What’s better for soothing arthritis pain – ice or heat?

Arthritis is a leading cause of disability globally and it has no cure. In this report by Sade Oguntola, experts say application of heat and cold are one simple, inexpensive and effective way to treat its symptoms such as painful joints at home.

We are in the months of the rainy season now. For many people, the rainy season is a welcome time of the year, but for people with certain diseases like arthritis of joints, including the back, it can be painful, literally.

There’s plenty of anecdotal evidence about the relationship between arthritis symptoms and the weather. Most people who believe their arthritis pain is affected by weather say they feel more pain in the cold, rainy weather than in the warm, dry weather.

There’s plenty of anecdotal evidence about the relationship between arthritis symptoms and weather.

Arthritis is a leading cause of pain and disability worldwide. Fortunately, for many people with arthritis, two of the simplest, least expensive and most effective methods of pain relief are heat and cold treatments.

But, much more, both heat and cold therapies may be applicable at different times to alleviate swollen and painful arthritic joint. According to Dr Adeolu Jaiyesimi, a physiotherapist at the College of Medicine, University of Ibadan, such a painful, swollen joint can be treated with cold therapy when it has lasted for less than 72 hours.

Dr Jaiyesimi declared that the cold therapy will ensure that swelling is reduced while ensuring a pain relief.

However, he added: “But after 72 hours, heat is the preferred mode of treatment.

Heat treatments, such as heating pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Heat enhances circulation, delivering nutrients to joints and muscles.

Cold is best for acute pain; it restricts blood vessels, slowing circulation and reducing swelling. It also numbs nerve endings, dulling pain.

Heat or cold therapy works by stimulating the body’s own healing force. Heat dilates the blood vessels, stimulates blood circulation, and reduces muscle spasms. In addition, heat alters the sensation of pain.

Conversely, cold compresses reduce swelling by constricting blood vessels. While cold packs may be uncomfortable at first, they can numb deep pain.

According to the American College of Rheumatology, five to 10-minute ice massages applied to a painful area within the first 48 hours of pain onset can provide relief.

Cold therapy is recommended for certain types of arthritis that cause painful inflammation flares, such as gout and pseudogout. People with other types of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis may benefit from both heat and cold therapy.

Nonetheless, Dr Jaiyesinmi added : “Applying a hot compress will give superficial heat to only calm muscle spasm in that joint. It does not address the arthritis pain which is as a result of a degenerative process going on in the cartilage.

“But, electrical modalities like TENS can help to block the transition of that pain from the joint to the brain so that the sensation does not get to the level of perception.”

Dr Jaiyesimi stated that the patient model of the TENS which is sold for N15, 000 and N20,000 per unit is also available, making it an easy way out of stiff and painful joints due to arthritis.

“It does not apply heat or cold; rather it introduces a form of electric current that will block the sensation of pain. When the treatment is received for about 10 to 15 minutes, it can confer at least two hours pain-relieving effect,” he added.

Dr Jaiyesinmi, however, said use of things such as collars and analgesic ointments only complement the treatment of a painful and swollen joint.

“The collar only supports the joints to prevent any awkward movement that can aggravate the pain. Also, in arthritis, the pain is inside the joints as such pain-relieving ointments, when used, will only act on the surrounding muscle and not the aching joint,” he added.

Nonetheless, he said that drugs are available to help repair worn out joints while also relieving the pain of arthritis.

Dr Felix Faniran, also, a physiotherapist said although in some instances, cold therapy may be the best option for treatment, where it is intolerable to an individual, it can be modified.

However, he added that both cold and heat therapies work differently on the aching joint to relieve pain.

He said, “those that can tolerate cold, we give a modified form of heat therapy and vice versa. When the joint is swollen, it is not advisable to use heat, heat will aggravate the swelling.

“But if the person has been treated for a few days with cold therapy, we usually continue with hot therapy when the swellen has subsided. Our findings on the patient will determine what will be the best option of treatment at any point in time.

“So you cannot say cold or heat is the best therapy for painful arthritic joint, it is subject to the condition of the patient. Both cold and heat will reliieve pain differently, as cold is expected to relieve a swollen part with pain, than heat when it is swollen in the acute phase.”

Dr Faniran stated that heat can be applied to a painful joint by different ways, one of which is the use of luminous and non-luminous lamps, with some heating to the bone and through the muscles.

In communities where access to modern heating modalities used in physiotherapy clinics are not available, Dr Faniran stated that dry heat such as heating pads, heat lamps and hot water bottles are sometimes adapted to treat aching joints.

Howbeit, heat is not recommended in certain circumstances. For example, heat should not be used if the joint is swollen or bruised. In these cases, it is usually better to use an ice or cold pack to reduce the swelling.

In addition, heat application is not recommended for people who have dermatitis, diabetes, an open wound or severe cognitive impairment. Also, people with heart disease or hypertension need to consult their doctor before using heat therapy.

Similarly, people with certain conditions such as Raynaud’s Syndrome, cold allergic conditions and paralysis or areas of impaired sensation (i.e. nerve damage) are usually advised to avoid ice application, such as ice packs.

For many people, heat therapy works best when combined with other treatment modalities, such as exercise.

According to Dr Faniran, aside from relieving a swollen and painful joint, exercises also need to be prescribed to ensure full recovery of movement and restore functionality to any  joint affected by arthritis.

“When there is arthritis pain, there is less movement. As a result, the muscles controlling that joint also become weak. So, we have to strenghten those muscles using strenghten exercises. Exercise is also prescribed to keep the integrity of the muscles in place.

“So it not about ameliorating the pain alone, but also preventing muscle loss and ensure they still perform their functions effectively. Invariably, it is about restoring the pateint totally to his formal status.”