Non-freezing cold injury: a multi-faceted syndrome

We read the paper “Chronic non-freezing cold injury results in neuropathic pain due to a sensory neuropathy” by Vale and colleagues recently published in Brain with great interest. Despite the impact non-freezing cold injury (NFCI) can have on an individual’s quality of life, little research has been conducted on this condition. Indeed, in the last 10 years only 16 full papers have been published on NFCI, of which six were reviews, four were epidemiological studies, two were case studies and only four were original research articles. The research articles, like the range of proposed pathogenesis and reported symptomology of NFCI, vary considerably: one reported data collected 30 years ago on Royal Marines involved in the Falklands Campaign (Golden et al. 2013), another related to an animal model of NFCI (Geng et al. 2015), a third focussed on vascular dysfunction in NFCI (Eglin et al. 2013), whilst Vale et al. (2017) concentrate on the neuropathy associated with NFCI. Whilst we are encouraged by further advances in our understanding of NFCI offered by this paper, we feel that it is important to highlight some limitations of this study in an area that has become blighted by repetition of unfounded speculation and uni-disciplinary investigation.