Thursday, February 9, 2012

Ice and CRPS or ICE and RSD

I have been asked this question so many times that I have written about it a lot. So if you have read it here or elsewhere before, feel free to skip on over it :-D

The question is, Is it bad to apply ice pack to the CRPS (or RSD) affected area? (or even nearby)

Or, Is it bad to use the hot/cold contrast therapy in the CRPS affected area?
(hot/cold contrast therapy

I would definitely suggest you read our physical therapy section of the website, especially the article on Ice and CRPS,

one section of the article on Ice and CRPS, Dr Hooshmand states the case very well when he says;

"On the other hand repetitive application of ice freezes and coagulates the myelin (fatty tissue insulating large nerve fibers) exactly like ice freezes and solidifies melted butter. As the ice freezes the large nerve fibers, causing freeze damage to the myelinated nerves, the patient develops sensory loss and pain due to permanent damage to the large sensory nerve fibers.

This aggravates the RSD by adding sensory nerve pain of non-sympathetic origin to the initial thermal sensory pain of sympathetic origin. As a result, Ice provides total anesthesia and relief of pain for several minute the same way as the hand becomes numb being exposed to snowballs in the winter. However, a few hours after the cessation of ice exposure, the pain recurs with vengeance due to reactive enlargement of blood vessels after the constriction of blood vessels due to exposure to ice. This phenomenon causes excellent relief of pain with ice treatment followed by not only aggravation of pain, but damage to the nerve fibers adding sympathetic independent pain (SIP) to the original sympathetic mediated pain (SMP)."

If you need a refresher course on SIP and SMP (IMP as it is sometimes called) check out this article.

But pay particular attention to the words I put in bold letters in the quote above. So often I hear from patients who say, "But it feels better when I apply ice or run my hands under cold, ice-cold water for a few minutes", but they have to do it more and more often as the weeks and months roll on. And then hours later the pain is worse then ever.

The reason they have to do it more often and the reason the pain is worse than ever afterwards is both the same, are both the same. That is what Dr Hooshmand is saying above. The more you do these things, the more you are breaking down the protective myelin sheath that protects the nerve. Pretty soon there is no going back, the damage is permanent and the pain is no longer SMP, or localized, but SIP, or brain centered. This is where the pain-cycle gets in that stuck position and is nearly impossible to break. It is also where it seems the disease spreads.

We hear so many sad stories of patients whose use of ice precipitated their spread of their CRPS, from the one small area to not just further up that limb but also the opposite limb. It also seems to accelerate the timing of the disease through the stages if ice is used repeatedly.

Remember also that ice, even very cold water/temperature, can cause the blood vessels to constrict and/or spasm. This is one of the four main symptoms of CRPS (spasms in muscles and/or blood vessels). It can be very, very painful for your extremities; toes, fingers, feet, hands, nose, etc.

So please, be very cautious here. If your physical therapist insists on using ice, educate them. This is your life we are talking about, you are the boss, take control, take charge!

There are other articles on the net besides the one sited above too. I just think his is the best and probably was the first!


Keith Orsini

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