A systematic review of the effectiveness of superficial heat and cold for decreasing pain and improving disability in adults with low back pain

A systematic review of the effectiveness of superficial heat and cold for decreasing pain and improving disability in adults with low back pain

BACKGROUND: While heat and cold therapies are often used for low back pain management, the evidence for such therapies is unclear and clinical practice guidelines have conflicting recommendations. AIM: To determine the effectiveness of superficial heat and of superficial cold therapies in decreasing nonspecific low back pain and improving disability in adults.

METHODS: Searches were undertaken within eight electronic databases. Only randomised controlled trials (RCTs) were included. Sets of two independent reviewers each applied eligibility criteria to the search output, extracted data on study design, participants and outcomes, and assessed risk of bias (using GRADE). Meta-analyses will be undertaken where possible. Summary of Findings tables were generated through RevMan Web and GradePro GDT.

RESULTS: The search identified 10,012 new articles since the last review, and 8,818 were removed as duplicates. At title and abstract 1,130 articles were screened, and 64 underwent full text screening. In total, 6 new RCTs were included and combined with 5 RCTs from the original review, 11 RCTs underwent analysis (n=1,395). The mean age of participants (from 9 trials) was 36 years. In ten trials participants had acute low back pain, with only one trial investigating chronic low back pain. Eight RCTs used heat wraps, one RCT used a heated blanket, one RCT used a heated plaster and education and rehabilitation and one RCT used a hot water bottle as the primary intervention. Outcomes of pain were heterogenous and the timing of outcomes varied, making meta-analysis of the outcomes difficult. Overall, all studies were susceptible to bias and rated as low quality.

CONCLUSION: 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. The evidence for the application of cold treatment to low-back pain and heat versus cold for low-back is even more limited, and no strong conclusions can be drawn.

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