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Cryotherapy has long been used by physical therapists and chiropractors in the management of acute and chronic pain. Multiple studies have demonstrated that both ice and menthol decrease blood flow and help to control pain; however, there is limited research to determine which form of cryotherapy works better on individual patients.


Fifty-one males and females between the ages of 19 and 65) with bilateral non- radicular, acute neck pain (myalgia) were given both ice and the topical analgesic Biofreeze on each side of the neck.

The study was randomized so that the ice was on the left side of the neck and the Biofreeze was on the right side or vice versa. Thus, both sides of the neck had one cryotherapy modality.


The patients were asked to rate their pain on a 0—10 Visual Analog Scale (VAS) for each side of the neck both before and immediately following the 10 min treatment. For actual levels of pain change, the average pre-treatment VAS score went from 6.24 to 3.65 for Biofreeze and from 6.31 to 5.00 for ice.

In addition, the patients were asked to answer the level of comfort of each modality during its application on a 5-point scale (1 = Very Unlikely or Very Uncomfortable and 5 = Very Likely or Very Comfortable). The average score on the 5 point Likert scale was 4.20 for Biofreeze and 2.57 for ice.

In addition, 9 out of 10 subjects reported that Biofreeze lasted longer.

Finally, the patients were asked the following day whether they preferred ice or Biofreeze and which modality had a longer lasting effect. Overall, when asked to rate the comfort and preference, patients preferred Biofreeze 8 to 1 (p < 0.001).

A paired t-test demonstrated that both ice and Biofreeze gave a significant reduction on pain levels (p < 0.001); however, there was nearly 2 times the reduction of pain on the Biofreeze side.


Both ice and Biofreeze significantly decreased pain levels; however, Biofreeze decreased pain nearly 2 times as much as ice. In addition, it was rated as substantially more comfortable, patients preferred it, and it lasted longer 9 out of 10 times.

Source: Bishop B et al. 2011. Effects of Biofreeze vs. ice on acute, non-complicated neck pain (Abstract) Clinical Chiropractic 14(4):153-54

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