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

Hot compresses can be used during the remission period of most chronic pains. Only a small number of people with hidden acute inflammation and skin perception disorders need to use them with caution or even completely banned.

I have come into contact with many middle-aged and elderly patients suffering from lumbar muscle strain, lumbar protrusion, and cold legs. Just like Aunt Zhang, who lives downstairs in my house. She has had lumbar protrusion for five or six years. During the remission period, she does not dare to stand and walk for long periods of time. When she wakes up in the morning, her waist is always as hard as a slab. I heard before that hot compresses will make the pain worse. I didn’t dare try it blindly because of severe inflammation. Later, I suggested that she use a hot water bottle at about 40℃ to apply on her waist for 20 minutes every day across her autumn clothes. After two weeks of this, she came up and said that now she doesn’t feel sore after going shopping for groceries for half an hour, and most of her stiffness has disappeared. Don't underestimate the stimulation of warm and warm heat. It is like a "gentle massage" for tight muscles and blocked small blood vessels. After being heated, local blood vessels expand and the circulation speed increases. Pain-causing substances such as inflammatory metabolic waste and lactic acid that usually accumulate in soft tissues can be taken away faster by the blood circulation. Adhesive fascia and spasm muscles can also slowly relax, and the pain will naturally be relieved a lot.

However, this is not a one-size-fits-all approach, and we have encountered many patients who have fallen into the trap in clinical practice. There was a 20-year-old patient with ankylosing spondylitis who was in remission and had no obvious symptoms. After exercising a few days ago, his sacroiliac joints became slightly swollen. He ignored it and continued to apply hot compresses every day. As a result, the pain was so painful that he struggled to put on socks after three days. When he came for a checkup, he discovered that it was an insidious attack of local acute inflammation. The hot compresses dilated blood vessels and aggravated the inflammatory exudation, which was equivalent to "delivering supplies" to the inflammation. For patients in the remission stage of rheumatoid arthritis, if the joints feel hotter than other joints recently and are slightly red, even if the pain is not severe, it is best not to apply heat first, otherwise it is likely to induce an acute attack.

There is another group of people who should pay special attention to, such as people with diabetic peripheral neuropathy and paraplegia who have reduced skin sensation. Even if they are in complete remission, it is best not to apply heat by themselves. They are not sensitive to temperature and can easily be burned by low temperatures unknowingly. If you really want to apply it, it is best to consult a doctor for evaluation, or ask your family to help control the temperature. Do not exceed 42°C and do not exceed 20 minutes. Oh, by the way, there is another misunderstanding that many people tend to make: if chronic pain is in the remission phase and you accidentally twist or hit the affected area, even if the pain is about the same as usual, do not apply heat within 48 hours. Use cold application to control local edema first, and then consider applying heat after the acute stage. Don’t reverse the order and aggravate the pain.

Generally speaking, the key to whether hot compress can be used during the remission period is to check whether the affected area is red, swollen, or has an elevated skin temperature. If not, most people can use it with confidence. If you are not sure, it is always right to ask your doctor first.