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BMJ Case Rep. 2018 Feb 12;2018. pii: bcr-2017-222236. doi: 10.1136/bcr-2017-222236.

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

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Department of Psychiatry, University of Cambridge, Cambridge, UK.
School of Health Sciences, University of East Anglia, Norwich, UK.


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.


cardiothoracic surgery; complementary medicine; pain (neurology); peripheral nerve disease; sports and exercise medicine

[Indexed for MEDLINE]

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