Whole Body Cryotherapy for Fibromyalgia: Application, Effects, and Suggested Treatment Regimens
Table of Contents
INTRODUCTION: MEDICAL USE REQUIRES SUPERVISION BY A DOCTOR Based on theoretical knowledge, clinical studies and experience the indication list for whole body cryotherapy has been increasingly justified and expanded over the last years6 to include a variety of health disorders. The terminology has also been adjusted to distinguish between talking about healthy subjects (cryostimulation) versus patients (cryotherapy). For some health conditions, the benefits of whole body cryotherapy have been proven to the point that recommendations to incorporate it in the treatment regimen are given by medical professionals with confidence. These conditions include inflammatory rheumatic diseases(rheumatoid arthritis and ankylosing spondylitis), degenerative rheumatic diseases (osteoarthritis) and chronic pains of various causes. The most common expectations from incorporating cryotherapy in treating the named disorders are reduction in inflammatory activity and pain. In many other cases, although positive treatment results have been obtained clinically, they show less consistency, lack statistical significance, or have not yet led to agreement on how to interpret the collected data. Fibromyalgia is one of such conditions. As a result, a more cautious approach to recommending and administering whole body cryotherapy is suggested. Regardless of the available proof of benefits, it must be noted that one needs a medical license to give any medical advice or, moreover, to prescribe a treatment. To date, too little is known about how fibromyalgia arises even among medical. professionals, and the attempts to explain the pathogenesis are still too inconsistent to enable treating this condition in a uniform and root cause related manner. All cryocenters that do not have the credentials to practice medicine must ALWAYS stress that whole body cryotherapy is an option that must be considered in every individual case by a doctor. Incase of fibromyalgia diagnosis, it should be a rheumatologist.
WHAT IS FIBROMYALGIA Fibromyalgia is a central nervous system disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Researchers believe that fibromyalgia affects the way the brain and spinal cord process pain signals. It is a rheumatic (musculoskeletal) condition and one of the many forms of arthritis – the disorders that affect the joints. At the same time, the nature of fibromyalgia is considerably different from, for example, rheumatoid arthritis. Despite similarities in characteristics and symptoms, fibromyalgia is NOT an autoimmune disorder, and it is NOT an inflammatory condition, either – studies have shown that inflammatory markers of fibromyalgia patients stay within normal ranges.
The biggest challenge of coping with fibromyalgia is extreme sensitivity to pain and other unpleasant sensations. It is caused by abnormal sensory processing in the central nervous system and characterized by: - Pain of changing intensity distributed over the entire body. - Tenderness of defined “tender points”. There are 18 of them. Diverse vegetative, functional, and psychological disorders (fatigue, poor sleep, anxiety, depression, reduced stress tolerance, circulatory disorders, excessive sweating, shivers, cold sensitivity of the fingers etc.) have also be reported. The above symptoms are also present in numerous other conditions. Not to confuse, fibromyalgia diagnosis primarily involves assessment of the distribution of pains and tender spots – they must be present on the right and left sides of the body and above as well as below the waistline. Of the 18 “tender points”,at least 11 must be tender:
Fibromyalgia symptoms often begin after an event, such as physical trauma, surgery, infection, or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. The primary symptom - widespread musculoskeletal tenderness and pain - is often accompanied by fatigue, poor sleep, memory issues, anxiety, and depression, seen by different experts as other fibromyalgia symptoms OR separate co-existing health disorders. Fibromyalgia patients may also experience tingling of the skin, prolonged muscle spasms in the limbs, neuropathy, muscle twitching, and bowel disturbances. As a chronic condition, fibromyalgia, once developed, can last for years or be lifelong. There is no known cure to date, but effective management of the symptoms is possible. THE SIZE OF THE PROBLEM Fibromyalgia affects 2 to 4% of the population, about 4 million US adults. Although not anywhere near as common as some other forms of arthritis, like rheumatoid or osteo-arthritis, it deserves and is getting increasingly more attention due to its devastating impact on the affected people’s quality of life. This is a depiction how fibromyalgia would look like if it were visible:
Raising fibromyalgia awareness has been taken on by some celebrities like Lady Gaga who suffers from the condition herself: “I get so irritated with people who don’t believe fibromyalgia is real. For me, and I think for many others, it’s really a cyclone of anxiety, depression, PTSD, trauma, and panic disorder, all of which sends the nervous system into overdrive, and then you have nerve pain as a result. People need to be more compassionate. Chronic pain is no joke. And it is every day waking up not knowing how you’re going to feel.” Fibromyalgia is most common in women, yet it can occur in men, too. The symptoms usually start showing in middle adulthood but have also been reported in teenagers and elderly.
THE RISK FACTORS AND THEIR MANAGEMENT The cause of fibromyalgia is not well understood, and there is no known way to prevent it. Many researchers believe that repeated nerve stimulation due to illness, injury, stress, trauma, or abuse can cause an abnormal increase in levels of certain chemicals in the brain that signal pain, leading to fibromyalgia. In addition, the brain's pain receptors seem to develop pain memory and become sensitized, meaning that they can overreact to painful and non-painful signals. Among the many factors that can potentially lead to these changes, experts mention: - Genetics- certain genetic mutations that may make a person more susceptible to developing the disorder. - Infections. Some appear to trigger or aggravate fibromyalgia. - Physical or emotional events, such as a car accident or prolonged psychological stress. - Rheumatic diseases that affect the joints, muscles, and bones, like osteoarthritis, rheumatoid arthritis, lupus, ankylosing spondylitis. While some of these factors are outside our control, the best way to reduce the risk of developing ANY health condition, including fibromyalgia, is to remain as healthy as possible - maintain a good diet, do safe exercise, get enough rest, and manage stress. Whole body cryotherapy positively impacts mood, ability to relax, and sleep. For these reasons, it is a good practice to incorporate into one’s health supporting lifestyle.
THE IMPORTANCE OF TREATMENT There is no known cure to date, but fibromyalgia symptoms can be effectively managed to maintain quality of life. The therapy of fibromyalgia must pursue a multimodal approach, potentially including moderate physical activity, various physical therapies, relaxation therapies, medication, and counseling on coping with stress and pain. Since the symptoms in fibromyalgia patients vary widely and so does their impact on the person’s life, there is no uniform “best practice” to produce results, and it is more likely that there will be significant differences in how people respond to the recommended therapies. To improve treatment efficacy and manage the risks of adverse effects, once diagnosed, fibromyalgia shouldALWAYS be treated by a rheumatologist. IN ADDITION to medical treatment, people can manage their fibromyalgia symptoms with other strategies which are proven to reduce pain and disability. Wholebody cryotherapy may be one of them. Your cryocenter may be able to help, for as long as the importance of an oversight by a health professional is understood and stressed and no medical advice or a recovery promise is given. As demonstrated in the following chapter, the results of cold exposure vary A LOT among people with fibromyalgia. THE ROLE OF CRYOTHERAPY
In many cases, whole body cryotherapy has proven to reduce fibromyalgia symptoms such as pain, fatigue, depressive mood, and impaired sleep, yet people’s tolerance to cold and therapeutic success may differ. Since fibromyalgia is a nervous system disorder, not a condition tied to blood flow impairment or inflammation, the positive outcomes in this case may be less consistent and some symptoms may even worsen. For this reason, administer wholebody cryotherapy with caution – begin with a low-dose trial session, carefully observe client’s responses, and continually ask for feedback. A study by R. Kurzeja and colleagues1 resulted in 53% of the participants dropping out due to ineffectiveness, panic symptoms, or adverse reactions. The rest 47%all experienced a decrease in pain intensity.
In other studies, the success rate (clear improvements) after 20 to 30 cold exposures has been observed to lie between 40 and 80%. It has also been concluded that gymnastic exercises1 to 3 hours after undergoing cryotherapy may add to the therapeutic success of the treatment. In general, the research results suggest that patients with fibromyalgia should try cryotherapy, IF POSSIBLE: “Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life, in comparison with the non-cryo-treated fibromyalgic subjects" (4).
CRYOTHERAPY PROTOCOLS FOR FIBROMYALGIA Like in other cases involving pain, the cryotherapy protocol to achieve a noticeable improvement should involve once daily (or as frequent as possible) treatments for at least 2 to 4 consecutive weeks. The more pronounced the symptoms, the more intense schedule is suggested for longer. Even twice-daily sessions could be recommended if possible. Here is a case study of a 27-year-old female with a long-standing history of fibromyalgia who was undergoing whole body cryotherapy treatments in Dr. J. Kuehne’s clinician Los Angeles, California: In her case, the reported problems included poor sleep for the past 2 years, morning stiffness and pain in the neck and shoulder region, as well as persistent lower back pain. On the physical exam she tested positive on 15 of 18 trigger points and stated discomfort on passive range of motion of the shoulder joints. Both rotator cuffs appeared intact, but the examination of the spine revealed mild scoliosis. She had no other medical problems, was not pregnant and did not take any medications or supplements. The doctor recommended and provided a total of 25 whole body cryotherapy treatments, 3 minutes each. The patient was wearing only gloves and socks during the treatment for maximal skin exposure to the cold temperatures. For the first 7 days, she was receiving 1 treatment per day, then 2 treatments per day for the rest of the course. The young woman reported improved sleep and energy level already after the first 3 treatments. Her mood also had begun to improve. After 5 treatments, she experienced a significant decrease in pain perception, as well as improved concentration. Assessment after 12 treatments showed decreased pain sensation to trigger point pressure. At the completion of all 25 treatments, the symptoms had improved significantly.
The below treatment protocols have been adapted based on the recommendations by Dr. Alan Christianson, NMD, one of the first whole body cryotherapy providing doctors in the United States.
In each case, the recommendation shall be coordinated with the doctor for possible adjustments and professional oversight of the patient’s reaction and progress.
Treatment protocol A for those with longer history of the disease and higher average pain scores:
- Pain scores of 6 or over.
- Sensitivity of 15 out of 18 trigger points, or more.
- Duration of symptoms greater than 2 years.
Minimum number of treatments: 20.
Recommended frequency of treatments: five days per week (weekdays). Duration of treatments: 4-5 weeks.
Treatment protocol B for those with more recent onset fibromyalgia and lower average pain scores: - Pain scores of 5 or under. - Sensitivity of 11 to 14 trigger points. - Duration of symptoms less than 2 years. Minimum number of treatments: 10. Best frequency of treatments: five days per week (weekdays). Duration of treatments: 2-3 weeks. The pain scores can be assessed using Fibromyalgia Impact Questionnaire or a subjective pain scale like this:
OTHER CONSIDERATIONS FOR MORE NOTICEABLE RESULTS
More than with other conditions, each case of fibromyalgia is different. Although there are general recommendations on how to manage the symptoms naturally and prevent or reduce flare-ups, it is important that the client talks to the doctor about treatment options and lifestyle changes that will best suit their specific needs. You cryocenter may raise the awareness of possible strategies without giving any advice or promise. In accordance with healthline.com, 5 universal strategies exist: - Practicing good sleep habits.
Poor sleep amplifies pain, making it harder to sleep, which causes even more pain, and so on. The vicious cycle could be broken by going to bed at the same time every day, making improvements in the environment (light blocking, noise isolation, temperature adjustment), and reducing stressors 1-2 hours before bedtime.
-Reducing stress, as the symptoms of fibromyalgia get worse with it. Stress busting techniques include deep breathing, meditation, acupuncture, bath, moderate outdoor activity, and similar. - Choosing the right type of exercise - regular low to moderate impact activity, like walking or yoga, over rigorous fitness plans that can make the symptoms worse. - Eating a balanced diet.
Gastrointestinal issues, such as irritable bowel syndrome, sometimes accompany fibromyalgia, and certain foods may make the symptoms worse. It is often best to minimize caffeine intake and fried foods, as well as foods high in sodium.
- Monitoring the symptoms. Journaling about flare-ups and related experiences (foods, activities, interactions with people) may provide insight into what is aggravating the symptoms and could also be a useful tool for the doctor in prescribing the best treatment.
SOURCES
1. R. Kurzeja, C. Gutenbrunner, B. Krohn-Grimberghe. Fibromyalgia: Comparison of Whole-Body-Cryotherapy with Two Classical Thermotherapy Methods
Aktuelle Rheumatologie 2003
2. W Samborski, T Stratz, M Sobieska, P Mennet, W Müller, J Schulte-Mönting. Intraindividual comparison of whole body cold therapyand warm treatment with hot packs in generalized tendomyopathy. Clinical trial. Zeitschrift fur Rheumatologie 1992 https://pubmed.ncbi.nlm.nih.gov/1574933/
3. Javier Rivera, María José Tercero, Javier Salas Salas, Julio Hernández Gimeno, Javier Sánchez Alejo. The effect of cryotherapy on fibromyalgia: a randomized clinical trial carried out in a cryosauna cabin.
Rheumatology International 2018
4. Bettoni L, Bonomi FG, Zani V, Manisco L et al. Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients.
Clinical Rheumatology 2013
5. Szczepańska-Gieracha J, Borsuk P, Pawik M, Rymaszewska J. Mental state and quality of life after 10 session whole-body cryotherapy. Clinical trial. Psychology, health, and medicine 2014 https://pubmed.ncbi.nlm.nih.gov/23535078/
6. Prof. Dr. Sc. Med. Winfried Papenfuß. Power from the Cold. Whole body cryotherapy at -110° C, a short-lasting physical therapy with a long-lasting effect. 5th, revised and expanded edition January 2016, ISBN 978-3-938912- 08-9
7. “WBC Protocols Pain” by Dr. Alan Christianson, NMD, for Millennium Ice 2013
Disclaimer: This article is a summary of available publications and some well- known practices that have proven to be effective in managing symptoms of fibromyalgia. At the same time, every condition is different, and the result depends on many factors. By no means should this document serve as a success guarantee or as a replacement for medical advice.