Musculoskeletal Pain Management and Thermotherapy: An Exploratory Analysis of Italian Physicians’ Attitude, Beliefs, and Prescribing Habits

Abstract

Purpose

In Italy, musculoskeletal (MSK) disorders are pervasive with one-third of adults seeking medical consultation for a MSK issue in the past year. MSK pain is often treated with local heat applications (LHAs) which can be integrated into MSK care by different specialists and in different settings. Compared to analgesia and physical exercise, LHAs have been less evaluated, and the quality of randomized clinical trials is generally low. The aim of the survey is to assess the knowledge, attitude, perception/practices of general practitioners (GPs), physiatrists and sports medicine doctors towards thermotherapy as delivered by superficial heat pads or wraps.

Patients and Methods

The survey was conducted between June and September 2022 in Italy. An online questionnaire with 22 multiple-choice questions was administered to explore the demographics and prescribing habits of the participants; the clinical profile of MSK patients; and physicians’ attitude and beliefs about the use of thermotherapy/superficial heat applications in MSK pain management.

Results

GPs are at the forefront of the MSK patient journey and preferentially select NSAIDs as first-line option in arthrosis, muscle stiffness, and strain while prescribing heat wraps as preferred choice in presence of muscle spasm/contracture. Similar pattern of prescribing habits was found among specialists who, in contrast to GPs, adopted more frequently ice/cold therapy to relieve pain due to muscle strain and limited paracetamol use. Generally, survey participants agreed on the benefits of thermotherapy in MSK care management, namely increased blood flow and local tissue metabolism as well as connective tissue elasticity and pain relief which all may be of help in attaining pain control and improvement of function.

Conclusion

Our findings provided the basis for further investigations aimed at optimizing the MSK patient journey while building up additional evidence supporting the benefit of using superficial heat applications to effectively manage patients with MSK disorders.

Keywords:

• musculoskeletal disorder
• superficial heat therapy
• general practitioner
• heat pads
• heat wraps

Acknowledgments

Writing and editing assistance, including preparation of a draft manuscript under the direction and guidance of the authors, incorporation of author feedback, and manuscript submission, was provided by EDRA, with the helpful support of Chiara Degirolamo, PhD, and supported by an unconditioned grant from Angelini Pharma.

Disclosure

Dr Fabrizio Gervasoni reports personal fees from Edra S.p.A., during the conduct of the study; personal fees, non-financial support from Edi Ermes, personal fees from Angelini Holding S.p.A., personal fees, non-financial support from Springer Healthcare Italia S.r.l., personal fees from Sanofi, personal fees from Bookia s.r.l., personal fees from Agence Compact, personal fees, non-financial support from Affidabile Formazione Continua S.r.l., personal fees from Edra S.p.A., personal fees from Dynamicom Education s.r.l., personal fees from Ibsa, personal fees from AlfaSigma, personal fees from Carocci Editore S.p.A., personal fees from Aretré S.r.l., personal fees from GlaxoSmithKline Consumer Healthcare S.r.l. Unipersonale, personal fees from SUMMEET S.r.l., personal fees from DOCEO ECM Educazione continua in Medicina S.r.l., personal fees from H-FARM S.p.A., personal fees from Mast&r S.r.l., personal fees from Ma.CRO Lifescience S.r.l., personal fees from SIMFER - Società Italiana di Medicina Fisica e Riabilitativa, personal fees from Italfarmaco, personal fees, non-financial support from I-TECH Medical Division (I.A.C.E.R.), personal fees, non-financial support from Podartis, grants from Società Aziende Chimiche Riunite Angelini Francesco A.C.R.A.F. S.p.A., outside the submitted work; Dr Massimiliano Franco reports grants from edra, outside the submitted work. Dr Alberto Magni reports grants from Pfizer, grants from Grunenthal, grants from MSD, grants from Mundipharma, grants from Angelini, outside the submitted work. This work was carried out thanks to an unconditioned grant from Angelini Pharma. The authors report no other conflicts of interest in this work.