Cold Hands and Feet in Multiple Sclerosis: What’s Really Going On?

Introduction

Living with Multiple Sclerosis (MS) can feel like walking through a maze—one filled with unpredictable symptoms and mysterious sensations. One such puzzling (and often frustrating) symptom is cold hands and feet. ❄️

You might be bundled in blankets, sipping hot tea, but your fingers and toes feel like icicles. 🧦 So, what’s going on? Is it poor circulation? Nerve damage? Something else?

In this guide, we’ll dive into everything you need to know about cold extremities in MS—why it happens, what it means, and how to manage it. Let’s warm up to the topic together. 🔥

🌡️ Is It Normal for People with MS to Have Cold Hands and Feet?

While not officially one of the “classic” MS symptoms, many people with MS do report cold sensations in their extremities, especially the hands and feet. It’s often described as:

Persistent coldness that doesn’t go away with temperature changes
One-sided coldness (e.g., only one foot feels cold)
Cold sensation even when skin feels normal to touch

These sensations can be deeply uncomfortable and interfere with daily activities, sleep, and overall quality of life.

🧠 What Causes Cold Hands and Feet in MS?

Cold extremities in MS are typically neurological in origin, rather than being caused by actual changes in skin temperature or blood flow. Here's a breakdown of what might be happening:

🔌 Nerve Damage (Sensory Dysfunction)

MS is a disease of the central nervous system, where the immune system mistakenly attacks the protective covering (myelin) of nerves. When sensory nerves are affected, your brain might misinterpret signals.

Even if your body is warm, damaged nerves might “tell” your brain that your hands or feet are cold.

🧠 Think of it like a faulty thermostat—it says you're freezing, even if the heat is on full blast.

🧊 Dysesthesia (Abnormal Sensations)

This includes tingling, burning, and cold sensations without an external trigger. Dysesthesia is common in MS and may feel like icy cold limbs even though your skin feels warm to others.

🧬 Autonomic Nervous System Dysfunction

The autonomic nervous system (ANS) controls involuntary functions like blood pressure and body temperature. If MS lesions affect parts of the brainstem or spinal cord involved in autonomic regulation, your ability to regulate blood flow and temperature can be impaired.

This may lead to actual vasoconstriction (narrowing of blood vessels), causing true coldness in the hands and feet.

🩸 Secondary Raynaud’s Phenomenon

Though not common, some people with MS also develop Raynaud’s phenomenon, a condition where cold or stress causes blood vessels in fingers and toes to spasm and restrict blood flow, leading to:

Pale or blue skin
Pain or numbness
Cold, clammy sensations

Raynaud’s isn’t caused by MS itself but may coexist or be triggered by immune system dysregulation.

🧊 Cold vs. Numbness: What’s the Difference?

Many people with MS confuse coldness with numbness or tingling (paresthesia). It’s important to note:

Sensation	Description
Cold	Feels like you're touching ice, even when you’re not
Numbness	Lack of feeling—like your limb is “asleep”
Tingling	Pins and needles, buzzing, or static-like feel

All these symptoms can stem from sensory nerve disruption, and they can sometimes overlap or switch unpredictably.

❄️ When Is It a Sign of Something More Serious?

While cold extremities can be a harmless (albeit uncomfortable) symptom of MS, it's important to rule out other causes, such as:

Peripheral vascular disease (PVD): Especially in older adults or smokers
Diabetes-related neuropathy
Thyroid disorders (like hypothyroidism)
Vitamin B12 deficiency
Medications that affect circulation or nerve function

✅ If your cold hands/feet come with skin discoloration, ulcers, or pain, consult a healthcare provider promptly.

🧪 Diagnosing the Cause

If you experience persistent or worsening cold sensations, your neurologist may recommend tests such as:

Neurological examination
MRI scans (to detect lesion progression)
Thermal or sensory tests
Blood tests (for thyroid, B12, diabetes, autoimmune issues)
Doppler ultrasound (to assess blood flow)

These tests help differentiate MS-related cold sensations from other vascular or systemic conditions.

🧤 Coping Strategies: How to Deal With Cold Hands and Feet

Luckily, there are several ways to manage this chilly symptom—ranging from lifestyle hacks to medical support.

🔥 Keep Your Core Warm

Your body prioritizes warmth for vital organs first. Keeping your core temperature high can improve blood flow to extremities.

Wear thermal layers
Use heated blankets or vests. For tools for people with MS, click here and here.
Avoid drafts and damp environments

🧦 Warm Up the Extremities

Use tools and techniques specifically for your hands and feet:

Heated gloves or socks (battery-powered or microwavable)
Hot water bottles or heating pads
Warm foot baths (but avoid if you have reduced sensation to prevent burns)
Hand warmers for use in cold environments

⚠️ Be cautious with direct heat—numbness can make it harder to detect burns.

🥗 Nutrition and Hydration

Certain nutrients may support nerve health and circulation, such as:

Omega-3 fatty acids (salmon, flaxseed)
Vitamin D and B12
Magnesium and iron (for circulation)

Drink plenty of water to maintain good blood flow, especially if you’re using muscle relaxants or DMTs that may dehydrate you. Want supplements for people with MS? Click here.

🧘 Reduce Stress and Anxiety

Stress activates the sympathetic nervous system, which can lead to vasoconstriction (narrowing blood vessels), making your extremities feel even colder.

Try:

Deep breathing or progressive muscle relaxation
Meditation or mindfulness apps
Gentle yoga or stretching. Want to train at home? Click here.

🚶Stay Physically Active

Even light movement can boost circulation and reduce cold symptoms:

March in place
Wiggle fingers and toes
Try resistance bands for arm/leg exercises
Go for short walks (indoors if needed)

💊 Medications and Therapies

In some cases, doctors may prescribe:

Gabapentin or pregabalin: For nerve-related sensations
Nifedipine or calcium channel blockers: For Raynaud’s
Topical creams: Containing capsaicin or menthol to alter nerve signaling
Occupational therapy: To improve hand function and circulation

Always consult your MS specialist before starting any new medications or supplements.

🛑 Things to Avoid

Some everyday habits might worsen cold sensations:

Caffeine and nicotine: These constrict blood vessels
Prolonged inactivity: Leads to sluggish circulation
Alcohol: Initially dilates vessels but reduces temperature regulation
Extreme cold exposure: Can trigger MS symptoms or lead to frostbite if sensation is impaired

🧬 Real Stories: What Others Say About Cold Hands and Feet in MS

"I always thought I had bad circulation until my neurologist explained it’s the MS messing with my sensory nerves. I keep hand warmers in every coat pocket!" – Sarah, 42

"Only my right foot feels cold. It used to drive me crazy, but now I use a heated foot pad, and it’s a game-changer." – Miguel, 35

"It’s like my brain forgets that I’m not actually in a snowstorm. The sensation is real, even if the temperature isn’t." – Claire, 29

These real-life testimonials show just how varied and personal the experience can be.

🧭 When to Talk to Your Doctor

Bring up cold sensations with your MS care team if:

It’s persistent or getting worse
It affects sleep or mobility
You notice color changes or skin damage
You’re not sure if it’s an MS symptom or something else

Having a symptom diary can help you track patterns and triggers before your appointment.

🧠 Could This Be a Relapse?

In rare cases, cold hands and feet may signal a new lesion or MS flare, especially if accompanied by:

New weakness
Balance issues
Visual disturbances
Numbness in other areas

If in doubt, contact your neurologist—they may recommend an MRI or corticosteroids to manage inflammation.

✅ Summary Checklist

Here’s a quick recap of what to do if you’re dealing with cold hands and feet due to MS:

✅ Rule out other causes with medical tests
✅ Use heating aids like gloves, socks, and blankets
✅ Boost circulation through movement and hydration
✅ Consider medications for nerve-related discomfort
✅ Manage stress to calm the autonomic nervous system
✅ Monitor symptoms and track changes
✅ Ask your doctor if you notice new or worsening signs

🔚 Conclusion: You’re Not Alone (and You’re Not Crazy!)

Cold hands and feet in MS can feel isolating and confusing, especially when others don’t understand what you’re experiencing. Whether it’s a phantom sensation or true coldness from autonomic dysfunction, you’re not imagining it—and you’re not alone. 💙

The key is to understand your body’s signals, take proactive steps, and lean on your healthcare team and community for support. Want an online therapist? Click here .

📚 References

National Multiple Sclerosis Society – www.nationalmssociety.org
Flachenecker P. "Autonomic dysfunction in multiple sclerosis." Journal of Neurology, 2007.
Zamboni P, et al. "Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis." J Neurol Neurosurg Psychiatry, 2009.
Cameron MH, et al. "Autonomic dysfunction in multiple sclerosis: implications for exercise." Autonomic Neuroscience, 2010.
Mayo Clinic: Raynaud's phenomenon – www.mayoclinic.org
National Institute of Neurological Disorders and Stroke (NINDS): Multiple Sclerosis – www.ninds.nih.gov