7 Tips from a doctor about using a heating pad (and cold packs) for a bad low back

Hello Doctor,

My chronic bad back seems to respond best to an old fashioned  heating pad.  Do you have any suggestions about how to use an electric heating pad for best results?

I have a tired old back that has bothered me for many years and acts up on me fairly often.  I have some lower back pain most of the time so I am always looking for ways to help myself without using prescription or over-the-counter drugs. I am concerned that if I had to use prescribed or non prescribed medication I would have to take them so often that I would either get hooked on them or hurt my body with bad complications and side-effects.  So I stay away from that junk and try to stay out of trouble while getting relief with simple and safe at-home remedies and low back stretches that seem to help me.

After a lot of experimentation I have learned that my low back does not respond well to a cold pack or an ice bag. Several times I used cold on my back during painful back episodes and I did not get the pain relief I get from using heat on it. I know the back pain was either worse or at least no better after using the cold on it.  But through trial and error I have found a lotta good relief from an old fashioned dry heating pad. I have read on this website that you promote the use of ice or cold applications for most problems, but for me it does not seem to work, dry heat does. 

Any suggestions for someone like me who does not seem to respond like everyone else? Any ideas and help will be appreciated.



Greetings Ray,

You might be surprised to learn that your poor response to ice or cold is not that unusual.  Certainly more people respond well to cold packs, than to heat of any form.  But still, there are some people like you who generally do better with heat.  This is why I suggest in several places on the Dr. Lumbago website that you must experiment with all of my suggestions to determine what works best for each individual. I do not present any laws written in stone, but ideas that you should freely experiment with to develop your own procedures for what works best for you.  

Here are some thoughts that come to mind about using your heating pad to good advantage for your chronic low back problem:

            1. Even though you have said you do not get a lot of relief from cold, and might even feel worse afterward, I offer to you another option with cold to experiment with that might give you the best response of all.  The next time you want to get some pain relief from your usual hot pack method, try alternating between hot and cold packs applied to your back in the area of greatest discomfort. If you have noticed that you do well with an electric heating pad, continue to use that for the heating part of your at-home care. You will probably want to try a few different cold sources – like a sealed gel-pack that you keep in the freezer, or a zip lock bag filled with crushed ice and a little water, or anything else that you have available that will act as a contrast to the heat you apply. The important thing in your case, since you do well with heat, is too begin your treatment with heat and to end your treatment with heat.  In this way you can do three cycles (hot-cold-hot) or five cycles (hot-cold-hot-cold-hot) or seven cycles (hot-cold-hot-cold- hot-cold-hot), with each application of heat or cold lasting five minutes each.  To clarify, the total time to do three cycles would be 15 minutes, to do five cycles would be 25 minutes, and to do seven cycles would be 35 minutes.  You can certainly use this technique for a longer time, by using nine cycles or more, if you want. Again, the important thing to keep in mind is to begin and end this therapy with heat. From my experience you will find greater pain relief by alternating heat and cold than using heat alone. 

            2.  A simple and effective hot pack can be made by filling an old fashioned rubber hot water bottle with hot water that is comfortable to the touch.  Fill the bottle half full of water that is comfortably hot as it comes out of the faucet.  Hold the hot water bottle upright as you squeeze it to eliminate any air that might be trapped inside. Removing air from the hot water bottle will allow for better heat transfer since you will access in all areas to hot water and not to air bubbles.

           3. Place a damp towel on the surface of the hot water bottle so the moist towel is between you and the hot water bottle.  Check early to see if you are being burned by the hot water bottle; after five minutes check to see that your skin is only a slight pink color and not a bright red. 

            4.  Never use a heating pad of any type for longer than 20 minutes at a time least your burn the skin over the area being heated. Do not purchase a heating pad unless it has a built-in timer that automatically turns the heating pad off.  This will prevent excessive use and build up of heat if you fall asleep or lose track of time while using the heating pad.

            5.  Invest in a moisture-proof electric heating pad that will give you the added benefit of damp heat that might penetrate deeper into your tight muscles and areas of arthritis.

           6.  Another trick for applying heat to your sore low back or shoulder is to try using a clean white sock with 2-3 cups of raw (uncooked) rice in it.  Pour the rice directly out of the box or bag into a clean sock and tie a knot at the end to keep the rice from escaping.  Put it in the microwave oven for 1-2 minutes to test to see if it comes out at the right temperature so it is hot enough to do you some good and still not so hot that it is uncomfortable or dangerous to use.  When the sock full of rice cools off it can be heated up again by placing back in the microwave for the same time you used before.  The more rice you have in the sock the longer it will take to heat up.  Keep the knot tied snugly on the sock and keep it handy for any kind of quick heat therapy needs your bad back might have in the future.   

            7.  Never lie on top of a heating pad when in use. Lying with a heating pad or hot water bottle under you will result in a much greater risk that you will burn your tissue. By applying your body weight to the surface of the heating pad you will compress the tissue and greatly reduce the blood circulation where the skin is being heated. When heat is trapped in that area because of the pressure of your body on the heating pad, and the heated tissue does not have circulating blood to cool it as would normally occur because of the pressure of your body on the heating pad, tissue burning easily develops. For a similar reason people get pressure sores (also known as bed sores or decubitus ulcers) when they sit too long or lie too long without moving because their body weight compresses the tissue, resulting in reduced blood circulation and tissue damage. 

Lastly, since you mentioned that you already stretch your low back to control your back pain episodes, I suggest that you look into inversion traction treatment that you can do at home. This is the kind of device that is designed to hold you by your ankles as you lie on it and it tips backward to hold you upside down while you hang by your ankles.  For many people it is an easy and very effective way to stretch the low back.

Thanks for the interesting question.  Good luck to you.  DL