Ice or Heat?

One of the most common questions I hear is, “should I put ice or heat on it?

When to ice:ice injury

Any new injury is a good candidate for ice. If there is swelling or warmth over the area, ice is a good idea. The cold will help to constrict the blood vessels in the area. This will limit the amount of swelling by decreasing the blood and fluid released into the damaged tissue. The ice will also help to slow nerve impulses. The numbing effect will decrease pain.

Whenever there is a new injury, the body releases chemicals in the area to limit the area of damage and to clean up the injured cells. Some of these chemicals trigger pain signals to be sent to the brain. By applying ice to the area, you limit the amount of these chemicals and the pain signals.

Because blood vessels can also be injured and because an injured area is used and moved less, the swelling that is allowed to accumulate may take awhile to dissipate. The extra fluid volume creates pressure and decreases mobility. That is why it is so important to ice right after something is injured.

Ice for prevention:

  • After a car accident, the victims may not feel pain initially due to the adrenaline released and other factors. Even if you feel fine, it is not a bad idea to put some frozen peas on your neck for 15 minutes when you get home.
  • After a hard workout. Many athletes will ice a joint they know gets a lot of work to prevent inflammation and injury. Example: baseball pitcher icing his shoulder and elbow when he leaves the game.

When not to ice: it hurts more than the expected uncomfortable nature of ice, Raynaud’s Syndrome, neuropathy or numbness. Do not apply chemical ice packs directly to skin.

When to heat:

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Pain

We don’t seem to understand it.  We are not that good at controlling it.  We are becoming better at addressing it.  We have a long way to go.

OxyContinPicture from Encyclopedia.com.  Info Video

There was a post on My Lymphoma Journey addressing this issue and it really got me thinking.

We are just leaving the declared decade of pain control and research.  So, where are we?  Pain is now the fifth vital sign.  Hospitals, doctors, and drug companies are now more attentive to the issue and attempt to relieve their patients’ agony.  There are still areas for awareness improvement.  For example: Medicare reimbursement, at some levels, is dependent on functional improvement.  Sleep and pain are not considered functional.  Therefore, a person can have 9/10 pain while trying to get dressed (after a sleepless night) but as long as they can get dressed independently they do not need treatment.

Opioid insanity

click for drugfree.org

There are some great new medicines on the market to help with pain control.  There are some to help neurogenic pain, such as Neurontin and Lyrica. (Hard to miss all the Lyrica commercials).  These are not opiate based.  Rather they seem to have their roots in seizure control medicines.  They do have their own side effects but can be very helpful.

Drugs, such as oxycodone, are being used to treat everything from acute (new) pain to chronic (long term) pain.  It is very powerful and has a pretty high street value.  Due to the abuse and over prescribing by many individuals, states are beginning to crack down on its use.  This includes more paperwork for doctors.  While making sure medicines are used ethically and as intended is very important, especially with narcotics, the increased paperwork and investigations have meant a new barrier to access.  Some doctors stopped prescribing it in order to avoid the whole issue.  Some pharmacists try to avoid it for the same reason.  Who wants to go to jail or lose their license because they did not research their patients’ lives enough.  I witnessed a doctor in the hospital accusing a patient of being a wimp and a “clock watcher”.  Only to discover later, he just did not like all the paperwork that he had to do every time he prescribed pain medicine.

An issue of particular importance for chronic pain patients is opioid-induced hyperalgesia.

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