control group (ICE) or a study group (CC). The ICE group consisted of 23 patients (aged 24.2 +/- 4.5 years); the CC group consisted of 21 patients (aged 24.8 +/- 5.6 years).
The ICE group received ice bags postoperatively; the CC group was provided with the Cryo/Cuff during the 14-day hospital stay. Girth, ROM, pain score (visual analog scale, and consumption of analgesics were determined on postoperative days 1 2, 3, 6, 14, and 28.
Twelve weeks after surgery, isokinetic testing was performed, and the functional knee score was determined. In the CC group, significantly less. swelling was observed (ft 0.035). These patients also reported less pain and had a significantly reduced consumption of analgesics (P < 0.04). On ail examination days, ROM in the CC group was up to 17 degrees greater than in the ICE group (P< 0.02). The functional knee score was significantly increased in the CC group (P = 0.025).
The results from our study document the advantages of continuous cold-compression therapy over cold alone following ACL reconstruction.
Randomised controlled trial
PMID: 7584198, UI: 96052600
[ 24 ]
The role of cold compression dressings in the postoperative treatment of total knee arthroplasty.
Levy AS, Marmar E
Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia,
Clin Orthop 1993 Dec; (297): 174-8
A prospective randomised study was performed to evaluate the role of cold compressive dressings in the postoperative treatment of total knee arthroplasty (TKA). Eighty consecutive unilateral and ton bilateral primary total knee replacements were evaluated in terms of blood loss, pain relief, and range of motion.642-732 pdf
Patients in the cold compression group demonstrated an average of 548 ml in suction drainage, whereas those in the control group averaged 807 ml. This resulted in an average 3.1 mg haemoglobin drop in the cold compression group and 4.7 mg in the control group. When body habitus and weight were taken into account in the cold compression group, an average total blood loss of 1298 cc was calculated, with 744 ml arising from soft tissue extravasation.
The corresponding total blood loss calculated average was 1908 ml in the control group, with 1101 ml attributed to soft tissue extravasation. Total injectable morphine per kilogram per initial 48 hours averaged 0.53 mg in the cold compression patients and 0.69 mg in the control patients. In the cold compression knees, range of motion averaged 86 degrees before operation, 53 degrees on postoperative day CPOD) 7, and 77 degrees on POD 14. In the control knees, range of motion averaged 88 degrees before operation, 44 degrees on POD 7, and 65 degrees on POD 14.
The use of cold compression in the postoperative, period of TKA results in a dramatic decrease in blood loss. jn0-643 dumpsIn addition, mild improvements are seen in early return of motion and injectable narcotic pain needs in the postoperative period.
Randomised controlled trial
PMID: 7902225, UI: 94062196
[ 25 ]
The effects of cold -therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction.
Cohn BT, Draeger RI, Jackson DW
Southern California Center for Sports Medicine, Long Beach 90806.
Am J Sports Med 1989 May-Jun; 17(3): 344-9
This prospective study assessed 54 consecutive arthroscopically assisted ACL reconstructions for the amount of postoperative pain relief provided by cold therapy, using the Hot/Ice Thermal Blanket. Twenty-six randomly selected patients undergoing this procedure were compared to a control group consisting of 28 patients having the identical procedure in which the Hot / Ice unit was not used postoperatively.
The initial ACL injury in both groups was sports related with the exception of three patients whose injury occurred while on the job. The Hot/Ice Thermal Blanket consists of two rubber pads (blankets) connected by a hose to the main cooling unit. The pads were applied to either side of the operated knee in the operative suite. The pads received fluid which was circulated from the main unit. The temperature of the fluid was set at 50 degrees in the recovery room and the unit was run continuously until the time of discharge, which was approximately 4 days.
Hot / Ice patients required 53% less injectable Demerol and 67% less oral Vistaril than patients in the control group. Hot/ice patients had made the conversion from injectable to oral pain medication an average of 1.2 days sooner than did their non-Hot / Ice counterparts. There was no appreciable difference in length of hospital stay.
Physical therapy and nursing records documented a greater percentage of compliant patients in the Hot/Ice group. According to these records the Hot/Ice patients were more helpful in self-assistance, were out of bed and ambulating in the halls more quickly, and did their range of motion exercises with greater ease.
(ABSTRACT TRUNCATED AT 250 WORDS)
Controlled clinical trial
PMID: 2729484, UI: 89270831
[ 26 ]
The effect of postoperative cold therapy in join-t surgery using a new cooling device
[Article in German]
Munst P, Bonnaire F, Kuner EH
Unfallchirurgische Abteilung, Chirurgischen Universitätsklinik Freiburg i. Br.
Unfallchirurgie 1988 Aug;14Ç4):2Z4-30
The effect of continuous cold therapy with a new cooling device in post-operative treatment after knee surgery has been proved.
Ten patients with different operations of the knee joint participated in this study. Eight out of ten patients reported no or poor pain, whereas in the control group especially after arthrotomy considerable or violent pain was reported.
After arthroscopic operations we found more an decrease of swelling and effusion, after arthrotomy more pain reduction. The subjective feeling of ail patients was very good and they were generally very receptive to it.
PMID: 3176193, UI: 89020505
[ 27 ]
Effects of thermal therapy on rehabilitation after total knee arthroplasty. A prospective randomised study
Hecht PJ, Bachmann S, Booth RE Jr, Rothman RH
Clin Orthop 1983 Sep ; (178): 198-201
The role of local heat or cold therapy used in conjunction with exercise in the rehabilitation of total knee arthroplasty patients was investigated.642-737 dumps
Thirty-six osteoarthritic patients were analysed. Parameters evaluated were range of motion, swelling about the knee, and pain. Ail patients received the total condylar knee prosthesis and began range of motion rehabilitation fourteen days after operation.
Results showed that temperature alteration does not augment passive range of motion after total knee arthroplasty.
lt was also shown that cold application decreases swelling as compared with heat. Additionally, the application of cold partially alleviates the discomfort of the rehabilitation process in certain patients.
Randomised controlled trial
[ 28 ]
Effects of continuous cryotherapy on the surgically traumatized musculoskeletal System. Perioperative Cryotherapy Study Group
[Article in German]
Albrecht S, Le Blond R, Cordis R, Kleihues H, Gill C
Abteilungen für Orthopädie sowie Physiotherapie und Physikalische Therapie des
Evangelischen Waldkrankenhauses Spandau.
Unfallchirurgie 1996 Aug;22(4):168-75
The in-vivo effectiveness of continuous cold pressure therapy was evaluated in 24 patients following elective knee or hip replacement surgery.
A cooling of the skin surface down to 8 degrees C resulted in a reduction of the epifascial tissue temperature to 22 degrees C. A significant reduction of subfascial pressure in combination with decreased protein leakage via redovac output were notable.
Observing a constant decreased pH-level increased oxygen saturation and reduced drop of base excess were interpreted as signs of reduced enzyme-linked metabolism activity.300-115 pdfClinically these findings were found in correlation to a 50% decrease of postoperative analgetic demands as well as a 20% increased range of motion level.
PMID: 8975448, UI: 96419900
[ 29 ]
The use of cold compression dressings after total knee replacement: a randomised controlled trial
Webb JM, Williams D, Ivory JP, Day S, Williarnson DM
Nuffield Orthopaedic Centre, Oxford, United Kingdom.
Orthopaedics 1998 Jan; 21(1): 59-61
This prospective, controlled study compared cold compressive dressings with wool and crepe in the postoperative management of patients undergoing, total knee replacement (TKR).
Forty TKR patients were assessed for blood loss, pain, swelling, and range of motion. Patients in the cold compression group had less blood loss through suction drainage (982 mL versus 768 mL).
A higher proportion of patients in the treatment group did not require blood transfusion postoperatively. Mean opiate requirements were lower in the cold compression group (0.57 versus 0.71 mg/kg/48 hours).
The cold compression device appeared to reduce blood loss and pain following TKR.
Randomised controlled trial
PMID: 9474633, UI: 98134974
[ 30 ]
Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction
Barber FA, McGuire DA, Click S
Piano Orthopaedic and Sports Medicine Center, Texas 75093, USA.
Arthroscopy 1998 Mar;14(2):130-5
This prospective, randomised study evaluated continuous-flow cold therapy for postoperative pain in outpatient arthroscopic anterior cruciate ligament (ACL) reconstructions.
In group 1, cold therapy was constant for 3 days then as needed in days 4 through 7. Group 2 had no cold therapy. Evaluations and diaries were kept at l, 2, and 8 hours after surgery, and then daily. Pain was assessed using the VAS and Likert scales. There were 51 cold and 49 non cold patients included.
Continuous passive movement (CPM) use averaged 54 hours for cold and 41 hours for non cold groups ÇP=.003). Prone hangs were done for 192 minutes in the cold group and 151 minutes in the non cold group. Motion at l week averaged 5/88 for the cold group and 5/79 the non cold group. The non cold group average visual analog scale (VAS) pain and Likert pain scores were always greater than the cold group. The non cold group average Vicodin use (Knoll, Mt. Olive, NJ) was always greater than the cold group use (P=.001).
Continuous-flow cold therapy lowered VAS and Likert scores, reduced Vicodin use, increased prone hangs, CPM, and knee flexion. Continuous-flow cold therapy is safe and effective for outpatient ACL reconstruction reducing pain medication requirements.
Randomised controlled trial
PMID: 9531122, UI: 98189607
[ 31 ]
Postoperative lumbar microdiscectomy pain. Minimalization by irrigation and cooling
Fountas KN, Kapsalaki EZ, Johns-ton KW, Smisson HF 3rd, Vogel RL, Robinson JS Jr
Department of Neurological Surgery, Medical Center of Central Georgia, Macon,
Spine 1999 Sep 15;24Ç18):1958-60
Study design :
Seventy patients undergoing de novo lumbar microdiscectomy were prospectively randomised into a control group and a group in which cold intraoperative wound irrigation along with postoperative wound cooling was used.
Postoperative analgesia requirements and length of hospital stay were analysed and correlated.
To evaluate the role of intraoperative cold irrigation and postsurgical cooling in minimizing postoperative lumbar discectomy pain.
Summary of background data :
Regulated hypothermia has been used frequently in pain reduction; however, the efficacy of such a strategy in lumbar
disc procedures has not been established.
Seventy patients (43 men and 27 women), operated on the first time for lumbar disk herniation were prospectively randomised into two groups. A standard microdiscectomy was performed on ail patients. In cohort A the wound site was irrigated-with a cold (18 C) 5% bacitracin solution for .5 minutes. Additionally, a cooling micro temperature pump was placed on the wound site for 24 hours after surgery.
The patients in the control group (cohort B) were treated in a standard fashion without additional hypothermic therapy. All patients received postoperative analgesia ‘through a self-administered morphine pump. The amount of postoperative analgesia received was calculated in morphine equivalents per kilogram. 400-101 pdfThe length of hospital stay was also noted.
The total amount of pain medication was significantly smaller in cohort A than in the control group (cohort B). For the statistical analysis of the results, covariate analyses for both the length of hospital stay and the morphine dose were used, demonstrating a statistically significant difference with P= 0.0001. No postoperative wound infection was noted in either group.
Intraoperative and postoperative wound site cooling is a safe, inexpensive, and efficient therapeutic method. lt reduces the patients’ postoperative pain, promotes earlier ambulation and decreases the length of hospital stay.
Publication Types: Clinical trial
Randomised controlled trial
PMID: 10515023, UI: 99444612
[ 32 ]
Use of cryotherapy for orthopaedic patients
McDowell JH, McFarland EG, Nalli BJ
Orthop Murs 1994 Sep-Oct; 13(5): 21-30
Effective pain management and prevention of oedema are goals for orthopaedic patients after injury and after surgery.
Cryotherapy is the use of cold to decrease swelling and pain when tissue is damaged secondary to trauma or surgery.
Although cryotherapy has been used for years by some practitioners to achieve these goals, it is gaining wider acceptance in sports medicine for acute and postoperative care. Newer techniques of application have broadened its use for postoperative care.
This article reviews the physiology of cold, basic principles of cryotherapy, various techniques of cold application, nursing assessment and care, and patient teaching for a patient with cryotherapy.
PMID: 7854825, UI: 95158059
[ 33 ]
Cold and heat application in musculoskeletal injury
J Emerg Nurs 1990 Jan-Feb; 16(1): 54-7
In physical -therapy there is rarely the opportunity to see patients in the very acute stage, but early intervention by emergency nurses can be the key to faster healing.
Follow-up visits in a physical therapy clinic can reinforce proper use of thermo-modalities in the home and can introduce appropriate movement techniques, therapeutic exercise programs, RECIPE, hydrotherapy, and modalities for pain to regain function as quickly and as safely as possible.
PMID: 2406497, UI: 90157288
[ 34 ]
Thermo- and hydrotherapy
[Article in German]
Presinger E, Quittan M
Universitätsklinik für Physikalische Medizin und Rehabilitation, Wien
Wien Med Wochenschr 1994;144C20-21):520-6
Muscle spasm can be reduced by heat as well as by therapeutic cold. However, in upper motor neuron lesions, cold is more effective in reducing the spasticity.
This effect lasts long enough to be of therapeutic value. Water immersion supports the reduction of muscle tone. Pain may be reduced by both thermal stimuli.
The pain threshold seems to be elevated by the direct effect of both heat and cold on the free nerve endings and the pain-killing fibers. The tendency to bleed is increased with heat application and decreased with cold therapy.
Oedema resulting from trauma is increased with heat, and decreased in its development by cold application. Joint stiffness is decreased with heat application and increased with cold application.
Water immersion removes weight from the joints and facilitates mobility.
PMID: 7879403, UI: 95185094
[ 35 ]
Postepisiotomy pain : warm versus cold sitz, bath.
LaFoy J, Geden EA
Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri.
J Obstet Gynecol Neonatal Murs 1989 Sep-Oct; 18(5): 399-403
A repeated measure experimental design (N = .20) was used to assess the effectiveness of a warm versus cold sitz bath in relieving postepisiotomy pain.
Sensation, distress, oedema, and haematoma ratings were obtained pre- and pos-treatments. Both therapies were found comparable, with the exception that the cold bath was significantly more effective in reducing oedema.
Recommendations for further clinical research are presented. The recommendation for practice is that patients be offered a choice of therapies.
Comment in: J Obstet Gynecol Neonatal Nurs 1990 Jan-Feb; 19(1): 13
PMID: 2795277, Ul: 90011438
[ 36 ]
A comparison of cold and warm sitz baths for relief of postpartum perineal pain
Ramier D, Roberts J
J Obstet Gynecol Neonatal Murs 1986 Nov-Dec; 15(6): 471-4
The effect of cold sitz baths for relieving perineal pain in the postpartum period after an episiotomy was evaluated.
Forty patients took both cold and warm sitz baths with random assignment of the initial bath. Patients rated the degree of perineal pain before and after each sitz bath and at half-hour and one-hour intervals after each bath. A pain scale using 0-5, 0 representing no pain and 5 representing extreme pain, was used.
Analysis of pain scale scores using a two-way analysis of variance with replications showed that cold sitz baths were significantly more effective in relieving perineal pain. The greatest amount of pain relief was experienced immediately after the cold sitz baths.
Randomized controlled trial
PMID: 3641900, UI: 87085879