Using heat therapy for back pain or ice therapy gives patients a take-home option for dealing with pain, especially before sleep
There is very little more frustrating for your patients than lack of sleep, particularly if it is a result of pain. The connection between chronic pain, and sleep issues is well known, as is heat therapy for back pain along with ice to deal with general pain or for help sleeping.
Chronic pain can make it difficult for your patients to fall or stay asleep. In turn, a lack of sleep can increase pain sensations. It can be difficult to determine how to treat these patients, given the strongly intertwined relationship between chronic pain and sleep, as well as the added complexity from other chronic conditions such as diabetes or high blood pressure.
Chronic pain and sleep numbers
According to the Centers for Disease Control and Prevention (CDC), more than 20% of American adults reported living with chronic pain in 2016, and 8% reported chronic pain that greatly affected their daily life.1
A 2015 poll conducted by the National Sleep Foundation found that people with chronic pain had an average sleep debt (the difference between the amount of sleep a person needs and what they actually get) of 42 minutes, as compared to only 14 minutes for those who experienced acute pain within the last week. Furthermore, as many as four in 10 people with chronic pain reported that their associated lack of sleep interfered with work, as well as negatively affected mood, personal relationships, and overall enjoyment of life.2
Treating chronic pain and sleep
Treating your patients who have chronic pain and sleep is somewhat of a “chicken and egg” problem, in terms of deciding which issue should be addressed first.
According to a 2008 article in Reviews in Pain, it is best to treat chronic pain and sleep issues concurrently, given how much the two are intertwined.3 Treatments such as diet, meditation, and hot and cold therapies, can be used in conjunction with pharmacological treatment to reduce pain and improve sleep.4
Heat and ice therapy for back pain
Using heat therapy for back pain or ice therapy gives patients a take-home option for dealing with pain, especially before sleep.
Heat therapy: Topical heat applications will improve circulation, allowing more blood flow to muscles and joints. It can also help heal tissue, which makes it optimal for your patients with chronic musculoskeletal pain, such as arthritis. This heat sensation is meant to distract the nerve endings on the surface of the skin at the localized site of pain.
Capsaicin, the active ingredient in peppers, is a common ingredient in topical analgesics used to treat chronic pain. A 2017 study in the Cochrane Database of Systematic Reviews examined the results of several smaller studies to determine the effectiveness of topical analgesics with capsaicin to treat post-herpetic neuralgia.5 The researchers found that the papers, when pooled together, all showed moderate support for high-concentration, topical capsaicin treatment to reduce pain.
Cold therapy: In comparison to heat therapy, cold therapy reduces blood flow to affected areas, producing a cooling or numbing effect. These therapies can include ice, cold gel packs, or topical analgesics. Unlike capsaicin, cold therapies numb the nerves at the skin’s surface. Menthol is the most popular ingredient in topical analgesics using cold therapy.
In a 2012 article in the International Journal of Sports Physical Therapy, researchers compared the effectiveness of a 3.5%-menthol topical gel to ice for treating sore muscles following arm exercise.6 The researchers found that subjects using the menthol gel reported less discomfort than did those subjects treated with ice therapy.
The cycle of chronic pain and sleep issues can be frustrating and exhausting for your patients. In cases such as these, you should not try to treat each problem separately, but instead from a more holistic view. Heat and ice therapy for back pain, or neck or other painful areas, with topical analgesics are a great way for your patients to do home therapy for both conditions, as needed. This will allow them to keep up treatment between chiropractic sessions.
- Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016. MMWR Morbidity and Mortality Weekly Report 2018;67:1001-1006.
- National Sleep Foundation. 2015 Sleep in America Poll.
- Tang NK. Insomnia co-occurring with chronic pain: Clinical features, interaction, assessments and possible interventions. Reviews in Pain. 2008;2(1):2-7.
- Cleveland Clinic. Should you use ice or heat for pain? clevelandclinic.org/2014/08/should-you-use-ice-or-heat-for-pain-infographic/ Published 8/11/2014. Accessed 7/31/2020.
- Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults – an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017;May 12(5):CD008609.
- Johar P, Grover V, Topp R, Behm DG. A comparison of topical menthol to ice on pain, evoked tetanic and voluntary force during delayed onset muscle soreness. International Journal of Sports Physical Therapy. 2012;7(3):314-322.