Thermotherapy

Published on 22/05/2015 by admin

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Last modified 22/04/2025

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Chapter 47 Thermotherapy

(Includes Hot Packs, Paraffin Wax, Infrared Lamps)

OVERVIEW.

Thermotherapy comprises a number of physical agents that use superficial heat to increase soft tissue extensibility, reduce pain, improve circulation, and accelerate healing. Thermal therapy is believed to accomplish these goals by increasing blood flow (vasodilation), reducing alpha motor neuron firing rate, increasing pain threshold (gating effect; reduced ischemia), and increasing metabolic activity (increasing the availability of oxygen to tissue).¹ Note: Because thermotherapy produces heat, the tissue needs to be capable to dissipating the heat via adequate blood circulation, and the patient must be capable of informing the clinician (or escaping) if the modality gets too hot.

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Six sources cited a total of 31 concerns for thermotherapy. Concerns ranged from 8 to 18 per source, with a physician citing the largest number. The largest proportion of concerns related to the skin, procedural, and circulatory issues. The most frequently cited concerns were malignancy, hemorrhaging, impaired mentation or sensation, and acute inflammation.

OTHER ISSUES: POSSIBLE PROCEDURAL IRREGULARITIES CONTRIBUTING TO COMPLICATIONS.

(1) Monitoring insulation: In a 1996 California lawsuit,² a 13-year-old girl received a $175,000 arbitration award after she sustained a third-degree arm burn from a hot pack that was inadequately insulated and not periodically monitored. (2) Monitoring excessive treatment: Waldorf et al³ reported on a 46-year-old woman who developed erythema ab igne (hyperpigmentation) from using an electric heating pad 12 hours a day for about 6 weeks. (3) Monitoring paraffin temperatures: The FDA⁴ reports14 incidences of paraffin wax device problems from September 1992 to January 2003. Of these, 10 reports were of wax becoming too hot. Five cases led to hand burns.

PROCEDURAL CONCERNS

Paraffin Wax

ADVERSE EVENTS

FDA ⁴ REPORTS FOR PARAFFIN BATH

14 Reports from 9/18/92 to 1/9/03

Date	Event
1/9/03	The bath overheated.
12/13/02	The drain heater coil overheated and the unit smoked.
4/18/02	The bath temperature was not regulated; a replacement thermostat corrected the problem.
4/3/02	Paraffin wax leaked onto the carpet.
1/13/98	The bath had a faulty thermostat; the wax reached a flash point and then caught fire. The incident was replicated by a biomedical department.
3/14/97	The bath provided insufficient heat.
4/02/02	The bath’s temperature fluctuated from low to high.
2/28/01	The paraffin wax surface was too hot.
2/13/01	A wax burn was reported (minor hand burn).
2/6/01	A patient complained the wax was too hot and sustained a second-degree burn to the fingers. The device temperature read 155°. The PTA noticed that the machine switch had been switched to Start instead of Operate.
7/29/98	An individual sustained a second-degree burn on the left hand after using the device in hospital. The wound took 3 to 4 weeks to heal.
12/29/95	During therapy, a patient’s right hand was dipped in paraffin and wrapped for 15 minutes. The next day, the patient returned with a dime-size blister that appeared to be a burn on the right finger.
2/15/95	The unit got too hot, and then not hot enough.
9/18/92	The temperature of the wax varied from one area of the unit to another.

Note: FDA reports do not necessarily establish cause-effect relationships between equipment and injury. Incidences may be due to equipment or user error. Also, some reports are alleged by attorneys.