PT - JOURNAL ARTICLE AU - Tom B Mole AU - Pieter Mackeith TI - Cold forced open-water swimming: a natural intervention to improve postoperative pain and mobilisation outcomes? AID - 10.1136/bcr-2017-222236 DP - 2018 Jan 19 TA - BMJ Case Reports PG - bcr-2017-222236 VI - 2018 4099 - http://casereports.bmj.com/content/2018/bcr-2017-222236.short 4100 - http://casereports.bmj.com/content/2018/bcr-2017-222236.full AB - 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.