Can heat compress be used during the remission period of chronic pain?

Most cases of chronic pain can be treated with moderate heat compresses during the remission period. However, there are a few cases with special causes that require extra caution, and even applying hot compresses is not recommended.

In the seven or eight years I have been doing rehabilitation, the patients I have encountered the most are patients in the remission stage of lumbar muscle strain, lumbar disc herniation, stable stage of degenerative knee arthritis, and post-surgery recovery from sports injuries. For chronic pain caused by soft tissue or degenerative lesions, the benefits of hot compress during the remission stage are basically far greater than the risks. I once had an old patient who worked in the field of design. He suffered from lumbar muscle strain for more than three years. When the pain was acute, he could not even sit in a chair. After the pain subsided, he always felt that his waist was stiff. When he got up in the morning, he had to hold on to the edge of the table for three to five minutes before he could straighten up. Later, he heard my suggestion to apply a coarse salt bag at about 42 degrees on his waist for 20 minutes every day. Within half a month, he told me that the stiffness in the morning was basically gone, and he did not feel as sore as before after sitting for three or four hours during the day.

In fact, the principle is simple. The appropriate temperature can penetrate 1-2 centimeters under the skin. The originally contracted blood vessels can relax and local circulation can start. The inflammatory factors and metabolic waste accumulated in the soft tissues can be taken away faster, and the tight muscle fascia can also be loosened. This is the same as the elasticity of frozen rubber bands that can be restored after being warmed.

However, don’t think that hot compress is a panacea. Clinically, we have encountered many cases where the condition worsened after applying it. This is why there are still different opinions on this issue. The core thing is to first figure out the cause of your chronic pain. Last month, I met a young man in his 20s who had a history of gout for two years. His uric acid has been floating above 600 μmol/L, and he has not been taking medication to control it. Recently, the pain of an acute attack had just subsided, and I felt that my ankle was stiff, so I used a hot water bottle to apply it for almost 40 minutes. As a result, I couldn’t sleep because of the pain that night. My ankle was swollen like a steamed bun, and I came to the emergency department again.

In addition to the remission period of gout with poor uric acid control, it is not recommended to use hot compress casually. There are also chronic pain caused by diabetic peripheral neuropathy. The patient's own skin sensation is reduced and it is easy to be burned by low temperature without even realizing it.； There is also chronic pain with no clear cause. If it is related to tumors, hot compresses will speed up local circulation and risk promoting the development of lesions. ； In addition, in some cases of neuropathic pain, such as postherpetic neuralgia, the nerves themselves are in a highly sensitive state, and the temperature stimulation of hot compresses may induce abnormal discharges, making the pain even more severe. Some studies now believe that for this type of chronic neurogenic pain, even in the remission period, the soothing effect of cold compress is better than hot compress. Of course, this also depends on the individual's feelings.

If you really want to apply it, you don’t have to do anything complicated. Just control the temperature at 40-45°C. Don’t stick a hot water bottle filled with freshly boiled water directly on the skin. Applying for 15-20 minutes each time is enough. Applying for too long may cause local edema, which will make you uncomfortable. If you feel pain, itching or your skin becomes red and swollen after applying it, stop immediately and don’t force yourself.

If you are really not sure whether your condition can be cured, it is better to ask the attending physician or rehabilitation practitioner first than to blindly try and get into trouble, right?