Cold therapy for chronic pain syndrome
Evidence review
Overview
Studies of cold therapy in mixed chronic pain populations have used whole-body cryotherapy (WBC), a few minutes of cold air at about -157 F in a chamber, which is a different method from a home cold plunge. Uncontrolled series report pain relief lasting about 90 minutes after each session and improved mood and well-being after 10 sessions. In a controlled inpatient pilot, adding WBC to multimodal pain treatment did not produce more pain reduction than multimodal treatment alone. No cold-water immersion study in chronic pain was found.
Key findings
- Controlled pilot, n=61: pain fell more than 1.39 NRS points in both the WBC and non-WBC groups; calprotectin fell with WBC (p=0.032) (Ritter 2025).
- Uncontrolled, n=120 mixed rheumatic pain: pain fell after each WBC session, with relief lasting about 90 minutes; no further improvement in the second half of 4 weeks (Metzger 2000).
- Uncontrolled, n=55 spinal or joint pain: quality of life (p=0.005) and well-being (p<0.001) improved after 10 sessions (Szczepańska-Gieracha 2014).
- No cold-water immersion or cold plunge study in chronic pain identified.
Every study we reviewed
1 found no effect · 2 mixed results · 1 found benefit
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 26 studies on chronic pain and musculoskeletal conditions, across all heat and cold therapies, including case reports and older work not graded here.
Analgesia by Cryotherapy in Patients with Chronic Pain with Analysis of Pain-Modulating and Pro-Inflammatory Parameters-A Clinical Controlled Pilot Study.
Ritter H et al. J Clin Med. 2025. PubMed 41226964 · DOI · Free full text
- Who
- Inpatients with chronic pain in a multimodal pain program (Germany)
- What
- WHOLE-BODY CRYOTHERAPY added to multimodal inpatient pain treatment (n=37) vs multimodal treatment without WBC (n=24)
- Measured
- Pain NRS; serum substance P, calprotectin, beta-NGF, CGRP
- Result
- Both groups had a mean pain reduction of more than 1.39 NRS points; calprotectin fell in the WBC subgroup (p=0.032); among patients without meaningful pain reduction, calprotectin fell more with WBC than without (p=0.042); no change in neuropeptides
- Limitations
- Pilot; not randomized; pain improved in both groups; WBC, not cold-water immersion
[Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases--pilot study].
Metzger D et al. Rehabilitation (Stuttg). 2000. PubMed 10832164 · DOI
- Who
- Consecutive rehabilitation inpatients: fibromyalgia 44%, rheumatoid arthritis 17%, chronic low back pain 16%, ankylosing spondylitis 11%, osteoarthritis 9% (Germany)
- What
- WHOLE-BODY CRYOTHERAPY closed chamber, mean 2.5 min, over a 4-week rehabilitation stay
- Protocol
- -157 °F · 2.5 min · 4 wk
- Measured
- Pain rating before and after sessions, tolerability
- Result
- Pain fell significantly after each session, with relief lasting about 90 minutes; baseline pain fell over the stay but not significantly from the middle to the end of the 4 weeks; well tolerated
- Limitations
- Uncontrolled; mixed diagnoses; short-lived per-session effect; German-language; WBC, not cold-water immersion
Mental state and quality of life after 10 session whole-body cryotherapy.
Szczepańska-Gieracha J et al. Psychol Health Med. 2014. PubMed 23535078 · DOI
- Who
- Patients with spinal pain syndromes (34) or peripheral joint disease (21) (Poland)
- What
- WHOLE-BODY CRYOTHERAPY, 10 sessions
- Measured
- Quality of life (WHOQOL-Bref), psychological well-being (PGWBI)
- Result
- WHOQOL-Bref (p=0.005) and PGWBI (p<0.001) improved; effects largest in women, spinal pain patients and those with severe depressive symptoms
- Limitations
- Uncontrolled; mood and quality-of-life outcomes only; WBC, not cold-water immersion
[The influence of cryochamber on parameters of blood pressure and pulse].
Szczepanowska-Wołowiec B et al. Przegl Lek. 2010. PubMed 20684337
- Who
- Rehabilitation inpatients with chronic pain from degenerative joint changes (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber combined with exercise, 10 sessions
- Measured
- Heart rate and blood pressure
- Result
- Resting heart rate 66.5 to 63.1 bpm (p<0.001); abstract reports systolic pressure 118.7 to 119.9 mmHg while describing a significant reduction
- Limitations
- Uncontrolled; cardiovascular safety outcomes only; internally inconsistent blood-pressure reporting in abstract; Polish-language; WBC, not cold-water immersion
Protocols used in the studies
Whole-body cryotherapy chambers at about -157 F (-105 C), about 2.5 minutes per session, 10 sessions or daily use over a 4-week rehabilitation stay, combined with exercise or multimodal pain treatment.
What is still unknown
Randomized trials with pain as the primary outcome; which chronic pain diagnoses respond; whether brief post-session relief helps patients engage in exercise therapy; whether cold-water immersion has any effect.
Safety
Cautions for cold therapy in this condition
- Whole-body cryotherapy was well tolerated in a 120-patient rehabilitation series (PMID 10832164).
- Resting heart rate fell after a course of WBC with exercise; blood-pressure reporting in that abstract is internally inconsistent (PMID 20684337).
- Whole-body cryotherapy contraindications and adverse events (16 documented across case reports and RCTs) are specific to cold-air chambers and do not transfer directly to cold-water immersion (Legrand 2023, PMID 37770960). See general cold safety entry.
For clinicians
Suggested rationale
Whole-body cryotherapy gives short-lived pain relief after each session in mixed chronic pain (Metzger 2000), but it did not improve pain beyond multimodal treatment alone in a controlled pilot (Ritter 2025); evidence for cold-water immersion in chronic pain is lacking.
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Typical ICD-10 codes: G89.4, G89.29. Examples only; the clinician assigns the code.
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