Should you use a hot water bag or an ice pack?
Is an electric heating pad better than a hot water bag?
Which one is better for swelling, hot or cold?
How long should you use or apply a hot pack or an ice pack?
Hi, I’m Dr. Andrea Furlan, a pain specialist in Toronto,
Canada. Today I’ll talk to you about the application of hot or cold to treat pain.
Before I continue, let me remind you that this video is for educational purposes only.
If you have a problem that requires medical attention, please talk to your doctor.
If there is an emergency, go to the nearest emergency department or call an ambulance.
Heat and cold are modalities that we use a lot in pain management.
First, let’s talk about sprains and strains. For example an ankle sprain.
You saw the doctor, they said there is no fracture or need to immobilize your ankle.
They told you to go home. The best treatment is RICE, yes
Rest, Ice, Compression and Elevation for a couple of days.
Ice is excellent for reducing inflammation. Inflammation is a natural response of the body
to repair the damage. Your body detected that there was an injury, maybe there was
a vein the ruptured, that is why there is this dark colour under the skin. Inflammation means
that the immune system is sending an army to fight the bacteria that penetrated the skin,
is sending a lot of blood to bring oxygen to the tissues and platelets to stop the bleeding,
and is sending cells to repair the damage and build a scar tissue to replace the damaged tissue.
Inflammation is always an exaggerated response. Your body will always send more than is needed.
So, the 4 signs of inflammation are: Rise in the temperature. So, if you touch the skin
in an area of inflammation you will notice it is warmer than the normal skin around it
Pain Redness
Swelling
When we apply RICE we are helping to reduce inflammation: we let the body part to rest,
we apply ice, apply compression and elevate the body part to help drain the excess fluid.
Ice will have an effect on reducing swelling because it closes the blood vessels that bring
more blood to the region. And Ice also blocks the neurons that transmit pain signals to the brain.
It is important to protect the skin from the ice because it can burn the skin. So, put a towel
or fabric between the ice and the skin and leave it there for no more than 20 minutes.
You may apply 3, 4, 5, 6 times a day, or even more for the first 3 to 7 days.
When you see that the swelling is reduced and pain is better, you may stop using ice.
Ice is also good for other types of pain, not just pain from sprains.
In cases of shoulder tendonitis, trochanteric bursitis, toothache, even headaches. There is
one type of arthritis that responds really well to ice, that is gout flares.
Any type of ice pack is good. You can just grab some ice cubes from the freezer, tuck them in a
bag and apply. Or you may purchase some more fancy ice bags like this one, or this one.
Now, when would you choose heat?
First of all, if there are signs of inflammation, you don’t want
to apply heat because you can make it worse. Heat is excellent for muscle pain. When there
is an acute injury, let’s say to the knee, you may apply ice to the knee, use compression but
the muscles around the knee will get tense, they will contract to protect the knee,
and they may develop myofascial trigger points. So, you may apply heat to the muscles, while you
are applying ice to the knee. Or after a week that the inflammation of the knee is better, you may
continue applying just the heat to the muscles, until they return to a normal state. Muscles that
get tense during an acute injury tend to stay like that for many weeks. They need some help to relax.
In the case of chronic inflammatory diseases like osteoarthritis, I also recommend applying heat
to the stiff and creaky joints. Especially in the morning,
when there is a need to lubricate the joints.
For low-back pain, there is very little evidence that ice or cold applications are helpful. But
there is some evidence that heat helps. They can apply heat for about 20 minutes,
preferably moist heat, like a hot pack, or a hot bath. If they use an electrical heating pad it is
important to avoid sleeping with them in bed as they may burn the person when they sleep.
Which one is best? A hot water bag, or an electrical heating pad. I prefer moist heat.
Even better, if possible, would be a towel immersed in hot water,
or even a hot water bath where your whole body is immersed in hot or warm water.
There is one situation that we recommend a contrast bath. It means to alternate hot and
cold to the same area. We use a contrast bath to reduce swelling in the foot or in the hand.
The person is instructed to prepare two buckets, one with very warm water,
around 40 Celsius or 104 Fahrenheit. The other bucket contains ice-cold water.
The person starts immersing the limb in cold water for 2 minutes, then moves to the second bucket of
warm water for 30 seconds. They do this for 15 minutes. The first and last should always be
the cold water. They can do this 3 times a day until the swelling is reduced.
People with cancer pain may find the application of heat and cold helpful.
However, they have to be careful to avoid burning the skin, with either ice or heat.
They should avoid applying to skin areas that are tender from radiation treatment,
or areas where the skin is open or broken. Also, never apply to bare skin
and avoid areas with poor circulation. They should always check with their doctors.
How about children or people with very thin skin? Can they use ice or heat packs?
An ice pack should be avoided or applied with caution in babies under six months of
age. Their skin is very fragile. For older children, it is safe,
and an ice pack should be applied for no longer than 10 minutes. A hot wet towel or
facecloth can be used in a plastic bag and wrapped around a child’s limb to apply heat.
The child should never be left alone with a hot pack. It is important to check the skin for signs
of redness, blisters or burning, as they may not be able to vocalize what they are feeling.
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