Introduction
The application of ice and cold-water immersion for therapeutic purposes in cases of some tissue injuries and edema can be dated back to ancient times. Indeed, cryotherapy was initially proposed by Hippocrates for relieving body swelling and muscle pain (Kwiecien & McHugh, 2021). It exists in various forms, from localized placement of ice to whole-body exposure (Kwiecien & McHugh, 2021). Although cryotherapy has not been approved for clinical use in some cases of exercise-induced injury due to the lack of scientific evidence, it is still widely implemented in sports medicine (Kwiecien & McHugh, 2021). Furthermore, this therapy was found to be effective in oncology care to prevent oral mucositis in patients undergoing hematopoietic stem cell transplantation or chemotherapy (Correa et al., 2020). It is sometimes used to treat such pre-cancerous states as cervical intraepithelial neoplasia (Duan et al., 2021). Cryotherapy is an effective method in curing some pre-cancerous lesions and exercise-induced muscle injury, but it requires a more individualized approach in terms of application duration.
Explanation and Background
Cryotherapy is the technique of cooling a specific area or whole body for therapeutic purposes. It can be performed using traditional ice packs, immersion in cold water baths, or special chambers. The latter can either be delivered by making an individual stand in a chamber where the body is exposed to cold temperatures or sitting in a room filled with cool air (Patel et al., 2019). During this procedure, a person is recommended to wear a mask and minimal clothing like shorts and socks (Patel et al., 2019). People should only spend 2-3 minutes in such chambers since the temperature there is -1350C (Patel et al., 2019). Localized exposure is usually more prolonged because the temperature is higher than in the case of whole-body cryotherapy. For example, to prevent oral mucositis in chemotherapy patients, it can be applied for 2-7 hours (Correa et al., 2020). The exact mechanism of cold exposure is still unclear, but it is known that cryotherapy has analgesic, anti-inflammatory, and regenerative effects on tissues and organs (Patel et al., 2019). This methodology has various beneficial biochemical effects on the human organism, facilitating recovery.
Risks and Benefits
Like any medical procedure, cryotherapy has its advantages, drawbacks, risks, and limitations that should be articulated to patients. The primary benefit of this therapy is that it reduces pain and inflammation following intense training (Kwiecien & McHugh, 2021). Indeed, cold exposure is particularly recommended if fast recovery is needed after exercise (Kwiecien & McHugh, 2021). Another advantage of cold exposure, especially in sports medicine, is that it induces the production of anti-inflammatory cytokines and reduces the release of pro-inflammatory markers (Patel et al., 2019). Furthermore, cryotherapy allows for the lessening of muscle damage after exercise. Research shows a 34% drop in creatinine kinase formation in muscles post-training after total-body cold exposure (Patel et al., 2019). Additionally, bone resorption decreases since cellular metabolism decelerates at low temperatures (Patel et al., 2019). Another benefit of whole-body cryotherapy is an improved lipid profile (Patel et al., 2019). The overall positive effect of cold exposure is evident in improving recovery from injuries and preventing some chronic illnesses.
Despite its undeniable benefits, healthcare practitioners should explain the potential risks of this procedure. One of the disadvantages is that cryotherapy may diminish the anabolic effect of training; hence, chronic use may be counter-indicated if the goal is to build muscle mass (Kwiecien & McHugh, 2021). Potential risks of cryotherapy include burns, asphyxiation, eye injury, frostbite, and loss of consciousness (Patel et al., 2019). Moreover, this therapy is contraindicated for patients with Raynaud phenomenon, cold intolerance, cryoglobulinemia, hypothyroidism, hypertension, gangrenous lesions, cardiovascular disorders, a history of cold injury, cachexia, and claustrophobia (Patel et al., 2019). However, these risks and contraindications mainly apply to whole-body cryotherapy rather than localized cold exposure.
Interdisciplinary Team’s Role and Responsibilities
Since cryotherapy has broad implications and associated risks, this technique must be performed only by trained personnel. Furthermore, various specialists should be involved in caring for patients needing cold-exposure treatment. For instance, oncologists should cooperate with cryotherapy specialists and researchers because a patient’s quality of life is a priority. Clinical studies showed that there is no statistically significant difference between 2-hour and 7-hour-long cryotherapy in preventing oral mucositis in cancer patients (Kwiecien & McHugh, 2021). It suggests that there is no need to apply more prolonged treatment in clinical practice if shorter is equally effective. Hence, it is critical for clinicians recommending cryotherapy to their patients to collaborate with researchers investigating this topic and implement the most recent and efficient protocols. Moreover, respiratory therapists, intensivists, and nurses must be present during the therapy to monitor patients’ well-being and intervene in case of pulmonary or cardiovascular complications.
Nursing Scope of Practice
The nursing staff is essential for patient care, and applying cryotherapy is no exception. Indeed, nurses mostly perform this procedure in patients requiring cold exposure. For example, they use cryotherapy for patients receiving chemotherapy to prevent oral mucositis, which is associated with an increased risk for infections, pain, and other uncomfortable symptoms (Park & Lee, 2019). The nursing staff makes every effort to reduce complications associated with anti-cancer treatment; thus, cryotherapy became the primary tool to combat various adverse effects of the main treatment. Notably, nurses should not only know how to perform the procedure but also understand the benefits and risks associated with it to be able to elaborate this information to patients. Additionally, they must know the duration of treatment and the body area that requires exposure. Nurses need to be able to act promptly if the person feels unwell by removing the ice pack or assisting the patient in leaving the chamber. Lastly, healthcare workers should maintain the same caring attitude towards patients as with other techniques, but they may be required to be more precise and punctual with cryotherapy due to the importance of timing.
Patient Education
Patient education is integral to treating people, and it should be done before any procedure. Individuals undergoing cryotherapy should receive detailed information about this method both in written and oral forms. Furthermore, patients should be offered a range of options available in the hospital. For example, for oral mucositis prevention, they may receive ice chips, cold water, or commercially available popsicles (Park & Lee, 2019). The teaching effectiveness can be checked by asking the patient to retell the learned information, which will allow to address misunderstandings.
Conclusion
Cryotherapy effectively reduces pain and inflammation after intense training, is a crucial component of preventing oral mucositis during chemotherapy, and is a robust way to eliminate pre-cancerous cervical lesions. It exists in various forms, such as ice packs and cold chambers that are used depending on patients’ needs. Its main advantage is that it provides analgesic and anti-inflammatory effects on tissues, but it possesses some risks, like frostbite and burns. Therefore, experienced personnel should monitor patients’ overall state during the procedure, control timing, and be prepared for immediate intervention in the case of complications.
References
Correa, M. E. P., Cheng, K. K. F., Chiang, K., Kandwal, A., Loprinzi, C. L., Mori, T., Potting, C., Rouleau, T., Toro, J. J., Ranna, V., Vaddi, A., Peterson, D. E., Bossi, P., Lalla, R. V., & Elad, S. (2020). Systematic review of oral cryotherapy for the management of oral mucositis in cancer patients and clinical practice guidelines. Supportive Care in Cancer, 28(5), 2449-2456.
Duan, L., Du, H., Belinson, J. L., Liu, Z., Xiao, A., Liu, S., Zhao, L., Wang, C., Qu, X., & Wu, R. (2021). Thermocoagulation versus cryotherapy for the treatment of cervical precancers. Journal of Obstetrics and Gynaecology Research, 47(1), 279-286.
Kwiecien, S. Y., & McHugh, M. P. (2021). The cold truth: The role of cryotherapy in the treatment of injury and recovery from exercise. European Journal of Applied Physiology, 121(8), 2125-2142.
Park, S. H., & Lee, H. S. (2019). Meta‐analysis of oral cryotherapy in preventing oral mucositis associated with cancer therapy. International Journal of Nursing Practice, 25(5), 1-13.
Patel, K., Bakshi, N., Freehill, M. T., & Awan, T. M. (2019). Whole-body cryotherapy in sports medicine. Current Sports Medicine Reports, 18(4), 136–140.