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Pain and physiology of cold

The main physiological effects of the application of cold are the following: analgesia, decrease in metabolism, vascular response

  • The application of cold at repeated intervals leads to an analgesic effect on the parts of the body treated (1-8). It has been demonstrated that nerve conduction decreases constantly with a decrease in temperature until conduction within the nerve fibers ceases completely. The myelinated fibers are the first ones to be affected (9). This slowing of the conductivity of the peripheral nerve fibers is found when the temperature drops to below 80,6°F (10). Other mechanisms are also involved: cold has a specific ‘anti-irritant��� function that protects from pain stimulus (11-13). Cold can also remove the causes of pain by reducing muscle spasm of the traumatized area, thus reducing the effects of ischemia secondary to the trauma (14).

    1 Bierman W. Therapeutic use of cold. JAMA 1955: 157: 1189-92.

    2 Downey JA. Physiological effects of heat and cold. J Am Phys Ther Ass 1964: 44: 713-17.

    3 Grant AE. Massage with ice (cryokinetics) in the treatment of painful conditions of the musculoskeletal system. Arch Phys Med 1964: 45: 233-7.

    4 Kalenac A, Medlar CE, Fleagle SB, Hochberg WJ. Athletic injuries: Heat vs. cold. Am Fam Phys 1975: 12: 131-4.

    5 Starkey JA. Treatment of ankle sprains by simultaneous use of intermittent compression and ice packs. Am J Sports Med 1976: 4: 142-4.

    6 Belitsky R, Odam S, Hubley-Kozey C. Evaluation of the effectiveness of wet ice, dry ice and cryogen paks in reducing skin temperature. Phys Ther 1987: 67: 1080-4.

    7 Weston M, Taber C, Casagranda L, Cornwall M. Changes in local blood volume during cold gel pack application to traumatized ankles. J Ortho Sports Ther 1994: 19: 197-9.

    8 Kowal M. Review of physiological effects of cryotherapy. J Ortho Sports Ther 1983: 5: 66-73.

    9 Murphy AJ. The physiological effects of cold application. Phys Ther Rev 1959: 40: 112-15.

    10 Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Med 1986: 3: 398-414.

    11 Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Sympt Manag 1994: 9: 56-9.

    12 Travell J. Ethyl chloride spray for painful muscle spasm. Arch Phys Med 1952: 33: 291-304.

    13 Scheffler N, Sheitel P, Lipton M. Use of Cryo/Cuff for the control of postoperative pain and edema. J Foot Surg 1992: 31: 141-8.

    14 Hocutt JE. Cryotherapy. Am fam Phys 1981: 23: 141-4.