Moist Hot Pack and Low Back Pain

Ann B., Laura S., Brandon W.

Managing low back pain can be very challenging as there are many nonsurgical therapies to choose from as treatment options. Heat is often used as a universal treatment for pain and discomfort. One traditional therapy that has been used to manage low back pain has been the use of moist heat packs. The physiologic responses of moist heat pack include increasing circulation, increasing muscle temperature, increasing tissue temperature, and relaxing spasms.

Supporting Evidence:

Nadler et al. looked at the difference between the use of continuous low-level heat versus the use of ibuprofen and acetaminophen in the treatment of acute low back pain. It was found that the heat wrap, when compared to the ibuprofen and acetaminophen respectively provided significantly better pain relief both on day one as well as days three and four. It also was found to provide decreased morning muscle stiffness, increased lateral trunk flexibility and decrease low back disability on day 4. In The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner, Steiner et al. found in a randomized controlled trial that continuous low-level heat therapy worn for eight hours a day over a three day period showed a significant increase in pain relief when compared to an unheated control treatment group. French et al. found that in a trial involving acute and sub-acute low-back pain patients, heat wrap therapy significantly reduced their low back pain after five days when compared to an oral placebo. They also looked at the effect of adding in exercise to the heat wrap therapy and found that it reduced pain after seven days.

Refuting Evidence:

Two main categories of modalities in treating chronic low back pain include electrotherapeutic modalities and physical agents. Poitras and Brosseau used a systemic review to evaluate the efficacy of these two main categories of modalities. As discussed in Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy, there are few studies which are found to support the use of thermotherapy. The only remarkable evidence shown was that TENS (transcutaneous electrical nerve stimulation) had an immediate effect on short-term pain relief, but had no impact on perceived disability or long-term pain. Petrofsky et al. examined the effectiveness of three heating modalities used on people that are overweight. The types of heat investigated included dry heat with a commercial chemical hot pack, hydrocollator heat packs, and whirlpool. Dry heat that maintains contact with the skin for a long time was found to be more effective than rapid moist heat, where the transfer of heat from the skin to the deep muscles was significantly impaired by thicker layers of subcutaneous fat.  Garra et al. compared heat and cold packs for neck and back strain with the use of ibuprofen therapy. A randomized controlled trial of efficacy found that using heat and cold packs had mild, but similar improvement in pain severity. In addition, there were no differences in pain scores between the heat and cold groups both before and after treatment.

In conclusion, the evidence supports the use of moist hot packs to manage low back pain.  Some of the literature, however, showed that other modalities (e.g. Cryotherapy, TENS, etc.) may also work to reduce pain, so more research is need to determine the most effective modality treatment.

References:

French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., & Esterman, A. J. (2006). Superficial heat or cold for low back pain. Cochrane database of systematic reviews (Online), (1), CD004750. doi:10.1002/14651858.CD004750.pub2

Garra, G., Singer, A. J., Leno, R., Taira, B. R., Gupta, N., Mathaikutty, B., & Thode, H. J. (2010). Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(5), 484-9. doi:10.1111/j.1553-2712.2010.00735.x

Nadler, S. F., Steiner, D. J., Erasala, G. N., Hengehold, D. A., Hinkle, R. T., Beth Goodale, M., Abeln, S. B., et al. (2002). Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain. Spine, 27(10), 1012-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12004166

Nadler, S. F., Weingand, K., & Kruse, R. J. (2004). The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain physician, 7(3), 395-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16858479

Petrofsky, J., Bains, G., Prowse, M., Gunda, S., Berk, L., Raju, C., Ethiraju, G., et al. (2009). Dry heat, moist heat and body fat: are heating modalities really effective in people who are overweight? Journal of medical engineering & technology, 33(5), 361-9. doi:10.1080/03091900802355508

Poitras, S., & Brosseau, L. (n.d.). Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. The spine journal : official journal of the North American Spine Society, 8(1), 226-33. doi:10.1016/j.spinee.2007.10.022