Who Should Not Use a Heating Pad

Most adults can use a heating pad safely with a towel, a sensible setting and a timer. But for some people, heat causes burns or makes a problem worse. Read this list before you buy one, and before you give one to your parents.

People who can’t feel heat properly

Your skin warns you before it burns. If that warning is weak, you can get a deep burn without noticing until the skin blisters.

• Diabetes with nerve damage (neuropathy), especially in the feet and legs. See heating pads and diabetes.
• After a stroke or spinal cord injury, on any area with reduced feeling. See heat pads after a stroke: what carers need to know.
• Numbness from any cause, including a recent nerve block or local anaesthetic.
• Numb patches around a surgical scar, which are common for months. See tight scar tissue and scar massage and a stiff knee after knee replacement.
• Older adults with thin skin can use heat, but only on low, for shorter sessions, with someone checking the skin. See safe heat at home for elderly parents.

People who can’t move the pad away

• Anyone drowsy from sleeping pills, strong painkillers or alcohol.
• People with dementia, or who can’t tell you it’s too hot.
• People with paralysis or very limited movement.
• Babies and young children. Their skin burns faster, and they can’t always tell you. See heating pads and children.

Areas you should never heat

• A fresh injury that is swollen, bruised or warm, in the first 48–72 hours. See the 48–72 hour rule.
• Broken skin: open wounds, surgical scars that haven’t fully healed, burns, blisters, rashes. See after surgery: when is heat allowed? If your skin is often broken or flaring, see eczema, psoriasis and fragile skin.
• Infection: skin that is red, hot, spreading or oozing, or any area when you have a fever.
• A hot, red, swollen joint. Gout and inflammatory flares need cold, not warmth. See gout flare: why a heat pad makes it worse.
• Varicose veins and swollen legs. Heat widens the veins and worsens the pooling. See varicose veins and swollen legs.
• A limb at risk of lymphoedema, after lymph node surgery or radiotherapy. See lymphoedema and heat.
• A pregnant belly. Heat on the lower back and shoulders on low is usually fine. Keep it off the abdomen. See heat during pregnancy, and after a caesarean, heat after a C-section.
• Skin with a heat rub on it. Menthol, capsaicin and “deep heat” creams plus a heating pad can burn. Use one or the other. See heat pads vs heat patches.
• Over TENS electrodes. See heat pad or TENS machine?
• Exposed metal: external fixators, pins or wires through the skin. Plates and joint replacements under healed skin are a different question. See heat pads with metal implants, plates and a pacemaker.
• An area with known cancer, or skin recently treated with radiotherapy. Ask your oncology team first.
• Unexplained tummy pain. See stomach ache: when a warm pad helps and when it’s dangerous.

Conditions where you should ask first

• Poor circulation (peripheral vascular disease). Your blood can’t carry the heat away fast enough, and skin can burn at a normal setting.
• A suspected blood clot (DVT). A swollen, warm, tender calf needs a doctor, not heat. See tight calves and night cramps.
• A pacemaker or other implanted electronic device. Keep the pad off the device site and check with your cardiologist. See heat pads with metal implants and a pacemaker.
• Bleeding disorders or blood thinners, if you’ve just knocked or bruised the area.
• Multiple sclerosis. Heat can temporarily worsen symptoms for some people. See MS and heat sensitivity.
• Osteoporosis with sudden new back pain. Get it checked before treating it at home. See osteoporosis and spinal compression fractures.
• Inflammatory arthritis during a flare, when the joint is hot, red and swollen. Cold suits a flare better. See rheumatoid arthritis: heat for stiffness, not for flares.
• Carpal tunnel and other nerve compression. Heat does nothing for the nerve and can worsen night tingling. See carpal tunnel: does a heat pad help?
• Breastfeeding with a blocked duct or mastitis, where long heat adds to the swelling. See blocked ducts and mastitis.

Pain that heat might hide

Heat can make you feel better while something serious carries on underneath. Don’t use a heating pad and wait it out if you have:

• Sudden, severe tummy pain, especially pain that moves to the lower right side.
• Chest pain, or pain spreading into your arm, jaw or upper back.
• Back pain with fever, weight loss, or loss of bladder or bowel control.
• Neck pain after a car accident, before anyone has examined you. See neck pain after a car accident.

Call 995 or go to A&E for these.

If you’re in the clear

Use a cover or towel, start on low, keep sessions to 15–20 minutes and check your skin each time. Read how long to use a heating pad, what temperature it should be, and whether it’s safe to sleep with one on.

Not sure heat is right for your problem at all? Start with heat or ice: a physio’s decision guide.

Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.