to the editor: I read with interest the “Diary from a Week in Practice” column in the September 1, 1998, issue of American Family Physician.

The Wednesday entry described a patient who used a plastic insert from his cooler as an icepack to relieve wrist pain caused by carpal tunnel syndrome. I recently saw a patient with a large area of second-degree “freezer burn” of the sacral area, caused by placing an insert from a cooler directly on the skin to relieve backache. The patient had experienced this complication before, but she thought she could control the burn effect by using the cooling insert for a shorter period of time.

Patients must be cautioned that these cooler inserts may cause severe burns.