Category Archives: Contrast Hot/Cold Water Immersion Therapy

Is There a Link Between Prolonged Psychological Stress And Physical Pain?

Featured Image of the ocean near the beach in the sun taken by myself. 

Dear Pain Matters blog readers,

Prolonged psychological stress can perpetuate chronic pain in some patients, while other people may be prone to chronic inflammatory diseases including cardiovascular disease, type II diabetes, depression, autoimmune diseases, upper respiratory infections and poor wound healing ability.

Immune cells are normally very sensitive to circulating stress hormones (glucocorticoids including cortisol), and as such, are usually able to shut down the pro-inflammatory response in the presence of glucocorticoids.

Chronic psychological stress can reduce the circulating stress hormone’s ability to interact with its receptor leading to glucocorticoid receptor resistance (GCR).

Repeated and ongoing exposure to a long-term threatening (real or imagined) and stressful experience can lead to insufficient glucocorticoid regulation (i.e. GCR), that in turn can lead to:

  • Insufficient control over the inflammatory response towards an infection;
  • Increased duration and/or intensity of the pro-inflammatory response; and
  • Increased pain levels and other signs and symptoms of chronic diseases.  

Studies have shown that some chronic stress sufferers (e.g. parents of children with cancer, spouses of patients with brain cancer and lonely people) present with GCR (Cohen et al, 2012).

Other Biomechanisms that Influence the Pro-Inflammatory Response and its Key Role in Maintaining Chronic Pain and Inflammation-Based Diseases:

See this Blog Post for more information:

What Can Done To Reduce Prolonged Psychological Stress?:

Steps must urgently be taken to reduce repeated and ongoing exposure to a prolonged threatening (real or imagined) and stressful experience.

This brings us to all those therapies that may induce the ‘relaxation response’ and/or lead one to a calmer disposition including:


Any therapy that can induce the ‘relaxation response’ is key to diverting attention away from repeated and ongoing psychological stress.

This will strengthen the immune cells’ ability to interact with circulating stress hormones (glucocorticoids including cortisol) and shut down an exaggerated pro-inflammatory response.

Conventional pharmacological treatment also plays an important role in reducing excessive inflammation.  The effectiveness of pharmacological drugs may be further enhanced by the body’s ‘relaxation response’, leading to lower drug dosages and fewer adverse effects.

The body’s innate ability to properly control a pro-inflammatory response is key to warding off chronic pain and disease.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.



(1) Study Finds Link Between Stress And Physical Pain

Huffington Post (03 April 2012)


(2) Clynes, Manfred

Sentics: The Touch of Emotions

250 pp, Doubleday/Anchor, New York, 1977 – Chapter 9 only

Peer-Reviewed Paper

(3) Cohen S, Janicki-Deverts D, Doyle WJ, et al.

Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk.

Proceedings of the National Academy of Sciences of the United States of America. 2012;109(16):5995-5999.



Cold Water Immersion or Contrast Hot/Cold Water Immersion Therapy – Does This Reduce Pain?

Dear Pain Matters blog readers,

Summer is fast approaching ‘Down Under’ (where I live, in Sydney, Australia).  As such, I am swimming and snorkelling almost daily in the ocean.  Yesterday, I even tried surfing!

Why am I telling you all this??

Well….Full immersion of the face in cold water (via a jump into the ocean, or otherwise) immediately activates the Mammalian Diving Response.  Why is this interesting? Read on…..

Did you know that our Mammalian Diving Response is the most powerful Autonomic Nervous System reflex known?  For example, this reflex immediately causes:

– Decreased heart rate;

– Vasoconstriction in the periphery (shunting of blood away from the arms and legs, and into the heart, brain and other organs); and

– Apnea/breath-holding, while underwater.

The Mammalian Diving Response can immediately be activated during a ‘relaxing’ cold plunge pool immersion, and also while snorkelling, free diving, and scuba diving in the ocean.

James Nestor, author of Deep, describes the Mammalian Diving Response in the following awe-inspiring 3-minute YouTube:

In sports medicine, Contrast Cold/Warm Water Baths (including full-body immersion) are often used to treat soft tissue and joint injuries.  This treatment promotes alternating vasodilation/vasoconstriction (almost like a ‘pumping action’).  This therapy can reduce swelling, pain and muscle spasm, while also increasing peripheral circulation.

A Turkish review paper discussed the benefits of Cold and Heat Therapy in Fibromyalgia patients.  

Mankind has practised Ice Cold/Cold/Cool/Warm/Hot Water Immersion Therapy (Contrast Water Immersion Therapy) for as long as we can remember.  For example, native Indians often soaked in natural hot springs and washed in cold lakes and rivers.

Immersion in plunge pools with varying water temperatures can give our Autonomic Nervous System a very good work-out.  Blood circulation is re-directed back and forth, from the legs/arms to the heart, brain and other organs (while immersed in cold water), and back to the legs and arms (while immersed in warm water).

You could think of Contrast Hot/Cold Water Immersion Therapy as being like a gym workout for your Autonomic Nervous System!

Immersion in cooler/cold water is a quick, simple, and effective way to re-activate our parasympathetic nervous system (including efferent vagus nerve).  It causes our heart rate to slow and our breathing rate to decrease.  At the same time, blood circulation is diverted away from our arms and legs, and into our organs including heart and brain.

Chronic pain conditions are often associated with localised inflammation, an overactive sympathetic nervous system, an underactive parasympathetic nervous system including reduced efferent vagal output, and reduced heart rate variability.


Would Cool Water Therapy (including brief facial immersion) lead to increased parasympathetic nervous system activity, reduced inflammation, and reduced pain?  

Could Contrast Cold/Warm/Hot Water Therapy also result in decreased pain?  

Under what circumstances does increased pain occur?

NOTE:  When warranted, this water-based therapy should always be medically supervised.

Wishing you all a good weekend!

Sabina Walker


(1) Cochrane; Alternating hot and cold water immersion for athlete recovery: A review; Physical Therapy in Sport (2004), 5, Pages 26-32.

(2) Al Haddad et al; Effect of cold or thermoneutral water immersion on post-exercise heart rate recovery and heart rate variability indices; Autonomic Neuroscience: Basic and Clinical (2010), 156(1-2), Pages 111-116.

(3) Buchheit et al; Effect of cold water immersion on postexercise parasympathetic reactivation; American Journal of Physiology. Heart and Circulatory Physiology (2009), 296(20), Pages H421-427.

(4) Aysegul Jale Sarac and Ali Gur; Complementary and Alternative Medical Therapies in FibromyalgiaCurrent Pharmaceutical Design (2006), 12, 47-57 47

(5) Panneton et al; Parasympathetic preganglionic cardiac motoneurons labeled after voluntary diving. Front Physiol. 2014 Jan 28;5:8. doi: 10.3389/fphys.2014.00008


(From a free-diving perspective) 

(6) Nestor, James; Deep – Freediving, Renegade Science and What the Ocean Tells Us About Ourselves; 2014