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Heat or ice: what's best for your pain?

Aches and pains. Sooner or later everyone has them — and wants them gone. Often, applying heat or cold will help. But which is the right choice? "Typically, if you have an injury that comes on suddenly, use ice in the first 48 hours to try to reduce swelling," says Jessica Diethelm, MD, an internist at Rush University Medical Center. "Then, it's whichever feels better for that particular issue."

Here, Diethelm offers advice on how to handle three common pain-producing scenarios:

1. You step off the curb and sprain your ankle. An ice pack wrapped in a towel can reduce swelling and fluid accumulation when soft tissues are injured. Apply the ice for 10 minutes. Repeat several times a day. Rest, compression dressings (such as an elastic bandage), and elevating the ankle may help as well. Note: Never apply ice directly to your skin. It can cause frostbite.

2. You regularly awaken with neck pain and stiffness. Persistent pain should be evaluated by your doctor. If caused by arthritis, a warm shower or heating pad applied for 10- to 15-minute periods may stimulate blood flow and relax muscles surrounding your joints. Ice can reduce inflammation and ease discomfort too. But on areas that lack much fat — your elbow, for example — application times around 10 minutes are best because longer periods may be more irritating than helpful, Diethelm says.

3. After a day spent moving heavy furniture, you have nagging back pain. Provided you don't have severe pain, leg weakness, loss of bowel or bladder control, or numbness and tingling in the legs — signs of a potentially serious problem that you should bring to your doctor's attention immediately — you can usually treat back pain at home, Diethelm says. Ten-minute periods of icing for the first 48 hours may numb the area, lessening pain — and that's likely to be the priority when you're hurting. If your discomfort is muscle-related and persists after two days, heat may help.

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