Cold therapy for multiple sclerosis (including heat sensitivity / Uhthoff phenomenon)
Evidence review
Overview
Two different cold approaches have been studied in MS. Cooling for heat sensitivity: lowering body temperature can reduce heat-related conduction block, and a sham-controlled RCT and a meta-analysis support cooling garments, while water immersion has been tested only as 30 minutes of lower-body pre-cooling in 61-63 F water in 6 patients. Whole-body cryotherapy (WBC: 2-3 minutes in a cryogenic chamber at about -166 to -202 F) has been studied mainly by a few Polish groups: one randomized trial and several controlled or uncontrolled series report reductions in fatigue, EDSS or spasticity and improved hand grip, gait, mood, pain or sleep after 10-20 sessions, while most biochemical studies found no change. No serious adverse events were reported, and one study found no prothrombotic effect. Patient surveys also report that sharp cooling can worsen symptoms. A randomized pilot of a 12-week program combining cold exposure with breathing exercises and mindfulness reported better cognition, fatigue, anxiety and depression scores than no intervention, but did not isolate cold. This is not evidence for cold plunge at typical plunge temperatures, and cold is not a disease-modifying therapy.
Key findings
- Crossover, 6 heat-sensitive MS patients: 30-min lower-body immersion in 61-63 F water before exercise lowered rectal temperature and limited post-exercise decline in 25-ft walk and fatigue (White 2000).
- Sham-controlled RCT (cooling garment, not immersion), 84 patients: high-dose cooling improved MS Functional Composite by 0.076 (p=0.007) (Schwid 2003).
- Meta-analysis (cooling garments), 13 studies, 384 participants: improved walking capacity and mobility, no harm reported (Stevens 2023).
- WBC RCT, 51 patients: 20 sessions reduced EDSS and spasticity, with only slight balance change; authors judged WBC without kinesiotherapy insufficient (Staszkiewicz 2025).
- WBC controlled study, 114 patients: after 20 sessions, hand grip (p<0.001), gait (p=0.001) and fatigue (p=0.024) improved; no change in controls (Radecka 2021).
- WBC alone vs exercise vs both (60 patients, two trials): combined WBC plus exercise gave the largest gains; between-group differences in strength were limited (Pawik 2019; Pawik 2026).
- Biomarker studies of 20 WBC sessions in women with MS found no change in oxidant-antioxidant balance, antioxidant enzymes, blood rheology or neuroplasticity markers (Ptaszek 2021-2023).
- Questionnaire, 125 patients: about half reported improvement in a cold bath (Brenneis 1979); sharp cooling worsened status in a 105-patient report (Zavalishin 1983).
- Randomized pilot, 25 completers: 12-week program combining cold exposure, breathing and mindfulness improved cognition, fatigue, anxiety and depression scores vs no intervention (Slezáková 2025); cold was not isolated.
Every study we reviewed
11 found benefit · 8 mixed results · 5 found no effect
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 37 studies on multiple sclerosis, across all heat and cold therapies, including case reports and older work not graded here.
Effect of precooling on physical performance in multiple sclerosis.
White AT et al. Mult Scler. 2000. PubMed 10871829 · DOI
- Who
- thermosensitive patients with MS
- What
- lower-body water immersion (pre-cooling) before 30 min of exercise at 60% VO2max vs no pre-cooling
- Protocol
- 61-63 °F · 30 min
- Measured
- rectal temperature, heart rate, RPE, 25-ft walk, fatigue
- Result
- Rectal temperature, heart rate and RPE significantly lower during pre-cooled exercise; 25-ft walk and fatigue deteriorated significantly more after non-cooled exercise.
- Limitations
- n=6; acute single-session; partial immersion in cool rather than cold water
A randomized controlled study of the acute and chronic effects of cooling therapy for MS.
Schwid SR et al. Neurology. 2003. PubMed 12821739 · DOI
- Who
- patients with definite MS, EDSS <6.0, self-reported heat sensitivity
- What
- LIQUID COOLING GARMENT (not water immersion): high-dose vs low-dose (sham) cooling for 1 h, then daily 1-h use for 1 month vs observation
- Protocol
- 60 min · 7/wk · 4 wk
- Measured
- MS Functional Composite, visual function, fatigue
- Result
- High-dose cooling: MSFC +0.076 (p=0.007); low-dose: trend (p=0.09); difference between conditions not significant. Timed gait and visual function improved in both; less fatigue during the month of daily cooling.
- Limitations
- different modality; modest effect size; no significant difference vs low-dose cooling
The effect of cooling garments to improve physical function in people with multiple sclerosis: A systematic review and meta-analysis.
Stevens CJ et al. Mult Scler Relat Disord. 2023. PubMed 37499339 · DOI · Free full text
- Who
- people with MS, EDSS 1-7.5 (13 studies)
- What
- COOLING GARMENTS (liquid-perfused or phase-change vests, hoods, cuffs; not water immersion)
- Measured
- walking capacity, functional mobility, strength, balance, fatigue
- Result
- Cooling garments improved walking capacity and functional mobility, with some studies showing better strength and balance; core and skin temperature, thermal sensation and subjective fatigue improved; no garment caused harm.
- Limitations
- different modality; pooled effect sizes not reported in abstract; mostly acute crossover studies
Effect of whole-body cryotherapy on body balance in patients with multiple sclerosis.
Staszkiewicz R et al. Acta Bioeng Biomech. 2025. PubMed 40544467 · DOI · Free full text
- Who
- people with MS, EDSS 3.5-6.5, spasticity 0-3 on modified Ashworth scale
- What
- whole-body cryotherapy chamber, 20 daily sessions without kinesiotherapy (n=33) vs control (n=18)
- Protocol
- daily/wk · about 4
- Measured
- EDSS, spasticity (modified Ashworth), static balance on stabilometric platform
- Result
- 20 WBC sessions significantly reduced EDSS and spasticity on both sides; balance improved only slightly. Authors concluded WBC without targeted kinesiotherapy is not sufficient for clear, measurable rehabilitation benefit.
- Limitations
- unblinded; no sham; between-group statistics not given in abstract; unequal arms
Combined Whole-Body Cryotherapy and Exercise vs Exercise Alone for Lower Limb Strength and Mobility in Multiple Sclerosis.
Pawik M et al. Med Sci Monit. 2026. PubMed 42538730 · DOI · Free full text
- Who
- people with MS
- What
- three groups of 20: whole-body cryotherapy chamber plus exercise, WBC alone, or exercise alone
- Measured
- isokinetic knee strength, Rivermead Mobility Index
- Result
- Knee flexor and extensor strength improved in the WBC plus exercise group; selected parameters also improved with WBC alone and exercise alone. Authors state differences between groups were limited.
- Limitations
- small groups; randomization not described in abstract; short duration
The effectiveness of whole-body cryotherapy and physical exercises on the psychological well-being of patients with multiple sclerosis: A comparative analysis.
Pawik M et al. Adv Clin Exp Med. 2019. PubMed 30968613 · DOI · Free full text
- Who
- people with MS
- What
- three groups: whole-body cryotherapy chamber alone, exercise training alone, or WBC plus exercise, for 14 days
- Protocol
- 2 wk
- Measured
- Psychological General Well-Being Index, Hospital Anxiety and Depression Scale, Rivermead Mobility Index
- Result
- Psychosocial well-being improved significantly in the exercise and WBC-plus-exercise groups; the WBC-alone group showed reduced depressive symptoms and improved functional status; the largest improvement was with WBC plus exercise.
- Limitations
- randomization not described; no sham; short follow-up; effect sizes not given in abstract
Adaptive changes in muscle activity after cryotherapy treatment: Potential mechanism for improvement the functional state in patients with multiple sclerosis.
Radecka A et al. NeuroRehabilitation. 2021. PubMed 33386821 · DOI
- Who
- people with MS (mean age 45)
- What
- whole-body cryotherapy chamber, 20 sessions (n=74) vs no WBC (n=40)
- Measured
- surface EMG, hand grip strength, Timed 25-Foot Walk, Fatigue Severity Scale
- Result
- After 20 sessions: hand grip increased (p<0.001), gait improved (p=0.001), fatigue decreased (p=0.024), with changes in resting and voluntary EMG amplitude; no significant changes in the control group.
- Limitations
- allocation method not described in abstract; unblinded; no sham
Impact of Whole-Body Cryotherapy on Pain, Sleep Quality, Functional Status, and Quality of Life in Multiple Sclerosis: A Comparative Study with Follow-Up.
Zielińska-Nowak E et al. J Pers Med. 2025. PubMed 39997323 · DOI · Free full text
- Who
- 30 people with MS and 43 without neurological disease
- What
- whole-body cryotherapy chamber, 10 sessions over 2 weeks
- Protocol
- -184 to -202 °F · 5/wk · 2 wk
- Measured
- pain (NRS), 30-second chair stand, Timed Up and Go, Pittsburgh Sleep Quality Index, WHOQOL-BREF, with 10-day follow-up
- Result
- In MS, pain, chair stand, one WHOQOL domain and sleep quality improved after treatment; only chair stand and one WHOQOL domain remained improved at 10-day follow-up. No deterioration in any parameter.
- Limitations
- no untreated MS control; unblinded; short follow-up; effect sizes not given in abstract
Whole-body cryostimulation (cryotherapy) provides benefits for fatigue and functional status in multiple sclerosis patients. A case-control study.
Miller E et al. Acta Neurol Scand. 2016. PubMed 26778452 · DOI · Free full text
- Who
- people with MS and fatigue: 24 low-fatigue and 24 high-fatigue, matched for age and sex
- What
- whole-body cryotherapy chamber, one exposure per day
- Protocol
- -166 or colder °F · daily/wk
- Measured
- Fatigue Severity Scale, Rivermead Motor Assessment, MSIS-29, EDSS
- Result
- Functional status and fatigue improved significantly in both groups; changes were greater in high-fatigue patients for MSIS-29 physical and psychological scores and two Rivermead sections.
- Limitations
- no untreated control (both groups received WBC despite 'case-control' title); unblinded
Long-term effects of whole body cryostimulation on uric acid concentration in plasma of secondary progressive multiple sclerosis patients.
Miller E et al. Scand J Clin Lab Invest. 2013. PubMed 24219650 · DOI
- Who
- 22 people with secondary progressive MS and 22 healthy controls
- What
- whole-body cryotherapy chamber, 10 daily 3-minute exposures
- Protocol
- 3 min · daily/wk · 2 wk
- Measured
- plasma uric acid, EDSS, at 1 and 3 months
- Result
- Uric acid rose after 10 exposures (p<0.0001) and remained higher at 1 and 3 months; EDSS was 7% lower directly after and 5% lower at 3 months.
- Limitations
- no untreated MS control; small; surrogate marker
[Cryostimulation factor supporting rehabilitation patients with multiple sclerosis and fatigue syndrome].
Miller E et al. Wiad Lek. 2010. PubMed 20941916
- Who
- people with MS, with (n=24) or without (n=36) fatigue syndrome (Polish report)
- What
- cryostimulation (whole-body) plus individual exercise program, all patients
- Measured
- EDSS, Fatigue Severity Scale, Lovett muscle strength
- Result
- Patients with fatigue syndrome had a greater decrease in EDSS and greater gains in quadriceps and iliopsoas strength than patients without fatigue (p=0.05).
- Limitations
- all patients received cryostimulation; comparison is between fatigue subgroups, not against a non-cryotherapy control
Effects of the whole-body cryotherapy on a total antioxidative status and activities of some antioxidative enzymes in blood of patients with multiple sclerosis-preliminary study.
Miller E et al. J Med Invest. 2010. PubMed 20299758 · DOI · Free full text
- Who
- 32 people with MS (16 WBC plus exercise, 16 exercise only) and 20 healthy subjects
- What
- whole-body cryotherapy chamber, 10 daily 2-3 minute exposures plus exercise vs exercise alone
- Protocol
- -166 to -184 °F · 2-3 min · daily/wk · 2 wk
- Measured
- plasma total antioxidative status, erythrocyte SOD and catalase
- Result
- Total antioxidative status increased after 2 weeks of WBC relative to the exercise-only MS group; SOD and catalase activity did not increase.
- Limitations
- biomarker outcomes only; small
Effects of whole-body cryotherapy on a total antioxidative status and activities of antioxidative enzymes in blood of depressive multiple sclerosis patients.
Miller E et al. World J Biol Psychiatry. 2011. PubMed 21083503 · DOI
- Who
- people with secondary progressive MS, 12 with and 10 without depression
- What
- whole-body cryotherapy chamber, 10 exposures
- Measured
- total antioxidative status, SOD, catalase
- Result
- Total antioxidative status rose in depressive (P<0.002) and non-depressive (P<0.01) patients; no effect on SOD or catalase.
- Limitations
- no untreated control; biomarker outcomes only
[The effects of whole-body cryotherapy and melatonin supplementation on total antioxidative status and some antioxidative enzymes in multiple sclerosis patients].
Miller E et al. Pol Merkur Lekarski. 2011. PubMed 21991843
- Who
- people with MS, 16 also given melatonin 10 mg (Polish report)
- What
- whole-body cryotherapy chamber, 10 daily 3-minute exposures, with or without melatonin
- Protocol
- -184 °F · 3 min · daily/wk · 2 wk
- Measured
- total antioxidative status, SOD, catalase
- Result
- Total antioxidative status increased after 10 exposures with or without melatonin; SOD and catalase rose only with melatonin.
- Limitations
- no untreated control; biomarker outcomes only
Effect of Whole-Body Cryotherapy on Morphological, Rheological and Biochemical Indices of Blood in People with Multiple Sclerosis.
Ptaszek B et al. J Clin Med. 2021. PubMed 34198961 · DOI · Free full text
- Who
- 15 women with MS receiving WBC, 20 women with MS without WBC, 15 healthy women receiving WBC
- What
- whole-body cryotherapy chamber, 20 sessions
- Measured
- blood counts, red-cell rheology, proteins and fibrinogen
- Result
- No significant effect of 20 WBC sessions on blood counts, rheology or biochemistry in women with MS (changes seen in healthy women).
- Limitations
- small; biomarker outcomes; overlapping participants with other reports from this group
Effect of Whole-Body Cryotherapy on Iron Status and Biomarkers of Neuroplasticity in Multiple Sclerosis Women.
Ptaszek B et al. Healthcare (Basel). 2022. PubMed 36141293 · DOI · Free full text
- Who
- 15 women with MS and 15 healthy women, all receiving WBC
- What
- whole-body cryotherapy chamber, 20 sessions
- Measured
- iron status and neuroplasticity biomarkers
- Result
- No significant effect of WBC on neuroplasticity biomarkers in women with MS or healthy women.
- Limitations
- small; biomarker outcomes; overlapping participants
Effect of Whole-Body Cryotherapy on Oxidant-Antioxidant Imbalance in Women with Multiple Sclerosis.
Ptaszek B et al. J Clin Med. 2023. PubMed 37762899 · DOI · Free full text
- Who
- 15 women with MS receiving WBC, 20 women with MS without WBC, 15 healthy women receiving WBC
- What
- whole-body cryotherapy chamber, 20 sessions
- Measured
- total antioxidant capacity, total oxidative status, nitric oxide, uric acid, MMP-9
- Result
- No significant WBC effect on oxidant-antioxidant balance, nitric oxide, uric acid or MMP-9 in women with MS (total oxidative status -14.03%, p=0.495).
- Limitations
- small; biomarker outcomes; overlapping participants
The effect of a series of whole‑body cryotherapy treatments on the activity of antioxidant enzymes in healthy women and women with multiple sclerosis.
Ptaszek B et al. Acta Neurobiol Exp (Wars). 2023. PubMed 37874191 · DOI · Free full text
- Who
- women with MS and healthy women, all receiving WBC
- What
- whole-body cryotherapy chamber, 20 sessions
- Measured
- catalase, glutathione peroxidase, superoxide dismutase
- Result
- No change in CAT, GPx or SOD after 20 sessions in either group; no adverse changes in the parameters tested.
- Limitations
- small; biomarker outcomes; overlapping participants
Whole-Body Cryotherapy Affects Blood Vitamin D Levels in People with Multiple Sclerosis.
Ptaszek B et al. J Clin Med. 2025. PubMed 40364117 · DOI · Free full text
- Who
- 15 women with MS receiving WBC, 20 women with MS without WBC, 15 healthy women receiving WBC
- What
- whole-body cryotherapy chamber, 20 sessions
- Measured
- serum 25(OH) vitamin D
- Result
- Vitamin D increased significantly after 20 WBC sessions in women with MS; the increase in healthy women was not significant.
- Limitations
- small; surrogate marker; season not addressed in abstract; overlapping participants
Impact of Whole-Body Cryostimulation (WBC) on Hemostatic Parameters in Patients with Multiple Sclerosis.
Zielińska-Nowak E et al. J Clin Med. 2026. PubMed 42652829 · DOI · Free full text
- Who
- 29 people with MS and 43 without MS
- What
- whole-body cryotherapy chamber, 10 consecutive 3-minute sessions
- Protocol
- -184 to -202 °F · 3 min · 5/wk · 2 wk
- Measured
- coagulation times, thrombus formation, fibrinolysis (safety)
- Result
- Mild changes in prothrombin and thrombin times without change in aPTT, thrombus formation or fibrinolysis; no prothrombotic state in MS.
- Limitations
- laboratory safety outcomes only; no untreated control
Whole-Body Cryostimulation in Multiple Sclerosis: A Scoping Review.
Alito A et al. J Clin Med. 2024. PubMed 38610768 · DOI · Free full text
- Who
- 13 articles on whole-body cryostimulation in MS (scoping review)
- What
- whole-body cryostimulation at -166 F (-110 C) or colder for 2-3 min
- Protocol
- -166 or colder °F · 2-3 min
- Measured
- functional, psychological and biochemical outcomes; adverse effects
- Result
- No significant changes in antioxidant enzymes, nitric oxide, metalloproteinases, blood counts, rheology or biochemistry; reductions in fatigue and improved functional status, mood and anxiety reported; no adverse effects reported.
- Limitations
- scoping review without pooled estimates; included studies small and mostly uncontrolled, from few research groups
[Effect of exposure to different temperatures on the clinical manifestations of multiple sclerosis].
Zavalishin IA et al. Zh Nevropatol Psikhiatr Im S S Korsakova. 1983. PubMed 6858475
- Who
- patients with multiple sclerosis (Russian report)
- What
- thermal procedures including hot baths and cooling
- Measured
- clinical manifestations of MS
- Result
- Moderate cooling without shivering improved clinical status; sharp cooling, like hot baths, worsened it.
- Limitations
- abstract only, in Russian; no quantitative results
[On the temperature sensitivity of multiple sclerosis patients (author's transl)].
Brenneis M et al. Fortschr Neurol Psychiatr Grenzgeb. 1979. PubMed 256872
- Who
- people with MS answering a questionnaire (German report)
- What
- self-reported response to heating and cooling, including cold baths
- Measured
- self-reported symptom change
- Result
- About half reported improvement in a cold bath; 90% reported worsening in a hot bath.
- Limitations
- self-report; no objective measures
A supplementary training program integrating cold exposure, breathing exercises and mindfulness as a complementary treatment for neuropsychological aspects of multiple sclerosis - a pilot interventional study.
Slezáková D et al. Mult Scler Relat Disord. 2025. PubMed 40267744 · DOI
- Who
- people with MS (12 in the intervention and 13 in the control group with complete data) (Slovakia)
- What
- 12-week Wim Hof Method program combining cold exposure (method not specified in the abstract), controlled breathing and mindfulness vs no intervention
- Protocol
- 12 wk
- Measured
- Cognition (SDMT, TMT-A, TMT-B), fatigue, anxiety (GAD), depression (PHQ-9)
- Result
- Greater improvement than controls in SDMT (p=0.045), TMT-A (p=0.041), TMT-B (p<0.001), fatigue (p=0.039), anxiety (p=0.015) and depression (PHQ-9, p=0.033).
- Limitations
- Pilot; 25 completers, number randomized not given; no-intervention control, unblinded; cold exposure combined with breathing and mindfulness, so its own effect cannot be separated.
Protocols used in the studies
Cold-water: 30 minutes of lower-body immersion in 61-63 F water immediately before exercise. Cooling garments: about 1 hour, acutely or daily for 1 month. Whole-body cryotherapy: chamber at -166 to -202 F (-110 to -130 C) for 2-3 minutes, once daily on weekdays for 10-20 sessions (2-4 weeks), often followed by exercise. No study has tested cold plunge at typical plunge temperatures in MS.
What is still unknown
Whether brief cold-water immersion matches garment cooling or WBC; optimal water temperature (studied range 61-63 F); durability of WBC effects beyond 3 months; sham-controlled WBC trials; safety of colder water in patients with spasticity or sensory loss; long-term functional benefit.
Safety
Cautions for cold therapy in this condition
- Cooling garments caused no harm across 13 studies (Stevens 2023, PMID 37499339); comparable safety data for cold-water immersion in MS do not exist.
- No adverse effects were reported across 13 WBC studies in MS (Alito 2024, PMID 38610768), and 10 WBC sessions did not produce a prothrombotic state (PMID 42652829). WBC is a supervised chamber procedure at extreme temperatures and is not equivalent to home cold-water immersion.
- Sharp cooling with shivering worsened clinical status in a report of 105 patients, whereas moderate cooling improved it (PMID 6858475); avoid exposures that provoke shivering or spasticity.
- MS can impair temperature sensation and mobility; immersion requires supervision and safe entry and exit. See general cold safety entry.
For clinicians
Suggested rationale
Lowering body temperature is an established symptomatic strategy for heat-sensitive MS: daily cooling-garment use produced modest objective improvements in a sham-controlled RCT (Schwid 2003), and lower-body cool-water pre-cooling limited exercise-induced deterioration in a small crossover study (White 2000). Whole-body cryotherapy has reported short-term reductions in fatigue, EDSS and spasticity in small, unblinded trials (Radecka 2021; Staszkiewicz 2025). Evidence supports cooling for heat sensitivity as an adjunct, not cold plunge as a disease-modifying therapy.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: G35. Examples only; the clinician assigns the code.
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