Applying a heating pad to an arthritic joint or an ice pack to a sprained ankle is a fairly simple approach to reducing pain
or inflammation. But even the simplest therapies require an understanding of why you do what you do, and how to do so safely.
Consider the basics of hot and cold therapy. Both relieve pain; they just use different pathways. For each method, the end
result is the same: they both block pain impulses and stimulate the release of endorphins.1,2,3
It's the same for inflammation: different methods, same result.1,2,3 Cold causes local vasoconstriction and increased blood viscosity. The decreased blood flow and slower metabolism blunt the
inflammatory response, limit swelling, reduce oxygen consumption, and control bleeding.1,2,3
Heat, on the other hand, controls inflammation by causing local vasodilatation and decreased blood viscosity. The increased
blood flow quickly brings immune responders to the site and clears away debris. It also increases swelling and oxygen consumption
and promotes bleeding.1,2,3 While these effects are beneficial, there's a downside to both, depending on the size of the area being treated:4,5 Cold can cause shivering, raise blood pressure, and decrease the respiratory rate. Prolonged exposure may cause blistering
or necrosis. Heat can lower blood pressure and increase the respiratory rate. Prolonged exposure can lead to burns and necrosis.
Proper management of either therapy is a must.
Things about cold you must know
Cold therapy can be delivered in a variety of ways. Among the most common are disposable ice bags or collars, cold packs,
gels, water-filled electric cooling devices, and moist compresses, soaks, or sitz baths.4,6 In a pinch, you can even use a disposable glove. Fill it with ice and tie up the open end.
Cold works best when applied within the first 24 hours of injury or condition.6,7 Treatment is usually applied for 15 – 20 minutes followed by at least a 30-minute rest period.6,7 Because moisture intensifies cooling, cold compresses, soaks, or sitz baths should be used in shorter intervals (10-minute).8 Intermittent applications are generally continued for the first 24 – 48 hours.6,7
What's important to keep in mind is that while some disposable cold packs can be applied directly to the skin, many cannot.4 You'll need to wrap cold packs that can't be applied to the skin in a pillowcase, thin towel, or washcloth. The same applies
to electric cooling devices that don't have a protective cloth cover. Never place a cooling device on an open wound.5
Some like it hot (and some, cold)
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Before you apply cold therapy, always check the order for the type, duration, and number of repeated applications. Assess
the patient for adequate circulation and sensation. Gather gloves, waterproof pads, and the cold therapy. Depending upon what's
ordered, you may need to bring a clean basin, ice, towels, and tape.
Explain the procedure to the patient, and teach him that some numbness and tingling is to be expected.4 But instruct him to immediately report any burning, increase in pain, or severe numbness. These are signs of ischemia,
and you should stop the treatment.4,6
Place a waterproof pad under the area being treated. Don gloves and mold the pack—or wrap the pad—to the injury.
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