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Cold water or hot water for peripheral neuropathy?

by Boris Simkovich on Tue Apr 20, 2010 9:50 am

Many of you have probably seen the recent research summary at the Beacon, "Causes Of And Treatments For Multiple Myeloma Drug-Induced Nerve Damage."

At the end of that article, one of the suggestions for dealing with the pain and discomfort of peripheral neuropathy is "soaking or massaging one’s feet in icy water." This recommendation comes straight from the original research article, which you can read here.

A Beacon reader followed up with me about our article. He said he thought the article was very good, but that he disagreed with the recommendation about using icy water for the discomfort from peripheral neuropathy. He said that, in his experience, trying to use icy water to ease the discomfort of peripheral neuropathy has exactly the opposite effect -- it makes the peripheral neuropathy A LOT worse. He said that very warm water is actually the best thing to help relieve the pain and discomfort of peripheral neuropathy.

These comments don't surprise me. However, I was wondering what sort of experiences others have in this regard. Have you found cold water or warm water to be better for helping with the pain of peripheral neuropathy?

I also was wondering if the recommendation to use icy water is partly based on any protective or preventative effect the icy water might have. I believe that icing wounds, for example, is often recommended because it encourages the body's natural defenses to "hurry" to the area, protect it, and start the healing process. Is this part of the rationale behind recommending the use of icy water for peripheral neuropathy (PN)?

Boris Simkovich
Name: Boris Simkovich
Publisher & Founder
The Myeloma Beacon

Re: Cold water or hot water for peripheral neuropathy?

by NSTEWART on Tue Apr 20, 2010 3:59 pm

I'm answering you from the point of view of a physical therapist who treats people with chronic low back pain who often have exacerbations of acute pain and spasms. I tell people to try both moist heat or ice and see which works better in relieving their acute symptoms. I imagine that that might be the same with PN. Some people respond more favorably to heat and some to ice. That also might change depending on what is causing an acute episode. Would this also change with PN depending on what is aggravating it on any particular day? I don't know, but it is something to consider and to try.

Name: Nancy Stewart
Who do you know with myeloma?: self
When were you/they diagnosed?: 3/08
Age at diagnosis: 60

Re: Cold water or hot water for peripheral neuropathy?

by Bob on Tue Apr 27, 2010 3:28 am

Actually Nancy, no comparison can be made between muscular distress/back trauma and PN. Neuropathy is ethereal because it is a product of an insult to the central nervous system rather than an affliction in a part of the body. That's why pain killers don't do very much to relieve neuropathy. Some people believe that because one PN sensation is that of burning, that immersion in cold will help. Sadly, logic can't really be applied; a lot of people feel a sensation of burning simultaneously to a sensation of extreme cold and the aching that accompanies it.

I was the one who wrote to the Beacon questioning the use of cold water. The suggestion was totally backwards to my personal experience and the experiences of other Myeloma victims I've chatted with, exchanging ideas on ways to reduce the sensations of our PN.

However, the article is a good one; recommending soft shoes or just thick fuzzy socks, massage and stimulation of the affected areas, placing pillows on each side of your legs to make a tent to prevent the bed clothes from putting pressure on hurting feet, and keeping warm.

I kept a thick pile rug remnant on my desk and would rub my hands on it as I watched tv or read. I also bought one of those bead car seat pads and put it on the floor to roll my feet back and forth on. All of these provided relief, albeit temporary. The only thing that really suppresses PN is stopping what causes it and allowing time to pass. In most people it will fade within 18 months or so. In others it can be permanent. It all depends on the chemo in use and the individual's tolerance to it. The worst of the symptoms usually fade in two or three months.


Name: Bob Kirkpatrick
Who do you know with myeloma?: Myself
When were you/they diagnosed?: Feb 08, 2008
Age at diagnosis: 60

Re: Cold water or hot water for peripheral neuropathy?

by Dr. Craig Hofmeister on Wed May 12, 2010 9:32 pm

None of my patients have ever found cold water to be beneficial. Hot water hasn't really been helpful either. Most patients will describe that their feet always feel "cold", this stage is usually either before or after the tingling / numb / pain stage. Temperature changes for peripheral neuropathy are rarely helpful.

Most treatment for peripheral neuropathy is based on treatment for neuropathy due to diabetes -- this neuropathy in general effects hands and feet just like that of Velcade, thalidomide, or vincristine. The most effective treatments for diabetes involve a combination of two classes of drugs

1) Drugs that decrease pain sensitivity including neurontin, lyrica, and cymbalta; and
2) Drugs that decrease certain pain impulses such as narcotics (methadone, oxycodone, morphine).

In our clinic with patients with severe neuropathy, we often start patients on a combination of lyrica + methadone but that is certainly not right for everyone and no comparison trials have yet been reported.
Dr. Craig Hofmeister
Multiple Myeloma Clinic, The Ohio State University

Dr. Craig Hofmeister
Name: Craig C. Hofmeister, M.D.

Re: Cold water or hot water for peripheral neuropathy?

by billwoods on Mon Aug 30, 2010 11:12 am

I recently went white water rafting for 4 hours. My feet were immersed in very cold water for the entire time. I then found that I had no symptoms of neuropathy in my feet and lower legs for 2 full days. I have never gone 24 hours without severe and painful neuropathy. I tried to duplicate this at home but did not keep my feet in the cold water for such a long time (usually less than 15 minuts as it hurts!). At home with ice water I did not get therelief.


Re: Cold water or hot water for peripheral neuropathy?

by Chuck on Mon Aug 30, 2010 1:53 pm

Hi Bill,

Your experience after your rafting trip makes me wonder if the trick is to keep your feet in water that is relatively cold, but not unbearably cold, for an extended period of time -- say, 30-60 minutes. The trick may be finding a temperature that's cold enough to get rid of the PN for a while, but not so cold that it's unbearable.



Re: Cold water or hot water for peripheral neuropathy?

by az_momy on Tue May 22, 2012 10:25 pm

I found this today while doing a search for "what's better for neuropathy cold vs hot." I have post-chemo peripheral neuropathy.

I was excited to read what the other patients and the doctor described as neuropathy symptoms, as that is exactly how I would describe my symptoms. I've had a hard time trying to explain it to others who can only relate to the pins and needles aspect.

The reason I wanted to search was because I went swimming in a friend's pool twice this week and discovered that while I'm swimming in the relatively cold water, I can't feel pain in my feet, but the pain in my hands worsens. After I get out of the pool, I still don't notice the pain in my feet until I go to bed -- but my hands continue to have the cold, numb, tingling, burning, arthritis-like pains.

I wonder why it would work for one part of the body and not the other?

My friend asked me today if heat would help, and I believe that would cause more inflammation around the nerves -- but I haven't tried it.

Anyway, I'll continue swimming because I think it helps with circulation without doing weight-bearing exercise -- and my feet feel good for a few hours.

Thank you to the others who posted, so I can finally feel like someone understands what I'm experiencing! Would love to hear more feedback as to what helps!


Re: Cold water or hot water for peripheral neuropathy?

by jjnfla on Fri Feb 15, 2013 6:21 pm

My neuropathy is chemo-induced and is only in my feet at this time - 3 years post treatment. The thought of heat on my feet makes me shudder.

I tried gabapentin [Neurontin] to no avail - it just prevented my elimination system from functioning. The only thing that helps me is placing my feet on an ice pack and when the pain is so bad I can't sleep, I take 2 Tylenol as well and am able to get to sleep.

It is a medical travesty that our brilliant researchers have not found a treatment for cancer that doesn't kill one's good cells along with the cancer cells.


Re: Cold water or hot water for peripheral neuropathy?

by Cha Ching Queen on Tue Sep 03, 2013 10:40 pm

I came to this thread while searching whether ice or heat is better for peripheral neuropathy. I guess I still didn't really get an answer, but just wanted to commiserate with you all.

I have chemo induced PN. My chemo for breast cancer ended almost 3.5 years ago. I've tried all kinds of drugs and nothing seems to really help. Cymbalta is the only one that I think maybe helped a little so I'm still on it.

hope you all get some relief soon.


Cha Ching Queen

Re: Cold water or hot water for peripheral neuropathy?

by LibbyC on Tue Sep 10, 2013 4:59 am

My peripheral neuropathy doesn't seem too bad but I wont be putting my feet into cold water. My feet really "burn" when they are cold. For me, warm water is much better. Usually I use a wheat bag to warm my feet.

As it has been ~ 4 years since my peripheral neuropathy started, I think I am stuck with it.

Name: LibbyC
Who do you know with myeloma?: myself
When were you/they diagnosed?: 2009
Age at diagnosis: 43


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