Continuous low-level heat wrap therapy is effective for treating wrist pain1

      Abstract

      Michlovitz S, Hun L, Erasala GN, Hengehold DA, Weingand KW. Continuous low-level heat wrap therapy is effective for treating wrist pain. Arch Phys Med Rehabil 2004;85:1409–16.

      Objective

      To evaluate the efficacy of continuous low-level heat wrap therapy for the treatment of various sources of wrist pain including strain and sprain (SS), tendinosis (T), osteoarthritis (OA), and carpal tunnel syndrome (CTS).

      Design

      Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial.

      Setting

      Two community-based research facilities.

      Participants

      Ninety-three patients (age range, 18–65y) with wrist pain.

      Intervention

      Subjects with moderate or greater wrist pain were randomized and stratified to 1 of the following treatments: efficacy evaluation (heat wrap, n=39; oral placebo, n=42) or blinding (oral acetaminophen, n=6; unheated wrap, n=6). Data were recorded over 3 days of treatment and 2 days of follow-up.

      Main outcome measures

      The primary comparison was between the heat wrap and the oral placebo group among SS/T/OA subjects for pain relief. Outcome measures included pain relief (0–5 scale), joint stiffness (101-point numeric rating scale), grip strength measured by dynamometry, and perceived pain and disability (Patient Rated Wrist Evaluation [PRWE]); subjects with CTS also completed the Symptom Severity Scale and Functional Status Scale.

      Results

      Heat wrap therapy showed significant benefits in day 1 to 3 mean pain relief ( P=.045) and increased day 3 grip strength ( P=.02) versus oral placebo for the SS/T/OA group. However, joint stiffness and PRWE results were comparable between the 2 treatments. For the CTS group, heat wraps provided greater day 1 to 3/hour 0 to 8 mean pain relief ( P=.001), day 1 to 3 mean joint stiffness reduction ( P=.004), increased day 3 grip strength ( P=.003), reduced PRWE scores ( P=.0015), reduced symptom severity ( P=.001), and improved functional status ( P=.04). In addition, the heat wrap showed significant extended benefits through follow-up (day 5) in the CTS group.

      Conclusions

      Continuous low-level heat wrap therapy was efficacious for the treatment of common conditions causing wrist pain and impairment.

      Keywords

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      References

        • Kuschner S.H.
        • Lane C.S.
        Evaluation of the painful wrist.
        Am J Orthop. 1997; 26: 95-102
        • Tanaka S.
        • Wild D.K.
        • Cameron L.L.
        • Fruend E.
        Association of occupational and non-occupational risk factors with the prevalence of self-reported carpal tunnel syndrome in a national survey of the working population.
        Am J Ind Med. 1997; 32: 550-556
        • Warren N.
        • Dillon C.
        • Morse T.
        • Hall C.
        • Warren A.
        Biomechanical, psychosocial, and organizational risk factors for WRMSD.
        J Occup Health Psychol. 2000; 5: 164-181
        • Arndt R.
        Work pace, stress and cumulative trauma disorder.
        J Hand Surg [Am]. 1987; 12: 866-869
        • Webster B.S.
        • Snook S.H.
        The cost of compensable upper extremity cumulative trauma disorders.
        J Occup Med. 1994; 36: 713-717
        • Feuerstein M.
        • Miller V.L.
        • Burrell L.M.
        • Berger R.
        Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability.
        J Occup Environ Med. 1998; 40: 546-555
        • Keogh J.P.
        • Nuwayhid I.
        • Gordon J.L.
        • Gucer P.W.
        The impact of occupational injury on injured worker and family outcomes of upper extremity cumulative trauma disorders in Maryland workers.
        Am J Ind Med. 2000; 38: 498-506
        • Pransky G.
        • Benjamin K.
        • Hill-Fotouhi C.
        • et al.
        Outcomes in work-related upper extremity and low back injuries.
        Am J Ind Med. 2000; 37: 400-409
        • Nadler S.F.
        • Steiner D.J.
        • Erasala G.N.
        • et al.
        Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain.
        Spine. 2002; 27: 1012-1017
        • Nadler S.F.
        • Steiner D.J.
        • Erasala G.N.
        • Hengehold D.A.
        • Abeln S.B.
        • Weingand K.W.
        Continuous low-level heatwrap therapy for treating acute, nonspecific low back pain.
        Arch Phys Med Rehabil. 2003; 84: 329-334
        • Nadler S.F.
        • Steiner D.J.
        • Petty S.R.
        • Erasala G.N.
        • Hengehold D.A
        • Weingand K.W.
        Overnight use of continuous low-level heatwrap therapy for relief of low back pain.
        Arch Phys Med Rehabil. 2003; 84: 335-342
        • Akin M.D.
        • Weingand K.W.
        • Hengehold D.A.
        • Goodale M.B.
        • Hinkle R.T.
        • Smith R.P.
        The use of continuous topical heat in the treatment of dysmenorrhea.
        Obstetr Gynecol. 2001; 97: 343-349
        • Jordan R.
        • Carter T.
        • Cummins C.
        A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome.
        Br J Gen Pract. 2002; 52: 670-673
        • Tetro A.M.
        • Evanoff B.A.
        • Hollstien S.B.
        • Gelberman R.H.
        A new provocative test for carpal tunnel syndrome.
        J Bone Joint Surg Br. 1998; 80: 493-498
        • Levine D.W.
        • Simmons B.P.
        • Koris M.J.
        • et al.
        A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.
        J Bone Joint Surg Am. 1993; 75: 1585-1592
        • Mathiowetz V.
        • Weber K.
        • Volland G.
        • Kashman N.
        Reliability and validity of grip and pinch strength evaluations.
        J Hand Surg [Am]. 1984; 9: 222-226
        • MacDermid J.C.
        Development of a Scale for patient Rating of Wrist Pain and Disability.
        J Hand Ther. 1996; 9: 178-183
        • Cook R.J.
        • Farewell V.T.
        Multiplicity considerations in the design and analysis of clinical trials.
        J R Stat Soc A. 1997; 159: 93-110
        • US Food and Drug Administration
        Guideline for the clinical evaluation of analgesic drugs. US Department of Health and Human Services, Rockville1992 (Dec)
        • SAS Institute Inc.
        SAS/STAT software changes and enhancements through release 6.12. SAS Institute Inc, Cary (NC)1997: 247-348
        • Pederson D.M.
        • White G.L.
        • Murdock R.T.
        • Richarson G.E.
        • Trunnel E.P.
        Identifying workers risk of cumulative trauma disorders.
        J Am Acad Physician Assist. 1989; 4: 280-288
        • Williams R.
        • Westmorland M.
        Occupational cumulative trauma disorders of the upper extremity.
        Am J Occup Ther. 1994; 48: 411-420
        • Nadler S.
        • Nadler J.W.
        Cumulative trauma disorders.
        in: DeLisa J.A. Rehabilitation principles and practice. 3rd ed. Lippincott-Raven, Philadelphia1998: 1661-1676
        • Ekenvall L.
        • Gemne G.
        • Tegne R.
        Correspondence between neurological symptoms and outcome of quantitative sensory testing in hand-arm vibration syndrome.
        Br J Ind Med. 1989; 46: 570-574
        • Koskimies K.
        • Farkkila M.
        • Pyykko I.
        Carpal tunnel syndrome in vibration disease.
        Br J Ind Med. 1990; 47: 411-416
        • Lundborg G.
        • Gelberman R.H.
        • Minteer-Convery M.
        • Lee Y.F.
        • Hargens A.R.
        Median nerve compression in the carpal tunnel—functional response to experimentally induced controlled pressures.
        J Hand Surg [Am]. 1982; 7: 252-259
        • Gelberman R.H.
        • Hergenroeder P.T.
        • Hargens A.R.
        • Lundborg G.N.
        • Akeson W.H.
        The carpal tunnel syndrome.
        J Bone Joint Surg Am. 1981; 36: 380-383
        • Melzack R.
        • Wall P.D.
        Pain mechanisms—a new theory.
        Science. 1965; 150: 971-979
        • Nathan P.W.
        The gate-control theory of pain.
        Brain. 1976; 99: 23-58
        • Wall P.D.
        The gate control theory of pain mechanisms.
        Brain. 1978; 101: 1-18
        • Davis K.D.
        • Kwan C.L.
        • Crawley A.P.
        • Mikulis D.J.
        Functional MRI study of thalamic and cortical activations evoked by cutaneous heat, cold, and tactile stimuli.
        J Neurophysiol. 1998; 80: 1533-1534
        • Dumitru D.
        Electrodiagnostic medicine focal peripheral neuropathies. Hanley & Belfus, Philadelphia1994: 140-142
        • Burke D.T.
        • Burke M.M.
        • Stewart G.W.
        • Cambre A.
        Splinting for carpal tunnel syndrome.
        Arch Phys Med Rehabil. 1994; 75: 1241-1244
        • Rempel D.
        • Manojlovic R.
        • Levinsohn D.G.
        • Bloom T.
        • Gordon L.
        The effect of wearing a flexible wrist splint on carpal tunnel pressure during repetitive hand activity.
        J Hand Surg [Am]. 1994; 19: 106-110
      1. Michlovitz S.L. Thermal agents in rehabilitation. 3rd ed. Davis, Philadelphia: FA1996
        • Knight C.A.
        • Rutledge C.R.
        • Cox M.E.
        • Acosta M.
        • Hall S.J.
        Effect of superficial heat, deep heat and active exercise warm-up on the extensibility of the plantar flexors.
        Phys Ther. 2001; 81: 1206-1214
        • Wright V.
        • Johns R.J.
        Quantitative and qualitative analysis of joint stiffness in normal subjects and in patients with connective tissue diseases.
        Ann Rheum Dis. 1961; 20: 36-46