“So… Which One Do I Use Doctor… Heat or Ice?"
Heat And Arthritis Pain Relief
By Nathan Wei
Heat has long been used to provide temporary relief
of arthritis pain, and is used in many different forms. Contrast baths,
whirlpools, electric pads, microwaveable gel packs, hydrocollator
packs, infrared lamps, and hot showers are some of the different techniques
used. Even warm tap water probably will meet some of your needs for
heat therapy at home.
Heat can provide temporary relief of pain and stiffness,
and can prepare you for physical activity or exercise. For example,
morning stiffness is a common problem for many people with rheumatoid
arthritis.
Because your body has been still during the night
you may need special help to get going in the morning. The following
combination of techniques using heat can reduce the length and the
severity of morning stiffness:
1. Sleep in a sleeping bag (which helps retain body
heat) or with an electric blanket (following the manufacturer’s instructions).
2. Take your aspirin or other anti-inflammatory medication
an hour before you get out of bed in the morning. (Keep a few crackers
at your bedside to take with the medication to avoid stomach irritation.)
3. Take a warm shower or bath immediately after you
get up.
4. Then do limbering-up exercises after your shower
or bath while you still feel warm.
Safety is important in choosing the form of heat you
use. You should take great care to avoid burns or electric shocks.
Heat must be used with much caution on any area of the body with poor
circulation or where you cannot feel heat or cold normally. It should
not be used over areas where your skin is fragile or broken.
Only mild heat is necessary to get results. You are
aiming for a temperature just slightly above body temperature, and
you do not have to apply heat for a long time. You will get full benefit
by using heat for 20 minutes each time.
Moist heat is any technique in which water is used
to conduct the heat, such as a bath or shower or hydrocollator packs.
People with arthritis prefer moist rather than dry heat, such as a
heating pad. Moist heat penetrates more deeply than dry. You will
have to try both and see which is more effective and convenient for
you.
Heating pads are available which provide either moist
or dry heat, but they should be chosen and used with care. Make sure
the pad is approved by the Underwriter’s Laboratory. Look for those
which have temperature control switches; those without temperature
settings get hotter and hotter until you switch them off.
When using a pad, never lie on top of it and make
sure you do not fall asleep while it is on. Severe burns can result!
It may be wise to use a timer during the treatment. Check the instructions
on use carefully. Regularly inspect the pad for any cracks in the
plastic cover.
Hydrocollator packs are canvas bags containing silicone
gel which retain heat for a long time. You can buy them in different
shapes at pharmacies. Some people like them because they lose heat
more slowly than most wet compresses. The pack is heated in water,
wrapped in 8 to 10 layers of heavy toweling and placed over the painful
joint.
The pack is heated in a large pot of water and placed
on heavy towels. Place the surface with the thickest layer of toweling
over the part to be treated.
Keep in mind that hydrocollator packs do have drawbacks.
They are not practical if heat is needed for several joints, because
each pack can be used for only one part at a time. They are also cumbersome
to use and may be too heavy placed over a painful joint. If your hands
are affected by your arthritis, it may be difficult for you to remove
the heavy pack from the water with the tongs. So you may need help.
Again, you must be very careful about burns. If you decide to try
such a pack, follow the manufacturer’s instructions carefully.
Microwaveable gel packs are popular. Follow the instructions
carefully or else the bag containing the gel may leak… or even worse
explode and cause serious burns!
Physical therapists sometimes use melted paraffin
as a means of applying heat, particularly to the hands. There are
units available for home use as well. Because they involve high temperatures,
paraffin baths should be used with caution. Patients with osteoarthritis
or rheumatoid arthritis involving the hands often find paraffin to
be helpful.
You can buy nylon and spandex gloves which can reduce
morning stiffness of the hands for some people when worn at night.
The gloves are available in both men’s and women’s sizes.
It is important to wear adequate, warm clothing in
cold weather. Some people find that knitted, woolen or fleece pullover
cuffs on painful joints, especially the knees, ankles and elbows are
helpful in keeping the joints warm and more comfortable in cold weather.
Some people with arthritis find that heat does not
help them. In fact, the reverse is often best-cold compresses. Cold
may be especially effective when active inflammation produces severe
pain and joint swelling. Only trying different modalities will enable
you to find out which is best for you.
It is easy to make a cold pack by filling a small
plastic bag with a few ice cubes. A bag of frozen vegetables wrapped
in a towel can be used. Place any cold pack over the painful joint
with a layer of terry cloth toweling in between. The same precautions
that apply to the use of heat should be observed when using cold.
The maximum benefit is achieved in less than 20 minutes. You may wish
to repeat this application several times a day.
For many people with arthritis an effective approach
is alternating warm and cold water applications, a process called
contrast baths. It is most useful for a hand or foot which can be
dipped in a large pot filled with water. If you decide to give it
a try, use a thermometer to check temperatures.
1. Fill one container 2/3 full with 110 degree F water.
2. Fill a second container 2/3 full with 65 degree F water.
3. Put your hands or feet completely into the warm water for three
minutes; then put them into the cold water for one minute.
4. Repeat step #3 two more times.
5. End the treatment with three more minutes in the warm water; then
carefully dry the hands or feet.
Finally…and very importantly… with acute musculoskeletal
pain, and particularly with injuries, always use ice. The formula
to remember is RICE...
- Rest
- Ice
- Compression
- Elevation
Dr. Wei (pronounced “way”) is a board-certified
rheumatologist and Clinical Director of the nationally respected Arthritis
and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor
of Medicine at the University of Maryland School of Medicine and has
served as a consultant to the Arthritis Branch of the National Institutes
of Health. He is a Fellow of the American College of Rheumatology
and the American College of Physicians. For more information on arthritis
and related conditions, go to: http://www.arthritis-treatment-and-relief.com
