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

Hot compresses can be used during the remission period of most chronic pain, but there are also a few cases where it is not suitable. The academic community does not have a completely unified standard answer to this question, so you have to judge based on your own situation. I have been in the rehabilitation department for almost five years, and I have met many patients who use hot compresses as a "universal pain reliever." Not long ago, an old patient with a history of lumbar protrusion for five years came for a follow-up consultation. He said that he had not had acute pain in the past six months, but his waist was sore and stiff every day after get off work. I used a hot water bag at about 42 degrees for 15 minutes every day at home.

In fact, the reason is not difficult to understand. In the remission phase of chronic pain, there is generally no redness, swelling, heat and pain as in the acute attack phase. The local accumulation is inflammatory metabolic waste caused by long-term tension and strain. Hot compress is equivalent to "opening a small valve" for tight muscles and clogged microcirculation. The blood vessels dilate and the blood flow rate increases. These wastes can be metabolized faster, and the tight muscle fibers will relax accordingly. The feeling of soreness and stiffness will naturally be alleviated. Some people believe that as long as there is no obvious acute inflammation, whether it is chronic pain caused by muscle strain or bone and joint degeneration, hot compresses can be used to improve symptoms during the remission period. Indeed, many patients in clinical practice have reduced the frequency of attacks by this method.

However, many doctors hold different views and believe that not all chronic pain is suitable for hot compresses, and a small number of people even experience more severe pain after using hot compresses. Last month, I treated an aunt who suffered from post-herpetic neuralgia. She heard from her neighbor that hot compresses could relieve the pain, so she applied it for ten minutes during the remission period when the pain was less severe. As a result, the neuralgia broke out that night, and the pain kept her awake all night. In fact, for this kind of neuropathic chronic pain, the damaged nerve endings are extremely sensitive. Warm stimulation can induce abnormal discharges, and the originally good remission period can be stimulated into an acute attack. This kind of situation is completely unsuitable for hot compresses. There are also patients with autoimmune-related rheumatoid arthritis and ankylosing spondylitis. Some studies have pointed out that even hot compresses during the remission period may induce local immune responses and worsen subsequent inflammation.

In addition, the operation of hot compress itself is also very particular. Hotter is not better or longer is not better. I once had an old diabetic friend who wanted to apply a hot water bottle for comfort when his waist was in remission. He himself has diabetic peripheral neuropathy and his perception of temperature is much slower than ordinary people. He didn't feel hot after applying it for forty minutes. When he took it off, he had already developed a low-temperature scald blister on his waist. It took almost a month to heal. Some people also have unhealed skin damage or eczema at the site of chronic pain. Hot compresses can easily induce infection and should be avoided.

In fact, it is not that complicated to judge whether it can be applied. You should first touch the painful area. If there is no obvious redness, swelling or hotness to the touch, try to apply it warmly for ten minutes. If you feel relaxed and comfortable after applying it, you can continue to use it. If you feel tingling, itching or uncomfortable after applying it, don't try it forcefully. It is safer to ask your doctor for details.