Cold Intolerance Measured by the CISS Questionnaire in a Normative Study Population

Cold intolerance is a frequent sequela after upper extremity nerve injury. The Cold Intolerance Symptom Severity (CISS) questionnaire was developed by Irwin et al. to assess the severity of cold intolerance in a patient population with surgical repair of peripheral nerve lesions in the upper limb. The aim of the reported study was to evaluate the CISS questionnaire in a normative study population and to define the threshold for abnormal cold intolerance.

One hundred and forty-eight volunteers completed the CISS questionnaire and a cold intolerance score was calculated. The possible score ranged between a minimum of 4 and a maximum of 100. In addition to the questionnaire, information was obtained about age, gender, and dominant hand of the subjects. Also, previous surgery or trauma of the upper extremity were noted. Subjects with a history of upper extremity nerve injury were excluded.

The CISS score of the normative study population ranged between 4 and 57, with a mean score of 13.8 (SD 10.6). The highest score (57) was found in a subject with Raynaud's disease. The parameters gender (male 12.2 vs. female 17.2, p = 0.016) and previous surgery (no 13.7 vs. yes 20.1, p = 0.048) showed a significant difference in mean CISS score. Age and previous non-surgical injury did not have a significant correlation with the CISS score.

Normal study subjects without previous history of peripheral nerve injury in the upper extremity on average expressed mild symptoms of cold intolerance. Based on these results in the normative study population, the authors suggested twice the standard deviation added to the mean (21.2 + 13.8) = 35 as a threshold for pathologic cold intolerance.