CRPS + extreme cold (29.12.2017)
What do we mean by ‘extreme cold’ in Montréal, Canada? Well, today we actually have a weather warning in effect, just for that!
Our high temperature for the day was a windchill/RealFeel of -36C (or -33F, for my American friends), which will continue into the overnight hours. And it’s getting colder; the forecast for Saturday is -42C, or almost -44F. Even for folks who like winter, this weather’s unseasonably cold. Incredible though it may seem, our winter only began a week ago; on December 21st!
According to Environment Canada, “extreme cold warnings are issued when very cold temperatures or wind chill creates an elevated risk to health such as frost bite and hypothermia”(1). In these temperatures, it only takes a few minutes for frostbite to develop on any exposed skin.
And for many individuals, these types of temperatures can be lethal; homeless people, and those who don’t have adequate winter clothing (boots, coats, hats, mittens, scarves, …) can perish from exposure if they’re outside for any length of time. This is one of the reasons for which I donate to charities which operate shelters for homeless persons, and give lightly-used winter clothing and boots to community groups working with recent immigrants and refugees.
You’re probably wondering by now why I’m writing about weather in a ‘rare disease’ blog, so here’s the reason. One of the – many! – things I’ve found out, after being diagnosed with Complex Regional Pain Syndrome (CRPS, sometimes still called RSD or Reflex Sympathethic Dystrophy), is that the limbs and extremities affected by this rare neuro-inflammatory disease don’t react well to cold temperatures.
CRPS most often affects one of the extremities (arms, legs, hands, or feet)(2), which usually becomes extremely sensitive to changes in temperature because the “damaged nerves are no longer able to properly control blood flow, feeling (sensation), and temperature to the affected area”(3).
One research study noted that “Changes in vascular sensitivity to cold temperature and circulating catecholamines may be responsible for vascular abnormalities. Alternatively, RSD may be associated with an abnormal (side different) reflex pattern of sympathetic vasoconstrictor neurons due to thermoregulatory… stimuli generated in the central nervous system”(4).
‘Vascular abnormalities’ is another way of saying that something’s not working properly – or is working differently – in blood vessels of the area affected by CRPS. ‘Thermoregulation’ refers to the body’s temperature control, involving the brain’s hypothalamus. So the CRPS-related sensitivity to cold could come from changes to the blood vessels or from alterations in the body’s temperature control system in those areas of the body; or both.
With today’s extreme weather, it was just too cold for me to do any outdoor sports because of my CRPS-affected hand and arm. So I went to my gym this morning… and remembered that there are both a dry and steam sauna at the very end of the women’s locker room.
Although I don’t usually use the sauna, as I don’t like hot temperatures, I found out today that my CRPS arm & hand absolutely adore the dry sauna! The sauna was the only place in which my hand and arm weren’t in severe pain today.
And because my physiotherapy clinic is in the same building as my gym, I was able to pop in and warm up my hand again before my physio session tonight. My hand was so painful, from the cold, tonight – despite the warmest extreme-weather mittens I own – that I went into the sauna fully dressed; I only took off only my boots!
The woman in the sauna gave me a very strange look; I went in while still wearing my winter parka and 2 layers of fleece sweaters, and started pulling off clothes – to the base layers – while my hand was warming up. So it seems that I now have another incentive to go to my gym, when the weather’s cold!
(1) Environment Canada. Alerts for Metro Montréal – Laval: WARNINGS 3:59 PM EST Friday 29 December 2017 Extreme Cold Warning in effect. Web: https://weather.gc.ca/warnings/report_e.html?qc67
(2) New York State Department of Health. What is Reflex Sympathetic Dystrophy (RSD) Syndrome Syndrome [Complex Regional Pain Syndrome (CRPS)]? Feb 2015. Web: https://www.health.ny.gov/diseases/chronic/reflex_sympathetic/
(3) VeriMed Healthcare Network. Complex regional pain syndrome. MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services. Updated 21 Dec 2017. Web: https://medlineplus.gov/ency/article/007184.htm
(4) Baron R, Maier C. Reflex sympathetic dystrophy: skin blood flow, sympathetic vasoconstrictor reflexes and pain before and after surgical sympathectomy. Pain. 1996 Oct;67(2-3):317-26. Web: https://www.ncbi.nlm.nih.gov/pubmed/8951925