Can I use a heating pad for lower back pain?

Heating Pad for Lower Back Pain

Yes, you can and should use a heating pad for lower back pain—it is a safe, effective, and evidence-based self-care option that provides moderate pain relief, particularly for acute low back pain. 1

Strength of Evidence

The American College of Physicians and American Pain Society joint clinical practice guideline explicitly recommends heating pads or heated blankets as a self-care option for short-term relief of acute low back pain. 1 This recommendation is supported by good-quality evidence showing moderate benefits for acute episodes. 1

How to Use a Heating Pad Effectively

For acute low back pain (less than 4 weeks duration):

• Apply heat for 20-30 minutes at a time, 3-4 times daily 2
• Continuous low-level heat therapy (maintaining approximately 40°C for 8 hours/day) provides superior pain relief compared to ibuprofen or acetaminophen 3
• Avoid direct contact between the heat source and skin to prevent burns 2
• The temperature should be approximately body temperature or slightly warmer, not excessively hot 2

Expected benefits:

• Pain relief averaging 10-20 points on a 100-point pain scale 1
• Improved muscle flexibility (approximately 4.3 cm improvement in lateral trunk flexibility) 3
• Reduced muscle stiffness 3
• Decreased disability scores 3

Comparison to Other Treatments

Heat wrap therapy demonstrates superior efficacy to oral medications for acute low back pain. In head-to-head trials, continuous low-level heat provided greater pain relief than ibuprofen (1200 mg/day) or acetaminophen (4000 mg/day), with benefits extending beyond the treatment period. 3

Heat therapy can be combined with first-line medications (acetaminophen or NSAIDs) and advice to remain active for optimal results. 1, 4

Evidence for Chronic Low Back Pain

For chronic low back pain (lasting more than 12 weeks), the evidence is less robust but still supportive. Heat therapy provides mild pain relief (approximately 10% reduction in subjective pain) and is safe for regular use. 5, 6 The American College of Rheumatology conditionally recommends thermal interventions for musculoskeletal pain conditions. 2

Safety Profile

Adverse events from superficial heat therapy are rare and minor, primarily consisting of mild skin irritation. 1 This makes heating pads one of the safest treatment options available, with a more favorable safety profile than NSAIDs or other pharmacologic interventions. 1

Critical Contraindications

Do not use heat therapy if: 2

• Signs of inflammation are present (significant swelling or redness)
• You have impaired sensation and cannot feel if the heat is too intense
• The area has open wounds or skin damage

What NOT to Do

• Do not apply heat for more than 30 minutes continuously to avoid tissue damage 2
• Do not use heat as a substitute for remaining active—bed rest worsens outcomes; continue normal activities as tolerated 1, 4
• Do not rely solely on heat therapy—combine it with activity modification and consider medications if needed 1, 4

When to Seek Further Evaluation

Obtain immediate medical evaluation if you experience: 4

• Progressive neurological deficits
• Cauda equina syndrome symptoms (bowel/bladder dysfunction, saddle anesthesia)
• Fever or signs of infection
• History of cancer or unexplained weight loss