Cold or heat therapy is typically effective for back pain relief apart from using pain relief medications. However, some back pain may respond to heat therapy, not cold therapy, and vice versa. Some individuals may find it challenging to decide when to use cold or heat therapy for back pain relief. You can typically use whichever therapy you prefer. However, speak with your doctor about which might be the most effective for your pain. Commonly, heat is recommended to relax tight muscles, but ice may reduce swelling.

This article explains cold and heat therapy, how to use both, and possible associated risks. 

Cold therapy involves the application of cold to a specific or generalized part of the body. The precise mechanism of how cold therapy relieves pain is uncertain. Research scientists have proposed that cold therapy helps reduce inflammation and cellular oxidative stress, and reduces the sensitivity of pain receptors.

Medical professionals classify cold therapy as local and nonlocal.

Local cold therapy is application of ice to a specific area of the body. Ice is typically a commonly available choice for local cold therapy for back pain. You may apply ice to your back using the following methods:

Nonlocal cold therapy entails applying cold to a partial area or the whole body. Partial cold therapy requires using nitrogen gas to generate cold and spraying it on the region. Whole-body cold therapy involves an enclosed chamber filled with circulating nitrogen and oxygen to deliver cold to the entire body. Whole-body cold chambers may fit a single person, and some may fit more than one person. 

Cold therapy is not suitable for everyone, regardless of its effectiveness for back pain relief. Generally, doctors do not recommend cold therapy for individuals with the following medical conditions:

Before using cold therapy to relieve back pain, consult your doctor. They will perform a clinical evaluation and determine if cold therapy is safe for you.

Applying ice may help with localized pain like back pain. To apply ice on your back, wrap ice packs in a small towel and apply for 10–20 minutes. During this period, check the surrounding skin for sensation. This helps to avoid damage by the ice to the local tissues.

Medical professionals recommend the application of ice immediately or on the day of injury to help relieve pain.

Heat therapy for back pain involves applying a heat source to the back to increase the temperature of local tissues. These tissues include the skin, muscles, and nerves. The elevated temperature causes:

Medical professionals further classify heat therapy by the way the heat reaches the local tissues. Heat therapy can be in the form of superficial or deep therapy.

For superficial heat therapy, heat reaches the tissues via conduction or convection.

Superficial heat therapy via conduction entails transferring dry heat directly from the heat source to the tissues. Examples include:

Heat therapy via convection or moist heat occurs when heat is transferred via hot air or fluid. Examples of this method are:

For deep heat therapy, heat reaches local tissues through the conversion of the initial energy to heat energy. For example, during laser therapy, light energy converts to heat energy to penetrate the skin tissues.

Heat therapy is typically safe for back pain relief in most individuals. However, doctors do not recommend heat therapy for individuals with the following medical conditions: 

Heat therapy is also unsuitable for individuals with conditions that reduce pain sensations because it may lead to burns. Before using heat therapy, consult your doctor.

Learn when to contact a doctor about back pain.

To apply heat for back pain, follow these steps:

A hot water bottle is an example of a moist heat source readily available for acute back pain heat therapy.

Applying ice for acute or sudden back pain typically improves the pain, but it may affect the recovery of tissues. This is because blood vessels narrow or constrict when exposed to cold. This then reduces blood supply to the tissues. In contrast, heat therapy warms local blood vessels and improves blood flow in acute tissue injury.

The timing and underlying cause of the injury typically influence when to use heat and cold therapy. Some research has shown that using strictly cold or strictly heat therapy for pain may not be as beneficial as alternating treatments. In addition, using only one or the other can cause further issues if used long term.

One study from 2015 suggests that combination therapy of cold and heat may be more efficient and have fewer potential risks, especially in those with chronic lower back pain.

Discuss all options with your doctor to determine the most effective treatment for you.

Possible risks of ice and heat therapy typically vary, and depend on the duration of application.

Frostbite is a common risk of cold therapy. Frostbite is common with both local and whole-body cold therapy. Cold therapy also may cause the following in some individuals:

High temperature may cause skin burns or ulcers. Also, heat therapy may worsen or complicate disease progression in individuals with some medical conditions. These include peripheral vascular diseases.

Heat and cold therapy are alternative remedies that may relieve back pain. These therapies alter pain signal transmission along the pain nerve fibers, and reduce swelling and inflammation in local tissues. This typically causes the muscles to relax and relieve pain.

Heat and cold therapies generally are safe, but there are some risks. For example, cold therapy may cause frostbite, while heat therapy may cause skin burns or ulcers.

Doctors typically do not recommend heat or cold therapy for people with some medical conditions.

Consult your doctor before using heat or cold therapy for back pain relief.

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