Overnight use of continuous low-level heatwrap therapy for relief of low back pain

doi:10.1053/apmr.2003.50103

Archives of Physical Medicine and Rehabilitation

Volume 84, Issue 3, March 2003, Pages 335-342

https://doi.org/10.1053/apmr.2003.50103 Get rights and content

Abstract

Nadler SF, Steiner DJ, Petty SR, Erasala GN, Hengehold DA, Weingand KW. Overnight use of continuous low-level heatwrap therapy for relief of low back pain. Arch Phys Med Rehabil 2003;84:335-42. Objective: To evaluate of the efficacy and safety of 8 hours of continuous, low-level heatwrap therapy administered during sleep. Design: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. Setting: Two community-based research facilities. Participants: Seventy-six patients, aged 18 to 55 years, with acute, nonspecific low back pain. Interventions: Subjects were stratified by baseline pain intensity and gender and randomized to one of the following treatments: evaluation of efficacy (heatwrap, n=33; oral placebo, n=34) or blinding (unheated wrap, n=5; oral ibuprofen, n=4). All treatments were administered for 3 consecutive nights with 2 days of follow-up. Main Outcome Measures: Primary: morning pain relief (hour 0) on days 2 through 4 (0[ndash ]5-point verbal response scale). Secondary: mean daytime pain relief score (days 2[ndash ]4, hours 0[ndash ]8), mean extended pain relief score (day 4, hour 0; day 5, hour 0), muscle stiffness, lateral trunk flexibility, and disability (Roland-Morris Disability Questionnaire). Results: Heatwrap therapy was significantly better than placebo at hour 0 on days 2 through 4 for mean pain relief (P=.00005); at hours 0 through 8 on days 2 through 4 for pain relief (P[lt ].001); at hour 0 on day 4 and at hour 0 on day 5 for mean pain relief (P[lt ].001); on day 4 in reduction of morning muscle stiffness (P[lt ].001); for increased lateral trunk flexibility on day 4 (P[lt ].002); and for decreased low back disability on day 4 (P=.005). Adverse events were mild and infrequent. Conclusions: Overnight use of heatwrap therapy provided effective pain relief throughout the next day, reduced muscle stiffness and disability, and improved trunk flexibility. Positive effects were sustained more than 48 hours after treatments were completed. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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Citation Excerpt :
However, the sensitivity analysis, excluding 1 outlier study,37 showed that LHA is not more beneficial than placebo or sham to decrease pain (SMD=−1.741 [95% CI, −3.6 to 0.1]) The effect remained significant in favor of LHA at 2 follow-ups recorded 48 hours after initial LHA (SMD=−5.250 [95% CI, −5.7 to −4.7]).36,37 Our analysis revealed that LHA has a positive immediate effect on disability compared with the control group (SMD=−1.278 [95% CI, −2.4 to −0.1]) with a high heterogeneity (Q3=50.665; P<.001; I2=94.0%) (see fig 9).30,36,37
The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHAs) in individuals with acute or chronic musculoskeletal disorders.
An electronic search was conducted on MEDLINE, Cochrane Controlled Register of Trials, Current Nursing and Allied Health Literature, and the Physiotherapy Evidence databases up to December 2019.
Studies incorporating adults with any kind of musculoskeletal issues treated by LHA compared with any treatment other than heat were included.
Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool.
LHA showed beneficial immediate effects to reduce pain vs no treatment (P<.001), standard therapy (P=.020), pharmacologic therapy (P<.001), and placebo/sham (P=.044). Physical function was restored after LHA compared with no treatment (P=.025) and standard therapy (P=.006), whereas disability improved directly after LHA compared with pharmacologic therapy (P=.003) and placebo/sham (P<.028). Quality of life was improved directly after LHA treatment compared with exercise therapy (P<.021). Range of motion increased and stiffness decreased after LHA treatment compared with pharmacologic therapy (P=.009, P<.001) and placebo/sham (P<.001, P=.023). The immediate superior effects of LHA on muscular strength could be observed compared with no treatment (P<.001), cold (P<.001), and placebo/sham (P=.023).
Individuals with acute musculoskeletal disorders might benefit from using LHA as an adjunct therapy. However, the studies included in this meta-analysis demonstrated a high heterogeneity and mostly an unclear risk of bias.
Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition
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Citation Excerpt :
However, no studies have explored the use of superficial cryotherapy as a treatment for low back pain. A Cochrane review [209] identified a total of four studies exploring the effects of surface heat in the form of applying heating wraps or blankets for the treatment of patients with acute or subacute low back pain [210–213]. No studies have yet evaluated surface hyperthermia in patients with chronic low back pain.
The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine.
The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, “body of evidence” and “benefit and harm balance” were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members.
Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature.
The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Low back pain is a major health issue in most industrialized countries. Lumbar fascia is supported as a potential source of pain in the lumbar region. Myofascial release is a manual therapeutic approach that focuses on restoring altered soft tissue function. On the other hand, one of the most commonly used physical therapy methods for low back pain is electrotherapy. The purpose of this study was to compare the effect of lumbar Myofascial release and electrotherapy on clinical outcomes of Non-specific low back pain and elastic modulus of lumbar myofascial tissue.
Randomized, clinical trial.
Outpatient Low back pain clinic.
32 subjects with low back pain.
Subjects were randomized into the myofascial release group (n = 16) and electrotherapy group(n = 16). Subjects in the myofascial release group received 4 sessions of myofascial release in the lumbar region, and the electrotherapy group received 10 sessions of electrotherapy.
Low back pain severity, and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment.
An independent sample T-test was used to compare baseline variables in both groups (p > 0.05) (effect size≥0.83), Paired T-test was used to compare within-group changes after performing myofascial release and electrotherapy (p ≤ 0.023) (effect size≥0.56), and the GLM Anova test was used to Comparison of Changes in the Elastic Modulus of the Lumbar Spine and Low Back Pain between-group (F (10,21) = 12.10, P < 0.0005) (effect size = 0.86).
The improvements in the outcome measures suggest that lumbar myofascial release may be effective in subjects with non-specific low back pain. Data suggest that the elastic modulus of lumbar fascia and the severity of low back pain are directly linked. Decreasing the elastic modulus after myofascial release can directly affect reducing low back pain.
Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials
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The aim of this review and meta-analysis was to evaluate the effect of heat and cold therapy on the treatment of delayed onset muscle soreness (DOMS).
We followed our protocol that was registered in PROSPERO with ID CRD42020170632. A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Nine databases were searched up to December 2020. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis.
A total of 32 RCTs involving 1098 patients were included. Meta-analysis showed that, the application of cold therapy within 1 h after exercise could reduce the pain of DOMS patients within 24 h (≤24 h) after exercise (SMD -0.57,95%CI -0.89 to −0.25, P = 0.0005) and had no obvious effect within more than 24 h (>24 h) (P = 0.05). In cold therapies, cold water immersion (SMD -0.48, 95%CI -0.84 to −0.13, P = 0.008) and other cold therapies (SMD -0.68, 95%CI -1.28 to −0.08, P = 0.03) had the significant effects within 24 h. Heat treatment could reduce the pain of patients. It had obvious effects on the pain within 24 h (SMD -1.17, 95%CI -2.62 to −0.09, P = 0.03) and over 24 h (SMD -0.82, 95%CI -1.38 to −0.26, P = 0.004). Hot pack effect was the most obvious, which reduced the pain within 24 h (SMD -2.31, 95%CI -4.33 to −0.29, P = 0.03) and over 24 h (SMD -1.78, 95%CI -2.97 to −0.59, P = 0.003). Other thermal therapies were not statistically significant (P > 0.05). Both cold and heat showed effect in reducing pain of patients, however there was no significant difference between cold and heat group (P = 0.16).
The current evidence indicated that the application of cold and heat therapy within 1 h after exercise could effectively reduce the pain degree of DOMS patients for 24 h cold water immersion and hot pack therapy, which had the best effect, could promote the recovery of DOMS patients. But more high-quality studies are needed to confirm whether cold or heat therapy work better.
Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain
2020, Spine Journal
The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016.
The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.
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