Cold A cold
Cold A cold spray of the type used on athletes produces dramatic but brief relief. It cannot be caused by cooling the deep tissue that is damaged. The provoked impulses arriving in the spinal cord set off a temporary inhibition of the cells transmitting the injury signals.HeatThere is no doubt about the generally comforting, relaxing effect of overall heating, as witnessed in the Roman caldarium and the modern sauna. It is a standard treatment for anyone’s anxiety. A quite different treatment is local heat. In the words of T. S. Eliot:
Here comes the nurse with the red hot poultice, Slaps it on and takes no notice
The nurse may take no notice but the patient certainly does and shifts attention. Attention distraction is the basis of counter-stimulation. A third Cold A cold and quite different intention of heat therapy is to increase circulation and thereby to speed up the end of inflammation. Ultrasound and microwave therapy were invented for this purpose to heat deep tissue. The use of ultrasound will be described in the next chapter as an impressive example of a proven placebo effect.Gentle massage Delightful.Transcutaneous electrical nerve stimulationWhen I had discovered that the input from large, low-threshold sensory afferent nerves reduced the response of animal spinal-cord cells to an input from injury-detecting fibres, Sweet and I tried in Boston in 1967 to produce the same effect, first on ourselves and then on patients. We knew that a small electrical stimulus preferentially excited the large fibres so we superimposed a gentle tingling sensation on top of the painful area. When this can be achieved, it produces considerable relief of the pain. We extended the method to direct stimulation of nerves and of the spinal cord, but the most common use is to try to produce the effect by simple electrodes on the skin. It is no panacea but it works.*60\219\2*
