If you are injured, should you apply ice or heat to treat the pain? An emergency doctor explains.
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There are a whopping 35 million emergency department visits across the country each year for injuries. The majority of these are musculoskeletal injuries managed by X-ray imaging, splints and possible orthopedic surgery consultations. Most acute pain caused by stable fractures and sprains can be managed with standard medications like acetaminophen, ibuprofen, and narcotics.
The broader debate among emergency physicians and orthopedic surgery centers is which additional non-pharmacological treatment strategy is better for pain reduction and healing – cold or heat therapy.
There are limited data comparing the two modalities in head-to-head trials. Individually, both have demonstrated reduction in acute pain in small studies. I have found that most doctors recommend patients use one or the other based on their own anecdotal experience.
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What is the science behind the application of heat and cold for pain management?
Applying cold therapy like an ice pack signals the brain to trigger a complex physiological response. The muscular wall of blood vessels contracts in a process known as vasoconstriction. This vasoconstriction reduces blood flow to the affected area, which effectively limits inflammation and alleviates pain.
Cold therapy options include:
- ice packs
- Ice baths
- Coolant spray
- Ice massage
Thermotherapy, on the other hand, relaxes the muscles in the wall of blood vessels by vasodilation, which widens their diameter and increases blood flow. Heat therapy improves circulation and the flow of healing nutrients to the injured area. Similar to cold therapy, it has also been shown to reduce pain. In fact, a systematic review of 32 randomized controlled trials involving over 1,000 study participants found that cold and heat were effective in reducing pain.
Heat therapy options include both dry and moist heat options:
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General rule: 20 minutes walk, 20 minutes rest
Typically, you should apply cold or heat therapy for 20 minutes, then take a 20-minute break.
In general, cold and hot therapy is an excellent option for many patients. However, never apply cold or heat directly to an open wound. Patients with chronic medical conditions such as diabetes, dermatitis, multiple sclerosis and vascular disease should exercise caution or consult their doctor first.
The bottom line: Ice and heat are an option. Personally, I recommend using 20-minute cold therapy sessions for acute pain caused by injuries. Ice works very well to reduce both pain and swelling. After 72 hours, switch to heat to increase blood flow, improve healing, and reduce stiffness in the affected area.
Michael Daignault, MD, is a Los Angeles Board Certified Emergency Physician. He studied global health at Georgetown University and holds a medical degree from Ben Gurion University. He completed his emergency medicine residency at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault
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