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Hi Keith.
I posted this on your facebook page, but I'm not sure that was the best place for it. So I am repeating the post here.
I just was wanting to comment on ice and gout.
You and I both recently answered a question on Yahoo Answers. I said “ice good” and you said “ice bad” 🙂
It is a bit of a tricky one isn't it. When I had gout I found it incredibly useful to use ice on the affected joint(s). And that's why I recommend it.
But I can sort of see where you are coming from, because the crystals do form more rapidly when it is colder ? hence the middle of the night attacks in the extremeties.
I noticed on Gout Living (arthritis.org/goutliving.php”), which is a fairly new site put up by the Arthritis Foundation, that
they mention ice as a potential treatment. I assume that they know their stuff.Perhaps it's to do with the longevity of how long you ice the joint? I used to ice for 20 minutes every 2 hours, based on the treatment for soft tissue injuries.
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Brett
1. The use of ice is effectively simple anaethesia; you'd undoubtedly have better and longer lasting results with novocaine
2. Gout is not a soft tissue (impact trauma) injury, so your reasoning is flawed. Gout is a systemic inflammatory response, which depends on blood flow to the area to complete its natural cycle. Icing hinders this process.
Thanks for your input odo. I should have clarified my original post by stating that I am talking about acute gout pain management i.e. when the attack is just starting out and is in the first day or so.?
So I am not talking about the long term treatment, but what the sufferer can do right now to relieve their pain.
Ice is used in soft tissue injuries for the reduction of swelling, not as anaesthesia. It was in this context that I was comparing soft tissue injuries with gout attacks – i.e. the need to reduce the swelling that is causing the pain.
Soft tissue injuries, like gout, don't heal with ice treatment. Both sitations need blood flow to finish the healing process.
It is the swelling that exists in the initial stages of gout that I am talking about, not the ongoing issues after the attack has subsided. Perhaps bringing soft tissue injury into the conversation was a red herring… I really was only talking about the swelling.
As a result of coming across Keith's opinion, and also from your feedback too, I thought I'd better take a look and see if I could find out more. I don't want to be telling people the wrong thing.
I came across several sites which recommended ice/cold as a first treatment for gout. Now these aren't just any sites.. they were arthritis.org (The Arthritis Foundation), nhs.uk (National Health Service), bupa.co.nz (An aged care provider), and clinicalconnection.com (which has a lot of information on clinical studies).
I can provide the links if people are interested. I didn't want to pepper this post with links for fear of disappearing into the moderation or spam queue.
One particularly relevant quote from clinicalconnection.com I saw:
Ice may be applied for 20?30 minutes several times a day.
There are concerns that uric acid crystallization is accelerated by low
temperature, but in a 2002 study in the Journal of Rheumatology patients who
used ice packs had better relief of pain with no negative
side effects. Keeping the affected area elevated above the level of the heart
may help as well.Please don't get me wrong here. I am not trying to be antagonistic or anything. I'm just trying to get to the bottom of this gout/ice question. I've long recommended icing as an effective treatment in an acute attack. When I saw Keith's opinion that this might promote monosodium urate crystal production I was a bit worried that I had been wrong all this time.
All the best
Brett
Maybe, it's just a case of enduring more initial pain in order to speed up the healing process? [ie:?No Ice]
The long term pain of an attack is what wears me and many others down more than anything else!
I have used Soda Bicarb in?cool water as a soak with some success in the past – but never ice.
Before I start, may I just say a huge thank you to Brett for adding to the gout debate in a constructive manner without abusing us with promotions for his own website. I know he is not alone in making real contributions, but he is the first website owner to start a discussion for it's own sake, and not for self-advancement.
Brett Thurston said:
?which is a fairly new site put up by the Arthritis Foundation, that
they mention ice as a potential treatment. I assume that they know their stuff.
I doubt that is a safe assumption. That organization serves us well in the fact that it seeks to raise the profile of gout, but we should never lose sight of the reason why it does it ? to sell more Uloric and Adenuric (febuxostat).
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However, there is no need for us to fall out about ice as a treatment for gout. All advisers fall into one of two camps. You either manage gout pain, or you manage it's cause ? uric acid.
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If your focus is on relieving gouty arthritis pain, then there is plenty of evidence, scientific and anecdotal, that ice works. Similarly, there is evidence that heat and other forms of nerve stimulation help. Distraction therapy is probably useful for many people, but amongst the best non-medical treatments for most types of pain (not just gout) is anxiety therapy. I'm still researching that one, but it seems that the thought of pain is much worse than pain itself.
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If you seek to manage uric acid, then ice is a poor choice, as it encourages uric acid to form crystals. Temperature is probably the single biggest factor in triggering gout attacks.
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Given the plethora of gout pain treatments, and my own conviction that managing uric acid is much more important than managing gout pain, then my choice is to avoid ice. Others can make there own choice, but it is vital that they understand their options, and not simply rely on Internet quotations which get repeated time and time again. It's an easy trap to fall into, and I used to list ice as a gout treatment based on the number of times it cropped up on other sites, and the Rheumatology research you mention. Thanks to the discussions in this forum, I now realize that only gout sufferers truly understand gout, so we have to try to train our doctors and other health advisers to think more clearly.
I worry a little that there might still be some under-researched information on GoutPal.com from the early days. If anyone spots anything, please let me know by starting a new discussion here.
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A final thought on the pain vs uric acid issue. I was chatting with my gouty brother-in-law over the holiday. He is firmly in the gout pain camp. “What's the point of taking a pill everyday, when I only need a few pain-killers once or twice a year?”
A perfectly valid point of view, and I imagine he'd welcome the ice pack.
No Ice ? pretty simple.
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Well?- after thinking a bit, I decided to update my post.
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LOGICALLY? one should realize that Ice is most likely a bad idea.? HOWEVER we all react differently to different inputs, so if ICE does make your short term pain less, then go for it.?
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All I know is for me ICE was the devil and for many others…so just be careful.
FWIW, when I was in the throes of a debilitating gout attack in both knees last summer, I found that ice was very helpful in reducing the swelling.? Ice made it possible for me to walk a little bit.
It was disappointing to learn that ice probably makes gout worse in the long run.
Keith (Gout Admin) said:
…
A final thought on the pain vs uric acid issue. I was chatting with my gouty brother-in-law over the holiday. He is firmly in the gout pain camp. “What's the point of taking a pill everyday, when I only need a few pain-killers once or twice a year?”
A perfectly valid point of view, and I imagine he'd welcome the ice pack.
Keith, I hope that wasn't you who said that is: A perfectly valid point of view...
That is about the dumbest view point a rational, intelligent person can have!!! While s/he cuddles her/his pain brain, Mother Nature says: Have at it! I'll make damn sure you'll remember your stupidity down the line while I increase your uric acid in your blood.
Your gouty brother-in-law should apply for a job with the pharma industry. Since their motto is: Treat the symptoms, not the cause, he'd make an excellent salesman for them.
(Keith, I am really angry with you. I would have expected that statement from any body else, but not from YOU
, who always says: Manage your GOUT. I have NEVER heard you saying: Manage your pain.)I was puzzled by that comment too- as all the previous advice here?is?NOT ignore long term UA build up, so at best, only a temporary solution.? Valid, maybe- for an individual choice, but not ideal for most with knowledge of Gout.
Maybe we're being tested 😉
Oh dear ? I didn't mean to cause a family rift. I never knew frozen water could be so controversial
Keith said:
Before I start, may I just say a huge thank you to Brett for adding to the gout debate in a constructive manner without abusing us with promotions for his own website. I know he is not alone in making real contributions, but he is the first website owner to start a discussion for it's own sake, and not for self-advancement.?
Well as much as I'd like to say that I am very surprised that I am the first, unfortunately I'm not surprised at all. It just seems to be the way things are on the net at the moment ? everybody looking out for themselves, and not respecting the work that others are already putting in. I don't have any right at all to come stomping in here all over Keith's work, and why others think they do is beyond me.
Keith also said:
All advisers fall into one of two camps. You either manage gout pain, or you manage it's cause ? uric acid.
I'm not quite sure that I agree with this. Mainly because I have one (gout-free) foot in each camp.
I take a view of short term pain relief, coupled with long-term uric acid reduction. Ice and NSAIDs did the trick for me during the worst times, but obviously reducing the UA levels was the chief thing I needed to do (and did do)
In my research yesterday, which I posted about above, I also came across something else interesting. I wish I'd noted the URL down, but if I find it again I'll post it here.
Basically it said that people's reaction to ice could perhaps help doctors differentiate between gout and other forms of arthritis. If they reacted favourably to ice/cold, i.e. it soothed their pain, then it was more likely they had gout than any other form of arthritis.
Clearly this doesn't work in every case, as evidenced by what toofast had to say above
toofast: All I know is for me ICE was the devil and for many others?so just be careful.
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Regarding the impact of icing a joint and urate crystallisation? I'm aware that cold helps uric acid to crystallise and hence this is why icing would be a concern. But I'm wondering if anybody has seen any medical evidence that short-term icing of the joints during an acute attack has a negative effect on the long term prognosis of a gout sufferer.
In other words? sure there is a risk of more crystals being formed, but does the benefit of the reduced swelling in the acute attack outweigh this risk?
I don't know the answer to that, and I've not seen any medical evidence that points one way or the other. But very interested in seeing anything that is out there.
Keith said:
Distraction therapy is probably useful for many people, but amongst the best non-medical treatments for most types of pain (not just gout) is anxiety therapy. I'm still researching that one, but it seems that the thought of pain is much worse than pain itself.
I'm all for these sorts of therapies. There was a recent article on Zen meditation and pain which said that “Zen meditators still feel pain, but they don't think about it as much”!? It went on to say “The observation could have a bearing on the treatment of chronic pain among patients struggling with the impact of conditions such as arthritis and back pain.”
So yes ? there's a lot more to this pain thing than meets the eye.?
OK ? I'll sign off for now. Sorry about the long post
Now that I've crashed the party I'll go and find a quiet place to introduce myself properly.
Cheers
Brett
Brett Thurston said:
Oh dear ? I didn't mean to cause a family rift. I never knew frozen water could be so controversial
Worry not!
We are passionate here, and that is fine by me, as long as one remembers…?
Keith said:
Before I start, may I just say a huge thank you to Brett for adding to the gout debate in a constructive manner without abusing us with promotions for his own website. I know he is not alone in making real contributions, but he is the first website owner to start a discussion for it's own sake, and not for self-advancement.?
Well as much as I'd like to say that I am very surprised that I am the first, unfortunately I'm not surprised at all. It just seems to be the way things are on the net at the moment ? everybody looking out for themselves, and not respecting the work that others are already putting in. I don't have any right at all to come stomping in here all over Keith's work, and why others think they do is beyond me.
… Respect! All I ask really.
Keith also said:
All advisers fall into one of two camps. You either manage gout pain, or you manage it's cause ? uric acid.
I'm not quite sure that I agree with this. Mainly because I have one (gout-free) foot in each camp.
I take a view of short term pain relief, coupled with long-term uric acid reduction. Ice and NSAIDs did the trick for me during the worst times, but obviously reducing the UA levels was the chief thing I needed to do (and did do)
That is exactly correct. To be clear, I was talking about primary focus. Sensible people who believe uric acid management? is paramount, accept that pain relief is a necessary temporary measure. The other camp, and my soon-to-be-published research, suggests that it is strong and influential, regard pain relief as the only valid goal. I.e. they dismiss uric acid control as being too difficult (it's a bit more complicated than that, but that will do for now.
My conclusion on ice is that it would appear to be a serious risk factor for inducing urate deposits. As I cannot see how this would benefit a gout sufferer (beyond temporary pain relief) I cannot recommend it, especially since there are many more equally effective pain relief options. (If anyone wants to discuss these, please start new topics). I'm prepared to be open-minded about this, and would welcome more research. As I see it, the only way this research could be effective is to use DECT to measure the urate deposit effects, as no other technology can realistically assess the affect of ice within the joint.
hansinnm said:
Keith (Gout Admin) said:
…
A final thought on the pain vs uric acid issue. I was chatting with my gouty brother-in-law over the holiday. He is firmly in the gout pain camp. “What's the point of taking a pill everyday, when I only need a few pain-killers once or twice a year?”
A perfectly valid point of view, and I imagine he'd welcome the ice pack.
Keith, I hope that wasn't you who said that is: A perfectly valid point of view...
?That is about the dumbest view point a rational, intelligent person can have!!! While s/he cuddles her/his pain brain, Mother Nature says: Have at it! I'll make damn sure you'll remember your stupidity down the line while I increase your uric acid in your blood.
Your gouty brother-in-law should apply for a job with the pharma industry. Since their motto is: Treat the symptoms, not the cause, he'd make an excellent salesman for them.
(Keith, I am really angry with you. I would have expected that statement from any body else, but not from YOU
, who always says: Manage your GOUT. I have NEVER heard you saying: Manage your pain.)
Hans, I'm only here to help and advise. If someone wants to accept the risks of elevated uric acid, then they are perfectly within their rights to do so. Just as people have the right to smoke, partake in dangerous sports and many other aspects of the human condition, which is rarely bound by logic.
It only becomes unacceptable, to me, when the decision harms other people, or it is made in clear ignorance or through being duped.
The choice of ice to relieve gout pain (he said, desperately trying to keep this discussion on-topic) might not seem like the logical choice, but it does not make it invalid. As Brett has explained, there is clear evidence that ice is beneficial for gout pain. If all you worry about is gout pain, then a solution that brings immediate relief is valid. After all, my view that it might cause problems on the uric acid management front is not based on anything other than the well established fact that uric acid crystals form more readily at lower temperatures. I believe that ice to control gout pain ignores some vital issues regarding uric acid management, but it is difficult to prove. I can prove that prolonged exposure to cold is extremely bad for gout, but for short term relief, I can only say that, for me at least, it is not worth the risk.
There are wider issues at work here, including belief systems, attitudes to pain, attitudes to medicines, life goals etc, etc.
I'll state my case, of which I'm certain, but it is only my way.
In order to keep this discussion to ice, I'll start a new discussion in the Your Gout forum to try and explain my philosophy a little better.
While the 'Ice Jury' is out, maybe my suggestion of cold water soak for 20 mins or so is the best halfway house?
Even cool water feels great to a gouty foot!????
Ice ???? ? in the 'pain mindset' camp, possibly.
My?way, the? nearer to surface tissue gets a 'cold shrink' for a while helping ease discomfort?and the deeper joint deposits don't get the chance to start getting too?lucky and crystallising?even more with a 'payback' load!
PS: Where's Zip? He's missing all the fun? 🙂
Keith (Gout Admin) said:
Hans, I'm only here to help and advise.
If someone wants to accept the risks of elevated uric acid, then they are perfectly within their rights to do so. Just as people have the right to smoke, partake in dangerous sports and many other aspects of the human condition, which is rarely bound by logic.
It only becomes unacceptable, to me, when the decision harms other people, or it is made in clear ignorance or through being duped.
…
Well, Keith, as usually, you come through with flying colors. I cannot but accept your expanation.
Hi guys?
Moved to Manhattan and was without phone or internet for 19 days?how does one live like that? Anyhoo, I am back with a?blazing new 15.5 Mbps fiberoptic communications system?connection. YAAAY!
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Here's my take on ice: good and bad. It is good in that it reduces swelling temporarily; it is bad in that it?causes more precipitation of urate (urate solubility is extremely dependant on temperature…that's why we get it in our feet and hands.)
I think the bad outweighs the good.
Anyone who merely treats gout pain and ignores urate will soon find that he has made a bad mistake, because once tophi form and joint degradation occurs?there?is precious little that can be done to reverse the situation.? My God, how much trouble is it to take a 300 mg. allopurinol on a daily basis. It sure beats a?semi-annual or quarterly ?dose of prednisone for safety.
Brett Thurston said:
I take a view of short term pain relief, coupled with long-term uric acid reduction. Ice and NSAIDs did the trick for me during the worst times, but obviously reducing the UA levels was the chief thing I needed to do (and did do)
I agree.
I have found (and this is my experience only) that as soon as I feel the first twinges of gout coming on, I take one viclofen 25mg pill which usually kills the pain within 2 hours. The longer I go without any medication the longer it takes to get rid of the pain.
If ice contributes to the crystals why not take a pill instead of the ice treatment.
This along with the long term uric acid reduction suits both purposes, defeat pain and lower the uric acid.
As I said, this applies to me and I am just a learner and that is why I am here – to learn more about my gouty problem.
I have learnt more in a few days here that what all the health professionals ever told me.
(I hope this is on topic)
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