Low level Heat Wrap Therapy Safely Reduces Low Back Pain

Category: Pain/Anesthetics News
Article Date: 23 Jan 2006 - 0am (UK)

The use of continuous low-level heat wrap therapy (CLHT) significantly reduces acute low back pain and related disability and improves occupational performance of employees in physically demanding jobs suffering from acute low back pain, according to a Johns Hopkins study published in the December 2005 issue of The Journal of Occupational and Environmental Medicine.

"With recent concerns around the safety of oral pain medications, both patients and physicians are considering alternative treatment options for acute low back pain," said Edward J. Bernacki, M.D., M.P.H., associate professor of medicine at The Johns Hopkins University School of Medicine and the study's principal investigator. "The dramatic relief we see in workers using CLHT shows that this therapy has clear benefits for low back pain and that it plays an important role in pain management. Physicians and other health care providers in an occupational environment can tell patients that CLHT is a safe and effective alternative for treating acute low back plain."

In the study, 43 patients (age 20 to 62) who visited an occupational injury clinic for low back pain were randomized into one of two intervention arms: 18 patients received education regarding back therapy and pain management alone, while 25 received education regarding back therapy and pain management combined with three consecutive days of CLHT for eight hours continuously (ThermaCareŽ HeatWraps). The heat wrap is a wrap worn over the lower back, under the clothing. It uses an exothermic chemical reaction to deliver a low level of topical heat for at least eight continuous hours. All groups were assessed for measures of pain intensity and pain relief levels four times a day during the three treatment days, followed by measures for pain intensity and pain relief levels obtained in three follow-up visits on days 4, 7, and 14 from the beginning of the treatment. In addition, other measures were obtained and assessed by the Roland-Morris Low Back Disability Questionnaire and the Lifeware Musculoskeletal Abbreviated Assessment Form.

Patients who received CLHT for low back pain over a three-day period in conjunction with pain management education experienced rapid and significant reduction in pain intensity and greater pain relief when compared to patients who only received pain education. Patients on CLHT showed a 52 percent reduction in pain intensity and a 43 percent improvement in pain relief within one day of treatment as compared to the reference group. Both pain intensity reduction and pain relief were maintained for the three days of treatment with CLHT at 60 percent and 41 percent, respectively. Additionally, the benefits of pain relief and pain intensity reduction were maintained at a significant level in the CLHT patients in a follow-up period on day 4 and day 14 after treatment was discontinued.

Low back pain is one of the most common and therefore costly medical problems in industrialized countries, according to Bernacki, who also directs the Hopkins Department of Health, Safety and the Environment. Approximately 50 percent of working-age people in the United States are reported to suffer from acute low back pain every year, and it is estimated that the annual productivity loss from this condition totals between $20 and $50 billion. While guidelines for treating back pain are available, little has been done to translate these recommendations into occupational management to prevent episodic disability and loss of productivity and to improve employee effectiveness in the workplace, notes Bernacki.

Gary Stephenson
gstephenson@jhmi.edu
Johns Hopkins Medical Institutions
www.hopkinsmedicine.org

MS and cooling the body before or during exercise

Category: Multiple Sclerosis News
Article Date: 08 Nov 2005


Aerobic exercise is thought to help persons with multiple sclerosis fight fatigue, the most common symptom of the disease. Yet MS also appears to cause the body to heat up more quickly, compromising the ability to exercise.

New research at UB will investigate if cooling the body before or during exercise allows persons with MS to exercise longer, and which method is most effective. The study also will determine the effects of a 12-week aerobic exercise program on fitness, core and skin temperature, and heat flux in MS patients.

The study is funded by a $449,999 grant from the National Institute on Disability and Rehabilitation Research, U.S. Dept. of Education.

"Exercise is good for MS, but it must be done correctly," said lead investigator Nadine Fisher, Ed.D., clinical associate professor of rehabilitation science in the UB School of Public Health and Health Professions. Carl Granger, Ph.D., UB professor of rehabilitation science, is co-investigator.

"Exercise can build up strength and endurance, reduce depression and increase endorphins, the chemicals in the brain responsible for positive moods," she said. "We are trying to find out how to reduce the exercise limitations MS places on people."

The study will involve 60 persons with MS and will be conducted in two phases. During the first phase, which will comprise four weeks, each participant will exercise under a different cooling condition each week to determine how different cooling methods affect exercise performance and core body temperature.

The conditions are no cooling; cooling before exercise by wearing a specially designed, temperature-controlled cooling vest; cooling during exercise while wearing the vest, and cooling using a method of their choosing other than the vest.

Before each condition, participants will swallow a "temperature pill," a plastic, vitamin-pill-sized sensor developed by NASA that transmits temperature readings to an external monitor as it travels through the body.

During the 12-week second phase, participants will be assigned randomly to one of three groups: an exercise program with cooling, an exercise program without cooling, or no exercise, which will serve as the control group. Various physiological measurements will be taken during the exercise programs, which will take place three days a week for an hour, with built-in rest periods.

The control group will be contacted by phone every two weeks to replicate the benefits of social interaction that the exercise program provides Fisher said she hopes to show that cooling can help persons with MS increase their exercise, and that an aerobic exercise program can improve their functioning and cardiovascular health.

"Positive results of our study would lead to a better understanding of the possibilities of cooling treatment and exercise rehabilitation for these individuals," said Fisher.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.

Lois Baker
ljbaker@buffalo.edu
University at Buffalo
http://www.buffalo.edu