Is Cryotherapy Good For You?

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Cryotherapy has both physical and mental benefits, from relieving chemotherapy side effects, cancers, arthritis and pain to improving your metabolic markers, muscles, skin, mood and sleep

Cryotherapies, or cold therapies, include a variety of methods. Common types include cold water immersion (CWI), spa cryotherapy -- immersing the whole body in a cryotherapy chamber with freezing or nearly freezing temperatures for three to five minutes -- and cryotherapy applications using ice cubes, ice packs, frozen gloves or socks.

Another example is medical cryotherapy, also known as cryoablation or cryosurgery, which uses extreme cold to freeze and remove abnormal tissue to treat skin diseases such as warts and skin tags in addition to prostate, cervical, skin, bone or liver cancers.[i]

Cryotherapy for Cancer-Related Adverse Effects

Chemotherapy treatments for cancer often result in adverse effects such as oral mucositis -- red, sore mouth and/or gums and open sores in the mouth[ii] -- anorexia, or abnormally low body weight, or peripheral neuropathy -- damaged nerves leading to weakness, numbness and pain usually found in the hands and feet.

In 72 patients with esophageal cancer who were treated with chemotherapy of docetaxel, cisplatin and fluorouracil (DCF), 58 patients received cryotherapy -- where they sucked on ice cubes or chips during their DCF administration -- while 14 received no cryotherapy. The cryotherapy group had significantly lower incidences of mucositis and anorexia compared to the non-cryotherapy group.[iii]

In 50 subjects given chemotherapy for gynecologic cancers, half of the participants were assigned to oral cryotherapy during chemotherapy and the other half were the control group receiving 0.9% normal saline gargles three times before meals. The study revealed that oral cryotherapy was more effective than the usual care regime of saline gargles to reduce oral mucositis, reactive oxygen series and inflammatory cytokines and to improve oral comfort in the cancer subjects.[iv]

From a meta-analysis of 14 trials with 1,577 participants, oral cryotherapy was conclusively associated with a significantly lower risk of developing oral mucositis from cancer chemotherapies and promising but not conclusive evidence for those in a bone marrow transplant setting. More high-quality trials in the future are needed for this setting.[v]

The empirical evidence supports recommendations for oral cryotherapy to prevent oral mucositis in  patients undergoing autologous hematopoietic stem cell transplants either with high-dose melphalan conditioning protocols or bolus 5-fluorouracil chemotherapy in a systematic review of 36 research papers.[vi]

Such transplants are most often indicated in multiple myeloma and lymphoma cancers.[vii] Results of another meta study -- examining 15 research trials involving 919 cancer patients -- provide a scientific basis for oral cryotherapy as a viable treatment to significantly reduce severe oral mucositis.[viii]

To treat the side effect of chemotherapy-induced peripheral neuropathy, a number of studies have shown the significant effectiveness of wearing frozen gloves and socks including research involving 40 breast cancer patients,[ix] 44 women with breast cancer,[x] 39 breast cancer subjects[xi] and 54 early stage breast cancer participants who were in the cryotherapy group compared to the control group.[xii]

Cryotherapy May Relieve Exercise-Induced Effects

Cryotherapy may relieve sleep and muscle issues caused by exercise-induced muscle damage, muscle atrophy and exercise-induced muscle soreness. The use of a three-minute whole body cryotherapy (WBC) session after exercise training in the evening improved subjective and objective sleep quality in 22 physically active men, which is believed to be related to greater pain relief and improved parasympathetic nervous activity during the slow wave sleep period.[xiii]

In a study of 21 physically active men who strength trained for 12 weeks, two days per week, the men had either cold water immersion (CWI) treatment or active recovery (ACT) with low intensive exercise after high-intensity exercising (the control group). Both groups had strength and muscle mass increases in the short run. 

A second trial of nine active men who did single-leg exercises followed by CWI or ACT revealed CWI attenuated more acute changes in satellite cell numbers and activity of kinases that regulate muscle hypertrophy, a large growth in muscle or bulking of the muscle. This translates into smaller but long-term training gains in muscle strength and hypertrophy compared to ACT.[xiv]

Oxidative Stress and Metabolic Markers

Ten sessions of WBC performed in a closed cryochamber for three minutes a day followed by kinesiotherapy or movement therapy for 60 minutes significantly improved the lipid profile and decreased oxidative stress in 16 healthy subjects.[xv]

Researchers studied different temperatures and duration of cryotherapy using a mouse model on oxidative stress markers and found that WBC at a temperature below 60 degrees centigrade (C) may be more beneficial than below 90 degrees C for most of the markers. The highest total antioxidant capacity was observed in the below 60 degrees C for five days rather than 10 days.[xvi]

In a study comparing winter swimmers who ice bathed with healthy people who have never been swimming in winter, winter swimmers were found to have more tolerance to environmental stress and an increased ability to adapt to repeated oxidative stress markers.[xvii]

In a systematic review of 104 studies on voluntary cold water immersion, the treatment seems to reduce and/or transform body adipose tissue, as well as reduce insulin resistance and improve insulin sensitivity, which could protect against cardiovascular diseases, obesity and other metabolic diseases while offering prophylactic or disease-prevention health effects.[xviii]

Arthritis

Nearly 1 in 3 U.S. adults with doctor-diagnosed arthritis -- which includes rheumatoid arthritis, osteoarthritis, fibromyalgia, lupus, gout or ankylosing spondylitis[xix] -- have severe joint pain, fatigue and functional limitations or disabilities.[xx] In a review of six studies with a total of 257 rheumatoid arthritis (RA) patients, chronic cryotherapy resulted in significant decreases in pain and a 28-joint disease activity score.

For molecular pathways, local cryotherapy induced an intra-joint temperature decrease, thought to downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but more molecular studies are needed in RA to verify. Using cryotherapy to treat RA could potentially reduce corticosteroid and nonsteroidal anti-inflammatory drug doses.[xxi]

In a study of 47 patients with various knee inflammation diseases including gout, RA, spondyloarthritis and calcium pyrophosphate dihydrate crystal deposition diseases (CPPD) or pseudogout, local ice cryotherapy significantly reduced pain and inflammation measured by pro-inflammatory cytokines including interleukin six (IL-6), interleukin one beta (IL-1β), vascular endothelial growth factor (VEGF), and impacted signaling mechanism of nuclear factor kappa p65 (NF-kB-p65) and immunity mediation of prostaglandin E2 (PG-E2) synovial levels, especially in the microcrystal-induced arthritis group.

Only phosphorylated NF-kB-p65 significantly decreased in rheumatoid arthritis and spondyloarthritis patients with the ice therapy.[xxii] In a trial of 60 fibromyalgia (FM) patients, those treated with WBC using the Cryosense TCT cabin had decreased pain and disease severity compared to those who just rested (the control) with cryotherapy recommended as a useful complementary FM therapy. [xxiii]

In supervised therapy of 92 ankylosing spondylitis (AS) patients, subjects were assigned to one of three groups for eight days:

  • WBC below 110 degrees C with exercise therapy
  • WBC below 60 degrees C with exercise therapy
  • Exercise therapy alone

WBC at below 110 degrees C with exercise therapy had the most significant AS disease activity reduction compared with the other two groups.[xxiv]

Multiple Sclerosis

Oxidative stress is an important factor that contributes to disease progression in multiple sclerosis (MS). Treatment of 28 MS patients who underwent 10 WBC exposures of below 120 degrees C for three minutes per day resulted in Increased total antioxidative status level of their MS, meaning decreased oxidative stress and MS progression.[xxv]

Dividing 60 MS patients into three groups,  including cryotherapy, physical exercise training and cryotherapy with physical exercise training, research showed that the combined WBC with physical exercise training had the most statistically significant differences in psychosocial well-being, reduction of depressive symptoms and improved functional status of MS.[xxvi]

Depression, Anxiety and Brain Disorders

In a control and study group of 60 outpatients 18 to 65 years old with depression and anxiety disorders who received standard psychopharmacotherapy, the study group was also treated with 15 daily visits to a cryogenic chamber for two to three minutes from below 160 degrees C to below 110 degrees C. After three weeks, scientists observed a decrease of at least 50% from the baseline depression scores in 34.6% of the study group and 2.9% of the control group.

A decrease of at least 50% from the baseline anxiety scores in 46.2% of the study group and in none of the control group for mood and anxiety was also found.[xxvii]

In a trial of 30 adults diagnosed with depressive episodes, those treated with 10 WBC sessions lasting two minutes with temperatures below 110 degrees C to below 135 degrees C within a two-week period showed significant improvement in reduced total scores in scales assessing depressive symptoms, higher quality of life including physical, psychological and environmental health and a significant increase in self-reported well-being.[xxviii]

In a nine-week study of 84 adults aged 60 or older, those given computerized cognitive training alone or combined with 10 sessions of WBC experienced decreased cognitive decline or dysfunction and improvement in several cognitive domains including verbal fluency, learning ability and memory. However, only in the group with combined interventions did the participants show significantly fewer depressive symptoms compared to the control group of no WBC intervention.[xxix]

Alzheimer's disease (AD) -- the most common form of dementia -- is one of the major causes of disability and mortality in aging adults. Mild cognitive impairment is regarded as the first detectable sign of cognitive decline. In their research review, scientists show the mechanisms of cryostimulation and postulate that WBC would be a viable means of preventing AD due to its anti-inflammatory and antioxidative effects.[xxx]

Warts

Common warts are benign growths caused by human papilloma viruses (HPV). One study involved 35 patients with 414 common warts divided into two groups treated either by cryotherapy using liquid nitrogen spray or by 90% trichloroacetic acid (TCA).

The liquid nitrogen cryotherapy group beat the TSA group with significantly better results in the mean percentage of improvement, grade of improvement and complete cure of warts.[xxxi]

Genital warts are a common sexually transmitted disease. Cryotherapy using liquid nitrogen represents the first line of therapy. In a retrospective study, data from 50 women with genital warts who were treated with cryotherapy in a period from 2012 to 2018 were analyzed. Cryotherapy had a high success rate of 78% in healing genital warts, decreased the concentration of HPV virus and removed the trigger that allows the development of cancer.[xxxii]

Two genital warts of 16 male patients each were randomly assigned to receive either cryotherapy using the Wartner mixture of dimethyl ether (75%) and propane (25%) (treatment) or liquid nitrogen cryotherapy (control). The Wartner compound was as effective as the conventional cryotherapy method using liquid nitrogen for treating genital warts.[xxxiii]

Cryotherapy or Not?

Cryotherapy, in its many forms, is considered a safe nontoxic way for many cancer patients undergoing chemotherapy to reduce harmful side effects such as oral mucositis, anorexia and peripheral neuropathy. It may also be helpful to address the negative effects of strenuous exercise and offers support for diseases including certain cancers, arthritis, MS, AD, depression, anxiety and warts.

Cryotherapy is also seen as a preventive strategy to improve metabolic markers and lower oxidative stress, which are highly associated with cardiovascular diseases, diabetes and obesity. On balance, cryotherapy could lift your mood, create better sleep, decrease muscle and joint pain, increase your cognitive abilities and improve your health, so why not try it? To learn more, please visit GreenMedInfo.com for research on cryotherapy and hydrotherapy.


References

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[ii] Oncolink. Support. Side Effects. Gastrointestinal Side Effects. Mucositis. All About Mucositis. https://www.oncolink.org/support/side-effects/gastrointestinal-side-effects/mucositis/all-about-mucositis

[iii] Koichi Okamoto, Itasu Ninomiya, Takahisa Yamaguchi, Shiro Terai, Shinichi Nakanuma, Jun Kinoshita, Isamu Makino, Keishi Nakamura, Tomoharu Miyashita, Hidehiro Tajima, Hiroyuki Takamura, Sachio Fushida, Tetsuo Ohta. Oral cryotherapy for prophylaxis of oral mucositis caused by docetaxel, cisplatin, and fluorouracil chemotherapy for esophageal cancer. Esophagus. 2019 04 ;16(2):207-213. Epub 2019 Jan 1. PMID: 30600487

[iv] Nayeon Shin, Younhee Kang. [The Effects of Oral Cryotherapy on Oral Mucositis, Reactive Oxygen Series, Inflammatory Cytokines, and Oral Comfort in Gynecologic Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial]. J Korean Acad Nurs. 2019 Apr ;49(2):149-160. PMID: 31064968

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[xiii] Wafa Douzi, Olivier Dupuy, Maxence Tanneau, Geoffroy Boucard, Romain Bouzigon, Benoit Dugué. 3-min whole body cryotherapy/cryostimulation after training in the evening improves sleep quality in physically active men. Eur J Sport Sci. 2019 Jul ;19(6):860-867. Epub 2018 Dec 14. PMID: 30551730

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[xviii] Espeland D, de Weerd L, Mercer JB. Health effects of voluntary exposure to cold water - a continuing subject of debate. Int J Circumpolar Health. 2022 Dec;81(1):2111789. doi: 10.1080/22423982.2022.2111789. PMID: 36137565; PMCID: PMC9518606.

[xix] Kelley GA, Kelley KS, Hootman JM, Jones DL. Effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases: a meta-analysis. Arthritis Care Res (Hoboken). 2011 Jan;63(1):79-93. doi: 10.1002/acr.20347. PMID: 20824798.

[xx] Duca LM, Helmick CG, Barbour KE, Murphy LB, Guglielmo D, Odom EL, et al. State-Specific Prevalence of Inactivity, Self-Rated Health Status, and Severe Joint Pain Among Adults With Arthritis -- United States, 2019. Prev Chronic Dis 2022;19:210346. DOI: 10.5888/pcd19.210346

[xxi] Xavier Guillot, Nicolas Tordi, Laurent Mourot, Céline Demougeot, Benoît Dugué, Clément Prati, Daniel Wendling. Cryotherapy in inflammatory rheumatic diseases: a systematic review. Expert Rev Clin Immunol. 2014 Feb ;10(2):281-94. Epub 2013 Dec 18. PMID: 24345205

[xxii] X Guillot, N Tordi, C Laheurte, L Pazart, C Prati, P Saas, D Wendling. Local ice cryotherapy decreases synovial interleukin 6, interleukin 1β, vascular endothelial growth factor, prostaglandin-E2, and nuclear factor kappa B p65 in human knee arthritis: a controlled study. Arthritis Res Ther. 2019 Jul 30 ;21(1):180. Epub 2019 Jul 30. PMID: 31362785

[xxiii] Javier Rivera, María José Tercero, Javier Salas Salas, Julio Hernández Gimeno, Javier Sánchez Alejo. The effect of cryotherapy on fibromyalgia: a randomised clinical trial carried out in a cryosauna cabin. Rheumatol Int. 2018 12 ;38(12):2243-2250. Epub 2018 Oct 23. PMID: 30353267

[xxiv] Mateusz Wojciech Romanowski, Anna Straburzyńska-Lupa. Is the whole-body cryotherapy a beneficial supplement to exercise therapy for patients with ankylosing spondylitis? J Back Musculoskelet Rehabil. 2019 Sep 20. Epub 2019 Sep 20. PMID: 31594196

[xxv] Elzbieta Miller, Małgorzata Mrowicka, Katarzyna Malinowska, Józef Kedziora, Ireneusz Majsterek. The effects of whole-body cryotherapy and melatonin supplementation on total antioxidative status and some antioxidative enzymes in multiple sclerosis patients. Pol Merkur Lekarski. 2011 Sep ;31(183):150-3. PMID: 21991843

[xxvi] Malwina Pawik, Joanna Kowalska, Joanna Rymaszewska. The effectiveness of whole-body cryotherapy and physical exercises on the psychological well-being of patients with multiple sclerosis: A comparative analysis. Adv Clin Exp Med. 2019 Nov ;28(11):1477-1483. PMID: 30968613

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[xxviii] Joanna Rymaszewska, Katarzyna Urbanska, Dorota Szcześniak, Tomasz Pawłowski, Karolina Pieniawska-Śmiech, Izabela Kokot, Lilla Pawlik-Sobecka, Sylwia Płaczkowska, Agnieszka Zabłocka, Bartłomiej Stańczykiewicz. Whole-body cryotherapy - promising add-on treatment of depressive disorders. Psychiatr Pol. 2019 Oct 30 ;53(5):1053-1067. Epub 2019 Oct 30. PMID: 31955185

[xxix] Senczyszyn A, Wallner R, Szczesniak DM, Łuc M, Rymaszewska J. The Effectiveness of Computerized Cognitive Training Combined With Whole Body Cryotherapy in Improving Cognitive Functions in Older Adults. A Case Control Study. Front Psychiatry. 2021 Jun 25;12:649066. doi: 10.3389/fpsyt.2021.649066. PMID: 34248698; PMCID: PMC8267365.

[xxx] Misiak B, Kiejna A. Translating whole-body cryotherapy into geriatric psychiatry--a proposed strategy for the prevention of Alzheimer's disease. Med Hypotheses. 2012 Jul;79(1):56-8. doi: 10.1016/j.mehy.2012.03.033. Epub 2012 Apr 26. PMID: 22541861

[xxxi] Azza Mahfouz Abdel Meguid, Amira Ali Abdel Motaleb, Amany Mohamed Ibrahim Abdel Sadek. Cryotherapy vs trichloroacetic acid 90% in treatment of common warts. J Cosmet Dermatol. 2019 Apr ;18(2):608-613. Epub 2018 Oct 24. PMID: 30358072

[xxxii] Mahira Jahic. Cryotherapy of Genital Warts. Mater Sociomed. 2019 Sep ;31(3):212-214. PMID: 31762705

[xxxiii] A Firooz, H Hosseini, L Izadi Firouzabadi, M Nassiri Kashani, S A Nasrollahi. The efficacy and safety of other cryotherapy compounds for the treatment of genital warts: a randomized controlled trial. J Dermatolog Treat. 2019 Mar ;30(2):176-178. Epub 2018 Jun 27. PMID: 29790804

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