1. Home>
2. Specialties>
3. Emergency Medicine>
4. Summary and Comment

Hot Packs and Cold Packs Are Equally Effective for Treating Neck or Back Strain

But whether these therapies provide any benefit over ibuprofen alone is unclear.

Pain management is the primary concern when treating patients with acute neck or back strain. Hot packs or cold packs are often recommended — despite little evidence that either is effective — particularly when used with standard therapy, such as nonsteroidal anti-inflammatory drugs. In a prospective study, 60 adult patients who presented to an academic emergency department with acute neck or back strain received single 400-mg doses of oral ibuprofen and were then randomized to application of hot packs or cold packs to the strained area for 30 minutes. Patients rated pain on a 100-mm visual analog scale and a verbal rating scale before receiving ibuprofen and immediately after hot pack or cold pack treatment.

The mean decrease in pain scores after treatment was statistically significant in both groups (9 and 8 mm) but did not meet the authors' predefined threshold for clinical significance (15 mm). Pain scores did not differ significantly between the two groups before and after treatment. Use of rescue analgesia also did not differ significantly between the two groups. About 80% of patients in each group expressed a desire to use their respective packs in the future.

Comment: Let's admit it — we've all recommended hot or cold local therapy for acute neck or back strain. This small study suggests that, at least in terms of measurable short-term relief of pain, neither therapy provides clinical benefit when ibuprofen is prescribed in analgesic doses.

— Diane M. Birnbaumer, MD, FACEP

Published in Journal Watch Emergency Medicine June 4, 2010

Citation(s):

Garra G et al. Heat or cold packs for neck and back strain: A randomized controlled trial of efficacy. Acad Emerg Med 2010 May; 17:484.

• Medline abstract (Free)

Reader Remarks:

Review and add to remarks on this article

• well duh!
  DS proctor, ambulatory, 7 Jun 2010 1:50 PM EST
  Vessels exposed to cold, reflexively vasodilate when the cold therapy is removed, creating the same effect as heat!
• Hot and Cold Packs
  RA Mahmoud, 7 Jun 2010 1:50 PM EST
  I haven't read the primary article, but the review appears to conflate "clinical benefit" with "pain relief". For example, I... [more]
• hot/cold packs
  Eugene Charles, private practice - NYC, 7 Jun 2010 3:23 PM EST
  I have found clinically that when you place the most appropriate modality for that individual's condition (heat or cold) for... [more]
• Ice
  Peter J. Stanton, DC, MS, DABCO, 7 Jun 2010 3:23 PM EST
  With an acute injury I want to slow the inflamatory response. Ice lowers tissue temps, has an analgesic effect and... [more]
• Let's hear it for ice
  Diane H Campbell MD, 8 Jun 2010 1:01 PM EST
  With acute injury, I am always concerned about the complex pathway we call the inflammatory response, and I am certainly... [more]

2011 Top Stories