Pain Tolerance: The Influence of Cold or Heat Therapy

Knee skin temperature response of patients with bilateral patellofemoral syndrome before and after heat and cold stress

Patellofemoral Pain Syndrome is characterized by the presence of pain in the front area of the knee, which occurs when performing common activities such as climbing stairs, and bending the knees, among others. The objective of this research was to evaluate the detection capability of infrared thermography in patients with Patellofemoral Pain Syndrome, in the baseline state, as well as after the application of thermal stress. The investigation was conducted in 48 patients, who were subdivided into four groups (n = 12). Two subgroups were healthy patients and two with Patellofemoral Pain Syndrome. For the diagnosis of the syndrome, a manual evaluation was performed using the Zohlen test and Q angle measurement. Subsequently, cold stress was applied for 10 min to a healthy subgroup and an experimental subgroup. The remaining two subgroups were subjected to heat stress for 15 min. Thermographic images of the lower extremities were acquired at seven time points, at baseline, immediately after application of thermal stress and then every 3 min until 15 min were completed. It was observed that patients presented Patellofemoral Pain Syndrome bilaterally. After statistical analysis, it was found that there were no significant differences in baseline temperature between the groups. However, for heat stress, a higher temperature was observed in the group with Patellofemoral Pain Syndrome (p < 0.05) in the recovery period, and in the case of cold stress, only a lower temperature in the left knee immediately after the application. In conclusion, it is not possible to detect patellofemoral syndrome bilaterally in the baseline state by thermography and neither is it evident in cold stress. However, after heat stress, thermal recovery is lower for the PFPS group, so it would be susceptible to detection.

Infrared Thermography as a Non-Invasive Tool in Musculoskeletal Disease Rehabilitation—The Control Variables in Applicability—A Systematic Review

In recent years, the usefulness of infrared thermography (IRT) as a valuable supplementary imaging method in medical diagnostics, as well as for assessing the effects of the treatment of musculoskeletal injuries, has been increasingly confirmed. At the same time, great importance is attached to the standards of thermographic research, the fulfillment of which determines the correct methodology and interpretation of the results. This article discusses the medical applications of infrared thermography in musculoskeletal system diseases, with particular emphasis on its usefulness in assessing the therapeutic effects of physical treatments used in rehabilitation. The literature from the last decade that is available in the Medline and Web of Science databases has been reviewed. Among the physiotherapeutic methods used, the following were selected that directly affect the musculoskeletal system: cryotherapy, laser therapy, electrotherapy, diathermy, and massage. The article summarizes all the guidelines and recommendations for IR imaging in medicine and rehabilitation.

Temperature-Mediated Nerve Blocks in the Treatment of Pain

PURPOSE OF REVIEW

Analgesic hot and cold temperatures have been used for both conservative and ablative therapies for millennia. There are well-known locoregional neurovascular changes associated with the application of heat or ice in the literature and in practice. The oscillation between heat and cold has recently been identified as a synergistic mechanism of action with early translational results in humans.

RECENT FINDINGS

Recent mechanistic work in the feline model has demonstrated that a reliable, reversible nerve block can be achieved within a temperature range that is non-destructive (15-45°C). The underlying mechanism is a newly described hysteresis in the responsiveness of peripheral nerves to alternating thermal stimuli resulting in nerve blockade. Recently presented feasibility data reports positive results in subjects with occipital pain and peripheral scar pain in terms of pain and associated symptom improvement. Temperature-mediated changes in pain and sensation have been observed for hot and cold applications at a variety of temperatures. Recent insights into the synergy between preheating followed by cooling resulting in peripheral nerve fiber block has potential in a variety of conditions in which peripheral nerve etiology is noted. Recent findings in chronic headache patients report decreased pain and symptom improvement. Further studies are ongoing to understand the indications for this novel therapy.