Heat Wins Over NSAIDs for Acute Low Back Pain

A randomised controlled trial published recently in the journal Spine has compared the efficacy of topical heat methods with common oral NSAIDs and analgesic treatment for acute low back pain.

A total of 371 patients with acute nonspecific low back pain were randomised to receive either:

1. Continuous low-level heat wrap therapy at 40 degrees C for 8 hours per day (113 patients)
2. Acetaminophen (113 patients)
3. Ibuprofen (106 patients)

The remaining patients were randomised to one of 2 placebo groups for blinding, receiving either oral placebo (20 patients) or unheated back wrap (19 patients).

Outcome measures included pain relief, muscle stiffness, lateral trunk flexibility, and disability. Efficacy was measured over 2 treatment days and 2 follow-up days.

The heat wrap proved superior to the medication for the outcome measures.

• On the 1st day, pain relief for the heat wrap was higher than for ibuprofen or acetaminophen.
• Extended pain relief (Days 3 to 4) for the heat wrap was also higher than for ibuprofen or acetaminophen.
• Lateral trunk flexibility was also improved with the heat wrap during treatment versus acetaminophen and ibuprofen.
• Day 1 reduction in muscle stiffness with the heat wrap was greater than with acetaminophen.
• Disability was reduced with the heat wrap as compared with ibuprofen and acetaminophen on Day 4.
• None of the adverse events were serious. The highest rate (10.4%) was reported in the ibuprofen group.

The conclusion of the authors was that continuous low-level heat wrap therapy was superior to both acetaminophen and ibuprofen for treating low back pain.

Source: Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine 2002;27:1012-7