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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.