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BMJ Case Reports 2018; doi:10.1136/bcr-2017-222236
  • Unexpected outcome (positive or negative) including adverse drug reactions
  • CASE REPORT

Cold forced open-water swimming: a natural intervention to improve postoperative pain and mobilisation outcomes?

Press Release
  1. Pieter Mackeith2
  1. 1 Department of Psychiatry, University of Cambridge, Cambridge, UK
  2. 2 School of Health Sciences, University of East Anglia, Norwich, UK
  1. Correspondence to Dr Tom B Mole, tm507{at}cam.ac.uk
  • Accepted 5 December 2017
  • Published 12 February 2018

Summary

Postoperative neuropathic pain exacerbated by movement is poorly understood and difficult to treat but a relatively common complication of surgical procedures such as endoscopic thoracic sympathectomy. Here, we describe a case of unexpected, immediate, complete and sustained remission of postoperative intercostal neuralgia after the patient engaged in an open-water swim in markedly cold conditions. Though an incidental chance association is possible, the clear temporal proximity linking the swim with pain remission makes a causal relationship possible. We discuss plausible mechanisms that may underlie the relationship and discuss the potential implications for postoperative pain management and patient-centred mobilisation. We recommend further evaluation of cold forced open-water swimming as a mobility–pain provocation challenge to see if the observed unexpectedly positive outcome can be replicated. With the poor response to traditional management, there is a need for novel, curative interventions for postoperative neuropathic pain and associated impaired mobility.

Footnotes

  • Contributors TBM conceived the article. Both authors collected and interpreted the data and drafted the manuscript critically for important intellectual content and gave approval of the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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