Cold sensitivity and MS

Cold sensitivity is a type of temperature sensitivity that can be experienced by people with MS. It describes the temporary worsening of MS symptoms in response to a decrease in temperature.

On this page we look at common triggers of cold sensitivity and the symptoms that are typically affected. We also look at some practical approaches that can help manage the effects of the cold.

Cold sensitivity is a type of temperature sensitivity that some people with MS experience. It describes the temporary worsening of MS symptoms in response to a decrease in temperature. Around 15 in 100 people with MS report experiencing cold sensitivity. It is much less common than heat sensitivity, which can also occur in MS.

Although different to symptoms worsening due to the cold, it is recognised that many people with MS find they frequently get cold feet or legs and find it difficult to warm up. The suggestions to manage this are the same as the practical tips for managing cold sensitivity.

It is usually triggered by cold weather or sitting near a draught. It can also be triggered by long periods of inactivity. So, this may be an issue if MS significantly impacts your mobility.

If you experience cold sensitivity, it tends to affect symptoms related to your joints, muscles and circulation. When you’re cold, your muscles tighten (contract) more. Blood vessels also constrict, especially those in the skin and the hands, feet, fingers and toes (extremities). This happens to reduce heat loss and protect the vital organs.

The existing symptoms most likely to worsen if you experience cold sensitivity are:

• increased stiffness and spasticity 
• nerve pain – especially altered sensations such as burning, numbness or pins and needles
• mobility – your movement might be slower or tasks that rely on fine motor skills, like fastening buttons or brushing your teeth, are more difficult
• fatigue – keeping warm uses more energy adding to fatigue
• depression – especially if the cold coincides with poor weather and less sunlight. 

Some people also experience the symptoms seen in Raynaud’s phenomenon (NHS.UK). This can include the skin turning white or blue, especially in the toes or fingers, due to restricted blood flow. 

This is often followed by numbness and tingling as you warm up, with the skin turning red as the blood flow returns to the affected area(s). In brown or black skin, Raynaud’s may make your fingertips appear paler. Raynaud’s can overlap with MS, so see your GP if these types of symptoms are getting worse and affecting your daily life.

Although symptoms can flare up very quickly, they should improve within a few hours once you warm back up.

The increase in symptoms in response to cold is not usually due to new MS damage. It is a temporary response triggered by an external factor. Once your temperature returns to normal, the symptoms should settle back down within a few hours.

Cold or damp weather, insufficient heating and not moving enough can all trigger cold sensitivity. Cold sensitivity is best managed by keeping your core warm alongside regular, gentle movement to avoid muscle stiffness and spasticity.

The following are some ideas of things you can try to help you manage the effects of the cold and maintain a more stable core body temperature.

Keeping your living space warm, especially the rooms you use the most, is key. 

• Try to ensure your home is well insulated. This will make it less expensive to heat. 
• Keeping windows and internal doors closed can help minimise drafts. Blankets, thick curtains and draught excluders can help in older homes.
• Drawing curtains early and regularly bleeding radiators can help keep your home warm at no extra cost.
• Avoid sitting near windows or drafts if you can and try not to spend long periods sitting still, especially in colder rooms. 

Small portable heaters can be useful for keeping individual rooms warm. Some heaters are cheaper to run than others, but portable heaters can sometimes be more expensive to use than central heating. It may actually be more cost-effective to turn up your main heating a degree or two instead. 

Try to aim to keep yourself consistently warm rather than reacting when you start to feel the cold. It is more efficient to ensure that you don't lose heat than to warm yourself up again if you get cold. Where possible, try to keep moving as much as you can. Where this is not possible the following can help.

• Warm blankets, throws or wraps can be helpful, especially if you spend long periods sitting. Some blankets have sleeves which can help make it easier to move around without having to keep taking it on and off.
• Hot water bottles. 
• Microwaveable heat pads. 
• Heated throws. 
• Electric blankets. 

The advantage of these is that they keep you cosy without affecting anyone else you live with. One thing to bear in mind, though, is that you will need to be careful if MS affects how your body detects heat, or you have reduced sensation or numbness in your skin. You could damage your skin without being aware of it, so avoid direct skin contact to minimise the risk of burns or scalds from any external heat sources.

Warm showers or baths can help warm you up if you have got very cold.

The priority is to keep your core warm. Multiple thin layers work especially well. They trap heat better, and you can easily add or remove layers to adjust your temperature as needed. 

• Think about starting with a thermal base layer. 
• Fleeces and woollen clothing make good mid-layers.
• High-waisted skirts and trousers can help keep the lower back warm. 
• Consider using a heated vest or jacket. 
• When choosing an outdoor coat, look for something that is insulated or windproof.

With MS, your hands, feet and head can be particularly susceptible to the cold, even if you don’t experience cold sensitivity. So, it’s important to keep them protected. Thermal socks, slippers or boots are good for the feet. Protect your head, neck and face from drafts with hats and scarves. They may also help reduce any nerve pain in the face or neck that is triggered by the cold. Tube scarves can be particularly useful as they can be pulled up or down as needed. Protect your hands with gloves or mittens. Consider fingerless gloves if you need to carry out tasks indoors to make them easier. 

Some people find hand warmers and heated insoles helpful. As with other external heat sources, be careful if you have reduced sensation.

Eating well can help. Hot food and hot drinks will help raise your core temperature. As well as keeping you warm, they give your body the fuel it needs to generate internal heat. Try to avoid too much alcohol; it might feel warming, but it has the overall effect of cooling your body by causing your skin to flush and give off heat.

Moving around regularly helps reduce muscle stiffness, spasticity and spasms and improve your circulation. You could try some simple mobility exercises for your arms and legs. Even small, gentle stretches can prevent your muscles from tightening up. Or maybe go for a short walk around the house.

If you’re going to exercise outside when it’s cold, carry out a few minutes of stretching to warm up your muscles before you go out. This can reduce the shock of the cold air. Wrap up warm too.

Although swimming is a great form of exercise for MS, cold pools can be a trigger if you have cold sensitivity. For recreational swimming, a temperature of between 27°C-29°C is usually most comfortable.

Sometimes what appears to be cold sensitivity can actually be a sign of something else. You should check with your GP or MS team if you experience cold sensitivity and:

• pain such as numbness or tingling that doesn’t resolve 
• if stiffness, spasticity or spasms become significantly worse or persistent
• if symptoms don’t improve after you get warm. 

If you can’t move your legs easily, or spend a lot of time sitting, you may find that the skin becomes blotchy or discoloured (mottled) in your lower legs and feet. This is because it is harder for the muscles to pump oxygen-depleted blood back up to the heart if you have limited mobility. As a result, the skin can have a bluish hue in white skin, or a purplish or grey hue in black or brown skin. But it is possible to also have the circulation condition Raynaud’s (NHS.UK) which causes similar discolouration of the skin. 

Feeling cold more than usual can also be a sign of an underactive thyroid (NHS.UK). 

Both of these conditions can overlap with MS, so if you’re at all concerned it is worth getting checked by your GP or MS team. 

As both cold sensitivity and MS relapses can cause symptoms to worsen, you may be concerned about the reason for any changes you’re experiencing. Read more about is it temperature sensitivity or a relapse?

There is such a lot of clothing and equipment that can help with cold sensitivity that it can be hard to know where to start. An online search will provide you with lots of options, but it can be useful to seek personal recommendations where you can.

You may wish to ask other people with MS what products they have found helpful or ask your MS team for advice. MS Trust Facebook peer support group has a large community that you could ask.