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

Hot compress can be used in most scenarios during the remission period of chronic pain, but there are also a few cases where it is not suitable and cannot be generalized. I have been recovering from exercise for nearly 6 years. The most common patients I encounter are chronic patients with neck, shoulder, waist and leg pain. Most people do not feel sharp pain during the remission period, but local stiffness and soreness. They will become uncomfortable after sitting for a long time or standing for a long time. At this time, apply a warm water bottle or steam patch for more than ten minutes, and the tight muscles will loosen. The local circulation is opened, and the accumulated lactic acid and inflammatory metabolites can be taken away faster, and the whole person feels relaxed. Last week, an editor from a publishing house who had been working at her desk for a long time came for a follow-up consultation and said that she now wears a steam neck circumference for 15 minutes every day after get off work. The stiff neck-like neck pain that she would have once a month has not come to her door in the past two months.

But it’s really not suitable for everyone, and we in the industry now have different views on this. For example, when encountering patients with neuropathic pain, such as post-herpetic pain and diabetic peripheral neuralgia, even if there is only a slight tingling in the remission period, it is not recommended to use hot compresses casually. I treated a 62-year-old man last year. After the shingles healed, he always had a dull pain in his ribs, which he heard. The clerk said that hot compresses can activate blood circulation. I put the warmer on it for two hours at home. I was sweating from the pain that night. When I came in, I said it felt like someone was pricking me with a needle. In fact, the nerve sensitivity of these patients is already high, and the temperature stimulation of hot compresses will amplify the pain signal, which is not worth the loss. There is also the remission period for gout patients. If a large amount of uric acid crystals are deposited at the site of the previous attack, hot compresses may dilate blood vessels, which may stimulate local inflammatory reactions and induce acute pain. This is why we do not recommend using hot compresses.

Some studies have also suggested that if chronic pain has developed central sensitization, to put it bluntly, it means that the pain lasts too long and the brain has memorized the signal that "this place is going to hurt." In this case, the role of hot compress is very limited, and repeated temperature stimulation may even strengthen the brain's pain memory, which is not conducive to recovery. For this type of patients, it is recommended to give priority to sensory desensitization or exercise intervention. Hot compress can only be used as an auxiliary relaxation method, and cannot be used as the main relief method.

Of course, even if it is chronic pain caused by ordinary muscle strain that is suitable for hot compresses, don’t be too greedy for heat. Just control the temperature at 40 to 45 degrees, and the time should not exceed 20 minutes. In the past two months, I met a young man who slept with a hot water bottle overnight during the remission period of his lumbar protrusion. He got a shallow second-degree blister on his waist. There was nothing wrong with his waist, but the burn caused pain for less than half a month. It is really unnecessary.