Superficial heat or cold for low back pain

Monash Institute of Health Services Research, Australasian Cochrane Centre, Level 1, Block E, Monash Medical Centre, Locked Bag 29, Clayton, VIC, Australia, 3168.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 1(1):CD004750. DOI: 10.1002/14651858.CD004750.pub2
Source: PubMed


Heat and cold are commonly utilised in the treatment of low-back pain by both health care professionals and people with low-back pain.
To assess the effects of superficial heat and cold therapy for low-back pain in adults.
We searched the Cochrane Back Review Group Specialised register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to October 2005), EMBASE (1980 to October 2005) and other relevant databases.
We included randomised controlled trials and non-randomised controlled trials that examined superficial heat or cold therapies in people with low-back pain.
Two authors independently assessed methodological quality and extracted data, using the criteria recommended by the Cochrane Back Review Group.
Nine trials involving 1117 participants were included. In two trials of 258 participants with a mix of acute and sub-acute low-back pain, heat wrap therapy significantly reduced pain after five days (weighted mean difference (WMD) 1.06, 95% confidence interval (CI) 0.68 to 1.45, scale range 0 to 5) compared to oral placebo. One trial of 90 participants with acute low-back pain found that a heated blanket significantly decreased acute low-back pain immediately after application (WMD -32.20, 95%CI -38.69 to -25.71, scale range 0 to 100). One trial of 100 participants with a mix of acute and sub-acute low-back pain examined the additional effects of adding exercise to heat wrap, and found that it reduced pain after seven days. There is insufficient evidence to evaluate the effects of cold for low-back pain, and conflicting evidence for any differences between heat and cold for low-back pain.
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.

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    • "While there is still insufficient evidence regarding the effects of the application of cold for LBP, there is moderate evidence that heat wrap therapy reduces pain and disability for patients with back pain that lasts for less than three months. The relief is relatively small and has only been shown to occur for a short time [24]. Heat wraps are traditionally part of the treatment offered in rehabilitation facilities for patients with chronic LBP, which seems contradictory. "
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    ABSTRACT: Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain. This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.
    BMC Complementary and Alternative Medicine 02/2007; 7(1):42. DOI:10.1186/1472-6882-7-42 · 2.02 Impact Factor

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    ABSTRACT: A B S T R A C T In contemporary musculoskeletal therapy it is common to apply topical cooling agents such as ice, particularly in the context of the RICE (Rest, Ice, Compression and Elevation) protocol. Traditional Chinese medicine (TCM) practice, however, has tended, for two millennia, to use heat rather than cold to treat musculoskeletal injuries, due to the traditional belief that enhancing circulation is likely to be beneficial, while impeding circulation is likely to be deleterious. This narrative review examines the evidence to support the use of ice alone (not as part of the RICE protocol) and the use of heat in the treatment of acute soft tissue injuries, rheumatoid arthritis, osteoarthritis and low back pain. Conclusions: Ice, applied to muscles, appears to have a local anaesthetic rather than an analgesic action. Evidence on the efficacy of ice in reducing oedema is contradictory. Insufficient evidence was found to support the assertion that ice can reduce muscle spasm, however there is evidence that heat can. In rheumatoid arthritis neither heat nor cold showed evidence of benefit. Knee oedema associated with osteoarthritis showed no significant improvement from ice massage, whereas knee oedema following arthroplasty improved with ice packs but not with hot towels. For low back pain there is moderate evidence of significant short- term benefit from heat wraps but insufficient evidence to draw conclusions on the use of cold. Low back pain studies comparing heat and cold yielded conflicting evidence.
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