Treating Pain with Heat and Cold

  • Application of superficial heat or cold treatments may reduce or relieve pain by decreasing sensitivity to pain, producing vasodilation (heat) or vasoconstriction (cold) and by altering blood flow. 
  • Heat therapy increases blood flow, metabolism, and the elasticity of connective tissue. Increased tissue temperature stimulates vasodilation promoting blood flow (nutrients and oxygen).  
  • Cold therapy down-regulates production of inflammatory and pain-inducing prostaglandins and diminishes the activation threshold of tissue nociceptors.
Clinical Use: 


Heat: Topical heating methods may provide benefit for several painful conditions, but especially useful for treatment of muscle tension or spasms (e.g., back, neck, menstrual pain), joint stiffness (e.g., osteoarthritis, carpal tunnel syndrome), and postoperative pain. 

Cold: Topical application of cold may also provide benefit for muscle spasms (e.g., back pain, aching muscles) and joint stiffness (e.g., rheumatoid arthritis). Additionally, for migraine headaches, pain in acute trauma, inflammation, and surgical incision pain. Cold may produce partial or even complete numbness.

Applications: (heat):
    Moisture increases heat penetration
    Temperature max: 40-45 °C / 104 ° F
    Duration: 5 – 30 minutes max.

Applications (cold): 
    Provide gradual onset of cold
    Temperature: 15°C / 59 °F
    Duration: Maximum therapy time: 20 minutes, with option to cycle 20 minutes on/20 minutes off based on patient preference. 

Special Considerations: 

Important contraindications for heat:

  • Bleeding
  • Topical menthol 
  • Medicated ointments
  • Burned or radiated skin
  • Vascular diseases
  • DVT

Important contraindications for cold: 

  • Poor circulation
  • Peripheral vascular disease
  • Raynaud’s phenomenon
  • Radiated skin

Aciksoz, S., Akyuz, A., & Tunay, S. (2017). The effect of self‐administered superficial local hot and cold application methods on pain, functional status and quality of life in primary knee osteoarthritis patients. Journal of Clinical Nursing, 26(23-24), 5179-5190. doi:10.1111/jocn.14070

Karadağ, S., Taşci, S., Doğan, N., Demir, H., & Kiliç, Z. (2019). Application of heat and a home exercise program for pain and function levels in patients with knee osteoarthritis: A randomized controlled trial. International Journal of Nursing Practice, 25(5), e12772-n/a. doi:10.1111/ijn.12772

Moore, M., Schuler, M., Wilson, S., Whisenhunt, M., Adams, A., Leiker, B., Butler, T., Shankweiler, C., Jones, M., & Gibson, C. (2019). More than pills: alternative adjunct therapies to improve comfort in hospitalised patients. BMJ open quality, 8(2), e000506.

Piana, L. E., Garvey, K. D., Burns, H., & Matzkin, E. G. (2018). The cold, hard facts of cryotherapy in orthopedics. The American Journal of Orthopedics (Belle Mead, N.J.), 47(9)