FAST FACTS:  Non-Drug Treatment: Heat

Heat treatments are placed at or near the site of the pain to relieve the pain. Heat relieves pain by 1) improving circulation to skin and muscles, 2) relaxing muscles and reducing muscle spasms and irritation, and 3) decreasing sensitivity to pain.

Heat Treatment Options:

•  Moist compress
•  Instant heat pack/heated wrap 
•  Adhesive warming patch
•  Gel/clay pack
•  Hydrotherapy/Whirlpool
•  Heating Pad
•  Hot water bottle

Heat Application guidelines:

• DO NOT:
  1. Do not use heat therapy without provider approval
  2. Do not use if it increases the pain
  3. Do not use on areas being treated by radiation or open wounds
  4. Do not put boiling water in a hot water bottle or on a washcloth - water temperature should be between 104-degrees & 113-degrees Fahrenheit
  5. Do not apply heat directly over transdermal medication patch
  6. Do not apply transdermal patches immediately after taking a shower or bath
  7. NEVER USE PRODUCTS CONTAINING MENTHOL WHEN USING HEAT.  These products cause skin to absorb heat more deeply and might cause burns (examples: Icy Hot or Ben-Gay)
  8. Do not use heat on acute injury; may increase inflammation or bleeding in area
  9. Do not use a heat lamp
  10. Do not use on area with edema (swelling) or on areas with a sensory deficit

• DO:
  • Regularly check your skin areas for irritation or burns and document
  • Apply heat on the area for 20 to 30 minutes every 2 hours
  • Use a layer of fabric between the heat source and skin (i.e., towel)
  • Track pain intensity, location, characteristics
  • Remove heat source if skin turns bright red, especially if you are unable to feel pain or heat- this puts you at risk for burning your skin
  • Discontinue transdermal patches 1 hour before taking a bath or shower
  • Wash your hands with soap and water after applying transdermal patches

• CAREFUL USE:
  • Patient with peripheral neuropathies - use caution in areas where there is an impaired ability to feel
  • Patient with bleeding disorder – be cautious of risk for increased bleeding
  • On individuals with thin/fragile skin
  • Heating pad, on lowest setting, while individual is awake

Necessary equipment for warm, moist compress treatment:

• Small hand towel
• Compress (e.g., flax seeds bag, clay pack, reusable gel pack)
• Thermometer (type used for pools or spas)
• Six-inch elastic wrap, or other device to secure the pack

Directions:  

1. Flax seed or clay/gel compress can be microwaved per manufacturer’s instructions.
2. Place towel in warm water, or moist towel can be placed in a towel warmer. 
3. Check temperatures of moist towel and compress, making sure that temperatures of both items are between 104- and 113-degrees Fahrenheit.
4. Wrap warm moist towel around the warmed compress
5. Apply to appropriate area and secure loosely with elastic wrap
6. Keep towel/compress on area for as long as possible to obtain relief, usually 20 – 30 minutes. Re-warm when towel or compress is no longer warm. Check temperature each time compress is reapplied. Typically applied intermittently on skin for 10 – 20 minutes at a time.
7. Try alternating hot and cold to improve comfort. Find correct area or temperature that provides optimal pain relief.

What Else You Can Do:

• Ensure you are trained appropriately prior to implementing this Nondrug Treatment Technique, speak with your healthcare team to determine correct technique or where to find prior training if you need additional training.
• Request assistance as needed to implement this Nondrug Treatment Technique, i.e., if needed to prepare & apply the warm compress or ace wrap; or if you need assist with timing the application of heat; etc.
• Document all Nondrug Treatment Techniques in your Pain Diary and log pain information before and after use of Nondrug Treatment.

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. Swedish Medical Center. Nursing Assistant End-of-Life: Computerized Educational Program. Pittsburgh, PA: Hospice and Palliative Nursing Association; 2006.
3. Elsevier Patient Education. (2020). Heat therapy. https://www-clinicalkey-com.proxy.lib.uiowa.edu/#!/content/patient_handout/5-s2.0-pe_7c47b79d-fc7f-4c74-9754-e23e82a11074
4. Lisi, D. M. (2019). OTC transdermal analgesic patches in pain management. U.S. pharmacist: The pharmacist’s resource for clinical excellence. https://www.uspharmacist.com/article/otc-transdermal-analgesic-patches-in-pain-management