Low-level heat wrap therapy reduces acute low back pain

The use of continuous low-level heat wrap therapy (CLHT) significantly reduces acute low back pain and related disability and improves occupational performance of employees in physically demanding jobs suffering from acute low back pain, according to a Johns Hopkins study published in the December 2005 issue of The Journal of Occupational and Environmental Medicine.

"With recent concerns around the safety of oral pain medications, both patients and physicians are considering alternative treatment options for acute low back pain," said Edward J. Bernacki, M.D., M.P.H., associate professor of medicine at The Johns Hopkins University School of Medicine and the study's principal investigator. "The dramatic relief we see in workers using CLHT shows that this therapy has clear benefits for low back pain and that it plays an important role in pain management. Physicians and other health care providers in an occupational environment can tell patients that CLHT is a safe and effective alternative for treating acute low back plain."

In the study, 43 patients (age 20 to 62) who visited an occupational injury clinic for low back pain were randomized into one of two intervention arms: 18 patients received education regarding back therapy and pain management alone, while 25 received education regarding back therapy and pain management combined with three consecutive days of CLHT for eight hours continuously (ThermaCare. HeatWraps). The heat wrap is a wrap worn over the lower back, under the clothing. It uses an exothermic chemical reaction to deliver a low level of topical heat for at least eight continuous hours. All groups were assessed for measures of pain intensity and pain relief levels four times a day during the three treatment days, followed by measures for pain intensity and pain relief levels obtained in three follow-up visits on days 4, 7, and 14 from the beginning of the treatment. In addition, other measures were obtained and assessed by the Roland-Morris Low Back Disability Questionnaire and the Lifeware Musculoskeletal Abbreviated Assessment Form.

Patients who received CLHT for low back pain over a three-day period in conjunction with pain management education experienced rapid and significant reduction in pain intensity and greater pain relief when compared to patients who only received pain education. Patients on CLHT showed a 52 percent reduction in pain intensity and a 43 percent improvement in pain relief within one day of treatment as compared to the reference group. Both pain intensity reduction and pain relief were maintained for the three days of treatment with CLHT at 60 percent and 41 percent, respectively. Additionally, the benefits of pain relief and pain intensity reduction were maintained at a significant level in the CLHT patients in a follow-up period on day 4 and day 14 after treatment was discontinued.

Low back pain is one of the most common and therefore costly medical problems in industrialized countries, according to Bernacki, who also directs the Hopkins Department of Health, Safety and the Environment. Approximately 50 percent of working-age people in the United States are reported to suffer from acute low back pain every year, and it is estimated that the annual productivity loss from this condition totals between $20 and $50 billion. While guidelines for treating back pain are available, little has been done to translate these recommendations into occupational management to prevent episodic disability and loss of productivity and to improve employee effectiveness in the workplace, notes Bernacki.