A frequent conversation with my patients is how and when to use hot or cold for Pain Relief?

There are some easy simple rules.

Sudden onset/new pain = Cold.  

New pain nearly always has an element of inflammation.  Your body is trying to heal something.  Inflammation works by creating extra blood supply to flood the area with chemicals and cells that heal and protect.  This causes pain.  As part of its safety mechanism the body always over reacts.  You check if it was a tiger after you ran, it might be too late to check first.  So it’s ok to use cold to calm that reaction down and relieve pain.  Pain and temperature travel on the same nerves; so the cold will override the pain during application, but also beyond that with the reduction of congestion in the soft tissues.  However, because your ability to detect temperature may be reduced, due to the pain, you also need to take care to not give yourself an ice burn.

Cold Compress.

Take a sports pack or other frozen item (such as a bag of frozen peas)

Wrap in a tea towel or apply through your own clothing to the area of pain.  

Apply for ten minutes.  (this is usually sufficient, bony areas or top of the neck less my be enough, or on a well padded area such as the buttock longer may be needed upto 15 mins.  If it starts feeling too cold or hasn’t yet felt effective adjust).  You can do this upto ten minutes once a hour (this prevents over chilling).  

At a minimum apply 3-4 times a day, morning, midday, evening and prior to bedtime.  (Bedtime doesn’t sound attractive I know but it can really help you have a more comfortable night).  If out and about a cold can of fizzy drink makes a good stand-in.  Or if travelling take a plastic bag with you and ask for some ice.  

Many patients say to me ‘Oh I hate cold’.  When they tell me that they clearly haven’t tried it.  When in severe pain it’s my temperature of choice, it’s so soothing.


If you really aren’t sure which is use go for: Hot and Cold.

This encourages the circulation speeding up healing.

When the acute inflammatory response has settled (usually after 3-4 days) alternating Hot and Cold is the way to go. 

Start and finish with the cold application (through fabric as above)

Alternate with heat (hot water bottle or wheat bag or hot sports pack)

Apply two minutes of each totally 15 minutes.  

Do 3 times a day minimum.  

For feet bowls of water can be easiest.

When can I use just Heat?

End of day tired muscles enjoy heat to relax them or uninflammed arthritic joints (if you are suffering a worsening of your usual arthritic pain then the joint is inflamed).  The easiest way to use heat like this is a bath or shower or wheat bag (I like these because they stay warm just long enough).  The big NO NO is sitting on a hot water bottle for hours or going to bed with the hot water bottle on the sore spot and not moving.  Hot water bottles stay hot too long.  The number of patients (especially the elderly) who have made their pain worse with hot water bottles I have lost count of.  It feels nice at the time, but the next day it will be worse.  You don’t see physio’s running on with a hot water bottle during a sports match they run on with ice.  

With experience you will learn what suits your body when.  The correct use of temperature really helps.  The number of patients who come back saying ‘gosh it really worked’.  It’s a nice natural method to reduce the number of analgesics you may need too.  

If you are unsure of the cause of a new pain then it is advisable to seek advice from a medical professional.  This doesn’t necessarily need to be a doctor, it depends on your symptoms, but any medical professional will know where to direct you if they can’t help you themselves.