COOL THERAPY: Relief and Physiological Benefits for Patients with Multiple Sclerosis

by Mitch Abrahamsen, MD

Multiple Sclerosis (MS) is a chronic disease of the central nervous system (CNS), affecting millions of people worldwide. MS is characterized by acute inflammatory episodes in the CNS, often transitioning to a progressive neurodegenerative phase. MS can result in significant mental and physical symptoms, especially muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, cognitive impairment and depression.

Additionally, a vast majority of MS patients struggle with heat intolerance and experience temporary worsening of clinical signs and neurologic symptoms with heat exposure (Uhthoff’s phenomenon). Heat exposure intensifies the disease symptoms and can result in extreme fatigue, blurred vision, loss of balance or a worsening of cognitive symptoms such as concentration or memory (Davis et al., 2018). These temporary changes can be triggered by even a slight elevation in core body temperature (one-quarter to one-half of a degree) negatively impacting the quality of life of the sufferers.

For many years, physicians advised newly diagnosed persons with MS to limit physical activity and exercise due to concerns about worsening disease progress and to minimize pain and fatigue. In particular, patients with severe heat intolerance frequently decrease physical activity fearful of worsening their symptoms due to the negative affects they have experienced from overheating and sweating. However, numerous studies support regular exercise training for patients with MS as a therapeutic tool to facilitate improvements in different areas of cardio fitness muscle strength, flexibility, balance, fatigue, cognition, quality of life and respiratory function.

Over 50 years ago, cool therapy was recognized as providing significant improvement in patients who were chronically ill with multiple sclerosis (Boynton et al., 1959). The simple treatment of immersing patients in cool water for as little as 10 min resulted in less muscle spasm, greater comfort while sitting or standing, and improved ambulatory of functional ability in a majority of patients. The degree of improved neuromuscular coordination varied between patients, importantly however, all patients reported feeling more relaxed. Since these early studies slight decreases in body temperature have been documented to produce a temporary relief of MS-associated symptoms. Methods for treatment range from as simple as a cold shower or vests containing frozen gel packs, or as complicated as the cooling suits introduced in the United States in the 1990s or exercise facilities in dedicated cool rooms (Ozkan-Tuncay and Mollaoglu, 2017).

As part of regular exercise program for MS patients, physicians are keenly aware of the importance of matching the intensity of the activity with the patient’s physical ability and the ability the MS patient to stay cool. Thus, a physical training program combined with a cooling strategy supports a positive influence on both cognitive and physical condition, as well as perceived fatigue and emotional well-being of MS patients.


Opal Cool

As reported in Multiple Sclerosis News Today, several recent studies support the value of cool therapy for patients suffering from MS. In one of the “passive cooling” studies, where MS patients used ice or cold gel packs to reduce heat, 50% of patients experienced the beneficial effects of the cooling intervention for two to eight hours after the treatment. The research concluded, “pre-cooling therapy can prevent the symptom worsening due to increased body temperature in multiple sclerosis patients without causing adverse effects. In addition, cool therapy and “precooling” have been shown to be an important component supporting active exercise programs (Halabchi et., 2017; Kaltsatou and Flouris, 2019).

Opal Cool products are specifically designed with formulated phase change materials that are safer and more comfortable to wear than ice or gel packs. Opal product can be worn directly on the skin, or over light clothing and maintains a cooling temperature for up to an hour. Adjustable straps are included to deliver a comfortable fit for all body sizes and shapes and allow for an active lifestyle without inhibiting movement. Opal wearable products are FDA-registered devices specifically to provide cool therapy at either 58℉ or 80℉  depending on the specific product and desired effect.

For decades, ice or frozen gel packs have been the “go to” method for providing cooling activity for overheated individuals or pain relief following injury or post-exercise recovery. But research now shows that extremely cold treatment modalities, like ice and other cryotherapies, can actually have negative implications. Since the human body, and your cells, are mostly comprised of water, subjecting your body to “freezing” temperatures (frozen water) has the potential to essentially turn off your physiological processes that are important for normal biological processes.

Unlike ice therapy which has to be cycled on and off, our cold therapy products deliver consistent therapeutic temperatures without the risk of severe skin damage (think ice burn or frost bite) or internal complications like vasoconstriction (when your blood vessels shrink and blood flow to the injury slows way down). The 58 o F products provide cooling benefits for up to an hour and can be recharged in a refrigerator or in a cooler with ice in < 30 minutes. These products provide a wearable option for staying cool while exercising or during normal daily activities, or can be used to “precool” targeted area prior to engaging in strenuous activities. By employing two such products sequentially (one being worn while the other is cooling) uninterrupted cooling therapy can be provided without worrying about messy ice or gel packs or needing uncomfortable or specialized clothing attire.

The 80℉ products feel surprisingly cool against your 98.6℉ body temperature. These products provide a cooling benefit for up to 2 hours and does not require refrigeration. Products will recharge anytime they are not in contact with your body and the ambient temperature is below 80℉. (Normal room temperature is 72℉). The 80℉ cool pad provides a pleasant overall body cooling sensation while sitting at your desk, in a chair, or in the car. For a cool night sleeping, a cool pad on your pillow provides for a cool night of sleep.


References and General Information

https://multiplesclerosisnewstoday.com/?s=cooling+therapy&header-search-submit=Search

Boyton, BL., Garramone, PM. And Buca, J. 1959. Cool baths as an adjunct in the treatment of patients with multiple sclerosis. Q Bull Northwest Univ Med Sch 33(1):6-7.

Halabchi, F. et al., 2017. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol. 17:185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602953/

Giesser, B.S. 2015. Exercise in the management of persons with multiple sclerosis. Ther Adv Neurol Disor. 8:123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409551/

Kaltsatou A and Flouris AD. 2019. Impact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: a systematic review. Mul Scler Relat Disord 27:419-423. https://www.msard-journal.com/article/S2211-0348(18)30498-X/pdf

Ozkan-Tuncay F and Mollaoglu M. 2017. Effect of the cooling suit method applied to individuals with multiple sclerosis on fatigue and activities of daily living. J Clin Nurs 26:4527-4536. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13788

Gonzales B, Chopard G, Charry B, et al. 2017. Effects of a Training Program Involving Body Cooling on Physical and Cognitive Capacities and Quality of Life in Multiple Sclerosis Patients: A Pilot Study. Eur Neurol. 78:71–77. https://www.karger.com/Article/Abstract/477580

Davis SL, Jay O and Wilson TE. 2018. Thermoregulatory dysfunction in multiple sclerosis. Handb Clin Neurol 157:701-714. https://www.sciencedirect.com/science/article/pii/B9780444640741000422