When to Use HEAT or ICE for Pain

Health Professional

Since the days of cavemen, two remedies for pain have existed: heat and ice. Imagine the caveman after hunting all day coming back to the cave with a sore back. He'd probably put his back to the fire to warm it up or find a chunk of ice to rub the soreness away. Those in pain naturally find the things that help to relieve the pain. But in the current age of pill bottles and needles, remedies of old are being forgotten. People often forget to try them or just don't know when or how to use them. Heat and/or ice therapy are just as useful as they used to be back in the days of hunting, gathering and man's first episode of pain.

During your episode of pain after doing something that you might regret doing, you may wonder what works best, heat or ice? Actually, both have been shown to effectively reduce pain. Ice lollies reduce the pain after tonsillectomies.1Ice relieves the pain after knee replacement surgery.2 The coldness constricts blood vessels, reduces swelling and provides numbness the area affected by the acute injury. In other situations, heat has been proven to be effective at relieving discomfort from things like chronic low back pain because it reduces muscle spasms.3 Cavemen did not know the reason why heat and ice worked; they just knew that it did and that was all that mattered. Besides, they did not have very many options back then.

Today, you have more options, but you should still consider heat or ice as one of your first weapons against pain. When is the best time to try ice or heat? Ice is always best after a new injury like right after spraining an ankle or knee. The joints tend to swell quickly and that leads to more pain. Ice helps to control swelling and inflammation. Ice is also helpful to apply shortly after doing an activity you might soon regret to prevent a sudden onset of pain too.

After the swelling is gone, then you might want to consider using heat. Heat helps to relax muscles that can tighten around an area like a vise grip. Heat seems especially useful for chronic neck and low back pain. But surprisingly, some types of heat are helpful for arthritic pain too. Ultrasound is a type of deep heat therapy used for joint injuries and arthritis in physical therapy offices.4 Hot paraffin wax is also comforting to the arthritic hands that dip into it.

For those that want to get fancy, alternating heat and ice is also worth a try. This strategy is called contrast therapy in the sporting world where athletes hope to recover quickly after a game in preparation for the next. People in athletic departments, clubhouses, spas and therapy offices grab for heat packs, cold packs or take the plunge into warm or cold water on a regular basis. If its good enough for them, maybe you should try it as well.

Nothing fancy is necessary to access these pain treatments of old; just a sack of frozen peas or hot bath will do. Either way, ice and heat have been here for our comfort since the beginning of time and they are here to stay. Just don't forget about these time tested treatments for pain because you might need them someday.

  1. Clin Otolaryngol. 2011 Dec;36(6):566-70
  2. Orthop Nurs. 2011 Jan-Feb;30(1):29-36
  3. Arch Phys Med Rehabil. 2012 Feb;93(2):367-72
  4. Arch Phys Med Rehabil. 2012 Jan;93(1):35-42.