Ice vs. Heat Therapy as a Treatment for Pain

Raj N. Sureja, MD

With the advanced technology and multitude of pharmaceuticals that physicians have at their disposal to treat patients with pain, it is no wonder that we may forget to utilize very effective, but often overlooked, forms of treatment.  Such is the case with using heat or ice therapy to treat pain.  In this article, I will compare and contrast the two and describe appropriate uses for both when seeking pain relief.

Ice Therapy – Including ice packs, chemical cold packs, ice baths, ice massage, cold or coolant sprays, frozen peas, cryotherapy (treatment in a super cold chamber)

Benefits

  • Typically used immediately after an injury
  • Reduces swelling, bruising and inflammation
  • Can temporarily reduce nerve activity
  • Used for sprains, strains, dislocations, fractures, tendons and ligament tears, also after surgery
  • Provides pain relief by numbing the area
  • Can be used frequently – 10-20 minutes at a time, multiple times a day
  • Requires a freezer, chemical reaction pack, cold spray or cold chamber
  • Low cost when compared to pharmaceuticals or other treatments (except for cold chamber)

Risks

  • Can cause freeze damage to human tissues, nerves and skin
  • Should never be applied directly to the skin
  • Must be used intermittently (on/off) and monitored to prevent injury
  • Should not be used if you have:
    • Poor circulation
    • Cardiovascular issues
    • Heart disease
    • Stiff or tight muscles
    • Diabetes
    • Sensory perception disorders

Heat Therapy – Including heating pads, saunas, hot baths, hot towels, muscle rubs, chemical hot packs, sunshine, capsicum rubs or skin patches

Benefits

  • Typically used for non-acute injury or conditions
  • Arthritic conditions and muscle aches respond well to heat therapy
  • Increases circulation, blood flow and relaxes muscles in area to which it is applied
  • Requires electricity, chemical reaction, hot water over the counter muscle rub or capsicum (hot pepper derivative) to generate heat
  • Low cost when compared to pharmaceuticals or other treatments (except for sauna)

Risks or Contraindications

  • Should not be applied to broken skin, open wounds, fractures or bruises
  • Requires care and monitoring to insure that temperature is not too hot and skin is not burned
  • Should not be used by persons with these conditions:
    • Diabetes
    • Infected wounds or skin
    • Vascular Disease
    • Skin problems
    • DVTs (blood clots)
    • Multiple Sclerosis
    • Heart Disease – check with your doctor
    • Hypertension – check with your doctor
    • Pregnancy – Baths and Saunas may not be advised

Although these are general guidelines for use, if ice therapy doesn’t work to alleviate your pain, you may certainly try heat therapy. You can also use these two therapies in conjunction for treatment.  For example, ice for joint swelling and acute pain and heat for stiffness of arthritis.  It is important to realize that what works for one person may not work for you.  The next time you are in pain, try ice or heat (or both) for your pain, instead of reaching for a medication.  You may be surprised at how effectively these “old school” remedies can be.