Topical analgesic treatment for pain and inflammation: hot or cold?

Find the hot (or cold) spot when choosing a topical analgesic

One of the most common and effective treatments against pain and inflammation is the use of hot or cold topical methods. This treatment has the added bonus of being easy for your patients to do at home between office visits. In fact, most of your patients are probably already familiar with the RICE (Rest, Ice, Compression and Elevation) treatment plan for pain, particularly following a fall resulting in bruising and swelling. Other situations, however, may call for topical application of heat.

It is important for your patients to understand which type of treatment is best for which type of pain. As a general guideline, cold therapy is better for acute injuries or pain, while heat therapy works better for chronic muscle pain and stiffness.^1-3 Read further to find out more about each type of therapy and which conditions they best treat.

Heat therapy

Heat applied topically improves circulation and blood flow to stiff and sore muscles and joints, increasing flexibility. Topical heat can also heal damaged tissue, making it an excellent option for your patients with chronic pain, including arthritis and tendonitis.² Minor stiffness and tension usually requires about 15 to 20 minutes of heat therapy, while moderate to severe pain can benefit from extended periods, depending on the type of heat application.^1-4 Heating pads, for example, should only be used for 10 minutes at a time, while a warm bath (92°F to 100°F) could extend up to two hours.

There are two types of heat therapy that can be used at home. Dry heat includes modalities such as heating pads, capsaicin-based topical analgesics, or hot rice packs. Moist heat involves warm towels or baths. A 2013 article in the Journal of Clinical Medical Research compared dry versus moist chemical hot packs following exercise.⁴ A group of 100 subjects were assigned to use either the dry or moist heat pack both immediately after 15 minutes of squat exercises and again, 24 hours later. Strength, muscle soreness, tissue resistance, and force required to move the knee were measured before the exercise and for three days following exercise. The moist heat pack had the same amount of pain reduction as the dry pack, but over a shorter period of time (two hours versus eight hours).⁴

Cold therapy

Cold therapy, sometimes called cryotherapy, reduces blood flow to an affected area, significantly reducing inflammation, swelling and pain.^1-3,5 As mentioned previously, this makes it ideal for acute injuries, such as sprains or soft tissue damage resulting from slipping and falling. There are a number of topical cold therapies that can be used, including ice packs or frozen gel packs, or coolant sprays, gels or creams.

Any ice or gel packs should be wrapped in a thin washcloth before being applied to the affected area to prevent damage to the skin. Leave the pack on for only 10 to 15 minutes at a time, and reapply several times a day for up to 48 hours after the initial injury.^1-3,5 If the initial pain, swelling and bruising from the injury does not subside by that time, your patient should call you or their regular doctor.

The great thing about hot and cold topical treatments is that they are easy for your patients to continue at home between office visits. This will provide greater benefit for both acute and chronic joint and muscle pain and stiffness.

References

1. Cleveland Clinic. Should you use ice or heat for pain? clevelandclinic.org/2014/08/should-you-use-ice-or-heat-for-pain-infographic/ Published Aug. 11, 2014. Retrieved May 27, 2019.
2. Marshfield Clinic. Treating pain with heat or cold compress. org/sports-wrap/ice-or-heat Retrieved May 27, 2019.
3. Using heat and cold for pain relief. org/living-with-arthritis/treatments/natural/other-therapies/heat-cold-pain-relief.php Retrieved May 27, 2019.
4. Petrofksy J, Berk L, Bains G, et al. Moist heat or dry heat for delayed onset muscle soreness. Journal of Clinical Medical Research. 2013;5(6):416-425.
5. Johns Hopkins Medicine. Cryotherapy (cold therapy) for pain management. org/healthlibrary/conditions/orthopaedic_disorders/cryotherapy_cold_therapy_for_pain_management_134,95/ Retrieved May 27, 2019.