Practical guidance on the use of heat therapy for musculoskeletal pain in pharmacy practice

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.