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Ice vs Heat for pain
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I've seen several posts where people ask what to do for pain & there's always someone who says "NEVER use heat, only ice".
I for one don't tolerate ice/cold very well & it always seems to make it worse. I was also told by more than one of my doctors to use what feels better for me.
I decided to do some more research on the subject & thought it would be good to share the information since so many have questions.

Heat and ice both do same thing—they shock the body into breaking the pain-spasm cycle. Heat causes the body to circulate more blood to the area in order to cool it down. That brings more oxygen and nutrients, and removes waste products, which help heal the tissue. Cold is similar—the body sends more blood to the area to warm it up and promote healing.

Ice should only be used on the back by patients who clearly prefer it (for whatever reason), or when there is definitely a fresh injury. In fact, ice does not provide “significant” pain relief for “many types of back pain,” and most episodes of back pain are not caused by muscle strain, are not inflamed “injuries” per se, and should not be iced as if they are.
In some fresh back injuries — such as a lumbar whiplash in a car accident, or a severe attack of pain when trying to lift something heavy — the muscles themselves may be damaged, traumatized, and inflamed, and heat might exacerbate the inflammation while ice might help. But this is rare! The vast majority of back pain is not traumatic in nature, no tissue is damaged, and inflammation is either minimal or nonexistent.
So there is no particular reason to avoid heat. And if there’s no inflammation, what exactly would you ice?
Just like heating can aggravate inflammation, ice can also have unpleasant effects. Icing the back or neck sometimes aggravates back pain symptoms, particularly when it is unwanted. Sometimes there will be an immediate sensation of increasing spasm as ice is applied, but usually it will only feel somewhat unpleasant. But then, in the minutes and hours afterwards, stiffness and pain will increase — usually not dramatically, but who needs any increase in symptoms?

The majority of low back pain is probably not caused by inflammation or any kind of trauma, but by the pain of muscular trigger points, also known as “muscle knots” — a ubiquitous muscle dysfunction that is not well known to most health care professionals. Trigger points should never be underestimated — they are quite capable of causing severe back pain.
And trigger points generally dislike cold! Chilling the skin is actually a well known risk factor for the formation and aggravation of trigger points. How do you feel stepping into a cold shower? Cold applied to the skin stimulates a reflex that causes muscles to contract.

Around the world, doctors are telling their patients to ice their low back pain, due in part to ignorance of the role of trigger points, and to unjustified confidence that back pain is inflammatory in nature and will respond well to ice.

Some pretty good points to think about.
Posted on 01/26/13, 08:38 am
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Reply #1 - 01/26/13  9:29am
" Just thought I'd add that MANY of us here are recovering from surgeries, and the tissues/back ARE inflamed so ice WOULD be called for.

The same for people who have just herniated a disc -- those areas are inflamed too, so ice IS called for.

Here, the majority of complaints DO involve inflammation, so that's why we usually advise ice. There are times we advise heat too. It just depends on the case. Thanks for your post. "
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Reply #2 - 01/26/13  9:49am
" It's pretty much all personal opinion Leeall. I never found ice to help me at all, & I'm sure there are plenty of others as well.
I've had surgeries, I have herniated discs. Also sciatica, DDD, stenosis, & fibro. No ice. :-) "

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