I’ve used these off and on for a year or so and they work great! I’d slept in a bad position and woke up with a horribly stiff neck and shoulders. I used one of the patches overnight and the next morning the pain was about 90% gone.
According to the instructions, they are “air activated”.
In the package, they are folded and in a foil packet until they are needed.
Here’s what I know 'bout Thermacare (from a friend who works in powdered metals): the thermacare packs contain pellets of powdered (compressed) iron. Upon contact with the air, the iron oxidizes and heat is released as part of that chemical reaction.
Don’t know the science, but the friend who told me is an extremely reliable source. So I guess that’s something to think about until someone with some actual knowledge comes along.