Ice or Heat for Back Pain? What the Evidence Says

Ice or heat for back pain? For low back pain, heat has the better evidence. The evidence for cold is thin, and staying active beats bed rest.

What the evidence says about ice or heat for back pain

The Cochrane review pooled nine trials. In two trials of 258 people with acute or subacute low back pain, a heat wrap significantly reduced pain after five days compared with an oral placebo. In one trial of 90 people with acute low back pain, a heated blanket cut pain right after it was applied. In another trial of 100 people, adding exercise to a heat wrap reduced pain more at seven days.

For cold, the reviewers found too little evidence to say anything. They called the overall evidence base “limited” and asked for better trials. And this is low back pain. It doesn’t tell you what to do for neck pain, where our guide to a stiff neck after sleeping wrong applies.

The ACP’s take

The American College of Physicians’ 2017 guideline starts from a useful fact: most patients with acute or subacute low back pain improve over time regardless of treatment. For those patients it recommends nonpharmacologic treatment first, with superficial heat (moderate-quality evidence) at the top of the list. The other options it names, spinal manipulation included, rest on low-quality evidence.

Should you rest?

Mostly no. A Cochrane review of ten trials found that for acute low back pain, advice to stay active gave small improvements in pain relief and function compared with advice to rest in bed. For sciatica, it found little or no difference between the two. Staying active doesn’t mean pushing through sharp pain. It means not parking yourself in bed for days.

How to use heat safely

Put a layer of cloth between you and the heat source. Don’t fall asleep on a heating pad. Stop if your skin turns red or the pain gets worse. The trials don’t give a standard dose we can quote, so skip anyone who tells you an exact number of minutes as if it were proven. Our guide to sleeping with back pain has night-time ideas.

When back pain needs more than a heating pad

Numbness or weakness in a leg, new bladder or bowel changes, fever with back pain, or pain after a serious fall or accident need medical care. If you’re not sure whether it’s a strain or something more, read five signs your back pain isn’t just muscle strain. A first visit at Brooklyn Chiropractic Care starts with a consultation and an orthopedic and neurological exam.

Frequently Asked Questions

References

1. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006;(1):CD004750. PubMed: 16437495
2. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. PubMed: 28192789
3. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;(6):CD007612. PubMed: 20556780