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Journal of Performance Health Research

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Creative Commons Attribution-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.




Background: Cryotherapy has since long been used by physical therapists and chiropractors in the management of acute pain; more recently, its use has been shown to be effective in managing chronic pain. Multiple studies have shown that both ice and menthol reduce blood flow to the affected area and help control pain; however, there is limited research to determine the form of cryotherapy that works better on individual patients.

Purpose: The purpose of this study was to compare the effect of a cold pack and menthol topical gel on reports of pain among individuals with neck pain.

Methods: In this randomized study, 51 individuals in the age range of 19–65 years (37 ± 11.2 years) with bilateral, nonradicular, acute neck pain (myalgia) were included. Cold packs and Biofreeze®, a topical analgesic, were applied on either side of the neck (ie, ice on one side and Biofreeze on the other). The patients were asked to rate their pain on a 0–10 visual analog scale for either side of the neck both before and immediately following the 10-minute treatment. In addition, the patients were asked to answer 2 questions about which modality they would prefer to use in the future for pain management and their level of comfort with each modality during its application and to rate their answers on a 5-point scale (1 = very unlikely or very uncomfortable and 5 = very likely or very comfortable). On the next day of treatment with cold packs and Biofreeze, patients were asked to choose their preferred mode of treatment among the two and the modality that had a longer-lasting effect.

Results: Overall, when asked to rate the comfort and preference, patients preferred Biofreeze 8:1 (P = .000). The average score on the 5-point Likert scale was 4.20 and 2.57 for Biofreeze and cold pack, respectively. In addition, 9 out of 10 patients reported that the effect of Biofreeze lasted longer than that of ice (P = .000). Further, the average score for Biofreeze and ice was 4.47 to 2.63, respectively. For actual levels of pain relief, the average pretreatment visual analog scale score decreased from 6.24 to 3.65 for Biofreeze and from 6.31 to 5.00 for ice. A paired t test showed that both cold packs and Biofreeze significantly reduced pain (P = .000). However, the pain reduction was 2-fold with the Biofreeze treatment.

Conclusions: Both cold packs and Biofreeze significantly reduced pain; however, there was a 2-fold reduction in pain with Biofreeze. Biofreeze was rated as substantially more comfortable; patients preferred it, and its effect lasted longer in 9 out of 10 trials. This study was the first to evaluate the immediate effects of 2 different cryotherapy methods. It is not unexpected that the results of this study would differ slightly from other published studies evaluating menthol products. Conservative care specialists are often looking for methods to improve patient satisfaction and compliance. The present study indicates that Biofreeze is the preferred method of cryotherapy application by many neck pain patients on their first visit to the clinic.

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