Thermotherapy of Pain, Trauma, and Inflammatory and Degenerative Rheumatic Diseases

Summary

In the application of heat and cold to treat skeletomuscular pain and degenerative or inflammatory connective tissue and joint alterations, an apparent gap exists between the wealth of empirical therapeutic knowledge and the scarcity of information about the modes of temperature action on the underlying functional and structural disturbances. There is also a lack of sufficiently precise clinical criteria as indications of which of the various thermotherapeutic measures may be helpful. Therefore, only general therapeutic rules may be stated. Acute pain mostly responds favorably to local cold applications. In the supplementary treatment of chronic degenerative states of skeletal and joint alterations, mild local or general hyperthermia is usually beneficial in alleviating pain and functional impairments. For acute inflammatory and effusive disturbances, however, no general recommendations are possible; cold treatment is helpful in some and heat treatment in other conditions, and the conditions may change in the course of the individual disease. In emphasizing the possible analgesic effects of heat as well as cold it is important, however, to note that both may aggravate symptoms in certain pathological conditions and thus the indications must be tested. For hyper-thermic treatments, it has to be considered that definitive immunosuppression results only from severe hyperthermia whereas moderate hyperthermia may enhance immune defense. The currently available data about temperature effects on clinical, biochemical, and molecular parameters underlying inflammatory and immunological processes, although fragmentary, are encouraging enough to expect improvement of thermotherapeutic applications from further experimental and clinical efforts to understand how defined pathological processes are affected by local thermal stimulations and by the changes in general immune defense resulting from changes of whole-body temperature.