Cold therapy for fibromyalgia
Evidence review
Overview
No clinical trial of cold-water immersion, cold plunge or cold showers in fibromyalgia was found. Trials of whole-body cryotherapy (WBC), 1-3 minutes of cold air at about -89 to -202 F in a chamber, mostly report short-term improvements in pain, disease impact, sleep and quality of life, including a randomized trial in 43 patients with fibromyalgia and obesity in which WBC was added to rehabilitation. Results are not uniform: in a German comparison with peat baths and hot air (n=66), pain fell similarly in both groups and 53% stopped cryotherapy, including for panic symptoms, and an older 10-patient study found no significant pain advantage over controls. Benefits faded within about 3-4 months after a course ended, and WBC findings cannot be assumed to apply to water immersion.
Key findings
- No cold-water immersion trials in fibromyalgia identified.
- WBC RCT, n=43 with fibromyalgia and obesity: ten 2-min sessions at -166 F added to rehabilitation gave greater improvement in pain, depression, FIQ and sleep than rehabilitation alone; no difference in physical function (Varallo 2022).
- WBC randomized crossover, n=60: first-period pain VAS change 3.0 vs 0.3 and FIQ change 32.1 vs 0.4 vs rest (all p<0.001) (Rivera 2018).
- WBC controlled trial, n=100: greater quality-of-life improvement with 15 sessions than without (Bettoni 2013).
- WBC at -166 F vs peat baths and hot air, n=66: pain fell in both groups with no significant difference; 20 of 38 (53%) stopped cryotherapy for pain increase, lack of effect, panic symptoms or skin changes (Kurzeja 2003).
- Single cold-chamber exposure at -89 F, crossover n=17: current pain and well-being improved by 12-32% (Gutenbrunner 1999).
- Durability: no clinical benefit 3 months after stopping (Klemm 2021); patients recalled added benefit lasting 3-4 months (Verme 2024).
Every study we reviewed
6 found benefit · 3 mixed results
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 24 studies on fibromyalgia, across all heat and cold therapies, including case reports and older work not graded here.
The effect of cryotherapy on fibromyalgia: a randomised clinical trial carried out in a cryosauna cabin.
Rivera J et al. Rheumatol Int. 2018. PubMed 30353267 · DOI · Free full text
- Who
- patients meeting ACR fibromyalgia criteria from general practice
- What
- WHOLE-BODY CRYOTHERAPY (cryo chamber, cold air; not water immersion) vs rest
- Measured
- pain VAS, FIQ, severity index (ICAF)
- Result
- Period effect with carryover, so only first-period data analyzed: change in pain VAS 3.0 vs 0.3, FIQ 32.1 vs 0.4, ICAF 13.7 vs 0.07 (all p<0.001).
- Limitations
- different modality; open-label; first-period-only analysis; one author held stock in the device developer
Serial whole-body cryotherapy in fibromyalgia is effective and alters cytokine profiles.
Klemm P et al. Adv Rheumatol. 2021. PubMed 33436106 · DOI · Free full text
- Who
- 23 fibromyalgia patients and 30 healthy controls
- What
- WHOLE-BODY CRYOTHERAPY (cryo chamber, cold air; not water immersion): 6 sessions
- Protocol
- -202 (cryo chamber air) °F · 6 wk
- Measured
- pain VAS (primary), revised FIQ, cytokines
- Result
- Significant reduction in pain and disease activity after 3 and 6 sessions; no clinical benefit 3 months after discontinuation; cytokine responses differed from controls.
- Limitations
- different modality; no fibromyalgia control group; effect not durable
Effect of whole body cryotherapy interventions on health-related quality of life in fibromyalgia patients: A randomized controlled trial.
Vitenet M et al. Complement Ther Med. 2018. PubMed 29458933 · DOI
- Who
- patients with diagnosed fibromyalgia
- What
- WHOLE-BODY CRYOTHERAPY (cryo chamber; not water immersion): 10 sessions over 8 days plus usual care vs usual care
- Measured
- health-related quality of life
- Result
- Significantly improved health-related quality of life vs control, lasting at least 1 month; effect sizes not reported in abstract.
- Limitations
- different modality; very small; unblinded; erratum published (Complement Ther Med 2018;38:92-93)
Is Whole-Body Cryostimulation an Effective Add-On Treatment in Individuals with Fibromyalgia and Obesity? A Randomized Controlled Clinical Trial.
Varallo G et al. J Clin Med. 2022. PubMed 35893415 · DOI · Free full text
- Who
- Patients with fibromyalgia and obesity in inpatient multidisciplinary rehabilitation (Italy)
- What
- WHOLE-BODY CRYOTHERAPY chamber, ten 2-min sessions at -166 F (-110 C) over 2 weeks, added to rehabilitation vs rehabilitation alone
- Protocol
- -166 °F · 2 min · 5/wk · 2 wk
- Measured
- Pain severity, depressive symptoms, FIQ disease impact, sleep quality, performance-based physical function
- Result
- Both groups improved; WBC group had greater improvements in pain, depressive symptoms, disease impact and sleep quality; no between-group difference in physical function (effect sizes not in abstract)
- Limitations
- Small; unblinded; patients with obesity only; add-on to inpatient rehabilitation; WBC, not cold-water immersion
Whole-Body Cryostimulation: An Effective Complementary Treatment in Fibromyalgia? A Follow Up Study.
Verme F et al. J Pers Med. 2024. PubMed 39202027 · DOI · Free full text
- Who
- Patients with fibromyalgia and obesity 12 months after inpatient rehabilitation (Italy)
- What
- WHOLE-BODY CRYOTHERAPY, ten 2-min sessions at -166 F (-110 C) during rehabilitation (n=23) vs rehabilitation alone (n=23); telephone follow-up
- Protocol
- -166 °F · 2 min · 5/wk · 2 wk
- Measured
- Recalled duration of benefit for pain, well-being, sleep, fatigue, mood, anxiety; medication use
- Result
- Both groups reported improvement; the WBC group reported additional benefit in pain, general well-being and sleep lasting 3-4 months; fatigue, mood and anxiety similar
- Limitations
- Retrospective recall by telephone; small; WBC, not cold-water immersion
Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients.
Bettoni L et al. Clin Rheumatol. 2013. PubMed 23636794 · DOI
- Who
- Patients with fibromyalgia aged 17-70 continuing usual drug therapy (Italy)
- What
- WHOLE-BODY CRYOTHERAPY, 15 consecutive sessions (n=50) vs no cryotherapy (n=50)
- Measured
- Pain VAS, SF-36, global health status, fatigue severity
- Result
- Greater improvement in quality-of-life indexes with WBC than without (numeric results not in abstract)
- Limitations
- Not randomized; numeric effects not in abstract; WBC, not cold-water immersion
Primary fibromyalgia: comparison of cold chamber therapy with two classical heat therapy methods
Kurzeja R et al. Aktuelle Rheumatologie. 2003. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Primäre Fibromyalgie: Vergleich der Kältekammertherapie mit zwei klassischen Wärmetherapieverfahren
- Who
- Inpatients with primary fibromyalgia (ACR criteria) in a rheumatology and rehabilitation clinic (Germany); tricyclics, analgesics and NSAIDs allowed
- What
- WHOLE-BODY CRYOTHERAPY chamber at -166 F (-110 C) (n=38) vs daily alternating peat (moor) baths and hot-air treatment (n=28)
- Protocol
- -166 °F
- Measured
- Pain intensity (VAS), patient self-assessment, tender point count
- Result
- Pain intensity fell substantially in both groups, slightly more with cryotherapy, but the difference was not significant; 20 of 38 (53%) stopped cryotherapy because of increased pain, lack of effect, panic symptoms or skin changes; among completers, self-rated good outcome was 72% with cryotherapy vs 29% with heat
- Limitations
- Allocation method not described as randomized; active heat comparator rather than no-treatment control; 53% dropout in the cryotherapy arm with completer-only self-assessment; German-language abstract (translated by us); WBC, not cold-water immersion
Analgesic effects of natural sulphur baths and cold chamber exposure in fibromyalgia
Gutenbrunner C et al. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 1999. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Analgetische Wirkungen von natürlichen Schwefelbädern und Kältekammerexpositionen bei Fibromyalgie
- Who
- Patients with fibromyalgia syndrome (ACR criteria), Germany
- What
- Single WHOLE-BODY CRYOTHERAPY chamber exposure at -89 F (-67 C) for 1-3 min vs a thermoindifferent natural sulphur (H2S) full bath for 20 min vs a sham session without application, compared within patients
- Protocol
- -89 °F · 1-3 min
- Measured
- Pressure, heat-pain and cold-pain thresholds; current pain intensity and well-being (VAS)
- Result
- Pain thresholds rose after the cold chamber as after the sulphur bath, but the heat-pain threshold rose significantly less after the cold chamber (p<0.05); the cold-chamber effect did not appear on the shielded arm; current pain intensity and well-being improved after both applications (-12 to -32%)
- Limitations
- Single applications with immediate outcomes only; 17 patients; sham comparison not detailed in the abstract; chamber at -89 F, colder chambers are now typical; WBC, not cold-water immersion
Whole-body cryotherapy: a new option in the treatment concept of generalized tendomyopathy (GTM)
Stratz T et al. Generalisierte Tendomyopathie (Fibromyalgie) (book, Steinkopff). 1991. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Ganzkörperkältetherapie — Eine neue Möglichkeit im Therapiekonzept der generalisierten Tendomyopathie (GTM)
- Who
- 10 patients with fibromyalgia given whole-body cryotherapy and a control group (size not stated) given the same treatment without cryotherapy
- What
- WHOLE-BODY CRYOTHERAPY added to a treatment program vs the same program without cryotherapy
- Measured
- Spontaneous pain, tender-point pressure pain, vegetative and functional symptoms, sleep quality, mood and anxiety scales
- Result
- Clear pain relief in 6 of 10 patients lasting up to 4 weeks, but not significant vs controls; mood and anxiety scales did not differ significantly from controls; vegetative and functional symptoms and sleep quality improved significantly vs controls
- Limitations
- Book chapter; 10 treated patients; control group size and allocation not described; protocol not given in the abstract; WBC, not cold-water immersion
Protocols used in the studies
All fibromyalgia trials used whole-body cryotherapy chambers: mostly -166 F (-110 C) or -202 F (-130 C) air (one older study -89 F, -67 C), 1-3 minutes per session, single sessions or 6-15 sessions over 1-6 weeks, often added to inpatient rehabilitation. No water-immersion protocol has been tested in this population.
What is still unknown
Whether cold-water immersion has any effect in fibromyalgia; tolerability given altered cold pain processing and reported panic symptoms in cold chambers; maintenance schedules after a WBC course; blinded or sham-controlled trials; comparison with heat- and exercise-based care.
Safety
Cautions for cold therapy in this condition
- In a German inpatient comparison, 20 of 38 patients (53%) stopped whole-body cryotherapy because of increased pain, lack of effect, panic symptoms or skin changes (Kurzeja 2003, DOI 10.1055/s-2003-40442).
- Altered cold pain processing is common in fibromyalgia; tolerability of repeated cold-water immersion has not been studied.
- 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 added to rehabilitation improved pain, disease impact and sleep in a randomized trial in fibromyalgia (Varallo 2022), but benefits were short-lived after stopping (Klemm 2021), tolerance varied (53% dropout in one inpatient study, Kurzeja 2003), and there is no direct trial evidence for cold-water immersion or a home cold plunge in fibromyalgia.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: M79.7. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others