Pain treatment with heat

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Heat provides temporary relief in subacute and chronic traumatic and inflammatory conditions (eg, sprains, strains, fibrositis, tenosynovitis, muscle spasm, myositis, painful back, whiplash injuries, various forms of arthritis, arthralgia, neuralgia). Heat increases blood flow and the extensibility of connective tissue; decreases joint stiffness, pain, and muscle spasm; and helps resolve inflammation, edema, and exudates. Heat application may be superficial or deep. The intensity and duration of the physiologic effects are determined mainly by tissue temperature, the rate of temperature elevation, and the area treated.

Infrared heat is applied with a lamp, usually for 20 min/day. Contraindications include advanced heart disease, peripheral vascular disease, impaired skin sensation (particularly to temperature and pain), and significant hepatic or renal insufficiency. Precautions must be taken to avoid burns.

Hot packs are cotton cloth containers filled with silicate gel that are boiled in water, cooled, and applied to the skin. Wrapping the packs in several layers of towels helps protect the skin from burns. Contraindications are the same as for infrared heat.

A paraffin bath is used to apply melted wax heated to 49° C (120° F). The method of application is dipping, immersing, and painting. The heat can be retained by wrapping the affected area with terry cloth for 20 min. A hand is easy to dip or immerse, whereas a knee or elbow is best treated by painting. Paraffin is usually applied to small joints; it should not be used on open wounds or on persons allergic to paraffin.

Hydrotherapy may be used to enhance wound healing or to apply heat. Agitated warm water stimulates blood flow and debrides wounds. This treatment is often given in a Hubbard tank (a large industrial whirlpool) at 35.5 to 37.7° C (96 to 100° F). Total immersion at temperatures of 37.7 to 40° C (100 to 104° F) may also help relax muscles and relieve pain. Hydrotherapy is particularly useful in conjunction with range-of-motion exercises. It has no contraindications. However, patients may become fatigued during treatment, and BP may fall.

Short wave diathermy is the therapeutic application of high-frequency currents; it uses radiofrequency electromagnetic fields for therapeutic heating of tissues. For application, it uses capacitor plates or inductive coil applicators. Short wave diathermy appears to be less efficacious than previously thought; however, it is sometimes used to treat the pain of urinary calculi, pelvic infections, and acute and chronic sinusitis. Contraindications include malignancy, hemorrhagic conditions, peripheral vascular disease, loss of sensation, and nonremovable prostheses, pacemakers, or electrophysiologic braces. (Caution: Short wave diathermy cannot be used in people with metal implants.)

Microwave diathermy is simpler to apply and more comfortable than short wave diathermy and has more accurate output measurement. Microwaves are a form of electromagnetic radiation. Microwave diathermy is a form of heat therapy. A direct-contact applicator, 915-MHz microwave diathermy apparatus heats muscles uniformly. It provides deeper heat without undue heating of the skin, because microwaves are selectively absorbed in tissues with high water content (eg, muscles). Indications and contraindications are the same as for short wave diathermy.

Ultrasound uses high-frequency sound waves to penetrate deep into the tissue (4 to 10 cm), providing thermal, mechanical, chemical, and biologic effects. Indications for ultrasound treatment are listed in Table 291-3. Ultrasound should not be used to treat ischemic tissue, hemorrhagic diathesis, malignancies, anesthetized areas, or areas of acute infection. Also, it should not be used over the eyes, brain, spinal cord, ears, heart, reproductive organs, brachial plexus, or healing bones.


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