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Fire and Ice…

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...Well, actually heat and cold therapies. People with chronic pain often overlook these very effective and inexpensive therapies, that have minimal risk of side effects. There has not been much research on these therapies for treating chronic pain, and we don’t really know exactly how they work, but I can tell you from the experience of many of my patients that they help.

Which one should you use?
Whatever feels best! Try both, alone or in combination, and see what works for you. I generally recommend heat early in the day, before exercise or stretching, and before using ice, while cold is best later in the day, after exercise, and after using heat. I know some people who use heat on one area of their body while using cold on another.

Heat therapy:
Heat can be helpful for stiff and aching joints, and for stiff muscles. Many people with painful conditions such as fibromyalgia find heat to be quite soothing. However, heat should generally be limited to 30 minutes or less, because you can have increased muscle stiffness and pain if heat is on longer than that. Excessive use of heat can also cause scarring of the skin and tissues just under the skin. Be very cautious applying heat to an area that has reduced sensation, because burns can happen quickly.

Electric heating pads, on low or medium, are one source of heat, but your ability to move around is limited by how long the electric cord is. Microwaveable pads provide a source of heat that conforms better to the body, and can be applied to a body part using an elastic wrap (Ace bandage), so you can still move around. There are microwaveable pads available over-the-counter, filled with a silicone gel core, buckwheat hulls, or other substances. A cost-effective option is to put 3-5 pounds (give or take a pound or two) of uncooked rice in an old tube sock or pillowcase, and tie a knot in the open end. This can then be microwaved for use, and re-used over and over. Microwave just until the pack is warm, not too hot, to avoid burns. Smoosh the rice or gel around before using, to avoid hot spots.

Hot showers, warm baths and hand or foot soaks are other good sources of heat. You can add Epsom Salts to baths and soaks to add extra benefit from the magnesium (see another blog entry “Pain Relief in the Vitamin Aisle”). Paraffin dips are great for arthritic hands and feet. Paraffin is a waxy substance that starts to melt at around 99 degrees, so it can provide a nice warmth to aching hands and feet, with minimal risk of burning. Units that melt and hold enough paraffin for dipping can be bought for home use, starting at about $15.

Cold Therapy:
As many people with chronic pain say, “Ice is your friend.” Cold therapy is useful for reducing pain and inflammation (different from swelling, inflammation is a biological process that causes tenderness and increased sensitivity, among other things), and can soothe tight and sore muscles. Cold therapy is less likely to cause damage than heat, but frostbite and chilblains have been known to happen, especially on fingers and toes. Cold therapy on larger body parts, like backs, hips, and shoulders, should be left on for at least 30 minutes to get relief. The first few minutes can be uncomfortable, so use a cloth for insulation, allowing the area to cool down more gradually.

You can buy gel packs to put in the freezer, that get cold but don’t freeze solid soTopical creams they can conform to the body’s contours. You can make your own “gel” pack, using an old towel folded up in a ziplock bag, and equal parts water and rubbing alcohol to wet the towel. The rubbing alcohol keeps the water from freezing. Another option is to make one (or more) of those “rice bags” described above, but keep it in the freezer – an added benefit is that it won’t spring a leak. A bag of frozen peas is useful in a pinch, but isn’t very reusable – once it’s thawed, refreezing turns it into a solid block. If you are traveling, try using the disposable “instant ice packs” found in the first aid section of the pharmacy or online. These get really cold, so be sure you use a cloth to protect your skin.

Sometimes it’s helpful to have a solid block of ice to do a technique called “ice massage.” If you have a chronically sore and tight muscle, using a large ice cube or a bottle of frozen water to apply pressure to the muscle can sometimes convince that muscle to relax. This technique is also helpful in treating plantar fasciitis – roll the bottom of your foot over a frozen water bottle, as hard as you can, for several minutes, several times a day. This can help stretch the plantar fascia, as well as reduce inflammation and pain.

Topical creams that produce a sensation of heat or cold, like IcyHot, Tiger Balm or BenGay, don’t actually cause a change in temperature. Instead, they cause a sensation in the skin that is perceived as warmth or cold, or both. These products can be helpful, but may not work as well as actual cold or heat.

If you are not already using heat and cold, it may be worth adding these therapies to your arsenal of pain management techniques.


At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.

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