Cold sensitivity – pain and discomfort in the hand initiated by exposure to cold – is a well known problem following hand injuries, especially those associated with nerve lesions. It is also a prominent symptom among patients with hand-arm-vibration syndrome (HAVS); although not specifically considered in the Stockholm scale. The aetiology of cold sensitivity is unclear, and there are no well-accepted and well functioning principles for treatment of this problem.
A problem is the sparse data and reports how to define cold sensitivity particularly in relation to a normal population. A lack of a widely accepted method to measure the severity of cold sensitivity has inspired us to translate questionnaires that enlighten patients' subjective experience of cold sensitivity. The Swedish version of these instruments named Cold Sensitivity Severity scale and Cold Intolerance Symptom Severity score (CISS) are valid and reliable to assess cold sensitivity in the hand. Furthermore, we have defined a cut off value for CISS for definition of cold sensitivity as abase for our future studies in different patient cohorts with potential problems of cold sensitivity.
We are also working on a concept for treatment of cold sensitivity based on the Pavlov conditioning principle. In a long-term rehabilitation program, patients suffering from cold sensitivity are exposed to whole body cooling while the affected hand is warmed in water at 43º C. The sessions are repeated three times weekly for a period of six weeks. The concept is that a Pavlov reflex is set up associating cold exposure with a warm hand. Our results indicate a positive subjective effect for traumatic hand-injuries, with less discomfort when exposed to cold in daily activities, leisure activities or at cold workplaces. The patients experience of cold sensitivity and coping strategies are also considered.
Long-term studies are performed to evaluate cold sensitivity in patients with various hand injuries.