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      Properties of Thermal Analgesia in a Human Chronic Low Back Pain Model

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          For years, heat has been used for comfort and analgesia is recommended as a first-line therapy in many clinical guidelines. Yet, there are questions that remain about the actual effectiveness of heat for a condition as common as chronic low back pain, and factors such as time of onset, optimal temperature, and duration of effect.

          Materials and Methods

          A randomized double-blinded controlled trial was designed to compare the analgesic response to heat delivered via pulses at 45°C (experimental group, N=49) to steady heat at 37°C (control group, N=51) in subjects with longstanding low back pain. Treatment lasted 30 minutes with follow-up out to four hours. The hypothesis was that the experimental group would experience a higher degree of analgesia compared to the control group. Time of onset and duration of effect were also measured.


          Both groups were similar in average duration of pain (10.3 years). The primary outcome measure was pain reduction at 30 minutes after the end of treatment, using a 10-points numeric pain scale. Reduction in pain was greater for the experimental group than the control group (difference in mean reduction = 0.72, 95% CI 0.15–1.29, p = 0.014). Statistically significant differences in pain levels were observed from the first measure at 5 minutes of treatment through 120 minutes after completion of treatment. Reduction in pain associated movement was greater in the active heat group than the placebo group (p = 0.04).


          High-level pulsed heat (45°C) produced significantly more analgesia as compared to steady heat at 37°C at the primary end point and for an additional 2 hours after treatment. The onset of analgesia was rapid, <5 minutes of treatment. The results of this trial provide insight into the mechanisms and properties of thermal analgesia that are not well understood in a chronic low back pain model.

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          Most cited references 28

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          Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline.

          A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available.
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            Opioids for Chronic Noncancer Pain

            Harms and benefits of opioids for chronic noncancer pain remain unclear.
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              Opioids compared to placebo or other treatments for chronic low-back pain.

              The use of opioids in the long-term management of chronic low-back pain (CLBP) has increased dramatically. Despite this trend, the benefits and risks of these medications remain unclear. This review is an update of a Cochrane review first published in 2007.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                13 August 2020
                : 13
                : 2083-2092
                [1 ]Soovu Labs Inc ., Seattle, WA, USA
                [2 ]Department of Health Services, University of Washington , Seattle, WA, USA
                [3 ]Northern California Research , Sacramento, CA, USA
                [4 ]Biology Department, University of Washington , Seattle, WA, USA
                Author notes
                Correspondence: Charles Chabal Soovu Labs Inc ., Seattle, WA, USATel +1 206-579-4910 Email Chuck@Soovu.com
                © 2020 Chabal et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 3, References: 35, Pages: 10
                Original Research

                Anesthesiology & Pain management

                thermal analgesia, heat, chronic low back pain


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