Cooling therapy is a form of complementary and alternative medicine (CAM) specific to the treatment of people with MS. Slight decreases in body temperature have been documented to produce a temporary relief of MS-associated symptoms. Methods for treatment can be as simple as a cold shower or as complicated as the cooling suits introduced in the United States in the 1990s.
For years, people have known that heat exacerbates symptoms in up to 80% of people with MS. In fact, one of the earliest tests for MS involved having people get in a hot bath and assessing their symptoms. Early in the course of the disease, people might only notice symptoms in situations in which body temperature is slightly increased, such as such as with sunbathing, fever, or exercise. While increasing body temperature worsens symptoms, cooling can sometimes have a beneficial effect.
There is a scientific basis for cooling therapy, unlike many other forms of CAM. In MS, the insulating material of nerves (myelin) is attacked and damaged. Nerve cells without this insulation have difficulty conducting signals at higher temperatures, so cooling them may facilitate conduction.
Many different cooling methods exist. Simple solutions like fans, air conditioners, ice packs, cold drinks, and cold showers or baths are easy and inexpensive. People with MS can also take care to avoid warm environments and cotton clothing. More sophisticated cooling methods, such as cooling vests can be purchased. Cooling garments can use either “passive” or “active” cooling methods. Passive systems make use of ice packs or evaporative cooling, making them relatively simple and portable. Active cooling is more effective, but involves more complicated garments through which coolants are actively circulated.
Evaluation in MS and Other Conditions
In the 1950s, a small research study found that a decrease is body temperature as small as one degree Fahrenheit produced measurable benefit. Another small study in the mid-1990s showed improvements primarily in fatigue and strength. A Swedish study involving 10 people with MS demonstrated benefits in transferring, walking, and urinating, and an overall improvement in their ability to care for themselves. Speech difficulties, sexual disorders, spasticity, visual difficulties, cognition, fatigue, tremor, and incoordination have all been shown to improve in other small-scale studies of cooling therapy.
A larger study in 2003 involving 84 participants with MS and heat sensitivity looked at the short- and long-term effects of cooling. This study used a cooling device developed by NASA and evaluated both high and low-dose cooling over the course of an hour of treatment. In the short-term study, small improvements were noted in the high-dose group. After daily cooling sessions for one month, people believed their strength, fatigue, and thinking improved.
The use of cooling garments is generally well tolerated. Some people feel a slight discomfort when cooling begins, and some find the cooling garments to be cumbersome.
Individual responses to cooling may vary. Sometimes the benefit is mild or cooling fails to significantly decrease body temperature. Also, in a subset of people with MS (approximately 1 in 10), cooling may have the opposite effect and increase the severity of MS-related symptoms.
Cooling therapy is generally well-tolerated, and limited research studies have shown possible benefits for some MS-associated symptoms. The symptoms that may improve from cooling include weakness, spasticity, tremor, incoordination, walking difficulties, fatigue, visual difficulties, speech disorders, cognitive difficulty, urinary difficulties, and sexual difficulties. In the future, cooling therapy may make the transition from CAM to mainstream medical treatment.
References and Additional Reading
Bowling AC. Complementary and Alternative Medicine and Multiple Sclerosis. New York: Demos, 2007, pp. 76-79.
Brenakker EA, Oparina TI, Hartgring A, et al. Cooling garment treatment in MS: clinical improvement and decrease in leukocyte NO production. Neurol 2001; 57:892–894.
Capell E, Gardella M, Leandri M, et al. Lowering body temperature with a cooling suit as symptomatic treatment for thermosensitive multiple sclerosis patients. Ital Neurol Sci 1995;16:533–539.
Feys P, Helsen W, Liu X, et al. Effect of peripheral cooling on intention tremor in multiple sclerosis. J Neurol Neurosurg Psych 2005;76:373–379.
Flensner G, Lindencrona C. The cooling-suit: a study of ten multiple sclerosis patients’ experience in daily life. J Adv Nursing 1999;29:1444–1453.
Guthrie TC, Nelson DA. Influence of temperature changes on multiple sclerosis: critical review of mechanisms and research potential. J Neurol Sci 1995; 29:1–8.
Ku Y-T, Montgomery LD, Lee HC, et al. Physiologic and functional responses of MS patients to body cooling. Am J Phys Med Rehabil 2000;79:427–434.
Ku Y-T, Montgomery LD, Webbon BW. Hemodynamic and thermal responses to head and neck cooling in men and women. Am J Phys Med Rehab 1996; 75:443–450.
Ku YT, Montgomery LD, Wenzel KC, et al. Physiologic and thermal responses of male and female patients with multiple sclerosis to head and neck cooling. Am J Phys Med Rehab 1999;8:447–456.
NASA/MS Cooling Study Group. A randomized controlled study of the acute and chronic effects of cooling therapy for MS. Neurol 2003;60:1955–1960.