Is heat or ice best for your back pain? We always tell our patients to use ice when it comes to neck or back pain, whether acute or an exacerbation of a condition. The reason is that when you have pain, you usually have inflammation that accompanies the pain. Ice has vasoconstrictive effects on soft tissue and will decrease that inflammation. Heat will dilate the tissues and create more inflammation in most cases. Heat typically feels better while in use, however the patient typically will feel worse the next day and never breaks the inflammatory process. Ice is safer than heat also. Ice does not have an effect once the tissue becomes cold and numb. So there is no risk of injury. On the other hand, heat, especially heating pads, can be used for too long of periods and harm the tissue.