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The return to normal skin temperature regulation

Warning: technical jargon ahead, formatted for computer viewing

Pain specialists call an increasing sensitivity to a varying stimulus "windup" for a quantitative measure of the nervous system functioning.

The experience of “coldness” typically marks transitions in skin temperature. For most people, the experience fades to no sensation as the skin prepares to detect the next small change in temperature.

An incessant experience of coldness may affect the quality of life. The stuck experience itself may become the problem, especially when the actual skin temperature isn't cold.

Some describe their unrelenting experience to be like holding ice or like “being burned by a blowtorch”.

However, the actual coldness may abruptly end. The warming response often marks the transition to normal functioning. A neurologist practitioner observes a pupillary response that marks the switch from impaired to normal functioning. This man's hands began normal rewarming during his first 2-minute stimulation.

In 2000, infrared photobiomodulation had been shown to prompt the return to normal skin temperatures that appears to interrupt the impaired skin temperature regulation such as with complex regional pain syndrome (CRPS or RSD).


Unfortunately, the infrared therapy was inefficient, and the events were rare. Surgery and anesthesia may force warming of a cold limb but does not prompt the return of normal functioning.

PhotoMed’s team set out to make the variable-wavelength therapy more efficient for helping people with CRPS and other people with impaired functioning. These people were often referred to physical therapy after interventions failed. There, the practitioners recognized that the body heals itself; the therapy prompts a restart.

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Could years of real-time data "explain" the unpredicted Quick Events?


The team developed sophisticated real-time recording systems. Thermal imaging connected-the-dots between therapy parameters, physiological responses, and outcomes.

The time shrank from hours with fixed wavelengths to less than a minute today for some impairments to respond. We call those Quick Events. The events mark the switch from unmanageable chronic state to normal in zero time.

The real-time recordings showed that normal healing could resume, such as with non-healing wounds. The responses were reproduced in feasibility studies and "normal" now lasting years for volunteers who let the team know how they are doing.


The explanation appears to be very basic. How many times does not-healing switch to healing before normal functioning resumes?


Thermal imaging lets the practitioner “see” skin temperatures.

The team focused on finding treatment parameters that might prompt Quick Events with a switch back to normal functioning.

Thermal imaging lets the practitioner “see” the actual skin temperatures. The practitioner could stop the stimulation upon noticing a rise in temperature.

This example shows well-regulated bilaterally synchronized temperatures throughout the visit. The consistent offset in temperatures suggests that the feedback sensing, circulation control, and the unknown systems are functioning correctly.

The engineers were delighted by the characteristic single overshoot in temperature followed by the return to normal functioning. This warming profile represents the shortest TIME for a system to achieve stability after a step change input to the vascular system.

This recording was taken before offsets were considered. The chart showed only one hand. Years later, the data was reviewed and plotted to help answer a different question. The value of the data increases with each subsequent examination because the testing do not need to be repeated.

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The stability of temperatures surrounding the response distinguishes CRPS from Raynaud’s syndrome. Raynaud’s may allow the circulation to effectively stop with insufficient or no control. Some cases progress to gangrene and amputation. Botox is used in some cases to cause an uncontrolled increase in circulation.

This case of Raynaud's syndrome by a 65-year old woman was triggered by repetitively using garden clippers. Exposure to cold is the most often reported cause.

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The temperature of the cold finger (darker) on the right hand continued to remain cold after her other fingers responded by warming.

A 3rd stimulation appears to accelerate warming. That finger warmed a few minutes later and remained Raynaud's free for more than 5 years.


Synchronized Response

Each 2-minute treatment may prompt a response, or not.

When the therapy doesn’t prompt a response, the practitioner may select a different range of wavelengths from the Instant Verification System.

The chart shows a constant offset of bilateral skin temperatures throughout large changes in the rate of blood circulation. The continuity of the offset illustrates the precision in the coordinated automation of the sensory and vascular systems.

This example tested wavelengths (TX1 and TX2) that had previously been found to be less likely to prompt a warming response in persistently cold hands.

The practitioner noticed a warming trend during the fourth 2-minute treatment.

Clip: 19 seconds

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A "comfort" thermostat?

The Team’s neurosurgeon advisor Robert E. Florin, M.D., suggested that the constant offset in temperature shows that the problem might be like a stuck “thermostat”.

However, the “thermostat” appears to affect the experience rather than the actual skin temperature.

The following example illustrates the separation between the experience of coldness and the actual temperatures.


A unilateral response tells a story about temperature and comfort.

The patient had undergone an experimental ketamine induced coma in Germany that provided only temporary relief from her CRPS.


Dr. Florin observed this patient, a nurse with CRPS, achieve near-complete relief within 30 minutes. Her relief lasted more than a year and was repeated.

She had arrived with both hands feeling like holding ice. Only her right hand could respond because the nerves in her left hand that control skin temperature had been surgically abolished.

At the end of the visit, she reported that both hands felt comfortable despite that her left hand had continued to cool.

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This case raised the first questions as to whether the experiences of pain and coldness were always linked to the actual temperature.

Later cases showed that a limb could be over-warm yet feel freezing cold. The same stimulations prompted the re-coordination of the temperature and the experience of skin temperature.

Could non-invasive therapies prompt the conclusion of an unceasing experience of coldness which, in turn, enables the normal temperature regulation resume?

Thermal imaging of a unilateral warming response. Lighter gray is warmer. The left hand had had the temperature regulating nerve abolished thus preventing a response. 12 seconds


Linear Synchronized Response

Dr. Florin was intrigued by recordings that showed the precision of the interacting physiological systems. The next example shows precise bilateral temperature tracking during both the normal warming phase and response.

This patient had just arrived with cold hands from being outdoors. Her discomfort was the significant pain in her left hand at the base of her thumb.

The practitioner didn’t notice the normal warming because the thermal images didn’t appear to change until after the 3rd 2-minute treatment.

The patient reported significant pain relief and a reduction in size of the lump at the painful spot in her hand. Her relief lasted more than a year after the single visit.

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Lighter gray is warmer. The practitioner didn’t notice the normal warming because the thermal images didn’t appear to change until after the 3rd 2-minute treatment.


Thermal imaging may help to prevent injuries caused sympathetic nerve blocks while attempting to diagnose abnormal skin temperatures.

Patients with complex regional pain syndrome (CRPS or RSD) may undergo a diagnostic procedure called a stellate ganglion block (SGB).

Patients with “hot” CRPS may be at risk of a temporary increase in pain from any sympathetic system stimulation, including photobiomodulation.

The SGB has been shown to cause increased pain long term.

The warming gradient toward the tips of the fingers may be large enough for the practitioner to detect by touch without the need for thermal imaging.