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[2008 updates are highlighted in red]
| Description: |
Cooling therapy is a form of CAM that is unique to MS (see also Chapter 4). It has been known for years that changes in body temperature may significantly affect MS symptoms. Specifically, small increases in body temperature (0.5˚C) may worsen symptoms, while small decreases may improve symptoms. Consequently, various cooling methods have been developed. These methods range from simple techniques, such as drinking cold liquids and staying in air-conditioned areas, to complex methods, such as using specially designed cooling suits. Cooling suits may be passive or active. Passive garments use evaporation or ice packs for cooling; active garments use circulating coolants. |
| Rationale: |
In MS, there is damage to myelin, the insulating layer of the nerve fibre that facilitates the conduction of nerve impulses. In these injured nerves, conduction of signals is blocked with small increases in temperature. Conversely, small decreases in temperature may facilitate transmission of signals. |
| Evaluation: |
Beneficial effects of cooling garments have been noted in several clinical studies. Unfortunately, some of these reports are preliminary and most of the studies have been small and not rigorously conducted. Among these studies, improvement in fatigue is frequently seen. Other symptoms showing improvement include leg strength, spasticity, walking, bladder dysfunction, sexual difficulties, visual changes, speech difficulties, cognitive difficulties, and incoordination. The results of the most rigorous cooling study in MS (randomised, controlled, blinded) have been published recently. In this study, it was found that, on the basis of objective measures, cooling was associated with mildly improved walking and visual function. By subjective measures, cooling improved fatigue, strength, and cognition. Cooling garments may be especially well suited for those who are known to be heat-sensitive. |
| Risks: |
The use of cooling garments is usually well tolerated. Some people feel uncomfortable when cooling begins, and handling of the garments may be cumbersome. Some people with MS have a paradoxical sensitivity to cold, in which case cooling may actually worsen symptoms. Costs of cooling are dependent on the method used. Simple techniques are of low cost. Cooling garments are of moderate cost. |
| Costs: |
Passive garments are generally less expensive than active garments. |
| Committee opinion: |
In the opinion of the Committee, cooling is a low-risk and relatively inexpensive therapy that has a clear scientific rationale. It is possibly effective for treating some MS symptoms, especially fatigue. Further studies are needed to determine whether it is definitely effective. |
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