Cryotherapy is the use of cold to treat pain or other conditions. The term also refers to the use of extreme cold, usually by means of liquid nitrogen, to destroy tissue such as skin lesions or certain forms of cancer.

Cold is used to treat both acute and chronic pain. Heat is also sometimes used to treat chronic and acute pain after the initial 48 hours, when cold is used to reduce swelling (see Thermotherapy).

Cryotherapy is a common home treatment and is used in healthcare settings as well. It can be used to treat numerous injuries, conditions and diseases including fractures, strains, sprains, back pain, neck pain, headaches and arthritis.

Cold can be applied using several methods, including ice, ice massage and cooling sprays. It can be applied for 10 to 20 minutes for up to two days after an injury.

Cryotherapy is the application of cold to treat pain or other conditions. People often use cryotherapy at home for minor conditions such as sprains. It is also employed in healthcare settings, such as treatment of musculoskeletal conditions in physical therapy or reduction of fever in a hospital. It is sometimes incorporated into other treatments, such as hydrotherapy (water therapy).

The term also refers to the application of extreme cold, usually by means of liquid nitrogen, to destroy tissue. This type of cryotherapy is also known as cryosurgery, cryoablation or targeted cryoablation. It is sometimes used to treat skin lesions, such as warts or skin tags, or certain types of precancerous and cancerous conditions.

Cold may be applied in a variety of ways, such as ice and cold baths. Applying cold reduces the temperature of an affected area, restricts blood vessels and prevents fluids from leaking into the surrounding tissues. This may reduce pain and swelling.

Cold decreases the sensitivity of nerve endings, resulting in a numbing sensation. This both distracts the patient from thinking about the pain and increases the pain threshold. Ice therapy also decreases tissue damage by decreasing swelling.

Heat is also sometimes used to treat chronic pain, but opinions differ as to which method works best. Heat increases blood flow to the muscles and makes connective tissue more elastic, thereby relieving joint stiffness. Among factors considered when determining whether to use heat or cold therapy are convenience and the patient’s preference.

Many injuries, conditions and diseases are treated with cryotherapy. They include:

• Injuries and trauma pain. Strains and sprains are the most common type of condition treated with cryotherapy. It is usually used immediately after an injury to reduce pain and swelling. Cryotherapy may also help mild stress fractures (breaks in bone caused by repeated or unusual stress), but significant stress fractures and other fractures may need such treatments as a splint, cast or surgery.

The American College of Foot and Ankle Surgeons cautions that, with falls or other mishaps, sprains and fractures can happen together and that a serious sprain can cover up symptoms of a fracture. Individuals who think they may have suffered a fracture are advised to seek medical attention.

• Headaches. Cold therapy is sometimes used with patients who have headaches, including migraines. Application of cold can numb nerves and increase the patient’s pain threshold.
  
  

Orofacial pain and dental pain. Cryotherapy may reduce inflammation and pain.



TMJ disorder. Application of cold packs can relieve tender areas.

• Testicular and scrotal pain. Cryotherapy is a common home treatment for many types of this pain, but certain forms (e.g., testicular torsion) require immediate medical attention.
  

• Postsurgical pain. Patients who have undergone orthopedic surgery such as a joint replacement (arthroplasty) may wish to ask their physician if cryotherapy sprays are recommended to ease discomfort.

• Eye pain. A physician may recommend cool compresses to relieve eye strain or discomfort.
  
  
• Ear pain. Cold treatments may reduce swelling and pain caused by external injury to or near the ear.
  
  
• Arthritis (inflammation of the joints). Arthritic conditions, particularly rheumatoid arthritis, sometimes respond to cryotherapy. Arthritic conditions are also sometimes treated with heat (thermotherapy).
  


• Tendinitis and bursitis. Cryotherapy may help with these conditions, which are often caused by overuse.
  
  
• Carpal tunnel syndrome. Cold packs may reduce swelling caused by this nerve entrapment disorder.
  
  
• Neck pain. Most conditions affecting the neck cause pain and stiffness along the base and sides of the neck. However, problems with the structures of the neck can also cause pain over the top of the head (tension headache), pain over the upper back (neck strain and fibromyalgia), or pain over the shoulder (neck strain or a pinched nerve in the neck).
  
  
• Back pain. Many episodes of back pain are caused by muscle strain, which can be caused by sudden movements, falls, sports injuries or lifting heavy objects.
  
  
• Shoulder pain and elbow and arm pain. Patients experiencing arm pain are often advised to follow the four-step recovery regimen known as RICE – rest, ice, compression and elevation.
  
  
• Knee pain. Knee injuries commonly occur during sports and other types of exercise, but they can also be the result of falls, sprains or degenerative or inflammatory conditions.
  
  
• Other types of joint pain. Most people experience joint pain at some time during their lives. Pain can be the result of a short-term injury or condition, but can also be chronic (long term).
   
• Certain types of abdominal pain. Sucking on ice chips sometimes relieves mild pain in the abdomen.

Cold may be applied in a variety of ways, including:

• Ice. Ice should not be applied directly to the skin. A protective barrier, such as a towel, should be used.
  
  
• Ice packs. Devices that store ice and can be kept cold in the freezer are available in drug stores and other shops.
  
  
• Chemical cold packs. These are available in stores and are often found in first aid kits. They are warm to the touch. When pressure is applied, the pack turns cold.
  
  
• Vapocoolant spray. These sprays often contain fluoromethane or ethyl chloride and are used to treat pain from muscle spasms.
  
  
• Cold baths. Soaking in very cold water can have the same effect as using other devices. Patients are advised not to soak for no longer than 20 minutes.
  
  
• Ice massage. Ice can be used to numb tissue before massage therapy, which is a type of manipulation therapy. Ice massage can deliver cold more efficiently to an area than cold packs or other means of applying cold.

Cold generally may be applied for 10 to 20 minutes and then removed. Cold sources should be sealed to avoid dripping, flexible so they conform to body parts and wrapped to prevent skin irritation.

With acute injuries, cold therapy is often used in conjunction with a first aid technique called RICE (rest, ice, compression and elevation). This technique involves:

• Resting the injured body part.
  
  
• Applying ice for intervals up to two days to reduce or prevent swelling.
  
  
• Wearing an elastic compression bandage for up to two days to reduce or prevent swelling.
  
  
• Keeping the injured body part elevated above the heart to reduce or prevent swelling.

Cryotherapy is easy to use, fast, efficient and cost-effective. However, there are certain conditions that should not be treated with cryotherapy, including:

• Poor circulation. In some people, blood circulates poorly throughout the body. Cold can aggravate this condition.
  
  
• Raynaud syndrome. In this condition, the smallest arteries that deliver blood to the fingers and toes constrict when exposed to cold or during emotional upheaval.
  
  
• Vasculitis (inflammation of the blood vessels). The damaged vessels do not function properly. Applying cold can worsen the condition.
  
  
• Impaired sensation, such as from neuropathy. People with reduced sensory abilities in some nerves, including some people with diabetes, should not use cryotherapy unless advised by their physician.
  

  

• Anxiety about cold. Some patients experience anxiety about the use of cold with treatment.
  
  
• Cryoglobulinemia. This condition involves abnormal proteins in the bloodstream that thicken or gel when they are exposed to cold.
  
  
• Paroxysmal cold hemoglobinuria. Rare blood disorder caused by the formation of antibodies that destroy red blood cells when a person is exposed to cold.

If cold therapy is applied for excessive periods of time, it can result in:

• Hypothermia. A medical condition in which a person’s body temperature drops significantly below normal temperatures, impairing metabolism.
  
  
• Frostbite. A medical condition in which skin and other tissues are damaged by extreme cold.

Rarely, cold therapy can increase pain temporarily.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about cryotherapy:

1. Is cryotherapy a treatment option for me?
   
   

2. How can applying cold relieve my pain?
   

3. Which type of cryotherapy do you recommend for me: ice, cold packs, cooling sprays, ice massage or another method?
   

4. Should I combine heat therapy with cold therapy to relieve my pain? If so, how?
   

5. Which injuries and conditions that I have or am at risk of respond well to cryotherapy?
   

6. Do I have any condition that rules out use of cryotherapy?
   

7. For how long should I apply cold?
   

8. How frequently should I apply cold?
   

9. At what point should I try another treatment or notify you if cryotherapy does not seem to be helping me?
   

10. What benefits can cryotherapy have for me?
    

11. Does cryotherapy pose any risks to me?