Paraffin post-PT (09.12.2016)
When this past summer turned to autumn, the leaves started to fall, and the weather got cooler… Wait a minute – this sounds like the opening line of a bad novel!
At the end of the summer (that’s better!), my physiotherapist asked whether any of my physicians had suggested hot paraffin treatments for my right hand; to help with some of the symptoms of my rare neuro-inflammatory disease.
My right hand and lower arm are affected by Complex Regional Pain Syndrome (CRPS), also called Reflex Sympathetic Dystrophy (RSD). See Code breaking for CRPS/RSD information. This disease usually affects the limbs and extremities (lower arm & hand, or lower leg & foot), and causes a multitude of signs & symptoms:
- Signs = What medical professionals can feel, see, measure, test (including blood tests & scans)
- Symptoms = What a patient experiences (in this case, me)
Different patients with this disease may have different signs & symptoms, to varying levels. But one symptom that almost all people with CRPS have, for the area of their body affected, is a bad reaction to cold temperatures.
CRPS makes my hand & arm ‘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”(1).
This sensitivity to cold may also be because of “an abnormal (side different) reflex pattern of sympathetic vasoconstrictor neurons due to thermoregulatory… stimuli generated in the central nervous system”(2). That means, more or less, that the body’s temperature control isn’t working properly in the area affected by CRPS.
So this sensitivity to cold could be caused by problems with the blood vessels, or by a malfunction in body’s temperature control system – in the specific area with CRPS. There’s a lot about CRPS that’s unknown, so this is the kind of ‘maybe it’s this, maybe it’s that’ outlook that I’m still getting used to!
I live in Montréal, where we have very cold winters which seem to last half the year, so this is really a problem for me! And I love winter sports; cross-country skiing, skating, and snowshoeing (up & down mountains, in the Adirondack Mountains in northern New York State).
Another common symptom of CRPS is joint pain, which is – of course! – also worse in cold weather. The type of treatment that my physiotherapist does for me is called manipulation and mobilization (M&M), to try to force the joints. Read M&M physiotherapy if you want a more detailed description.
The goal of M&M is to try to ‘break’ the adhesions that have formed in my wrist and in every joint of each of my fingers. It’s like my physiotherapist is trying to force scar tissue inside each joint, to break it up. And yes, it hurts. It hurts even more when the weather’s cold.
My physiotherapist’s idea was to get a small paraffin wax heating machine, at the clinic where I have the M&M treatment. A machine just big enough for me to dip my entire hand into it. Research has shown that hot paraffin treatments:
“with joint mobilization techniques are more effective than mobilization techniques without paraffin wax bath in the rehabilitation”(3) hand stiffness
“combined with exercises can be recommended for beneficial short term effects for arthritic hands”(4)
So he wondered whether hot paraffin treatments could help with some of the symptoms of my rare neuro-inflammatory disease; mostly the joint pain. I checked with one of my specialists, who agreed with me that the risk/benefit analysis looked good; that there was very little risk of harm, with a potential benefit to me.
So my physiotherapy clinic ordered a small paraffin wax heating machine, and I’ve used it a few times now. After each M&M session, when my finger & wrist joints are really hurting, it’s soothing to dip the entire hand & wrist into the hot paraffin. I dip the hand in and out of the hot wax several times, and my physiotherapist wraps the wax-coated hand & arm in plastic and then a towel.
We leave the plastic-wrapped wax on my hand for 15 minutes, sometimes longer. It really does make a difference, if only for a half hour or so. And it’s like a bit of a reward, after my painful M&M sessions.
Sometimes, with rare diseases and with life in general, the small things can make a big difference…
(1) 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 19 Sep 2016. Web: https://medlineplus.gov/ency/article/007184.htm
(2) 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
(3) Sibtain, Fozia, Asghar Khan, and Syed Shakil-ur-Rehman. Efficacy of Paraffin Wax Bath with and without Joint Mobilization Techniques in Rehabilitation of Post-Traumatic Stiff Hand. Pakistan Journal of Medical Sciences 29.2 (2013): 647–650. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809244/
(4) Robinson V, Brosseau L, Casimiro L, Judd M, Shea B, Wells G, Tugwell P. Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2002;(2):CD002826. Web: https://www.ncbi.nlm.nih.gov/pubmed/12076454