Can heat compress be used during the remission period of chronic pain? Why?

Most chronic pain can be relieved with moderate heat compresses. Only a few special cases with hidden inflammation and neuropathic pain require caution.

I have met many old patients with lumbar muscle strain and neck and shoulder fasciitis. During the remission period, there is no obvious redness, swelling, heat or pain, but they always feel local stiffness and soreness, and pain after sitting or standing for a long time. I apply a warm water bottle for 15 minutes every day. After a week or two, most people can feel that the tightness has relaxed a lot, and the frequency of pain attacks will also decrease.

In fact, to put it bluntly, for this kind of chronic strain pain, most of the local parts in the remission period are long-term muscle tension and stalemate, the blood circulation is slow, the metabolized lactic acid and inflammatory factors cannot be discharged, and they are blocked in the local area and repeatedly stimulate the peripheral nerves, which makes you always feel uncomfortable. Hot compress is equivalent to "warming and loosening" the frozen part. Once the blood vessels expand and the blood flow speed increases, the accumulated "metabolic garbage" can be taken away by the circulation faster, the spasmed muscles will slowly relax, and the discomfort will naturally be relieved.

However, this is not absolute, and there are still different voices in the industry. For example, for neuropathic chronic pain such as postherpetic neuralgia, some doctors do not recommend casual heat compresses because the damaged nerves are already in a hypersensitive state, and warm stimulation may induce abnormal nerve discharges and aggravate the burning pain. I met an elderly patient before who suffered from intercostal pain for more than half a year after herpes healed. I heard people said that hot compresses were useful, but the pain was so painful that he couldn't sleep all night after applying it. Later, he switched to warm and cool wet compresses to feel more comfortable. This situation completely varies from person to person. There is no unified application standard. You can know whether it is suitable for you after trying it for 10 minutes.

Another category of patients who are easily tripped up are patients with autoimmune diseases, such as patients with rheumatoid arthritis and gout. Sometimes they think they are in a stable remission period, but in fact there is already hidden inflammatory activity in the local area, but obvious redness and swelling have not yet appeared. At this time, blind heat application will increase the permeability of blood vessels, and more inflammatory substances will seep into the tissue space, which will induce acute attacks. There was an old patient with rheumatoid arthritis. His finger pain was well under control. He tried to cool down by applying hand warmers that day, but the next day his fingers were so swollen that he couldn't even hold chopsticks. When he checked his erythrocyte sedimentation rate, it turned out that inflammation indicators had quietly increased.

By the way, don't be too casual when applying hot compress. The temperature should be controlled at 40 to 45 degrees. It is best to apply it to the skin with a layer of cotton towels separated by a layer of cotton towel. Especially patients with diabetes and peripheral neuropathy are not sensitive to temperature and can easily be burned unknowingly. Applying for about 15 minutes each time is enough. Do not hold a hot water bag and apply it for an hour or two. Otherwise, long-term local congestion will cause edema, which is not worth the candle.