Practical Guidance on the Use of Heat Therapy for Musculoskeletal Pain in Pharmacy Practice
Main Article Content
Keywords
pharmacy, musculoskeletal pain, heat therapy, guidance, management
Abstract
Objective: Musculoskeletal pain (MSKP) is a leading cause of disability worldwide and a frequent concern for community pharmacy consultations. While superficial heat therapy (HT) is commonly recommended in clinical guidelines, practical pharmacy-specific guidance remains limited. This paper provides condition-specific recommendations and practical decision-making algorithms for the use of HT in MSKP within pharmacy practice. Methods: Recommendations were developed through two international multidisciplinary meetings that synthesized published evidence and real-world clinical experience. A structured consensus approach was used to identify patient profiles, red-flag indicators for referral, and appropriate use of HT as monotherapy or in combination with pharmacological and non-pharmacological interventions. Results: Practical algorithms tailored to pharmacy settings are presented for common MSKP scenarios including neck pain, low back pain, knee pain, and osteoarthritis. Guidance emphasizes a symptom-driven model, outlining when HT is appropriate, when combination strategies are needed, and when referral is required. Conclusions: This paper provides pharmacists with actionable, evidence-informed tools to support safe, patient-centered care in MSKP. While further research is warranted to validate these recommendations in prospective studies, these algorithms address an urgent need for practical pharmacy-based guidance in non-pharmacological pain management.
References
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7. Duggan C. Advancing the workforce to meet the Primary Health Care Agenda: pharmacy’s contribution to universal health coverage. Int J Pharm Pract. 2020;28:118 20.
8. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127:57 65.
9. Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician. 2004 Jul;7(3):395 99.
10. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284 99.
11. Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non specific neck pain: a systematic review. J Back Musculoskelet Rehabil. 2017;30:1149 69.
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14. Ventriglia G, Franco M, Magni A, Gervasoni F. Treatment algorithms for continuous low level heat wrap therapy for the management of musculoskeletal pain: an Italian position paper. J Pain Res. 2024;17:4075 4084.
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22. Phaner V, Fayolle Minon I, Lequang B, Valayer-Chaleat E, Calmels P. Are there indications (other than scoliosis) for rigid orthopaedic brace treatment in chronic, mechanical low back pain? Ann Phys Rehabil Med. 2009;52:382 93.
23. Gage BE, McIlvain NM, Collins CL, Fields SK, Comstock RD. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 2012;19:378 85.
24. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral pain syndrome. Am Fam Physician. 2019 Jan 15;99(2):88 94.
25. D’Ambrosi R, Meena A, Raj A, Ursino N, Hewett TE. Anterior Knee Pain: State of the Art. Sports Med Open. 2022;8:98.
26. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011;19(12):728 36.
27. Rossi R. Heat therapy for different knee diseases: expert opinion. Front Rehabil Sci. 2024;5:1390416.
28. McCarberg W, Erasala G, Goodale M, Grender J, Hengehold D, Donikyan L. Therapeutic benefits of continuous low level heat wrap therapy (CLHT) for osteoarthritis (OA) of the knee. J Pain. 2005;6:S53.
29. Petrofsky J, Laymon M, Alshammari F, Khowailed IA, Lee H. Continuous Low Level Heat Wraps; Faster Healing and Pain Relief during Rehabilitation for Back, Knee and Neck Injuries. World J Prev Med. 2015;3:61 72.
30. Karadağ S, Taşci S, Doğan N, Demir H, Kiliç Z. Application of heat and a home exercise program for pain and function levels in patients with knee osteoarthritis: a randomized controlled trial. Int J Nurs Pract. 2019;25:e12772.
31. Yildirim N, Filiz Ulusoy M, Bodur H. The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. J Clin Nurs. 2010;19:1113 20.
32. Öneş K, Tetik S, Tetik C, Öneş N. The effects of heat on osteoarthritis of the knee. Pain Clin. 2006;18:67 75.
33. Heiss R, Lutter C, Freiwald J, Hoppe MW, Grim C, Poettgen K, Forst R, Bloch W, Hüttel M, Hotfiel T. Advances in delayed onset muscle soreness (DOMS) – Part II: treatment and prevention. Sportverletz Sportschaden. 2019;33:21 29.
34. Hotfiel T, Freiwald J, Hoppe MW, Lutter C, Forst R, Grim C, Bloch W, Hüttel M, Heiss R. Advances in delayed onset muscle soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletz Sportschaden. 2018;32:243 50.
35. Connolly DA, Sayers SP, McHugh MP. Treatment and prevention of delayed onset muscle soreness. J Strength Cond Res. 2003;17:197 208.
36. Mayer JM, Mooney V, Matheson LN, Erasala GN, Verna JL, Udermann BE, Leggett S. Continuous low level heat wrap therapy for the prevention and early phase treatment of delayed onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87:1310 17.
37. Charlesworth J, Fitzpatrick J, Perera NKP, Orchard J. Osteoarthritis – A systematic review of long term safety implications for osteoarthritis of the knee. BMC Musculoskelet Disord. 2019;20:151.
38. Fu K, Robbins SR, McDougall JJ. Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2018;57(suppl_4):iv43 iv50.
39. Hunter DJ, Bierma Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745 59.
40. Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PFM, Lin I. Core recommendations for osteoarthritis care: a systematic review of clinical practice guidelines. Arthritis Care Res (Hoboken). 2023;75:1897 1900.
41. Moseng T, Vliet Vlieland TPM, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, Costa D, Doherty M, Finney AG, Georgiev T, Gobbo M, Kennedy N, Kjeken I, Kroon FPB, Lohmander LS, Lund H, Mallen CD, Pavelka K, Pitsillidou IA, Rayman MP, Tveter AT, Vriezekolk JE, Wiek D, Zanoli G, Østerås N. EULAR recommendations for the non pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis. 2024;83:730 40.
42. Kim H, Suzuki T, Saito K, Kim M, Kojima N, Ishizaki T, Yamashiro Y, Hosoi E, Yoshida H. Effectiveness of exercise with or without thermal therapy for community dwelling elderly Japanese women with non specific knee pain: a randomized controlled trial. Arch Gerontol Geriatr. 2013;57:352 59.
2. World Health Organization. Musculoskeletal conditions: fact sheet [Internet]. Geneva: WHO; [cited 2025 Mar 18].
3. Puntillo F, Giglio M, Paladini A, Perchiazzi G, Viswanath O, Urits I, Sabbà C, Varrassi G, Brienza N. Pathophysiology of musculoskeletal pain: a narrative review. Ther Adv Musculoskelet Dis. 2021;13:1759720X21995067.
4. Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014;69:119 30.
5. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72:220 33.
6. Murphy L, Ng K, Isaac P, Swidrovich J, Zhang M, Sproule BA. The role of the pharmacist in the care of patients with chronic pain. Integr Pharm Res Pract. 2021;10:33 41.
7. Duggan C. Advancing the workforce to meet the Primary Health Care Agenda: pharmacy’s contribution to universal health coverage. Int J Pharm Pract. 2020;28:118 20.
8. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127:57 65.
9. Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician. 2004 Jul;7(3):395 99.
10. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284 99.
11. Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non specific neck pain: a systematic review. J Back Musculoskelet Rehabil. 2017;30:1149 69.
12. Versus Arthritis. Neck pain exercise sheet [Internet]. [cited 2025 Mar 18].
13. Lubrano E, Mazas PF, Freiwald J, Krüger K, Grattagliano I, Mur E, Silva RQ, Maruri GR, de Medeiros LS. An international multidisciplinary Delphi based consensus on heat therapy in musculoskeletal pain. Pain Ther. 2023;12(1):93 110.
14. Ventriglia G, Franco M, Magni A, Gervasoni F. Treatment algorithms for continuous low level heat wrap therapy for the management of musculoskeletal pain: an Italian position paper. J Pain Res. 2024;17:4075 4084.
15. Maher C, Underwood M, Buchbinder R. Non specific low back pain. Lancet. 2017;389:736 47.
16. Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC Musculoskelet Disord. 2024;25:344.
17. Versus Arthritis. Low back pain exercise sheet [Internet]. [cited 2025 Mar 18].
18. Freiwald J, Hoppe MW, Beermann W, Krajewski J, Baumgart C. Effects of supplemental heat therapy in multimodal treated chronic low back pain patients on strength and flexibility. Clin Biomech (Bristol). 2018;57:107 13.
19. Cashin AG, Wand BM, O’Connell NE, Lee H, Rizzo RR, Bagg MK, O’Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2023;4:CD013815.pub2.
20. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27:2791 803.
21. Freiwald J, Magni A, Fanlo Mazas P, Paulino E, Sequeira de Medeiros L, Moretti B, Schleip R, Solarino G. A role for superficial heat therapy in the management of non specific, mild to moderate low back pain in current clinical practice: a narrative review. Life (Basel). 2021;11:780.
22. Phaner V, Fayolle Minon I, Lequang B, Valayer-Chaleat E, Calmels P. Are there indications (other than scoliosis) for rigid orthopaedic brace treatment in chronic, mechanical low back pain? Ann Phys Rehabil Med. 2009;52:382 93.
23. Gage BE, McIlvain NM, Collins CL, Fields SK, Comstock RD. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 2012;19:378 85.
24. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral pain syndrome. Am Fam Physician. 2019 Jan 15;99(2):88 94.
25. D’Ambrosi R, Meena A, Raj A, Ursino N, Hewett TE. Anterior Knee Pain: State of the Art. Sports Med Open. 2022;8:98.
26. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011;19(12):728 36.
27. Rossi R. Heat therapy for different knee diseases: expert opinion. Front Rehabil Sci. 2024;5:1390416.
28. McCarberg W, Erasala G, Goodale M, Grender J, Hengehold D, Donikyan L. Therapeutic benefits of continuous low level heat wrap therapy (CLHT) for osteoarthritis (OA) of the knee. J Pain. 2005;6:S53.
29. Petrofsky J, Laymon M, Alshammari F, Khowailed IA, Lee H. Continuous Low Level Heat Wraps; Faster Healing and Pain Relief during Rehabilitation for Back, Knee and Neck Injuries. World J Prev Med. 2015;3:61 72.
30. Karadağ S, Taşci S, Doğan N, Demir H, Kiliç Z. Application of heat and a home exercise program for pain and function levels in patients with knee osteoarthritis: a randomized controlled trial. Int J Nurs Pract. 2019;25:e12772.
31. Yildirim N, Filiz Ulusoy M, Bodur H. The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. J Clin Nurs. 2010;19:1113 20.
32. Öneş K, Tetik S, Tetik C, Öneş N. The effects of heat on osteoarthritis of the knee. Pain Clin. 2006;18:67 75.
33. Heiss R, Lutter C, Freiwald J, Hoppe MW, Grim C, Poettgen K, Forst R, Bloch W, Hüttel M, Hotfiel T. Advances in delayed onset muscle soreness (DOMS) – Part II: treatment and prevention. Sportverletz Sportschaden. 2019;33:21 29.
34. Hotfiel T, Freiwald J, Hoppe MW, Lutter C, Forst R, Grim C, Bloch W, Hüttel M, Heiss R. Advances in delayed onset muscle soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletz Sportschaden. 2018;32:243 50.
35. Connolly DA, Sayers SP, McHugh MP. Treatment and prevention of delayed onset muscle soreness. J Strength Cond Res. 2003;17:197 208.
36. Mayer JM, Mooney V, Matheson LN, Erasala GN, Verna JL, Udermann BE, Leggett S. Continuous low level heat wrap therapy for the prevention and early phase treatment of delayed onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87:1310 17.
37. Charlesworth J, Fitzpatrick J, Perera NKP, Orchard J. Osteoarthritis – A systematic review of long term safety implications for osteoarthritis of the knee. BMC Musculoskelet Disord. 2019;20:151.
38. Fu K, Robbins SR, McDougall JJ. Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2018;57(suppl_4):iv43 iv50.
39. Hunter DJ, Bierma Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745 59.
40. Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PFM, Lin I. Core recommendations for osteoarthritis care: a systematic review of clinical practice guidelines. Arthritis Care Res (Hoboken). 2023;75:1897 1900.
41. Moseng T, Vliet Vlieland TPM, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, Costa D, Doherty M, Finney AG, Georgiev T, Gobbo M, Kennedy N, Kjeken I, Kroon FPB, Lohmander LS, Lund H, Mallen CD, Pavelka K, Pitsillidou IA, Rayman MP, Tveter AT, Vriezekolk JE, Wiek D, Zanoli G, Østerås N. EULAR recommendations for the non pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis. 2024;83:730 40.
42. Kim H, Suzuki T, Saito K, Kim M, Kojima N, Ishizaki T, Yamashiro Y, Hosoi E, Yoshida H. Effectiveness of exercise with or without thermal therapy for community dwelling elderly Japanese women with non specific knee pain: a randomized controlled trial. Arch Gerontol Geriatr. 2013;57:352 59.
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Jun 20, 2026
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Practical Guidance on the Use of Heat Therapy for Musculoskeletal Pain in Pharmacy Practice. Pharm Pract (Granada) [Internet]. 2026 Jun. 20 [cited 2026 Jun. 21];24(2):1-10. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3525
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How to Cite
1.
Practical Guidance on the Use of Heat Therapy for Musculoskeletal Pain in Pharmacy Practice. Pharm Pract (Granada) [Internet]. 2026 Jun. 20 [cited 2026 Jun. 21];24(2):1-10. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3525