Cryotherapy |
Cold/ice packs Ice massage Cold bath Vapocoolant sprays | Decreased pain, edema, and inflammation | Anti-inflammatory steroids (glucocorticoids); nonsteroidal anti-inflammatory analgesics (aspirin and similar NSAIDs) | Peripheral vasodilators may exacerbate acute local edema. | Some forms of cryotherapy may produce local vasoconstriction that temporarily impedes diffusion of drugs to the site of inflammation. |
| Muscle relaxation and decreased spasticity | Skeletal muscle relaxants | Nonselective cholinergic agonists may stimulate the neuromuscular junction. | — |
Superficial and Deep Heat |
Local application Hot packs Paraffin Infrared Fluidotherapy Diathermy Ultrasound | Decreased muscle/joint pain and stiffness | NSAIDs; opioid analgesics; local anesthetics | — | — |
| Decreased muscle spasms | Skeletal muscle relaxants | Nonselective cholinergic agonists may stimulate the neuromuscular junction. | — |
| Increased blood flow to improve tissue healing | Peripheral vasodilators | Systemic vasoconstrictors (e.g., alpha-1 agonists) may decrease perfusion of peripheral tissues. | — |
Systemic Heat |
Large whirlpool Hubbard tank | Decreased muscle/joint stiffness in large areas of the body | Opioid and nonopioid analgesics; skeletal muscle relaxants | — | Severe hypotension may occur if systemic hot whirlpool is administered to patients taking peripheral vasodilators and some antihypertensive drugs (e.g., alpha-1 antagonists, nitrates, direct-acting vasodilators, calcium channel blockers). |
Ultraviolet Radiation | Increased wound healing | Various systemic and topical antibiotics | — | Antibacterial drugs generally increase cutaneous sensitivity to ultraviolet light (i.e., photosensitivity). |
| Management of skin disorders (acne, rashes) | Systemic and topical antibiotics and anti-inflammatory steroids (glucocorticoids) | Many drugs may cause hypersensitivity reactions that result in skin rashes, itching. | Photosensitivity with antibacterial drugs |
Transcutaneous Electrical Nerve Stimulation (TENS) | Decreased pain | Opioid and nonopioid analgesics; certain antiseizure drugs (e.g., gabapentin, pregabalin) | Opioid antagonists (naloxone, naltrexone) | — |
Functional Neuromuscular Electrical Stimulation | Increased skeletal muscle strength and endurance | Low-dose androgens in certain populations (e.g., androgendeficient men) | Skeletal muscle relaxants | — |
| Decreased spasticity and muscle spasms | Skeletal muscle relaxants | Nonselective cholinergic agonists may stimulate the neuromuscular junction. | — |