Everyday in the office I hear patients ask “should I use ice or heat for back pain?” It is confusing, because the ice and heat work in different ways and are best when used at different times.

When You Should Use Ice For Pain

In general, ice is best in the first 48 hours after a new pain, or an old pain that has now become worse. It is best done three times per day for twenty to thirty minutes. The ice should not touch the skin, but should have a cloth between the ice and the skin.

An ice massage can sometimes even be more helpful. A good way to perform this is to freeze a half full glass of water in a Styrofoam cup in the freezer, then remove the top half of the cup and use the block of ice to rub the sore area using a circular motion.

In patients who have long standing pain that has recently become worse, I tell patients to use the ice to prevent pain chemicals from being released into the muscles and making the muscles more sore.

The Best Use For Heat To Ease Pain

Heat works best for achy, longstanding pain–the kind of pain that is usually made better with activity. Heat can be done by microwaving a wet cloth/towel, using hot water in a shower, or a water bottle. Heating pads can also be used as well as warm gel packs. To avoid burns, place a cloth/towel between the heat source and the skin.

Many pains are a combination of sharp and stiff, so ice first for twenty minutes followed by ten minutes of heat.

Neither of these treatments should be used if the patient has dermatitis, an open sore, or doesn’t understand the risks of burn or frost bite

These treatments are inexpensive, can be done at home, and are available almost any time the patient needs relief.