Your back is aching. Do you reach for an ice pack... or a heating pad? The answer depends on several factors.

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Using ice or heat for back pain is a simple, drug-free treatment approach that can be very effective. Which one suits you best will depend on your individual back pain and, specifically, whether your aches and pains are chronic or acute.

Chronic pain may result from slow-developing conditions that cause a dull ache from time to time—for example, the kind of pain caused by spinal stenosis symptoms or by ongoing overuse of a particular muscle or muscle group. Acute pain might result from lifting or twisting, or from nerve-related back pain reasons such as sciatica.

When to Use Heat for Back Pain

When deciding whether to use ice or heat for back pain, keep in mind that heat is best for chronic, nagging pain. It helps stimulate blood flow to the affected area, and also can ease any tightness that could worsen the problem.

For an easy homemade heat pack, soak a towel in warm water. Or you can purchase reusable heat packs at drugstores and pharmacies; they can be warmed either by heating them in the microwave for 30 to 45 seconds (at high power in most microwaves—but be careful) or by immersing them in warm water.

Other types of disposable heat packs include those that incorporate heat cells designed to activate when exposed to air. Still another option is a heating pad that uses a battery or plugs into an electrical socket. Don’t wear one of these types of heat pack for any longer than 20 minutes at a time—and don’t use one while you’re sleeping.

When to Use Ice for Back Pain

Acute aches and pains can be severe and typically result from sudden, traumatic injuries, or from conditions like sciatica. In these cases, when it comes to choosing between ice or heat for back pain, cold therapy is best. Cold packs help to reduce swelling and pain, and also constrict blood vessels at the site of the injury, limiting internal bleeding and bruising.

As with heat packs, you can purchase manufactured ice packs at retail stores. You can also take the do-it-yourself route by creating an ice pack using a bag of frozen peas or a baggie filled with ice cubes or ice chips. Wrap it in a towel before you apply it to your back, and use it for 10 to 15 minutes at a time, several times during the day.

Keep in mind that back pain can be serious, and that any nagging pain or acute pain should be reported to your doctor. This is especially important if the pain follows a fall, since it’s possible you could have sustained a vertebral or hip fracture.

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Originally published in October 2016 and updated.