Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. Active warming during emergency transport relieves acute low back pain. The use of a back class teaching extension exercises in the treatment of acute low back pain in primary care. Continuous low-level heatwrap therapy for treating acute nonspecific low back pain. A randomized, controlled trial of manual therapy and specific adjuvant exercise for chronic low back pain. Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain. A randomized clinical trial of three active therapies for chronic low back pain. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. Overnight use of continuous low-level heatwrap therapy for relief of low back pain.
Restorative exercise and palliative modalities are frequently used together for the treatment of acute low back pain. However, little is known about the effects of combining these treatments.
                To evaluate the efficacy of combining continuous low-level heat wrap therapy with directional preference-based exercise on the functional ability of patients with acute low back pain.
                A randomized controlled trial was conducted at three outpatient medical facilities.
                One hundred individuals (age 31.2+/-10.6 years) with low back pain of less than 3 months duration.
                The primary outcome measure was functional ability assessed by the Multidimensional Task Ability Profile questionnaire. Secondary outcomes were disability assessed by the Roland-Morris Disability Questionnaire and pain relief assessed by a 6-point verbal rating scale.
                Participants were randomized to one of four groups: Heat wrap therapy alone (heat wrap, n=25); directional preference-based exercise alone (exercise, n=25); combination of heat wrap therapy and exercise (heat+exercise, n=24); or control (booklet, n=26). Treatment was administered for five consecutive days and included four visits to the study center over 1 week.
                At 2 days after the conclusion of treatment (Day 7), functional improvement for heat+exercise was 84%, 95%, and 175% greater than heat wrap, exercise, and booklet, respectively (p<.05). Seventy-two percent of the subjects in the heat+exercise group demonstrated a return to pre-injury function compared with 20%, 20%, and 19% for heat wrap, exercise, and booklet, respectively (p<.05). Disability reduction for heat+exercise was 93%, 139%, and 400% greater than heat wrap, exercise, and booklet, respectively (p<.05). Pain relief for heat+exercise was 70% and 143% greater than exercise and booklet, respectively (p<.05).
                Combining continuous low-level heat wrap therapy with directional preference-based exercise during the treatment of acute low back pain significantly improves functional outcomes compared with either intervention alone or control. Either intervention alone tends to be more effective than control. Prospective randomized blinded trial in a prehospital emergency system.
                To evaluate the effects of external active warming on acute back pain during rescue transport to hospital.
                Acute low back pain is one of the complaints that most often entails a visit to the physician or use of the emergency system. Superficial (e.g., hydrocolloid packs) and deep heating (e.g., ultrasound) can relieve acute low back pain in a clinical setting. Recent data showed significant benefit for patients in pain from minor trauma treated by active warming during emergency transport. Accordingly, we tested the hypothesis that active warming would reduce pain and anxiety in patients with acute low back pain being transported to a hospital.
                A total of 100 patients were included in our study. We selected only those suffering from acute pain > 60 mm on a visual analog scale in the lower back. Patients were randomly assigned to two groups: active warming with a carbon-fiber electric heating blanket (Group 1) versus passive warming with a woolen blanket (Group 2) during transfer to hospital. RESULTS.: Pain scores on arrival at the hospital differed significantly between Group 1 and Group 2 (P < 0.01). In Group 1, pain reduction from 74.2 +/- 8.5 mm VAS to 41.9 +/- 18.9 mm VAS (P < 0.01) was noted between departure from the emergency site and arrival at the hospital. Pain scores remained practically unchanged in Group 2 (73.3 +/- 11.9 mm VAS and 74.1 +/- 12.0 mm VAS).
                Active warming reduces acute low back pain during rescue transport. Back extension exercises are commonly recommended to treat acute low back pain. Evidence of their beneficial effect is, however, weak.
                We aimed to demonstrate a benefit of teaching back extension exercises in addition to usual GP care for acute low back pain.
                Patients with acute simple low back pain of less than 28 days duration, presenting to a GP, were randomized either to attend a back class or to receive conventional management. Outcome was measured using changes in the Oswestry disability score and visual analogue pain scale (VAS) on six occasions during 1 year and also a VAS and patient assessment of degree of disability during the previous 6 months at 1 year.
                Seventy-five patients were recruited. The principal outcome measures showed no difference between the two groups. The treatment group reported less chronic disability at 1 year (50% versus 14%, P < 0.007).
                A treatment effect has not been demonstrated, but some patients who would otherwise have reported mild pain were pain free after 1 year. This approach to treating back pain has not been shown to be effective. More much larger studies, with more intensive treatment, are required in order to decide whether physical therapy in primary care is beneficial as treatment for acute back pain. To evaluate the efficacy of 8 hours of continuous low-level heatwrap therapy for the treatment of acute nonspecific low back pain (LBP).
                Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial.
                Five community-based research facilities.
                Two-hundred nineteen subjects, aged 18 to 55 years, with acute nonspecific LBP.
                Subjects were stratified by baseline pain intensity and gender and randomized to one of the following groups: evaluation of efficacy (heatwrap, n=95; oral placebo, n=96) and blinding (oral ibuprofen, n=12; unheated back, wrap n=16). All treatments were administered for 3 consecutive days with 2 days of follow-up.
                Primary: day 1 mean pain relief (0- to 5-point verbal response scale). Secondary: muscle stiffness (101-point numeric rating scale), lateral trunk flexibility (fingertip-floor distance), and Roland-Morris Disability Questionnaire over 3 days of treatment and 2 days of follow-up.
                Heatwrap therapy was shown to provide significant therapeutic benefits when compared with placebo during both the treatment and follow-up period. On day 1, the heatwrap group had greater pain relief (1.76+/-.10 vs 1.05+/-.11, P <.001), less muscle stiffness (43.1+/-1.21 vs 47.6+/-1.21, P=.008), and increased flexibility (18.6+/-.44 cm vs 16.5+/-.45 cm, P=.001) compared with placebo. Disability was also reduced in the heatwrap group (5.3 vs 7.4, P=.0002). Adverse events were mild and infrequent.
                Continuous low-level heatwrap therapy was shown to be effective for the treatment of acute, nonspecific LBP.
                Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation This article examines the effectiveness of manual therapy with specific adjuvant exercise for treating chronic low back pain and disability.
                A single blind, randomized, controlled trial was employed. Patients were prescribed an exercise program that was tailored to treat their musculoskeletal dysfunctions or given a nonspecific program of general stretching and aerobic conditioning. In addition, patients received manual therapy or sham manual therapy. Participants were seen for 6 weekly sessions and were asked to perform their exercise program twice daily.
                Seventy-two out of 100 patients completed the study. Multivariate tests conducted for measures of pain and disability revealed a significant group by time interaction (P = 0.04 and P = 0.05, respectively), indicating differential change in these measures pretreatment to posttreatment as a function of the treatment received. When controlling for pretreatment scores, patients receiving manual therapy with specific adjuvant exercise reported significant reductions in pain. No change in perceived disability was observed, with the exception that patients receiving sham manual therapy with specific adjuvant exercise reported significantly greater disability at posttreatment.
                Manual therapy with specific adjuvant exercise appears to be beneficial in treating chronic low back pain. Despite changes in pain, perceived function did not improve. It is possible that impacting chronic low back pain alone does not address psychosocial or other factors that may contribute to disability. Further studies are needed to examine the long-term effects of these interventions and to address what adjuncts are beneficial in improving function in this population. A prospective, randomized, single (investigator) blind, comparative efficacy trial was conducted.
                To compare the efficacy of continuous low-level heat wrap therapy (40 C, 8 hours/day) with that of ibuprofen (1200 mg/day) and acetaminophen (4000 mg/day) in subjects with acute nonspecific low back pain.
                The efficacy of topical heat methods, as compared with oral analgesic treatment of low back pain, has not been established.
                Subjects (n = 371) were randomly assigned to heat wrap (n = 113), acetaminophen (n = 113), or ibuprofen (n = 106) for efficacy evaluation, or to oral placebo (n = 20) or unheated back wrap (n = 19) for blinding. Outcome measures included pain relief, muscle stiffness, lateral trunk flexibility, and disability. Efficacy was measured over two treatment days and two follow-up days.
                Day 1 pain relief for the heat wrap (mean, 2) was higher than for ibuprofen (mean, 1.51; P = 0.0007) or acetaminophen (mean, 1.32; P = 0.0001). Extended mean pain relief (Days 3 to 4) for the heat wrap (mean, 2.61) also was higher than for ibuprofen (mean, 1.68; P = 0.0001) or acetaminophen (mean, 1.95; P = 0.0009). Lateral trunk flexibility was improved with the heat wrap (mean change, 4.28 cm) during treatment (P </= 0.009 vs acetaminophen [mean change, 2.93 cm], P </= 0.001 vs ibuprofen [mean change, 2.51 cm]). The results were similar on Day 4. Day 1 reduction in muscle stiffness with the heat wrap (mean, 16.3) was greater than with acetaminophen (mean, 10.5; P = 0.001). Disability was reduced with the heat wrap (mean, 4.9), as compared with ibuprofen (mean, 2.7; P = 0.01) and acetaminophen (mean, 2.9; P = 0.0007), on Day 4. None of the adverse events were serious. The highest rate (10.4%) was reported in the ibuprofen group.
                Continuous low-level heat wrap therapy was superior to both acetaminophen and ibuprofen for treating low back pain. A randomized clinical trial.
                To examine the relative efficacy of three active therapies for chronic low back pain.
                There is much evidence documenting the efficacy of exercise in the conservative management of chronic low back pain, but many questions remain regarding its exact prescription and method of application. The most successful method must be identified to enable refinement of future rehabilitation programs to target the specific needs of the patient with chronic low back pain and the budget of the healthcare provider.
                One hundred forty-eight patients with chronic low back pain were randomized to one of the following treatments, which they attended twice a week for 3 months: 1) modern active physiotherapy, 2) muscle reconditioning on training devices, or 3) low-impact aerobics. Pretherapy and posttherapy, objective measurements of lumbar mobility were performed, and questionnaires were administered inquiring about self-rated pain and disability, and psychosocial factors. Similar questionnaires were administered 6 months after therapy. The data were analyzed using the intention-to-treat principle.
                Of the 148 patients, 16 (10.8%) dropped out of the therapy. One hundred thirty-seven questionnaires (93%) were available for analysis at all three time points. After therapy, significant reductions were observed in pain intensity, frequency, and disability; Fear-Avoidance Beliefs about physical activity (FABQactivity); and "praying/hoping," "catastrophizing," and "pain behavior" coping strategies--each with no group differences in the extent of the response. These effects were maintained over the subsequent 6 months, with the exception of disability and FABQactivity for the physiotherapy group. There were small but significant posttherapy increases in lumbar mobility, with aerobics and devices showing a greater response than physiotherapy.
                The general lack of treatment specificity suggests that the main effects of the therapies were educed not through the reversal of physical weaknesses targeted by the corresponding exercise modality, but rather through some "central" effect, perhaps involving an adjustment of perception in relation to pain and disability. The direct costs associated with administering physiotherapy were three times as great, and devices four times as great, as those for aerobics. Administration of aerobics as an efficacious therapy for chronic low back pain has the potential to relieve some of the huge financial burden associated with the condition. To evaluate the efficacy of chiropractic spinal manipulation, manual flexion/distraction, and hot pack application for the treatment of low back pain from osteoarthritis (OA) compared with moist heat alone.
                Two hundred fifty-two patients with low back pain secondary to OA were randomly assigned to either the treatment group (moist hot pack plus chiropractic care) or the moist heat group subjects, which attended 20 treatment sessions over several weeks. At sessions 1, 5, 10, 15, and 20, they rated pain using a visual analog pain scale, activities of daily living using the Oswestry Low Back Pain Questionnaire, and a range of motion (ROM) using the J-Tech Dual Digital Inclinometer (JTECH Medical Model no. AA036).
                Session I ratings indicated that the two groups were equivalent on all pain and flexion scores. The treatment group reported greater and more rapid pain reduction and greater and more rapid ROM improvement than the moist heat group. The treatment group also had greater improvements than the moist heat group in daily living activities in 4 of the 9 areas measured.
                Chiropractic care combined with heat is more effective than heat alone for treating OA-based lower back pain. Pain reduction occurs more rapidly and to a greater degree, and ROM increases more rapidly and to a greater degree. To evaluate of the efficacy and safety of 8 hours of continuous, low-level heatwrap therapy administered during sleep.
                Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial.
                Two community-based research facilities.
                Seventy-six patients, aged 18 to 55 years, with acute, nonspecific low back pain.
                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.
                Primary: morning pain relief (hour 0) on days 2 through 4 (0-5-point verbal response scale). Secondary: mean daytime pain relief score (days 2-4, hours 0-8), mean extended pain relief score (day 4, hour 0; day 5, hour 0), muscle stiffness, lateral trunk flexibility, and disability (Roland-Morris Disability Questionnaire).
                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<.001); at hour 0 on day 4 and at hour 0 on day 5 for mean pain relief (P<.001); on day 4 in reduction of morning muscle stiffness (P<.001); for increased lateral trunk flexibility on day 4 (P<.002); and for decreased low back disability on day 4 (P=.005). Adverse events were mild and infrequent.
                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.
                Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
The evidence base to support the common practice of superficial heat and cold for low back pain is limited and there is a need for future higher-quality randomised controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub-acute low-back pain, and that the addition of exercise further reduces pain and improves function. The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain. There is conflicting evidence to determine the differences between heat and cold for low-back pain.