Symptom Management

Almost all persons with multiple sclerosis suffer from increased sensitivity to heat, also known as thermosensitivity. An increase in heat will often result in a worsening of symptoms such as fatigue, visual loss, spasticity, weakness and pain. The increase in heat can be due to external or internal factors. Externally, an increase in heat can result from an increased environmental temperature. Internally, core temperature can increase because of a fever from an infection or during exercise that can also lead to symptoms of thermosensitivity.
 
The increase in heat because of exercise can be especially troublesome for persons with MS, as exercise is needed to address the loss of mobility that is usually inevitable with this disease. However, the use of readily available cooling garments can be extremely helpful for persons with MS in limiting the effects of thermo-sensitivity. Proper use of these garments can not only decrease the effects of heat, but also allow the person with MS to exercise for longer periods of time. The purpose of this article is to discuss two of the best known types of cooling methods – active and passive cooling – and give some suggestions as to how to decide which approach might be best for you.
 
Passive Cooling is probably the most widely used type of cooling. It is called passive, as it does not rely on a power source to cool, but rather cools through the use of ice packs or gel. Passive cooling is generally inexpensive and portable, but has the disadvantage of limited duration of cooling, as the devices themselves require re-cooling every two to four hours. They also can be heavy.
 
There are many different types of passive cooling available. These include:

• Wearable water-based ice packs:
These are generally worn in garments such as vests, hats or bandanas. The packs have to be frozen and can provide cooling for about three hours. The amount of cooling they provide can be somewhat regulated by the number of packs used. After the ice has melted they have to be refrozen, which limits the amount of time they can be used. Although these provide effective cooling, some patients complain they are heavy, especially if a number of ice packs are required. It is the least expensive of the cooling options and is available for free through organizations such as the MSFocus: the Multiple Sclerosis Foundation.

• Phase Changing Packs:
These contain a gel-like oil that freezes and can be used in the same manner as water-based ice packs. The gel has a higher freezing temperature than water-based packs and so it has the advantage of a longer period of cooling, and the ability to cool again by submerging in ice water (does not require a freezer).  


 • Hydrogel packs:
These use a gel that is activated when placed in water. There is also a hydrogel vest with built-in hydrogen crystals. This is lighter than other vests but the cooling lasts for a shorter period of time. 


• Water-activated garments:
These retain the water temperature after soaking, and cool as the water evaporates.  



Active Cooling is a somewhat more “high tech” approach to cooling. Rather than
achieving cooling through ice packs or gel packs, active cooling uses a  motorized system to circulate cold water around the body.

These devices were originally developed to aide in treating athletic injuries and decrease swelling following orthopedic surgery. The advantage of active cooling is that, because of the motorized component, the cooling effects can last longer. Additionally, the devices are constructed so that if desired, only specific body parts can be cooled such as shoulders, elbows, knees, and ankles. 

There are two significant disadvantages to active cooling, one being cost. They can cost anywhere from $150 to several thousand dollars. The other disadvantage is that they can be much heavier as they require a power source. This makes them well-suited for being used in an indoor setting where the individual does not have to move around a great deal, but a problem for outdoor use. Active cooling comes in a variety of garments such as vests and shorts, but all must be connected to a power source.

In summary, a wide variety of cooling garment options exist that can benefit all persons with MS who suffer from thermosensitivity. Passive cooling is less expensive, but maintains cooling for a shorter period of time. Active cooling is more expensive, but can maintain cooling for longer. It does however require connection to a power source making portability something of a problem. With either choice however, the thermosensitive person with MS will be in better shape.

Herb Karpatkin PT, DSc, NCS, MSCS is an assistant professor in the DPT program at Hunter College, as well as the owner of Herb Karpatkin Physical Therapy, a private practice specializing in MS.

Dr. Stefanie DiCarrado, PT, DPT, is a physical therapist at Aspire Center for Health and Wellness, and is a project manager and content developer at the Brookbush Institute, both based in New York. Stefanie has a B.S. in Information Technology, received her doctorate in Physical Therapy at Hunter College, and is a Certified Personal Trainer and Corrective Exercise Specialist through the National Academy of Sports Medicine.