There are as many as 35 million emergency room visits across the country for injuries. Most of these are musculoskeletal injuries treated with X-ray imaging, splints, and possibly consultations for orthopedic surgery. Most acute pain from stable fractures and sprains can be treated with standard medications such as acetaminophen, ibuprofen, and narcotics.

The larger debate between emergency physicians and orthopedic surgeon centers is about which complementary non-pharmacological treatment strategy is better for pain relief and healing – cold or heat therapy.

Limited data is comparing the two modalities in direct studies. Individually, both have shown a reduction in acute pain in small studies. I have found that most doctors will recommend patients use one or the other based on their anecdotal experience.

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What is the science behind applying heat and cold for pain relief?

The application of cold therapy, such as an ice pack, signals the brain to trigger a complex physiological response. The muscle walls of blood vessels contract in a process called vasoconstriction. This vasoconstriction reduces blood flow to the affected area, effectively limiting inflammation and suppressing pain.

Cold therapy options include:

Ice packsIce bathsCool spray Ice massage

Heat therapy, on the other hand, relaxes the blood vessel wall muscles via vasodilation, increasing their diameter and blood flow. Heat therapy improves circulation and the flow of healing nutrients to the injured area. As with cold treatment, it has also been shown to reduce pain. A systematic review of 32 randomized control trials involving more than 1,000 study participants indicated that cold and heat relieve pain.

Epsom salt should be a staple in your medicine cabinet at home. Heat therapy options include both dry and moist heat options:

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General rule: 20 minutes on, 20 minutes off

As a rule of thumb, you should apply cold or heat therapy for 20 minutes and then take a 20-minute break.

In general, cold and warm therapy is a good option for many patients. However, never apply cold or hot directly to an open wound. Patients with chronic medical problems such as diabetes, dermatitis, multiple sclerosis, and vascular diseases should exercise caution or consult their physician first.

The bottom line: both ice and heat are an option. Ice works very well to reduce both pain and swelling. I recommend using a 20-minute cold therapy session for acute injury pain. After 72 hours, switch to heat to increase blood flow, improve healing and reduce stiffness in the affected area.

Michael Daignault, MD, is a board-certified ER physician in Los Angeles. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He studied Global Health at Georgetown University and received a medical degree from Ben-Gurion University. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault.


I have been blogging since August 2011. I have had over 10,000 visitors to my blog! My goal is to help people, and I have the knowledge and the passion to do this. I love to travel, dance, and play volleyball. I also enjoy hanging out with my friends and family. I started writing my blogs when I lived in California. I would wake up in the middle of the night and write something while listening to music and looking at the ocean. When I moved to Texas, I found a new place to write. I would sit in my backyard while everyone else was at work, and I could write all day.