Cold therapy for myalgic encephalomyelitis / chronic fatigue syndrome
Evidence review
Overview
In a Polish study, 32 patients with chronic fatigue syndrome completed 10 sessions of whole-body cryotherapy (brief extreme cold air in a chamber) combined with static stretching over 2 weeks. Fatigue decreased and some cognitive measures improved, and WBC was well tolerated; at 4 weeks the improvements were maintained in most of the 22 patients reassessed. There was no untreated or sham control, stretching was given to all, and cold-water immersion has not been studied in ME/CFS.
Key findings
- WBC plus stretching, 32 CFS patients: significant decrease in fatigue and improvements in processing speed and set-shifting; well tolerated (Kujawski 2022)
- 4-week follow-up: all three fatigue scales improved in 17 of 22 reassessed patients (Kujawski 2023)
Every study we reviewed
2 found benefit
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 10 studies on chronic fatigue syndrome (me/cfs), across all heat and cold therapies, including case reports and older work not graded here.
Combination of whole body cryotherapy with static stretching exercises reduces fatigue and improves functioning of the autonomic nervous system in Chronic Fatigue Syndrome.
Kujawski S et al. J Transl Med. 2022. PubMed 35715857 · DOI · Free full text
- Who
- 32 patients with chronic fatigue syndrome and 18 healthy controls
- What
- whole-body cryotherapy chamber (WBC; cold air, not water immersion) plus static stretching, 10 sessions over 2 weeks
- Protocol
- 5/wk · 2 wk
- Measured
- fatigue, daytime sleepiness, cognitive function, autonomic and cardiovascular function; tolerability
- Result
- Fatigue decreased significantly in the CFS group; processing speed and set-shifting improved in both groups; WBC was well tolerated.
- Limitations
- no untreated CFS control; unblinded; WBC effect not separable from stretching; effect sizes not given in abstract
Effects of whole-body cryotherapy and static stretching are maintained 4 weeks after treatment in most patients with chronic fatigue syndrome.
Kujawski S et al. Cryobiology. 2023. PubMed 37230457 · DOI · Free full text
- Who
- patients with chronic fatigue syndrome followed up 4 weeks after WBC plus stretching (same program as Kujawski 2022)
- What
- whole-body cryotherapy chamber (WBC; cold air, not water immersion) plus static stretching, 10 sessions
- Protocol
- 5/wk · 2 wk
- Measured
- fatigue scales (CFQ, FIS, FSS), cognitive tests, aortic stiffness, autonomic function at 4 weeks
- Result
- Reductions in fatigue, aortic stiffness indicators and autonomic symptoms, and cognitive improvements, were maintained at 1 month; all three fatigue scales improved in 17 of 22. Ten initially treated patients were not assessed.
- Limitations
- same cohort as Kujawski 2022; 10 of 32 lost to follow-up; no control; authors advise caution
Protocols used in the studies
Whole-body cryotherapy chamber sessions (temperature not given in the abstracts) followed by static stretching, 5 sessions per week for 2 weeks (10 sessions). No cold-water immersion protocol has been studied.
What is still unknown
Sham-controlled trials separating WBC from stretching; use of current ME/CFS diagnostic criteria; durability beyond 1 month; risk of post-exertional malaise; whether cold-water immersion has any role.
Safety
Cautions for cold therapy in this condition
- WBC was well tolerated by patients with CFS in a supervised program (PMID 35715857).
- Post-exertional symptom exacerbation and orthostatic intolerance are common in ME/CFS; any program should start gradually and be monitored.
- See general cold safety entry.
For clinicians
Suggested rationale
An uncontrolled study of whole-body cryotherapy plus static stretching in chronic fatigue syndrome (Kujawski 2022) reported reduced fatigue that was largely maintained at 4 weeks; controlled trials are lacking and the findings do not extend to cold-water immersion.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: G93.3, G93.32. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others