Should healthcare professionals be considering drug free interventions for pain relief?

A recently published BMJ Case Report suggests they should.

Cold forced open-water swimming: a natural intervention to improve postoperative pain and mobilisation outcomes?

Tom B Mole / Pieter Mackeith BMJ Case Reports 2018:bcr-2017-222236 : Feb 18

Unexpected pain relief following open water swimming in markedly cold conditions.

Dr Mole of Cambridge University and Dr Mackeith of East Anglia University recently published an interesting Case Report in the British Medical Journal where severe intercostal pain was permanently alleviated through cold water swimming.

The patient, a 28 year old amateur tri-athlete had severe intercostal neuralgia following endoscopic thoracic sympathectomy. He was prescribed a course of physiotherapy alongside non-steroidal and opiate analgesics to help alleviate the pain. This proved to have only a marginal effect and after 10 weeks the patient was still experiencing severe pain following movement as a result of which his return to normal everyday activities was severely compromised.



The peer reviewed article states “Postoperative neuropathic pain exacerbated by movement is poorly understood and difficult to treat but a relatively common complication of surgical procedures such as endoscopic thoracic sympathectomy.”

It continues to describe “a case of unexpected, immediate, complete and sustained remission of postoperative intercostal neuralgia after the patient engaged in an open-water swim in markedly cold conditions.”

The ambient temperature was around 8C and it was estimated the sea temperature was around 11C.

The authors speculate whether there is a causal relationship or whether this was an incidental chance association.

As there is a poor response to traditional pain relief strategies in these conditions they suggest a need for novel, curative interventions for post-surgery pain and associated impaired mobility.

They recommend further evaluation of cold water swimming as a mobility-pain provocation to establish if the observed unexpected outcome could be replicated.



The patient was discharged following surgery “with a course of physiotherapy and combination analgesics including paracetamol, non-steroidal and opiate medication” which provided limited improvement.

After 10 weeks the patient continued to report limited mobility and continued  pain preventing return to pre-surgery levels of activity and impaired quality of life.

Without consulting health professionals the patient, who had been a recreational triathlete, “exposed himself to open-water swimming in an attempt to manage the pain through distraction.”

Due to the rocky shoreline the patient had to jump into the sea, plunging into markedly cold water and being unable to exit at this point was forced to swim for around one minute to reach an area where he could safely climb ashore.



Despite the patient’s expectation of severe pain, the patient unexpectedly reported no provocation of pain during the swim, has had no further episodes of intercostal neuralgia and reports being able to move and exercise freely without pain.

The analgesics prescribed by the primary care provider have been discontinued.


Learning Points

Damage to peripheral nerves during surgery can lead to difficult to treat post-operative pain, impaired mobility and lowered quality of life.

Cold water swimming may trigger a surge of sympathetic activity and catecholamines (e.g. adrenaline or dopamine) that may provide short-term endogenous analgesia (pain relief due to internal rather than conditions) and allow aggressive manipulation of the kinetic chain under pain-free conditions.

Cold water swimming may overcome reluctance to engage in painful postoperative movement thereby preventing the pain/immobility becoming chronic.

Further studies required to attempt replication of positive outcomes for postoperative neuropathic pain and immobility after exposure to cold water swimming.





Given this single case study I can understand why one might speculate that the sudden shock of the cold combined with the forced exercise were the main constituents contributing to the positive outcome in this instance.

However, having had exposure to many dozens of case studies over a number of years using low temperature hydrotherapy for pain relief I can report many cases of pain relief without any sudden shock or exercise i.e. standing or sitting in a properly designed designed without exercise could produce significant and sustained pain relief across a range of acute & chronic pain conditions.

A properly designed cold or CryoSpa facilitates control over temperature, turbulence and hydrostatic pressure providing the possibility of optimal recovery conditions without the risks associated with open water swimming.

For more information contact Colin Edgar:

Telephone: +44 (0) 2892 690056