Use of cryotherapy for orthopaedic patients

Effect of intracanal cryotherapy on postoperative pain after endodontic treatment: systematic review with meta-analysis

Objectives

This study aimed to evaluate the effectiveness of final irrigation with cold saline solution after endodontic treatment compared with saline solution at room temperature against postoperative pain following endodontic treatment.

Materials and Methods

A broad search was performed in the PubMed, Web of Science, Scopus, Cochrane Library, Virtual Health Library (LILACS), and Grey Literature databases. Two independent reviewers performed data extraction, risk of bias using the Cochrane methodology, and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Results

Eight studies were included in qualitative synthesis. Intracanal cryotherapy favored the reduction of postoperative pain in the systematic review. Four studies were included in meta-analyses. The meta-analysis showed that intracanal cryotherapy reduced postoperative pain in teeth with symptomatic apical periodontitis (SAP) at 24 hours. There was no association between intracanal cryotherapy and control (room temperature) groups in teeth with normal periapical tissue with respect to postoperative pain at 24 hours and 48 hours.

Conclusions

Intracanal cryotherapy was effective in reducing postoperative pain after endodontic treatment in teeth with SAP.

Effect of intracanal cryotreated sodium hypochlorite on postoperative pain after root canal treatment - A randomized controlled clinical trial

Introduction

The postendodontic pain is caused by either microbial, mechanical, or chemical factors or combinations of these. The incidence of postoperative pain ranges from 1.4% to 53%. The management of postendodontic pain is a crucial factor for a successful practitioner. Cryotherapy is a new therapeutic option applied in sports medicine and surgery for the management of pain and for postoperative care.

Aim

The purpose of this study was to evaluate and to compare the effect of intracanal cryotreated sodium hypochlorite and room temperature sodium hypochlorite on postoperative pain after root canal treatment.

Materials and Methods

Sixty-four patients were selected according to inclusion criteria and baseline score was recorded. After obtaining consent, the access cavity was opened under local anesthesia. On the completion of cleaning and shaping, the patients were randomly divided into two groups: Group A: Normal Room temperature NaOCl and Group B: Cryotreated NaOCl (2°C-4°C), each of the canals further received 20 ml of the respective irrigants based on the groups allocated. The final rinse was done with saline, and canals were dried and obturated in the same appointment. Postoperative visual analogue scale pain levels were recorded at 6, 24, and 48 h over the phone.

Results

The data were analyzed using SPSS software. The results of the present study showed that cryotherapy group showed a statistically significant reduction in postoperative pain levels at all tested time intervals and reduced analgesic intake at 6 h postoperatively.

Conclusion

Cryotherapy could be used as an easy and cost-effective technique for controlling postendodontic pain in the day-to-day clinical practice.

Pain Management Strategies in Shoulder Arthroplasty

Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts.

Ice Reduces Needle-Stick Pain Associated With Local Anesthetic Injection

BACKGROUND

Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system.

OBJECTIVES

Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections.

METHODS

Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test.

RESULTS

Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783).

CONCLUSIONS

Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection.

Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial

PURPOSE

Purpose of the present study was to investigate the acute effects of a cold compression bandage on pain, swelling and skin-surface temperature after the first 24 h after arthroscopic surgery of the shoulder in a stationary setting and to compare it with cold therapy using only a cold pack. It was hypothesized that using the bandage is more effective in reducing pain and swelling after 24 h compared with using only a cold pack.

METHODS

Fifty-two patients (53 ± 12.2 years) were randomly assigned to two groups after arthroscopic surgery. The first group wore a cold compression bandage, and the second group a conventional frozen cold pack. Pain, swelling and skin-surface temperature were measured 2, 8 and 24 h after surgery. Differences within and between groups were analysed.

RESULTS

Both groups showed a significant reduction of the circumference of the arm 15 and 20 cm proximal of the lateral epicondyle 24 h after surgery (cold compression: p = 0.003; p < 0.001; cold: p < 0.001). Pain at rest was significantly reduced with cold compression bandage 24 h after surgery (p = 0.001). Skin temperature increased in both groups 24 h after surgery (bandage: p < 0.001; cold pack: p = 0.002). After 24 h, pain during activity was significantly decreased in the group wearing the bandage compared with the group using the cold pack (p = 0.026).

CONCLUSIONS

Based on the results of this study, no recommendation can be made with respect to the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Clinicians should question the need of expensive cold compression bandages in the short-term post-operative treatment after arthroscopic surgery of the shoulder.

LEVEL OF EVIDENCE

II.

Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients

A study of 86 patients undergoing total knee arthroplasty (TKA) was performed to evaluate the role of cold compression. The patients were treated with cold compression or epidural analgesia for 3 days after TKA. Pain was measured on a visual analog scale, and total consumption of analgesics was recorded. Range of movement (ROM) was recorded before TKA until 3 weeks postoperatively. Weight bearing, blood loss, and time in hospital were recorded. Visual analog scale scores and analgesic consumption were equal in both groups. Range of movement at discharge was 75 degrees in the cold compression group vs 63 degrees in the control group. By 3 weeks' follow-up, ROM was 99 degrees vs 88 degrees. Mean Hb values averaged 120 mmol/L in the cold compression group vs 109 mmol/L in the control group after surgery. Mean time in hospital of patients with cold compression averaged 4.8 days vs 6.2 days in the control group. The study shows that cold compression therapy improves the control of pain and might thus lead to improvement in ROM and shorter hospital stay.

Cryotherapy after total knee replacement: a survey of current practice

BACKGROUND AND PURPOSE

Cryotherapy is commonly used during physiotherapeutic rehabilitation after total knee replacement (TKR). Evidence for treatment effectiveness is contradictory and there are no clinical guidelines to inform treatment protocols within this patient group. The present survey investigated current cryotherapy practice after TKR throughout the United Kingdom (UK).

METHOD

A postal survey, containing open and closed questions, was distributed to senior inpatient orthopaedic physiotherapists (n = 453).

RESULTS

The response rate was 67% (304/453) and 58% (263/453) of the responses were completed by physiotherapists who treated TKR patients in the acute phase. Of these, 33% (85/263) routinely applied some form of cryotherapy after TKR. Physiotherapists working in the private sector were more likely to use cryotherapy and had greater access to Cryocuff equipment. The two main methods of cryotherapy application were the Cryocuff device, 59% (155/263) and crushed ice, 30% (79/263). Treatments were applied most frequently between 24 and 48 hours post-surgery, for 20 minutes, twice a day. Lack of proven efficacy was the most frequently stated reason for not applying cryotherapy treatment, and swelling was the most common indicator for treatment. There was particular uncertainty about the physical management of the Cryocuff device.

CONCLUSIONS

There was little consensus with regard to treatment indicators, method of application and the management of cryotherapy after TKR. The results highlight a lack of consistency in the application of cryotherapy after TKR, indicating a need for further research.

The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials

BACKGROUND

There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical basis.

STUDY DESIGN

Systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries.

METHODS

A computerized literature search, citation tracking, and hand searching were carried out up to April 2002. Eligible studies were randomized-controlled trials describing human subjects recovering from acute soft-tissue injuries and employing a cryotherapy treatment in isolation or in combination with other therapies. Two reviewers independently assessed the validity of included trials using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.

CONCLUSION

Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.

Influence of whole body cryotherapy on depressive symptoms - preliminary report

BACKGROUND

Cryotherapy has a long tradition in somatic medicine. Yet we know very little about its impact on psyche and mood disturbances in particular. Therefore there is a real need for scientific investigations into this problem.

OBJECTIVE

The study reported here was an initial approach to whole-body cryotherapy (WBCT) as a potential treatment modality for depression and was expected to provide rough data helping to design a future project with extended methodology, larger sample groups and longer follow-up.

METHODS

Twenty-three patients aged 37-70 years gave informed consent to participate in the study. Ten WBCT procedures (160 s, -150°C) were applied within 2 weeks. Participants were recruited from depressed day hospital patients. Antidepressive medication was not ceased. Symptoms were rated at the beginning and end of this intervention using the 21-item Hamilton Depression Rating Scale (HDRS). Changes in scores were analyzed in the group of patients for every item separately as well as for the sum of all items for each patient.

RESULTS

Almost for each individual HDRS item, the overall score for all patients together was significantly lower after WBCT. This means that all symptoms, except for day-night mood fluctuations, were presumably positively influenced by cryotherapy. The HDRS sum-score for each patient after WBCT was lower than that of the baseline and reached statistical significance in a paired samples t-test. Every patient was therefore considerably relieved after WBCT.

CONCLUSIONS

It appears that WBCT helps in alleviating depression symptoms. Should this be confirmed in the extended study we are currently implementing, WBCT may become an auxiliary treatment in depression.

The effect of continuous cryotherapy on glenohumeral joint and subacromial space temperatures in the postoperative shoulder

PURPOSE

The objective of this investigation was to determine the effect of continuous cryotherapy on glenohumeral joint and subacromial space temperatures in the postoperative shoulder.

TYPE OF STUDY

Prospective, randomized, and controlled clinical trial.

METHODS

Twenty patients (10 cryotherapy, 10 controls) with a full-thickness rotator cuff repair were monitored with temperature sensors in the glenohumeral joint and subacromial space of the shoulder for 23 postoperative hours. Statistical analysis (P <.05) was performed using the Mann-Whitney rank-sum test.

RESULTS

In comparing the cryotherapy and control groups, analysis of the glenohumeral joint and subacromial space temperatures revealed a statistical significance at 4, 8, and 23, and 4, 8, 16, and 20 postoperative hours, respectively. In addition, a trend toward a temperature-rising phase occurs from 4 to 12 hours and is followed by a trend toward a thermostatic phase from 12 to 23 hours during which temperatures remain relatively constant. The subacromial space was consistently cooler than the glenohumeral joint by an interval between 0.07 degrees C to 0.50 degrees C except at 23 hours postoperative where the glenohumeral joint was 0.05 degrees C cooler.

CONCLUSIONS

Continuous cryotherapy causes a statistically significant reduction of both glenohumeral joint and subacromial space temperatures in the shoulder at variable times during the first 23 postoperative hours. Previous investigations have shown that minor elevations in intra-articular temperature can stimulate proteolytic enzyme activity, which has detrimental effects on articular cartilage. Previous research has also shown that cryotherapy is an effective nonpharmacological method of pain control. Yet the literature has assumed that the effects of cryotherapy are part of the basic analgesia mechanism because of a reduction in joint temperature. Our results affirm that reductions in glenohumeral joint and subacromial space temperatures in the postoperative shoulder do occur, leading to potential benefits of continuous cryotherapy as an effective mode of pain control in the postoperative care of patients.

Does cryotherapy affect intraarticular temperature after knee arthroscopy?

Cryotherapy is a common modality used after arthroscopic procedures. The current authors investigated whether regions deeper than the lateral gutter experience similar temperature reductions with cryotherapy, supporting a more global temperature effect on the synovium. Thermocouple probes were arthroscopically placed intraarticularly in the medial gutter and suprapatellar pouch after routine knee arthroscopy. Twelve patients were divided into two groups for temperature measurement during 2 hours. Ice was applied only for the first hour in Group 1 (n = 6) and only for the second hour in Group 2 (n = 6). The medial gutter and suprapatellar pouch had significant decreases (average, 2.7 degrees -5 degrees C) in the temperature when ice was applied and a significant increase (average, 1.7 degrees -3 degrees C) in the temperature without ice. Also, the temperatures in the medial gutter and suprapatellar pouch correlated with each other. At 1 hour, the mean difference between ice versus no ice was on average 6 degrees C. Cryotherapy globally decreased intraarticular temperature in the absence of hemarthrosis.

The efficacy of continuous cryotherapy on the postoperative shoulder: a prospective, randomized investigation

This prospective, randomized investigation evaluated the efficacy of cryotherapy on subjective responses after both open and arthroscopic procedures on the shoulder. Seventy patients were randomly assigned to one of two study groups: (1) continuous cryotherapy group and (2) age-matched control group. Visual analog scales were used to assess subjective responses on postoperative days 1, 7, 14, and 21. On day 1, patients receiving cryotherapy reported significantly less pain during sleep and significantly more comfort in bed and rated their sleep as more restful than the control subjects. During days 7 through 21, cryotherapy subjects reported a significant reduction in frequency and intensity of pain, as well as less pain during shoulder rehabilitation, than the control subjects. These results indicate that cryotherapy is an effective method for postoperative pain control because it decreases the severity and frequency of pain and allows a return to normal sleep patterns while increasing overall postoperative comfort and satisfaction.

A randomized prospective study to assess the efficacy of two cold-therapy treatments following carpal tunnel release

A prospective randomized study was performed comparing the efficacy of controlled cold therapy (CCT) with the efficacy of ice therapy in the postoperative treatment of 72 patients with carpal tunnel syndrome. Immediately after surgery, patients applied either a temperature-controlled cooling blanket (CCT) or a standard ice pack over their surgical dressings. Pain was assessed by visual analog scale and swelling by wrist circumference preoperatively, immediately after surgery, and on postoperative day 3. Patients kept log books of daily treatment times. Narcotic use (of Vicodin ES) was determined by pill count at day 3 and by daily log book recordings. Patients who used CCT showed significantly greater reduction in pain, edema (wrist circumference), and narcotic use at postoperative day 3 than did those using ice therapy. This study indicates that after carpal tunnel surgery, the use of CCT, compared with traditional ice therapy, provides patients with greater comfort and lessens the need for narcotics.

Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy

Cryotherapy is a modality commonly used after arthroscopic procedures. We divided 17 patients into two groups after routine knee arthroscopy: 12 patients were immediately treated with ice and 5 control patients were treated without ice for the first hour. In all patients, thermocouple probes were placed intraarticularly into the lateral gutter of the knee. Ice was placed on the operative knees of the treatment group for 2 hours. The control group had no intervention for the 1st hour and then had ice applied for the 2nd hour. Temperatures were continually recorded every minute for 2 hours. The temperature in the treatment group declined significantly, by 2.2 degrees C (95% confidence interval [-3.6 degrees C, -0.72 degrees C]) over the 1st hour and by 0.79 degrees C (95% CI [-1.8 degrees C, 0.18 degrees C]) over the 2nd hour (P = 0.008). The temperature in the control group increased significantly, by 5.0 degrees C (95% CI [2.4 degrees C, 7.5 degrees C]) over the 1st hour (P = 0.006). After ice was applied, the temperature fell significantly, by 4.0 degrees C (95% CI [-8.3 degrees C, 0.26 degrees C]) (P = 0.06). The difference between the temperature decrease in the treatment group and the increase in the control group at 60 minutes was 7.1 degrees C. This is the first rigorously conducted study in human patients that documents a statistically significant decline in intraarticular knee temperature with the application of ice and compression to the skin. The mechanism by which cryotherapy acts must therefore include the cooling effect on the intraarticular environment and synovium.

Postpartum perineal management and best practice

Sutured damage to the perineum occurs in at least 39% of women being delivered in Australia and perineal wound breakdown is associated with perineal oedema. The available literature was reviewed to ascertain what might constitute best practice for postpartum perineal wound management. Classification of levels of evidence was used to prioritise the available evidence. Little evidence that might be considered scientifically robust was found. Recommendations based on the available levels of evidence include a careful emphasis on perineal hygiene, cryotherapy, elevation of the foot of the bed in the presence of perineal oedema and regularly performed pelvic floor exercises.

Therapeutic effects of heat, cold, and stretch on connective tissue

The anatomic architecture of connective tissue is dependent on the stresses associated with motion. Immobilization results in stress deprivation, causing structural changes in the tissue matrix. The structural changes that occur are due to the remodeling of tissue to its new resting length while being held immobile. The goal of remodeling stiffened, shortened tissues is to regain tissue length and promote unrestricted tissue gliding. The article reviews studies that examine the viscoelastic response of connective tissue to heat, cold, and stretch. An understanding of connective tissue response to these therapeutic interventions will enable clinicians to choose the appropriate modality and apply stretching techniques in a safe, efficient manner to enable patients to regain mobility.

The Effects of Cryotherapy Applied through Various Barriers

The purpose of this study was to investigate the differences in skin temperature during ice application through a dry towel and a dry elastic bandage compared to application on bare skin. Nine subjects completed a 30-min treatment session that consisted of 0.68 kg of cubed ice applied under three conditions: through a dry towel, through a dry elastic bandage, and directly on the skin (control). Following the removal of the ice, all subjects were monitored for 20-min for skin temperature (S temp). There was a significant interaction in S temp between the control (12.50 ± 4.39 °C) and dry towel (23.48 ± 2.88 °C) conditions, the control (12.50 ± 4.39 °C) and dry elastic wrap (27.47 ± 2.36 °C) conditions, and the dry towel (23.48 ± 2.88 °C) and dry elastic wrap (27.47 ± 2.36 °C) conditions. The findings indicated that using a barrier (dry towel or dry elastic bandage) limits the temperature-reducing capacity of the ice and therefore its potential physiological effects.