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Pain management is the primary concern when treating patients with acute neck or back strain. Hot packs or cold packs are often recommended — despite little evidence that either is effective — particularly when used with standard therapy, such as nonsteroidal anti-inflammatory drugs. In a prospective study, 60 adult patients who presented to an academic emergency department with acute neck or back strain received single 400-mg doses of oral ibuprofen and were then randomized to application of hot packs or cold packs to the strained area for 30 minutes. Patients rated pain on a 100-mm visual analog scale and a verbal rating scale before receiving ibuprofen and immediately after hot pack or cold pack treatment.
The mean decrease in pain scores after treatment was statistically significant in both groups (9 and 8 mm) but did not meet the authors' predefined threshold for clinical significance (15 mm). Pain scores did not differ significantly between the two groups before and after treatment. Use of rescue analgesia also did not differ significantly between the two groups. About 80% of patients in each group expressed a desire to use their respective packs in the future.
Garra G et al. Heat or cold packs for neck and back strain: A randomized controlled trial of efficacy. Acad Emerg Med 2010 May; 17:484.
Comment
Let's admit it — we've all recommended hot or cold local therapy for acute neck or back strain. This small study suggests that, at least in terms of measurable short-term relief of pain, neither therapy provides clinical benefit when ibuprofen is prescribed in analgesic doses.