Renowned Endoscopic Spine Surgeon Dr. Kaixuan Liu on Hot v Cold for Back Pain

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“There’s a popular myth out there that heat and cold are interchangeable in treating back pain,” Dr. Liu explains. “It’s true that they both relieve pain, but the mechanisms that produce that pain relief are completely different,” he says. “That means each has its time and place.”

It is estimated that close to 80 percent of Americans will experience low back pain at some point in their lives, and about a third of U.S. adults have an aching back at least once a month. In fact, only headaches are higher on the list of most common neurological complaints.

But despite our familiarity with back pain, many of us aren’t sure how to treat it. Do we ice it, or apply heat? Does it even matter which method we use?

The fact is that the vast majority of low back pain, pain that’s centered in the lumbar region of the spine, just above your pelvis, will resolve on its own, generally within a few weeks, says Kaixuan Liu MD, PhD, nationally distinguished leader in endoscopic spine surgery and chief surgeon at Atlantic Spinal Care in Edison, N.J. And to help it along, you can use both heat and cold, but you’ve got to use them correctly, he says. Picking the wrong remedy can actually make your pain worse and potentially delay the healing process.

What Does What?
Before you start shopping for ice packs and hot water bottles, you must first understand what’s behind your pain, says Dr. Liu. Most acute back pain is caused by something mechanical: a traumatic injury, strain caused by excessive stress on the muscles and other tissues around your spine, or a surgery. “With a mechanical injury, you might feel anything from a dull aching to a shooting or stabbing pain,” Dr. Liu says. “You might also experience stiffness or loss of flexibility that prevents you from standing or sitting normally.”

This kind of mechanical injury generally produces acute pain (pain that’s short-lived) or recurrent (repeated bouts of acute pain). Chronic back pain, which is defined as pain that persists more than three months, can also be caused by mechanical injuries, along with degenerative conditions.

Why does it matter what’s causing your pain? “It’s all about inflammation,” says Dr. Liu. Acute injuries typically create inflammation, which is the body’s response to attack or injury (think exposure to a twisted ankle on the baseball field). It involves an influx of blood, various immune cells, and other things designed to get rid of the invading agents (if any) and start the healing process. “Inflammation is the body’s way of protecting itself,” Dr. Liu explains. “In the case of acute muscle or joint injury, or surgery, it creates swelling that is the beginning of a healing process.” In general, he says, it’s a good thing. But that swelling can also produce pain, so doctors advise various methods for reducing it.

Ice is a great remedy for acute inflammation, says Dr. Liu. “The cold shrinks the small blood vessels in the area, which keeps blood and other fluids from flooding to the injury site, thus decrease swelling. It also slows nerve impulses in the area, which interrupts the transmission of pain messages, and numbs the area much like a local anesthetic.” Cold also helps decrease tissue damage that can be caused by acute inflammation, he adds.

On the contrary, heat stimulates circulation, which makes it an effective pain remedy, but a poor choice for cases of acute inflammation. In fact, applying heat to an area that’s already acutely inflamed can make the swelling worse and cause more pain, says Dr. Liu.

But if your back pain isn’t tied to chronic inflammation which is usually associated with poor tissue circulation, you’d welcome the boost in circulation that heat brings, Dr. Liu says. Heat dilates the blood vessels in the area to increases the flow of blood, which carries oxygen and other nutrients to the muscles to help the damaged tissues heal. Heat also helps to relax muscles, which reduces painful spasms, and cuts down on stiffness. And because it stimulates the nerves on the surface of your skin, it also seems to “distract” the nerves that are sending pain messages to the brain, which also helps to reduce pain (or at least, your perception of pain).

Timing Is Everything
If your sore back is the result of an acute mechanical injury (and therefore entails inflammation), you can use ice and heat in a one-two punch, says Dr. Liu. Apply ice to the sore area with acute injury such as sprain, strain, or surgery, intermittently 20 minutes at a time for about 1-2 weeks. After that, use heat. Limit yourself to 15 or 20 minutes of either therapy every few hours, and be sure to keep your treatment comfortable: Never apply anything that’s so cold (or hot) that it hurts, and never put an ice pack or heating element directly against your body (always protect your skin with a towel or another insulator). One exception to this rule are the commercial “heat wraps” designed to be worn for several hours at a time. These wraps never get hot enough to burn your skin, and have been shown to be effective at relieving many types of low back pain.

“There’s a popular myth out there that heat and cold are interchangeable in treating back pain,” Dr. Liu explains. “It’s true that they both relieve pain, but the mechanisms that produce that pain relief are completely different,” he says. “That means each has its time and place.”

About Dr. Liu: Kaixuan Liu, M.D., Ph.D. is a nationally recognized leader in endoscopic spinal surgery. Dr. Liu is certified by The American Board of Pain Medicine and The American Board of Anesthesiology, and is a member of The International Society for Advancement of Spine Surgery, The American Society of Interventional Pain Physicians (ASIPP), The American Academy of Pain Medicine (AAPM), The International Intradiscal Therapy Society (IITS), and The American Society of Anesthesiologists (ASA). He also serves as an international surgeon for The Spinal Foundations in England. Dr. Liu is the founder of Atlantic Spinal Care, LLC, in Edison, New Jersey, http://www.atlanticspinalcare.com

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MELISSA CHEFEC
MCPR Public Relations
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