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Which is best for pain from DDD: Heat or Ice?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Degenerative Disc Disease
I'm 32 years old and am in the process of getting a correct diagnosis. I have had episodes on and off for the past 10 years or so, the current one has lasted about 6 months. I trained horses for most of my childhood from age 8 to 18 and had many falls, one resulting in a broken hip that was not identified right away and healed improperly. As a result, I have 25% degeneration in my L1 through L5 and 75% degeneration in my L5-S1. I have bulging in my L2-L3; L3-L4 (with protrusion) and L4-L5 with a slight bulge in L5-S1. This was all identified from a CT scan, which I understand is not ideal and may not be showing the whole story.

I'm taking 1,000mg Naproxen a day and 10mg flexeriol at night. I am scheduled to see a nuero in 6 weeks and to start PT in a week. I have a 1 year old, so not lifting anything is not an option. I also take oxycodone-apap 5-500mg. I am still in a lot of pain and find it difficult to sleep comfortably (which is why I'm posting this at 11:30PM!)

My chiropractor says to use ice, my primary says to use heat. I don't find that either gives much relief beyond 30 minutes or so.

Any suggestions for pain relief from DDD?


  • It is really a matter of personal preference for you at this point. I personally find that heat works better. Sometimes when one is in a lot of pain, the soft tissue overcompensates, which can cause very mild spasms that one might not even be aware of. I find that heat is soothing and I usually feel a bit more relaxed after lying on a heating pad for awhile.

    My massage therapist suggested I turn on my car's "seat heater" whenever I am driving a bit of a distance. So I do that now, most months of the year. Again, it provides just a bit of soothing heat that allows the muscles to avoid tensing up.

    I also enjoy a warm bath, or whirlpool.

    Sometimes you just have too much going on for something like ice or heat to help much. I suggest you talk to your physical therapist. They may have some good ideas that will provide some relief for you.
  • As for me, I cannot deal with the ice/cold thing. Seems to make me feel even worse. I tend to use heating blankets/ electric blanket at night, etc. b/c it seems to help with some of the spasms and pain. I think that it might be a personal preference . My doctor recommended that I try both of them and see if either would provide any temporary relief. I just feel worse all over when I get cold, so I feel better with the warmth. Good luck to you on finding what works best for you.
  • blondgrl said:
    As for me, I cannot deal with the ice/cold thing. Seems to make me feel even worse. I tend to use heating blankets/ electric blanket at night, etc. b/c it seems to help with some of the spasms and pain. I think that it might be a personal preference . My doctor recommended that I try both of them and see if either would provide any temporary relief. I just feel worse all over when I get cold, so I feel better with the warmth. Good luck to you on finding what works best for you.
    I'm exactly the same.
    The cold pack is either too cold or not cold enough, and is hard to adjust.
    I use an electric heat pack, which is a small pad covered in fleece.
    My wife just bought me one of those heat packs that you have to boil before each use. I find this a nuisance, plus it gets too hot. The instructions weren't made clear when she bought it, as it seemed like you just had to simply press a button to activate it.
    To me, heat is comforting; cold is annoying.Can't say I've found the cold to be any benefit either.
  • COLD

    There are a number of different cold agents available to cool injured tissues. When cold is applied to the tissues it lowers the temperature of the skin and the underlying tissue by abstracting or removing heat from the body. The most common methods of cooling are placing an ice or cold pack over an area or immersing in cold water.

    How does it work?

    Cold packs or ice work on the principle of conduction where the body part comes in direct contact with the cold agent. Conduction is the transfer of heat by the direct interaction of the molecules in the warmer area with those in the cooler area. The magnitude of the temperature change in the tissue will depend on several factors including:

    * the temperature differences between the cold agent and the tissue;
    * the time of exposure;
    * the thermal conductivity of the area being cooled, for example muscle verses adipose (fat) tissue
    * the type of cooling agent.

    When cold is applied to an area for 15 minutes or less the immediate response is vasoconstriction (decreased size) of the blood vessels in the skin and reduction of blood flow.

    What are the benefits?

    Cold is the thermal agent of choice for the first 6 weeks following injury. During this period the cold will help to decrease the swelling, inflammation and pain. Cold also decreases the metabolic rate and this is important because it will help to lessen the secondary injuries to the area from a lack of oxygen. Cold has also been found to decrease the nerve conduction speed. Transmission of impulses, for example impulses caused by painful stimuli, have been found to be decreased or even blocked.


    There are many thermal agents available for tissue heating. These generally fall within one of two categories: superficial and deep heating agents. Superficial agents include hot packs, paraffin wax, and a warm whirlpool. Deep heating agents such as ultrasound are used to increase the temperature of deeper tissues.

    How does it work?

    Many physiological changes occur with the application of both superficial and deep heat to the body tissues. The magnitude of these changes depends on several factors:

    * the extent of the temperature rise;
    * the rate of temperature increase within the tissue
    * the amount of tissue exposed to the heat.

    In order to achieve the maximal therapeutic effect of the heat the tissue temperature should be increased to between 40° C and 45° C (104° F and 113° F). Once the tissues reach this temperature the blood flow will increase to the heated area. Tissues heated to temperatures above this level have the potential to burn.

    What are the benefits?

    Elevating the tissue temperature has many therapeutic advantages. Chemical reactions in the cells within the body are influenced by temperature. An increase in the chemical reaction allows for an increase in oxygen uptake, therefore more nutrients will be available to help the tissues heal more quickly. Heating an area is also associated with an increased blood flow to the area. With increased blood in the injured area, nutrients are delivered and wastes are carried away from the area more effectively.

    Therapeutic heating has also shown to decrease pain and to help reduce muscle spasms. The physiological changes underlying these benefits include; an elevation of the level where pain is felt, a change in the speed of signal conduction along a nerve and a decrease in the rate of activation of the muscle fibers.

    Temperature elevation in combination with a stretch will also help to alter the length of connective tissue. Following an injury connective tissue structures will progressively shorten if full range of motion exercises are not performed. Adhesions may develop between the tissue layers and scar tissue may form at the site of injury to further limit mobility. Heat and stretch in combination can result in decreased joint stiffness and increased tissue flexibility, thus facilitating ease of movement and gains in range of motion.
    Keep positive!


    ...an old timer here and ex-moderator

  • I use a Hot Water Bottle, it forms easy to the curve of your back. Be very careful on how much hot water you use.
  • dilaurodilauro ConnecticutPosts: 9,846
    DDD is probably the most misunderstood spinal aliment.
    It is basically the nature aging process of our spines.
    Almost everyone will have some degree of DDD by the time they are 30. Others might start younger and more severe due to trauma, prior surgeries or some genetic links.

    Good news, that most cases are managed through NSAIDS and an approved exercise program. Surgery is only for those rare cases

    Understanding Degenerative Disc Disease
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Hey,

    I use these Thermacare wraps that go around your waist and lower back and velcro together in the front. Once opened, they stay hot for about 8 hours. I wear them all day and they help A LOT! You can get them at any drug store probably, but I get mine from Costco in a value pack. Might be pricey for some, but so worth it if you ask me.
  • To piggy back on what Bruce said
      * Cryotherapy, or cold therapy, when used in the proper clinical situation can diminish pain, metabolism, and muscle spasm, thus minimizing the inflammatory response and improving recovery after soft tissue trauma.
      * Benefits of compression used in conjunction with cryotherapy include improved contact between the skin and the cold source, greater reduction of blood flow to the region, and an increased insulation effect, which may further reduce tissue temperatures.
      * Caution should be used when applying to areas where a superficial nerve is located. It is recommended that the best practice is to always check with the individual's physician to see if any medical condition may prevent the use of cryotherapy.
      * Joints and muscles may benefit from the routine use of cryotherapy even when an injury has not taken place.

    Full article here
  • but have you tried alternating between the two? heat 20 minutes and ice 15? I do this when the pain/stiffness is really bad. Just a suggestion. I know the PT said cold was the best.
  • My doctor recommended SalonPas patches. Although they can be a little difficult to remove, they help throughout the day so you can go about your business or even sleep with one on at night. They're super inexpensive, in comparison to alternatives, and are available in any drugstore. It's a mentholated feeling, but not uncomfortable and you can feel the relief...I hope you find what works for you!
  • I prefer ice on my neck. Just freeze it and theres no pain...Its hard to get thru that first couple minutes but its so worth it. I also use heat, but only in hot baths or showers.....Good luck.
  • I realise this thread is old - the original question was Feb 2009! - but I just re-joined the site and I wanted to ad my $0.02.

    I find for severe localised pain such as my sciatica pain, an ice pack right on 'the spot' gives the best results. Usually allows me to continue to function during a working day. I use those small soft packaging icepacks that come with the deliveries of cold-chain items. The freezer is full of them!

    Everyone is different though. Best of luck.

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