Hot Packs and Cold Packs Are Equally Effective for Treating Neck or Back Strain

Summary and Comment |
June 4, 2010

Hot Packs and Cold Packs Are Equally Effective for Treating Neck or Back Strain

  1. Diane M. Birnbaumer, MD, FACEP

But whether these therapies provide any benefit over ibuprofen alone is unclear.

  1. Diane M. Birnbaumer, MD, FACEP

Pain management is the primary concern when treating patients with acute neck or back strain. Hot packs or cold packs are often recommended — despite little evidence that either is effective — particularly when used with standard therapy, such as nonsteroidal anti-inflammatory drugs. In a prospective study, 60 adult patients who presented to an academic emergency department with acute neck or back strain received single 400-mg doses of oral ibuprofen and were then randomized to application of hot packs or cold packs to the strained area for 30 minutes. Patients rated pain on a 100-mm visual analog scale and a verbal rating scale before receiving ibuprofen and immediately after hot pack or cold pack treatment.

The mean decrease in pain scores after treatment was statistically significant in both groups (9 and 8 mm) but did not meet the authors' predefined threshold for clinical significance (15 mm). Pain scores did not differ significantly between the two groups before and after treatment. Use of rescue analgesia also did not differ significantly between the two groups. About 80% of patients in each group expressed a desire to use their respective packs in the future.


Let's admit it — we've all recommended hot or cold local therapy for acute neck or back strain. This small study suggests that, at least in terms of measurable short-term relief of pain, neither therapy provides clinical benefit when ibuprofen is prescribed in analgesic doses.


Reader Comments (5)

Peter J. Stanton, DC, MS, DABCO

With an acute injury I want to slow the inflamatory response. Ice lowers tissue temps, has an analgesic effect and decreases muscle activity. Yes there is a vaso dialation effect after 10-20 minutes but the tissues where the injury is are still colder. Heat also relaxes muscles via different mechanism but raises tissue temps and feeds the inflamatory cycle. Both feel good initially but in this study patients were not followed past perhaps 2 hrs. Do patients RECOVER faster with the ice protocol for the first 2-3 days? I'll bet yes.

Competing interests: None declared

Diane H Campbell MD

With acute injury, I am always concerned about the complex pathway we call the inflammatory response, and I am certainly concerned well beyond the time patients are in the ER. I can't see this study teaching us much. I am concerned that it might get enough press to get people thinking that it doesn't matter whether you treat with heat or cold, when actually it is a study that doesn't give us useful information on exactly that question.

Competing interests: None declared

Eugene Charles

I have found clinically that when you place the most appropriate modality for that individual's condition (heat or cold) for 10 seconds over the indicated area, the patient will immediately experience a transient increase in range of motion. I invite you to try it. Be well.

Competing interests: None declared

RA Mahmoud

I haven't read the primary article, but the review appears to conflate "clinical benefit" with "pain relief". For example, I wonder about the traditional thinking that cold packs in the first 24-72 hrs reduced the degree of inflammation from the acute event causing the pain, while hot packs thereafter increase blood flow to speed the repair and remodeling/healing process? Wasn't the idea always to shorten the duration and not just severity of illness? These packs are likely not a practice supported by even moderate level evidence, but it is also a practice associated with extremely low risk and cost. Conceivably, the process of applying packs (of whatever type) might in theory reduce excessive early activity that could exacerbate spasm or injury. This comment doesn't question the narrow research validity, but just whether the conclusions are over-reaching. I wonder if E.R. docs did the research, and in an ER setting, instead of primary care docs/setting, and if that might explain a potentially problemmatic narrower perspective in drawing conclusions?

Competing interests: None declared

DS proctor

Vessels exposed to cold, reflexively vasodilate when the cold therapy is removed, creating the same effect as heat!

Competing interests: None declared

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