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September 6, 2002
Low level heat wrap therapy is more effective than over-the-counter oral medications for relieving low back pain, according to the results of a nationwide study led by a sports medicine researcher at the University of Medicine and Dentistry of New Jersey (UMDNJ).
In the six-month study involving 371 patients, participants were given the maximum recommended non-prescription dosages of ibuprofen and acetaminophen or low level wrap heat therapy for two days to treat acute low back pain.
The results showed that the low level heat wrap therapy provided significantly more pain relief beginning on the first day of treatment than the oral analgesics and that the effects lasted more than 48 hours after the treatment was completed.
"Although clinical guidelines in the U.S. have recommended the use of self-administered heat, this is the first study to compare the effectiveness of topical heat treatment versus oral analgesics for treating muscle pain and stiffness," according to Dr. Scott F. Nadler, director of sports medicine at UMDNJ-New Jersey Medical School in Newark and co-investigator of the study.
"Confirming that this treatment is effective is important to patients because it gives them a treatment option that does not have the potential risk to the liver, kidneys, and gastrointestinal tract than can accompany inappropriate analgesic usage," said Dr. Nadler, who is also an associate professor of physical medicine and rehabilitation at the medical school.
The study, published in the journal Spine, was conducted at 11 test sites nationwide in a randomized, active-controlled clinical trial.
Low back pain is the leading cause of disability in people under age 45 and the cost to society is estimated to range from $20 to $50 billion per year, according to statistics provided by the Agency for Healthcare Policy and Research of the U.S. Department of Health and Human Services.
The participants in the study were between the ages of 18 and 55 years of age and were evaluated to be experiencing at least moderate back pain. They were assigned to one of five groups and underwent treatment continuously over two days.
One group was given 400 milligrams of ibuprofen three times a day and one dose of oral placebo. A second group was given 1000 milligrams of acetaminophen four times a day. A third group was given only oral placebos.
The fourth group wore a heat wrap around the lumbar region of the torso. Called ThermaCare®, the heat wrap was developed by the Procter & Gamble Health Sciences Institute in Cincinnati, Ohio. It heats to 104F degrees within 30 minutes of exposure to air and maintains this temperature continuously for at least an eight-hour period of wear. The fifth group was assigned an unheated heat wrap.
The researchers found that the heat wrap group showed significant improvements in pain relief, lateral trunk flexibility, muscle stiffness and disability compared with the patients taking ibuprofen or acetaminophen.
"On the first day of treatment, the heat wrap gave patients greater pain relief -- 33% and 52%, respectively -- when compared to ibuprofen and acetaminophen," Dr. Nadler said. "The heat wrap also improved trunk flexibility -- 71 and 48 percent, respectively -- compared with ibuprofen and acetaminophen after just two days of treatment."
Dr. Nadler attributed this difference in part to the continuous use of heat combined with the ability of individuals wearing the heat wrap to continue to maintain normal activity levels. "The wraps are not bulky and can be worn under clothing while people work, exercise or relax," he said. "They not only provide pain relief but they may also help many patients return to normal activity. In some instances, they may enable people with low back pain to resume normal exercise activities to relieve muscle stiffness and improve strength and flexibility of the spine and extremities."
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