In an attempt to treat their back pain, most people who are not my patients will pull out the electric heating pad or heat patches and either lay on it in bed or lean back against it while sitting in their Recliner. They will admit that it feels good while it is on but that the pain comes back when they take it off. Out of frustration these people will come into my office and ask “Ok, Doc, which is better for treating back pain: hot packs or ice packs.” I have been in practice for 20 years and this is by far the most popular question I hear. Even within the medical community there is a lot of disagreement as to whether ice or heat is better in treating back pain.
For the purposes of this article I will not bore you with the physiology of pain and how ice and heat work in treating pain. Just remember that if after using ice for about 20 minutes your back feels worse, all you have to do is put heat on your back. But if you start off using heat and the pain gets worse, you cannot reverse the effect by using ice. Why you ask? The reason is simple. If your back feels worse from using heat, you increased inflammation. Typically, ice is used to treat pain due to an injury because ice decreases swelling, whereas heat is used to treat stiffness and soreness by increasing circulation to that area.
Unfortunately, the lower back, and for that matter the entire spine, is a very complicated structure that does not follow the rules of the other joints of the body. The most common question I get is which is better ice or heat. For most people the knee jerk reaction is heat is better. I would venture to say that most health care providers recommend heat as well. But when in doubt use ice. If you use heat on an inflamed joint you will promote swelling. For the simple reason that you can reverse the effects, always start with ice. For some reason even people who get injured in auto accidents and at work are often told by their health care provided to use heat, but that’s not always the best start.