The action of heat or cold can be beneficial in contrasting pain. The application of heat generates a greater inflow of blood (vasodilatation), and therefore of oxygen; the cold instead induces vasoconstriction, with a reduction of the blood microcirculation. Therefore, when is it useful to use cold and warm therapy?

Professor Daniela Lucini, head of the Department for Exercise Medicine in Humanitas and Dr. Maurizio Fornari, head of Neurosurgery in Humanitas, replied to Corriere della Sera.

The application of heat and cold depends on the cause of pain. If the pain is caused by an infection, such as abscess to a tooth, using cold is better. Abdominal cramps that may occur during the menstrual cycle can be relieved by heat, as well as muscular contractures; while for edema and swelling in case of distortion, cold therapy is again recommended,” says Professor Lucini.


Tears, distortions, cramps and contractures

Both applications can be useful on a muscular level, but in different contexts: after a fall trauma, using cold is better. In the presence of a muscle tear, the pain is caused due to inflammation and thus cold therapy is recommended. Similarly, in the case of ankle distortion, the intervention with the application of cold must be timely “, explains Professor Lucini.

Cramps and muscular contractures can be treated with heat therapy: muscle tension due to misplaced postures for a long time, e.g. after long journeys in the car, cervical or contraction headache, where pain originates in the neck and shoulder muscles. For the treatment of muscle contractures there are two fundamental and particular rules: the first is not to apply cold. The second is to keep it warm as much as possible. Heat can come from a knit, a scarf (silk scarf for the summer) or by using thermal bearings (there are also some with cherry stones to be put in the oven),” says the professor.


What to do in case of back pain?

When back pain is associated with muscle pain, trauma, contraction, tearing and stretching, cold treatment is indicated in the acute phase. A simple ice bag is also fine. Cold reduces back muscle tension and reduces the local inflammatory process,” says Dr. Fornari.

If back pain is caused by the displacement of a supporting structure of the spinal column, warm remedies should be preferred. The displacement may be carried by a single vertebra (spondilolisthesis) or may fit into a more complex framework of degeneration of the entire column (degenerative cleavage). Within the therapies prescribed by the treating physician, it is also possible to benefit from the action of heat with the application of thermophorics, electro-medical devices that emit heat, but above all with thermal baths in hot water. In the latter case, the action of water is also exploited, along with the reduction of the gravitational load on the joints. Backache may also be associated with irritation or compression of the nerve root. In case of root pain, the application of heat may bring some relief. However, the benefit of heat in case of back pain with nervous trunk irritation is modest.

If you are struck by the so-called witch’s blow, “the drug treatment can be accompanied by heat therapy,” adds Dr. Fornari.


Cryosurgery and Thermoablation

The action of heat and cold is also exploited in the surgical field: “With cryosurgery and thermoablation, the power of heat and cold can also be exploited within the vertebra for the treatment of metastatic column tumors. In the first case, gases are used at subzero temperatures, while radio frequencies are used for thermoablation. The advantage of cryosurgery is that cold-induced lesions are visible and identifiable with magnetic resonance,” concludes Dr. Fornari.