According to the latest federal survey on complementary and alternative medicine (CAM) utilization in the U.S., nearly four in 10 adults (38.3 percent) and one in nine children (11.8 percent) use CAM, and musculoskeletal conditions constitute the number-one reason for visiting a CAM provider. In fact, “back pain or problem” and “neck pain or problem” rank first and second in terms of conditions for which adults use CAM therapies (17.1 percent and 5.9 percent, respectively), while “back or neck pain” is the second most common reason for child CAM use (6.7 percent of children).

http://www.naturopathydigest.com/archives/2009/jan/cam.php

Heat* Plus Exercise: Best Treatment for Acute LBP?

While chiropractic adjustments are considered one of the most effective forms of care for the treatment of low back pain (LBP), health care practitioners often employ other methods for back pain relief. Among the more common techniques are the application of heat and specific exercises that help strengthen the back and improve range of motion.

However, until now little is known about whether a combination of these treatments may be more effective than a single intervention.

In this randomized, controlled trial, 100 individuals with LBP lasting less than three months were allocated to one of four groups: a heat wrap therapy group (in which patients wore a disposable low-level heat wrap eight hours per day for five consecutive days); an exercise group (consisting of flexion and extension exercises performed one time every hour while the patient was awake for five consecutive days); a heat-plus-exercise group; and a control group that received an educational booklet on acute low back problems. At baseline, the participants were examined by a practitioner for assessments on functional ability, disability levels, pain intensity and pain relief. The same assessments were performed 2 days, 4 days and 7 days after randomization.

By day 7, patients in the heat-plus-exercise group experience significant improvements in function, disability and pain relief compared to the other groups. Functional improvement for heat-plus-exercise patients was 84%, 95% and 175% greater than patients in the heat wrap, exercise and control groups, respectively. Pain relief among the heat-plus-exercise patients was 70% greater than in the exercise patients, and 143% greater than the control patients.

The researchers stated that the combination of heat and exercise "provided superior functional improvement, disability reduction, and pain relief" compared to single interventions. They added that health care providers "should consider using continuous low-level heat wrap therapy in conjunction with exercise therapy during the early stages of care for acute low back pain in order to achieve optimal functional improvements during recovery."

Heat Wrap Beats Analgesics for Acute LBP (Lower Back Pain)

The two most commonly used nonprescription medications in the U.S. - ibuprofen and acetaminophen - are promoted as "first-line" management of acute low back pain (LBP). These analgesics may cause renal, gastrointestinal, and hepatic adverse conditions, however.

Self-administered topical heat wraps also have been recommended for acute LBP, but their efficacy has not been previously compared to these analgesics.

In this randomized trial, the authors compared eight hours/day of low-level (104°F) topical heat therapy with maximum recommended dosages of ibuprofen and acetaminophen. Additionally, oral and wrap placebos were administered to other groups randomized from 371 acute LBP subjects, all ages 18-55. Pain, muscle stiffness, disability, and lateral trunk flexibility were compared in the subjects over two days of therapy and two days of follow-up.

Results: Heat-wrap therapy was more effective than both analgesics. For days one, three, and four, the heat wrap was significantly more effective than ibuprofen and acetaminophen in terms of pain relief on a verbal rating scale. Lateral trunk flexibility was greater during treatment and on day four in the heat-wrap group. Disability was lessened more by heat wrap than by either analgesic on day four. Muscle stiffness was also reduced most in the heat-wrap group.

Based on these findings, continuous low-level, topical heat-wrap therapy may be better than either acetaminophen or ibuprofen for acute back pain. The authors recommend that it be considered as a front-line therapy when treating acute, muscle-based LBP.

Heat to Relieve Low Back Pain

You can apply heat to your sore back 72 hours after an injury occurs. Applying heat too soon after injury can make the swelling and inflammation worse.

* Apply heat for 20-minute periods. Moist heat (hot packs, baths, showers) works better than dry heat.

* Try an all-day heat wrap (such as Insta'Heat ), available in pharmacies. Research by the manufacturers of this new product suggests that during the first 2 days of heat treatment, 8 hours of heat wrap for acute low back pain is more effective than acetaminophen or ibuprofen at reducing pain and stiffness and increasing flexibility.

* If you are using an electric heating pad, avoid falling asleep while the pad is on. If you think you might fall asleep, set an alarm clock to go off in 20 minutes. Use heating pads set on low or medium, never on high.

After 72 hours of ice treatment, you may find that heat best relieves your pain. Or you may prefer to use ice only, or switch between heat and ice packs.


Author Shannon Erstad, MBA/MPH
Author Lila Havens
Editor Kathleen M. Ariss, MS
Editor Katy E. Magee, MA
Associate Editor Michele Cronen
Associate Editor Tracy Landauer
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Kathie Hummel-Berry, PT, PhD - Physical Therapy
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics