FAST FACTS:  Non-Drug Treatment: Cold

Cold treatments, such as frozen gel packs, bag of frozen vegetables, or cold cloths, are placed at or near the painful site. Cold works by numbing nerve endings in the skin, reducing muscle spasms, and decreasing swelling. Cold applications may work better than heat in some situations. Research has found: 1) cold usually relieves more pain and more quickly than heat; 2) pain relief from cold lasts longer than pain relief from heat; and 3) cold is more effective in decreasing pain and swelling in the first 72 hours following an acute injury. 

Cold Application Guidelines

• Do not use if it increases the pain.
• Provide extra warmth if needed (sweater, blanket) while cold is in place
• Use a single layer of cloth between ice pack and skin to prevent skin from freezing. 
• For some, a gradual onset of cold application is preferred. To do this, wrap the cold pack with many layers of cloth and remove the layers slowly, one at a time, so that skin gradually becomes accustomed to cold. Another way is to begin with a warm moist cloth between skin and cold pack.
• Age decreases the sense of touch, leaving older adults more vulnerable to burns, scratches, or other injuries. The use of a timer would be beneficial in preventing burns from cold application.
• Avoid applying cold packs to the following:
  • Areas being treated by radiation
  • Areas with poor circulation
  • Open wounds
• In addition to applying cold treatment to the painful site, it may also be applied:
  • On opposite side of body from where pain is felt
  • Above or below site of pain
• Try alternating cold applications with heat.  Find the correct area or temperature that provides the most relief.

Necessary Equipment

1. Source of cold:
   • Gel pack (homemade pack: pour 1/3 cup of rubbing alcohol and 2/3 cup of water into one self-sealing plastic bag.  Seal bag and place in freezer until slushy).
   • Crushed ice in a self-sealing plastic bag.
   • Instant cold packs
   • Bag of frozen peas or lima beans
2. Towel or pillowcase; which one used depends upon sensitivity to cold and/or touch.
3. Six-inch elastic wrap or other device to secure the pack

Directions

1. Remove cold pack from freezer and wrap in pillowcase or towel
2. Make sure bag does not leak
3. Assist your family member to get into a comfortable resting position and apply cold pack to painful area; secure with elastic wrap as needed.
4. Cold pack may be placed above or below site of pain, or on other side of body corresponding to where pain is located.
5. Leave on for 10-15 minutes, three to four times a day; cold packs can be applied for up to 20 minutes, but the minimum time needed is 5 minutes. Note: To be effective in decreasing swelling or pain, cold packs need to be applied to the tissue for a minimum of 5 minutes
6. Return cold pack to freezer for future use.

Notes

• Be sure you understand how to apply cold packs; if unsure, speak with your family member’s healthcare provider to determine correct procedure
• Provide help if your family member cannot apply the cold packs by themselves

What Else You Should Do

• Write down and share information about your family member’s pain with their healthcare provider
• Use a Pain Diary to note important information useful to the healthcare provider
• Encourage your family member to try a non-drug treatment and document impact on their pain

References:

1. Adapted from: Fouladbakhsh, J.M., et al., Nondrug therapies for pain management among rural older adults. Pain Manag Nurs, 2011. 12(2): p. 70-81. 2. The Nursing Home Pain Management Algorithm Clinical Trial, R01 NR009100, 7/1/05 – 4/30/10; Mary Ersek (PI) Used with permission of Mary Ersek and HPNA (2009). 
2. WedMD. 2021. When Should I Use Heat or Ice for Pain? Accessed 2.21.2022, https://www.webmd.com/pain-management/when-use-heat-ice
3. Health Essentials, Cleveland Clinic; December 8, 2020. Here’s How to Choose Between Using Ice or Health for Pain.. Accessed 2.21.2022. https://health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic/