Hidden Dangers of Chronic Heating Pad Use!

I absolutely detest “click-bait” titles, but this one is really important for those of us who live on a heating pad to manage our pain. So please do read on.


Recently I found some dark lines on my back which had a branched pattern — like veins on a leaf. There were no other symptoms except a slight bit of a burning sensation in the area. However, much of the skin on my back, arms and chest is tender and sore all the time anyway, so I didn’t think much of it.

Turns out, it is most likely a relatively rare condition called Erythema ab igne (EAI), also known as hot water bottle rash or toasted skin syndrome. (Sounds appetizing, eh?) “Erythema” refers to the “redness” of the skin in the area that is due to chronic and prolonged heat exposure (“igne”: fire). This is how this condition starts off, and typically goes unnoticed, until the reticulate (fishnet-like) patterns of hyperpigmentation appear.

EAI
Erythema ab igne (Image from Medscape)

EAI occurs at temperatures that will not burn the skin (~43-47 degrees C) but can cause damage to the skin and the blood vessels immediately underneath it. Historically, it was seen among older people who would sit close to a fire, or among workers exposed to heat on a daily basis (e.g. metalworkers, bakers, etc.). Nowadays, it is mostly seen among  chronic pain patients who repeatedly use heating pads for long periods of time. It is also often seen more in women than men, which I felt is worth mentioning because fibromyalgia also affects more women than men.

The only treatment option is to remove the source of heat immediately. And that is paramount, because while EAI is benign at first, if the offending heat source is not removed, it can progress over time to skin cancer! Just like chronic exposure to UV radiation can result in skin cancer, so can chronic exposure to infrared radiation (more commonly known as heat!).

Lay off the heating pad-1

The logic makes perfect sense, yet it feels like a nasty surprise nonetheless! I have been depending on my heating pad to be able to sit comfortably for some 3 years now. When I extolled its virtues for pain relief, I never knew it was damaging my skin (potentially irreversibly, depending on how far it has progressed).

Needless to say, this news did not make me happy. It feels critically unfair that one of the core pillars in my fibro management scheme is now being taken away from me. It feels like somebody’s idea of a very unfunny joke.

I also want to mention that there is another condition, called livedo reticularis, that looks similar to EAI, but may indicate more serious underlying disorders, such as lupus. But LR seems to typically show up as reddish fishnet-like pattern on the legs (and does not correspond with a patient history of heating pad use). Distinguishing between the two is very important, because one of the treatments for LR is application of heat to the affected area — the one thing you must avoid if it is EAI!

livedo-reticularis
Livedo reticularis (Image from MedicineNet.com)

If you see such marks on your skin, please have it checked out by a doctor, preferably a dermatologist as many primary care physicians are not even aware of EAI. This happened at a really bad time for me, because I need to change my GP with a change in health insurance. (Isn’t healthcare in America a dream?!) I am hoping the next doctor (whom I am yet to find) will take me as seriously and treat me with as much compassion as the last one, and have me properly checked out by relevant specialists.

The bottomline of this post is, if you suffer from chronic pain and heat is a major source of relief, please be judicious when using a heating pad or hot water bottle. There are hidden dangers associated with their chronic use, like the development of EAI, that I had no idea about! I am not sure I can completely give them up yet, but I am definitely cutting back on their use. It does make sitting at work very uncomfortable, but I am horrified by the potential of these lesions turning malignant. If you depend on the heating pad as much as I do, I do hope you will be careful about how long you use it for, so you don’t entirely lose your source of relief in the long run due to EAI.

Love,

Fibronacci

20 thoughts on “Hidden Dangers of Chronic Heating Pad Use!

    1. You’re most welcome Alanna, so many of us rely on heat to manage neuromuscular pain! I used to use the microwavable clay packs too — switched to an electric heating pad because I could have steady heat for longer, most consistently with that, instead of having to use the microwave at work all the time. Turns out it is that steady consistent use that can lead to EAI.

      Liked by 1 person

  1. Ouch, quite unappealing to have this happen when you’re just trying to ease your pain! A very good point about the commonalities with the fishnet pattern and other conditions, always wise to get it checked out if you’re unsure. Very insightful points! x

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    1. Yes, no kidding! I was upset to the point of tears because it just felt an insult to the injury. I depend on the heating pad so much as a non-pharmacological pain relief method, and now I cannot really use it any more. Just felt like yet another setback at a really bad time. I am probably overreacting but it just feels so hopeless at times. I do hope that this post reaches more chronic pain patients though! We need to be educated on safe heating pad use, because preventing EAI is really the only option. After it happens, unless you want it to progress to a malignant state after a while, you really have to stop using heat application. Which is such a bummer! At the same time, many other conditions like lupus share symptom similarities with fibromyalgia, so getting them checked out for potential LR is critical as well. I am glad you found this post educational and insightful!

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  2. I actually had no idea heating pads and even hot water bottles could be bad for you! I’m not one for using them but I do like heat and warmth. From what I gather, when the damage is done to the skin, the damage is done – and progressing to skin cancer over time sounds like such a serious thing. Maybe turning the heat down on these heating things might help. Then again, having looked a some of them in the past there doesn’t seem to be a way to control the heat – once it’s hot and running, it is running. Skin is the largest organ in our body and it protects us from so many little things, think dust, pollutants in the air, rough surfaces, sunlight, cold winds and so on. It is probably a more sensitive organ than we think. For instance, even if we get a cut, chances are that might leave a scar and our skin will never look the same again.

    Hope you take care with the heating pads and hot water bottles, and find some other form of relief. At least now you know the risks and you can think twice about using them 🙂

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    1. So true, Mabel – the skin is our largest organ, and while we often care about its cosmetic appearance, we don’t always pay attention to it as a health indicator. Heating pads and hot water bottles are not dangerous or bad for you per se however. This is a very rare condition that is pretty much only seen with people who use localized heat everyday, for several hours, for *years*. And even after EAI develops, for that to progress to malignancy can take *many* more years, and only if the source of heat is not removed. So I am pretty sure this is not something most people have to worry about — the one notable exception being those who use heat to find relief from chronic intractable pain (which, I know, is many of my readers), because they may have no other choice. This is an important stay-aware sort of message for them, but I hope it doesn’t scare most people from using a heated blanket on a chilly night. 🙂 At any rate, I certainly learned a lot about being more careful about heating pads through this experience. I technically shouldn’t use them at all anymore, at least where the EAI has developed, but I have few other choices at work. Skin cancer *is* serious business though, so I am not taking this lightly.

      Liked by 1 person

      1. That is good to hear that using heating pads and hot water bottles in moderation is okay for most people. But as you said, being aware of the dangers and taking precautions is worthwhile. Heat is so comforting to me…it makes me feel alive when I feel cold. I could easily use a heating pad all day in winter but never have because found it too inconvenient.

        Hope you do find options that work for you 🙂

        Liked by 1 person

        1. Ahh yes, watch out for using that heating pad all day! That could be dangerous — maybe just keep the heat down? For me, I have been using heat for so long, if I didn’t turn it up I couldn’t feel any heat at all. I think that’s where the problem started. Oh well! I am hoping to find new options too… considering a massage seat-back thingy (that you strap to your seat back). 🙂

          Liked by 1 person

    1. I had also never heard of this until it happened to me. And most doctors even know don’t know about this condition! As always, us chronic illness fighters need to watch out for ourselves and for each other. Stay empowered!

      Liked by 1 person

    1. Please be careful with it. I think it should be OK if the heat is not turned up too high and if you don’t use it for too long. I’ve been using heating pads so long, sometimes I can’t even feel the heat until it’s turned up kinda high. I suspect doing that for a long is what caused the EAI.

      Liked by 1 person

    1. You are welcome, Clare! EAI happens to be so rare that most people seem to only find out when it happens to them (as I did). So I was hoping to spread the word a bit among my chronic pain community friends about this. As for replacing my favorite method of pain relief, no clue what I am going to do for that yet. 😦

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  3. Oh, dear. I overheat easily (lack of temp regulation ftw), so I will often put the heating pad – or ice! – on over a washcloth or thin shirt. I wonder if that helps? Or if the old-time fire example implies direct contact isn’t necessary?

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  4. Also, I totally expected this post to be about the thing itself overheating and melting. Guess I’m still paranoid from my coffee warmer near fiasco. If it isn’t you burning the place down with the heat, it’s the heat burning YOU down. Spoonie life if just a catch-22 sometimes…

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  5. Thanks so much for this warning! I had never even heard of EAI before reading your post. I always use my heating pad on low, but I’ll definitely be more judicious in how often I use it. I’m definitely pinning and sharing on my FB page. Thanks again for the warning!

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  6. Try 100% Magnesium oil. I have it in a spray bottle from Vitamin Shoppe, it’s around $12 could be less other places. If you’re magnesium difficient, you will have a good nap, or sleep well if you apply the oil at night. You don’t even need much. I have Fibromyalgia and it helps any place I hurt. Great for arthritis too from what I hear.

    Liked by 1 person

    1. Thank you for telling me about magnesium oil! My therapist once suggested mag pills to counteract a potential deficiency (not sure I was ever checked), but they didn’t seem to do much. But I will try to find some of the oil and see if that helps. Thank you, and I hope you have a nice day! ❤

      Liked by 1 person

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