Cold Water Immersion for Gout Flares

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Cold water immersion is put to the test for burns, priapism, gout, and muscle aches.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

For centuries, cold temperatures have been used by humans for therapeutic, health and sporting recovery purposes. I had a series of videos on the sporting recovery case starting with this one, and then another on immune function. What else might cold be used therapeutically for?

Cold plunges do not seem to affect cholesterol or body weight, nor blood pressures over the long-term. Neither systolic nor diastolic blood pressures were altered in the long-term by cold water exposure. After our first plunge, our blood pressure may go up but over time our body seems to adapt. During cold exposure our brain doesn’t work as well, but there isn’t much evidence of any residual effect besides a transient boost I covered before.

Cold showers may help with priapism, which is a prolonged erection persisting for longer than four hours. I didn’t realize that could turn into a surgical emergency, but the prolonged lack of new oxygenated blood can cause some of the penile tissue to die off. Before it gets to that, you can try ice packs, or cold showers. In this case, the patient was instructed to vigorously climb up and down a set of hospital stairs for ten minutes, and within seven, he successfully deflated.

What about cold water for burns? Misinformation regarding first aid for burns is ubiquitous online. For example, due to the high frequency of toothpaste being applied to burns, Colgate posted something on its website urging people not to use toothpaste for burn injuries. More serious is the suggestion to immerse a burn in ice water. Ice or ice water can make matters worse, preventing blood flow and increasing burn depth and pain. So, what should we do for burns? A full twenty minutes of cool running water has been proven to be the most effective first aid intervention in improving burn outcomes––associated with faster healing and decreased odds of full-thickness burns, hospital admission, and need for skin grafts.

What about using cold to treat flares of a painful inflammatory arthritis called gout, caused by crystals of uric acid forming in your joints, crystallizing out of your blood like rock candy. Since uric acid is more likely to crystallize at lower temperatures, maybe that’s why people get gout flares in their toes, or grow crystals in their ears—the areas of the body that may be cooler. So, if cooling of the joints causes crystal precipitation, one might be concerned that applying cold could precipitate and worsen acute gout attacks. That may be why some doctors have suggested applying heat rather than cold to affected joints. You don’t know, until you put it to the test. And indeed, the application of covered ice packs—never apply ice directly to the skin—for 30 minutes four times a day reported a significantly greater reduction in pain compared with the control group.

What about cold water immersion for gout, dunking the inflamed joint for 20 min/day for four weeks in water that’s more cool than cold—like in the 70s Fahrenheit (21 – 26 °C)? That led to decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. Fantastic! Now, there didn’t seem to be an actual improvement in inflammation; the cool water may not actually be affecting the course of the disease, but rather just causing a kind of numbing or pain-killing effect. But either way, what a cheap, safe, easy treatment to help alleviate such a painful condition.

What about cold packs for myalgia, which means muscle pain or muscle aches? Here, study subjects applied a cold gel pack for low back pain for 10 minutes, and although pain had lessened at the end of the 10 minutes, by 30 minutes no significant difference was seen. Isn’t 10 minutes better than nothing? Well, there are some cautionary tales from the anti-inflammatory drug literature. Although NSAID drugs like ibuprofen or naproxen serve as a common management strategy for numerous forms of musculoskeletal complaints, evidence suggests that these drugs may contribute to tendon degradation, due to less blood flow because the inflammation was tamped down. Inflammation from injury plays a role in the healing process. Similarly, there are data indicating an increased risk for acute pain to transition to chronic pain with NSAID use. In other words, anti-inflammatory drugs could cause chronic pain. Despite pain-killing efficacy in the short term, the management of acute inflammation may be counterproductive for long-term outcomes of low-back pain sufferers, in that it could end up resulting in more chronic pain in the long-run.

Then, what about using heat therapy for something like delayed onset muscle soreness, the soreness you may get the day after a heavy workout? A total of 32 randomized controlled trials involving more than 1,000 patients were compiled, and the heat worked better. The application of cold therapy within one hour after exercise can reduce pain within the first 24 hours after exercise, but heat therapy after exercise can extend that relief for longer than 24 hours.

A meta-analysis comparing the effectiveness of nine different cold and heat modalities found that for people with this delayed onset muscle soreness, hot packs proved the most effective for pain relief over the first 48 hours.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

For centuries, cold temperatures have been used by humans for therapeutic, health and sporting recovery purposes. I had a series of videos on the sporting recovery case starting with this one, and then another on immune function. What else might cold be used therapeutically for?

Cold plunges do not seem to affect cholesterol or body weight, nor blood pressures over the long-term. Neither systolic nor diastolic blood pressures were altered in the long-term by cold water exposure. After our first plunge, our blood pressure may go up but over time our body seems to adapt. During cold exposure our brain doesn’t work as well, but there isn’t much evidence of any residual effect besides a transient boost I covered before.

Cold showers may help with priapism, which is a prolonged erection persisting for longer than four hours. I didn’t realize that could turn into a surgical emergency, but the prolonged lack of new oxygenated blood can cause some of the penile tissue to die off. Before it gets to that, you can try ice packs, or cold showers. In this case, the patient was instructed to vigorously climb up and down a set of hospital stairs for ten minutes, and within seven, he successfully deflated.

What about cold water for burns? Misinformation regarding first aid for burns is ubiquitous online. For example, due to the high frequency of toothpaste being applied to burns, Colgate posted something on its website urging people not to use toothpaste for burn injuries. More serious is the suggestion to immerse a burn in ice water. Ice or ice water can make matters worse, preventing blood flow and increasing burn depth and pain. So, what should we do for burns? A full twenty minutes of cool running water has been proven to be the most effective first aid intervention in improving burn outcomes––associated with faster healing and decreased odds of full-thickness burns, hospital admission, and need for skin grafts.

What about using cold to treat flares of a painful inflammatory arthritis called gout, caused by crystals of uric acid forming in your joints, crystallizing out of your blood like rock candy. Since uric acid is more likely to crystallize at lower temperatures, maybe that’s why people get gout flares in their toes, or grow crystals in their ears—the areas of the body that may be cooler. So, if cooling of the joints causes crystal precipitation, one might be concerned that applying cold could precipitate and worsen acute gout attacks. That may be why some doctors have suggested applying heat rather than cold to affected joints. You don’t know, until you put it to the test. And indeed, the application of covered ice packs—never apply ice directly to the skin—for 30 minutes four times a day reported a significantly greater reduction in pain compared with the control group.

What about cold water immersion for gout, dunking the inflamed joint for 20 min/day for four weeks in water that’s more cool than cold—like in the 70s Fahrenheit (21 – 26 °C)? That led to decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. Fantastic! Now, there didn’t seem to be an actual improvement in inflammation; the cool water may not actually be affecting the course of the disease, but rather just causing a kind of numbing or pain-killing effect. But either way, what a cheap, safe, easy treatment to help alleviate such a painful condition.

What about cold packs for myalgia, which means muscle pain or muscle aches? Here, study subjects applied a cold gel pack for low back pain for 10 minutes, and although pain had lessened at the end of the 10 minutes, by 30 minutes no significant difference was seen. Isn’t 10 minutes better than nothing? Well, there are some cautionary tales from the anti-inflammatory drug literature. Although NSAID drugs like ibuprofen or naproxen serve as a common management strategy for numerous forms of musculoskeletal complaints, evidence suggests that these drugs may contribute to tendon degradation, due to less blood flow because the inflammation was tamped down. Inflammation from injury plays a role in the healing process. Similarly, there are data indicating an increased risk for acute pain to transition to chronic pain with NSAID use. In other words, anti-inflammatory drugs could cause chronic pain. Despite pain-killing efficacy in the short term, the management of acute inflammation may be counterproductive for long-term outcomes of low-back pain sufferers, in that it could end up resulting in more chronic pain in the long-run.

Then, what about using heat therapy for something like delayed onset muscle soreness, the soreness you may get the day after a heavy workout? A total of 32 randomized controlled trials involving more than 1,000 patients were compiled, and the heat worked better. The application of cold therapy within one hour after exercise can reduce pain within the first 24 hours after exercise, but heat therapy after exercise can extend that relief for longer than 24 hours.

A meta-analysis comparing the effectiveness of nine different cold and heat modalities found that for people with this delayed onset muscle soreness, hot packs proved the most effective for pain relief over the first 48 hours.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

Other gout videos include Preventing Gout Attacks with Diet and Treating Gout with Cherry Juice.

 If you missed the previous cold plunge videos, check out: 

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