Does a heating pad help with lower back pain?

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Dainyal Siddiqui, MD

Internal Medicine

Manuel Jimenez, MD

Cardiology

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: February 18, 2025 • View editorial policy

From the Guidelines

The application of a heating pad to the lower back region has been shown to provide relief from acute and chronic lower back pain 1, 2, 3.

Temperature Setting: A temperature setting of 104°F (40°C) for 15-20 minutes, repeated 2-3 times daily, is commonly recommended.
Combination Therapy: Combining heat therapy with over-the-counter analgesics such as acetaminophen (650-1000mg every 4-6 hours) or ibuprofen (200-400mg every 4-6 hours) may enhance pain relief 4, 5.
Contraindications: It is essential to note that heat therapy should not be used in conjunction with certain medications, such as blood thinners, or in patients with certain medical conditions, including deep vein thrombosis or open wounds.
Evidence Quality: Moderate-quality evidence showed that a heat wrap moderately improved pain relief (at 5 days) and disability (at 4 days) compared with placebo 6, 7.
Comparison with Other Treatments: Low-quality evidence showed that a combination of heat plus exercise provided greater pain relief and improved RDQ scores at 7 days compared with exercise alone in patients with acute pain 8.

Studies have shown that heating pads can be an effective treatment for lower back pain 9, 10, 11.
A narrative review published in 2021 found that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility in patients with non-specific mild or moderate low back pain 9.
A randomized controlled trial published in 2002 compared the efficacy of continuous low-level heat wrap therapy with ibuprofen and acetaminophen in subjects with acute nonspecific low back pain, and found that heat wrap therapy was superior to both ibuprofen and acetaminophen for treating low back pain 10.
A systematic review published in 2006 found moderate evidence that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub-acute low-back pain 11.

A study published in 2010 compared the analgesic efficacy of heat and cold packs in relieving pain from back and neck strains, and found that both heat and cold packs resulted in a mild yet similar improvement in pain severity, but the choice of heat or cold therapy should be based on patient and practitioner preferences and availability 12.
A randomized controlled trial published in 2021 found that the combination of heat and transcutaneous electrical nerve stimulation does not reduce pain scores in patients with chronic low back pain, but improves pressure pain threshold values 13.

The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials 11.
There is insufficient evidence to evaluate the effects of cold for low-back pain, and conflicting evidence for any differences between heat and cold for low-back pain 11.