What’s better For Pain - Heat or Cold?

What’s better For Pain - Heat or Cold?

By Doug Lehman, PT

Often times, patients will ask me if they should use heating pads or ice to treat pain.  My answer varies depending on the type of pain.  There are two basic types of pain that we treat: acute and chronic.  Acute pain is pain that occurred recently, usually within the past 24 or 48 hours.  Chronic pain is pain that extends beyond the expected period of healing.

Acute injuries are usually treated with cold therapy.  The general rule with cold therapy is if an area is red, swollen, or inflamed, or the injury just happened, we want to cool the area down and prevent further or reduce any inflammation.  Cold therapy will reduce swelling and pain by constricting blood vessels.  It will also limit any bleeding that may occur.  Cold therapy is generally used after exercise, again to cool the inflamed areas.  Cold should not be used to treat chronic injuries before exercise. 

Some choices for treatment can range from a bag of ice (or snow for cold weather climates), a gel cold pack purchased from a store, or a large bag of frozen peas (yes, this does work, just don't eat the peas!).  Cold treatment can be applied for 20 to 30 minutes before allowing your skin temperature to return to normal before reapplying the cold therapy.

Heat will generally be used for chronic injuries.  It can help sore, stiff, nagging muscles and joint pain.  Heat should not be used with acute injuries or any injury exhibiting signs of swelling or inflammation.  Heat can help relax tight muscles or muscle spasms. Heat used before exercise will increase the elasticity of joint connective tissues and stimulate blood flow. 

Choices for heat treatment include an electric heating pad, a microwavable hot pack, or uncooked rice in a tube sock heated in the microwave (yes, this works too!).  Heat should be used for 15 to 20 minutes at a time with enough layers between the heat source and skin to prevent burning. 

Heat or cold therapy works by stimulating your body's own healing force.  Many arthritis doctors recommend both heat and cold treatments to help reduce inflammation and ease the pain and stiffness that comes with arthritis. It may take a little "trial and error" to learn which therapy works best for your pain, but you can use this blog as a starting point.  For chronic pain, feel comfortable utilizing the method that works best for you.