top of page

Hot or Cold for Pain

Learn when to apply heat packs and when to apply cold packs to treat pain and injury. 


Dealing with pain and stiffness can be a debilitating and frustrating situation for many. Pain relief from drugs and alternative therapies is also a major, multi billion dollar industry in this country. However, many are sensitive to these strong drugs or prefer not to risk their health with prolonged use of analgesics. Many also find the side effects almost as bad as the pain, or find little relief from pain drugs.

Therefore, finding safe yet effective pain management strategies is critical.

The most common pain relief used by pain sufferers is heat and cold. However, many people question which to use and how.

Cold, in the form of cold pack application or ice massage, is usually the preferred method of pain management for most ailments, especially in the first 72 hours of an injury. Cold increases blood flow, thus speeding up healing. It also decreases swelling, numbs the pain, and decreases muscle spasms.

Cold packs are available in any drug store, made at home with wet towels wrapped in a plastic bag, or made with a 2:1 ratio of rubbing alcohol to water placed in doubled Ziploc bags. Cold packs should be applied to the affected region with a wet towel between the skin and cold pack to provide a deeper penetration of the cold. Cold is kept on the area until the skin becomes numb, and then removed after five minutes more (usually 20 minutes total). Cold packs are usually for large areas of pain (larger than your hand).

Ice massage can also be performed at home by rubbing an ice cube or home made “ice water popsicle” over a region not greater than the palm of your hand for approximately five minutes or until the area becomes red and numb. This type of treatment is most often used with bursitis, tendonitis, or over a pinpoint muscle spasm.

Use of cold is not recommended for individuals with circulatory problems or diminished sensation. Cold application to the sacro-iliac joint or a stiff, arthritic joint may cause more pain and is not recommended.

Heat application promotes circulation and decreases stiffness. Admittedly, it also feels better than ice. Heat packs can be found in any drug store and electric, microwave, or hydroculator types are all acceptable, so long as they allow use of a damp towel to enhance the penetration of the heat.

A heating pad is used for 20 to 30 minutes at most to provide a burst of moist heat. Prolonged use of heat will lose it’s effectiveness over time, as the body can accommodate to the heat. Also, prolonged use of dry heating pads was found to dry out the skin and muscle of thin or frail people, primarily the elderly. As with cold, persons with circulatory or sensation problems should use caution. There also exists a concern with heat or cold in cancer patients, as the increased blood flow may spread the cancer cells.

Whether using heat or cold, a one hour break in between sessions is recommended and no more than five or six sessions per day, to prevent accommodation. One exception to this rule is consecutive heat and cold application. For muscular conditions, such as myofascial pain syndrome (MFPS), heat/cold/heat or the opposite cold/heat/cold can be an effective pain management tool. Massaging the area between the cold and heat application has also been found helpful in reducing muscle spasms.

If unsure if heat or cold could be problematic for a specific medical condition you have, consult with your doctor or other healthcare professional.

I have worked with children for many years and have found it important to closely supervise the use of heat or cold and watch for skin burns or frostbite.

There are many other pain management techniques, such as massage, traction, stretching, joint mobilization and others which should be explored with the direction of a physical therapist or healthcare professional.

Regardless of the type of pain or the number of years a person has suffered, pain relief is now available for many with the advent of new techniques and expanded information.

bottom of page