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Hussein AT, El-Khalifa HN, Mohamed ADA, Taju W. Effect of low-level laser therapy on pain reduction in orthodontic patients during molar distalization: A randomized controlled trial. Saudi Dent J 2024; 36:334-339. [PMID: 38420010 PMCID: PMC10897591 DOI: 10.1016/j.sdentj.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 03/02/2024] Open
Abstract
Aim To investigate the effects of low-level laser therapy (LLLT) on pain reduction in orthodontic patients during molar distalization. Materials and methods Twenty patients requiring bilateral maxillary first molar distalization were randomly assigned to two groups: the intervention group (mean age 15.61 ± 1.03 years) received multiple LLLT after every activation of the distalizing appliance (immediately and on the 3rd, 7th, and 14th days) and the control group (mean age 15.64 ± 1.08 years) who did not receive LLLT. Patients reported pain levels every day for 7 days following activation of the appliance using an 11-point numeric rating scale (NRS), then the pain experience of both the intervention and control groups was compared using Mann-Whitney U test. Results The mean pain scores on the 1st day were higher in the intervention group (9.27 ± 1.01) compared to that of the control group (8.80 ± 1.03). However, the mean pain scores of the intervention group (6.55 ± 1.29, 4.00 ± 1.26, 2.55 ± 1.29, 0.91 ± 1.04, 0.00 ± 0.00 and 0.00 ± 0.00, respectively) were lower than the control group (7.40 ± 1.90, 5.60 ± 2.07, 4.20 ± 1.99, 2.80 ± 1.93, 1.60 ± 1.58 and 0.40 ± 0.84, respectively) from the 2nd to the 7th day. All the differences were not statistically significant except on the 6th day (P-value = 0.003). The peak pain level was experienced by both groups on the 1st day, followed by a statistically significant gradual decrease in pain levels. Patients in the intervention group reported a shorter overall duration of pain. Conclusion Although LLLT, with the used parameters, reduced the overall duration of pain experience following maxillary first molar distalization, it was not effective during peak pain levels.
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Affiliation(s)
- Ahmed Talaat Hussein
- Department of Orthodontics, Faculty of Dental Medicine (Boys), Al-Azhar University, Cairo 11751, Egypt
| | - Hussein Nassef El-Khalifa
- Department of Orthodontics, Faculty of Dental Medicine (Boys), Al-Azhar University, Cairo 11751, Egypt
| | - Al-Dany Atwa Mohamed
- Department of Orthodontics, Faculty of Dental Medicine (Boys), Al-Azhar University, Cairo 11751, Egypt
| | - Waleed Taju
- Preventive Dentistry Department, Faculty of Dentistry, Umm Al-Qura University, P.O. BOX: 14405, 21955 Makkah, Saudi Arabia
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Soares Fonseca L, Pereira Silva J, Bastos Souza M, Gabrich Moraes Campos M, de Oliveira Mascarenhas R, de Jesus Silva H, Souza Máximo Pereira L, Xavier Oliveira M, Cunha Oliveira V. Effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain: a systematic review with meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3245-3271. [PMID: 37464184 DOI: 10.1007/s00586-023-07857-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND PURPOSE The aim of the present systematic review was to investigate the effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain. METHODS Searches were conducted in the MEDLINE, COCHRANE LIBRARY, EMBASE, AMED, PSYCINFO, and PEDRO databases up to 2022. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 tool. Estimated mean differences and respective 95% confidence intervals were presented for each paired comparison and the strength of the current evidence was assessed using the GRADE approach. RESULTS AND DISCUSSION Thirty-one original trials involving 2120 participants were included. All outcomes were self-rated. Pain intensity was measured using the Visual Analogue Scale or Numerical Rating Scale. Disability was evaluated using the Roland Morris Disability Questionnaire, Oswestry Disability Index or Hannover Functional Ability Questionnaire. Short-term: Moderate quality of evidence that mindfulness reduces disability compared to patient education (mean difference [MD] = - 1.38 [95% CI - 2.02 to - 0.73]); low-quality evidence that mixed exercise (MD = - 50.33 [95% CI - 57.11 to - 43.56]) reduces pain compared to no intervention, waiting list, placebo or sham; low quality of evidence that there is no effect for opioid compared to placebo (MD = - 8.26 [95% CI - 19.29 to 2.77]) with regards to reducing pain and opioid/acetaminophen reduces disability more compared to pregabalin (MD = 2.36 [95% CI] 1.86-2.86]). CONCLUSIONS The findings showed low or very low quality of evidence for non-pharmacological interventions with a large effect in short- and long-term follow-up. The two studies that provided moderate quality of evidence had a small clinical effect. Only two studies were found that investigated pharmacological therapies-both with low quality of evidence. However, the studies were methodologically weak and had small sample sizes. Given the adverse effects of low back pain and the scarce information on the effectiveness of pharmacological and non-pharmacological treatments for older people, future randomized trials should be encouraged.
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Affiliation(s)
- Letícia Soares Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil.
| | - Juliana Pereira Silva
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | | | - Rodrigo de Oliveira Mascarenhas
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Hytalo de Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Vinicius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
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ÖTEN E. The efficacy of ultrasound and low-intensity laser therapy in carpal tunnel syndrome. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1054837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Guimarães LDS, Costa LDCM, Araujo AC, Nascimento DP, Medeiros FC, Avanzi MA, Leal-Junior ECP, Costa LOP, Tomazoni SS. Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Pain 2021; 162:1612-1620. [PMID: 33449509 DOI: 10.1097/j.pain.0000000000002189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Photobiomodulation therapy (PBMT) has been used in several musculoskeletal disorders to reduce pain, inflammation, and promoting tissue regeneration. The current evidence about the effects of PBMT on low back pain (LBP) is still conflicting. We aimed to evaluate the effects of PBMT against placebo on pain intensity and disability in patients with chronic nonspecific LBP. This was a prospectively registered, randomised placebo-controlled trial, with blinded patients, therapists, and assessors. The study was conducted on an outpatient physical therapy clinic in Brazil, between April 2017 and May 2019. A total of 148 patients with chronic nonspecific LBP were randomised to either active PBMT (n = 74) or placebo (n = 74). Patients from both groups received 12 treatment sessions, 3 times a week, for 4 weeks. Patients from both groups also received an educational booklet based on "The Back Book." Clinical outcomes were measured at baseline and at follow-up appointments at 4 weeks, 3, 6, and 12 months after randomisation. The primary outcomes were pain intensity and disability measured at 4 weeks. We estimated the treatment effects using linear mixed models following the principles of intention-to-treat. There was no clinical important between-group differences in terms of pain intensity (mean difference = 0.01 point; 95% confidence interval = -0.94 to 0.96) and disability (mean difference = -0.63 points; 95% confidence interval = -2.23 to 0.97) at 4 weeks. Patients did not report any adverse events. Photobiomodulation therapy was not better than placebo to reduce pain and disability in patients with chronic nonspecific LBP.
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Affiliation(s)
- Layana de Souza Guimarães
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Amanda Costa Araujo
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Dafne Port Nascimento
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Flávia Cordeiro Medeiros
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Marina Athayde Avanzi
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Ernesto Cesar Pinto Leal-Junior
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Post-graduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
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Effective Low-Level Laser Therapy Including Laser Acupuncture Treatment Conditions for Non-Specific Chronic Low Back Pain: Systematic Review and Meta-Analysis. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2020.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Low-level laser therapy including laser acupuncture has been widely used for non-specific chronic low back pain in primary Korean medical clinics. However, there is no critically appraised data regarding which treatment conditions are most effective. A systematic review and meta-analysis was conducted to determine effective treatment conditions using 12 databases (PubMed, Ovid, CENTRAL, KoreaMed, KMBASE, KISS, NDSL, KISTI, OASIS, CNKI, CiNII, and J-STAGE). There were 1,019 studies retrieved and 13 studies included in this review. It was determined that when the power output was ≥ 50 mW, the beam size was increased to ≥ 1 cm2, the energy dose was increased to ≥ 4 J per point, the treatment interval was increased to ≥ 3 times a week, and the number of treatment sessions was increased to ≥ 10 treatments, these conditions appeared to increased treatment effectiveness.
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Low-Level Laser Therapy including Laser Acupuncture for Non-Specific Chronic Low Back Pain: Systematic Review and Meta-Analysis. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2020.00283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Low-level laser therapy including laser acupuncture (LLLT/LA) has been widely used for non-specific chronic low back pain (NCLBP). However, there is no critically appraised evidence of its potential benefits. This study aimed to evaluate the effectiveness of LLLT/LA for NCLBP. There were 12 databases (MEDLINE, CENTRAL, EMBASE, KoreaMed, KMBASE, KISS, NDSL, KISTI, OASIS, CNKI, CiNII, J-stage) searched for randomized controlled trials using LLLT/LA for NCLBP up until June 2019. The primary outcome was pain intensity and functional status/disability due to NCLBP. A random-effects meta-analysis was conducted on 20 studies involving 1,323 participants. LLLT/LA showed a significant positive effect on pain relief scores compared with sham treatments (SMD -0.51, 95% CI: -0.88 to -0.13; χ<sup>2</sup> = 31.12, I<sup>2</sup> = 74%). Alone, the therapy showed a significant positive effect on function/disability scores (30 participants, MD -11.90, 95% CI: -17.37 to -6.43). As an add-on treatment, it showed a significant positive effect on pain relief (80 participants, MD -5.10, 95% CI: -9.31 to -0.88; χ<sup>2</sup> = 28.99, I<sup>2</sup> = 97%) and improved function/disability scores (120 participants, MD 5.44, 95% CI: 2.19 to 8.68; χ<sup>2</sup> = 4.07, I<sup>2</sup> = 75%). Among 20 studies, 9 studies reported no adverse events and 1 study reported mild adverse events. LLLT/LA may be an alternative or add-on treatment for NCLBP.
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Amaral LK, Souza MB, Campos MG, Mendonça VA, Bastone A, Pereira LS, Mascarenhas RO, Oliveira VC. Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations. Arch Gerontol Geriatr 2020; 90:104177. [DOI: 10.1016/j.archger.2020.104177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/04/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022]
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Tomazoni SS, Almeida MO, Bjordal JM, Stausholm MB, Machado CDSM, Leal-Junior ECP, Costa LOP. Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review. J Physiother 2020; 66:155-165. [PMID: 32680739 DOI: 10.1016/j.jphys.2020.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/15/2019] [Accepted: 06/23/2020] [Indexed: 01/24/2023] Open
Abstract
QUESTION In people with non-specific low back pain (LBP), what are the effects of photobiomodulation therapy (PBMT) on pain, disability and other outcomes when compared with no intervention, sham PBMT and other treatments, and when used as an adjunct to other treatments? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS People with acute/subacute or chronic non-specific LBP. INTERVENTIONS Any type of PBMT (laser class I, II and III and light-emitting diodes) compared with no treatment, sham PBMT and other types of treatment, or used as an adjunct to another treatment. OUTCOME MEASURES Pain intensity, disability, overall improvement, quality of life, work absence and adverse effects. RESULTS Twelve randomised controlled trials were included (pooled n = 1,046). Most trials had low risk of bias. Compared with sham PBMT, the effect of PBMT on pain and disability was clinically unimportant in people with acute/subacute or chronic LBP. In people with chronic LBP, there was no clinically important difference between the effect of PBMT and the effect of exercise on pain or disability. Although benefits were observed on some other outcomes, these estimates were imprecise and/or based on low-quality evidence. PBMT was estimated to reduce pain (MD -11.20, 95% CI -20.92 to -1.48) and disability (MD -11.90, 95% CI -17.37 to -6.43) more than ultrasound, but these confidence intervals showed important uncertainty about whether the differences in effect were worthwhile or trivial. Conversely, PBMT was estimated to reduce pain (MD 19.00, 95% CI 9.49 to 28.51) and disability (MD 17.40, 95% CI 8.60 to 26.20) less than Tecar (Energy Transfer Capacitive and Resistive) therapy, with marginal uncertainty that these differences in effect were worthwhile. CONCLUSION Current evidence does not support the use of PBMT to decrease pain and disability in people with non-specific LBP. REGISTRATION CRD42018088242.
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Affiliation(s)
- Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Matheus Oliveira Almeida
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Jan Magnus Bjordal
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Martin Bjørn Stausholm
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Caroline Dos Santos Monteiro Machado
- Laboratory of Phototherapy and Innovative Technologies in Health, Nove de Julho University, São Paulo, Brazil; Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Ernesto Cesar Pinto Leal-Junior
- Laboratory of Phototherapy and Innovative Technologies in Health, Nove de Julho University, São Paulo, Brazil; Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
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Nascimento PRD, Costa LO, Araujo AC, Poitras S, Bilodeau M. Effectiveness of interventions for non-specific low back pain in older adults. A systematic review and meta-analysis. Physiotherapy 2019; 105:147-162. [DOI: 10.1016/j.physio.2018.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
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Tomazoni SS, Costa LOP, Joensen J, Stausholm MB, Naterstad IF, Leal-Junior ECP, Bjordal JM. Effects of photobiomodulation therapy on inflammatory mediators in patients with chronic non-specific low back pain: Protocol for a randomized placebo-controlled trial. Medicine (Baltimore) 2019; 98:e15177. [PMID: 30985704 PMCID: PMC6485775 DOI: 10.1097/md.0000000000015177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is ranked as one of the most prevalent health conditions. It is likely that some inflammatory mediators could be associated with pain and disability in these patients. Photobiomodulation therapy (PBMT) is a non-pharmacological therapy often used in patients with LBP and one of the possible mechanisms of action of therapy is modulate inflammatory mediators. However, to date there are no studies that evaluated the effects of PBMT on the levels of inflammatory mediators in patients with LBP. The aim of this study is to evaluate the acute effects of PBMT on systemic levels of inflammatory mediators and pain intensity in patients with chronic non-specific low back pain. METHODS AND ANALYSIS This is a prospectively registered, two-arm randomized placebo-controlled trial with blinded patients, assessors and therapists. Eighteen patients with chronic non-specific LBP will be randomized into 2 groups: placebo or active PBMT. The treatment will be provided in a single session. The primary outcome will be levels of prostaglandin E2 (PGE2). The secondary outcomes will be levels of necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and pain intensity. Biochemical and clinical outcomes will be measured at baseline and 15 minutes after the single treatment session. DISCUSSION Despite PBMT be used in musculoskeletal disorders such as LBP, to the best of our knowledge this is the first study that will investigate a possible biological mechanism behind the positive clinical effects of PBMT on non-specific chronic low back pain. ETHICS AND DISSEMINATION The study was approved by the Regional Research Ethics Committee. The results will be disseminated through publication in peer-reviewed international journal and conferences. TRIAL REGISTRATION NUMBER NCT03859505.
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Affiliation(s)
- Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Jon Joensen
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Martin Bjørn Stausholm
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingvill Fjell Naterstad
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ernesto Cesar Pinto Leal-Junior
- Laboratory of Phototherapy and Innovative Technologies in Health, Nove de Julho University
- Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Jan Magnus Bjordal
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Koldaş Doğan Ş, Ay S, Evcik D. The effects of two different low level laser therapies in the treatment of patients with chronic low back pain: A double-blinded randomized clinical trial. J Back Musculoskelet Rehabil 2017; 30:235-240. [PMID: 27472858 DOI: 10.3233/bmr-160739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of two different laser therapy regimens on pain, lumbar range of motions (ROM) and functional capacity in patients with chronic low back pain (CLBP). METHODS Forty nine patients with CLBP were randomly assigned into two groups. Group 1 (n= 20) received hot-pack + laser therapy 1 (wavelength of 850 nm Gallium-Aluminum-Arsenide (Ga-Al-As) laser); group 2 (n= 29) received hot-pack + laser therapy 2 (wavelength of 650 nm Helyum-Neon (He-Ne), 785 ve 980 nm Gal-Al-As combined plaque laser) for 15 sessions. Pain severity, patient's and physician's global assessments were evaluated with visual analogue scale (VAS). Modified Schober test, right and left lateral flexion measurements were done. Modified Oswestry Disability Questionnaire (MODQ) was used for evaluation of functional disability. Measurements were done before and after the treatment. RESULTS After treatment there were statistically significant improvements in pain severity, patient's and physician's global assessment, ROM and MODQ scores in both groups (P< 0.05). After the treatment there were statistically significant differences between the groups in lateral flexion measurements and MODQ scores (P< 0.05) except in pain severity, Modified Schober test, patient's and physician's global assessments (P> 0.05) in favor of those patients who received combined plaque laser therapy (group 2). CONCLUSION Laser therapy applied with combined He-Ne and Ga-Al-As provides more improvements in lateral flexion measurements and disability of the patients, however no superiority of the two different laser devices to one another were detected on pain severity.
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Affiliation(s)
- Şebnem Koldaş Doğan
- Department of Physical Rehabilitation and Medicine, Antalya Training and Research Hospital, Antalya, Turkey
| | - Saime Ay
- Department of Physical Rehabilitation and Medicine, School of Medicine, Ufuk University, Ankara, Turkey
| | - Deniz Evcik
- Department of Therapy and Rehabilitation, Haymana Vocational Health School, Ankara University, Haymana, Ankara, Turkey
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Glazov G, Yelland M, Emery J. Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials. Acupunct Med 2016; 34:328-341. [PMID: 27207675 PMCID: PMC5099186 DOI: 10.1136/acupmed-2015-011036] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The efficacy of low-level laser treatment (LLLT) for chronic back pain remains controversial due to insufficient trial data. We aimed to conduct an updated review to determine if LLLT (including laser acupuncture) has specific benefits in chronic non-specific low back pain (CNLBP). METHODS Electronic databases were searched for randomised trials using sham controls and blinded assessment examining the intervention of LLLT in adults with CNLBP. Primary outcomes were pain and global assessment of improvement with up to short-term follow-up. Secondary outcomes were disability, range of back movement, and adverse effects. A random effects meta-analysis was conducted. Subgroup analyses were based on laser dose, duration of baseline pain, and whether or not laser therapy used an acupuncture approach. RESULTS 15 studies were selected involving 1039 participants. At immediate and short-term follow-up there was significant pain reduction of up to WMD (weighted mean difference) -1.40 cm (95% CI -1.91 to -0.88 cm) in favour of laser treatment, occurring in trials using at least 3 Joules (J) per point, with baseline pain <30 months and in non-acupuncture LLLT trials. Global assessment showed a risk ratio of 2.16 (95% CI 1.61 to 2.90) in favour of laser treatment in the same groups only at immediate follow-up. CONCLUSIONS We demonstrated moderate quality of evidence (GRADE) to support a clinically important benefit in LLLT for CNLBP in the short term, which was only seen following higher laser dose interventions and in participants with a shorter duration of back pain. Rigorously blinded trials using appropriate laser dosage would provide greater certainty around this conclusion.
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Affiliation(s)
- Gregory Glazov
- Hillarys Medical Centre, Hillarys, Western Australia, Australia School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia
| | - Michael Yelland
- Primary Health Care, School of Medicine, Griffith University, Meadowbank, Queensland, Australia
| | - Jon Emery
- General Practice and Primary Care Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
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Huang Z, Ma J, Chen J, Shen B, Pei F, Kraus VB. The effectiveness of low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther 2015; 17:360. [PMID: 26667480 PMCID: PMC4704537 DOI: 10.1186/s13075-015-0882-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/30/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In recent decades, low-level laser therapy (LLLT) has been widely used to relieve pain caused by different musculoskeletal disorders. Though widely used, its reported therapeutic outcomes are varied and conflicting. Results similarly conflict regarding its usage in patients with nonspecific chronic low back pain (NSCLBP). This study investigated the efficacy of low-level laser therapy (LLLT) for the treatment of NSCLBP by a systematic literature search with meta-analyses on selected studies. METHOD MEDLINE, EMBASE, ISI Web of Science and Cochrane Library were systematically searched from January 2000 to November 2014. Included studies were randomized controlled trials (RCTs) written in English that compared LLLT with placebo treatment in NSCLBP patients. The efficacy effect size was estimated by the weighted mean difference (WMD). Standard random-effects meta-analysis was used, and inconsistency was evaluated by the I-squared index (I(2)). RESULTS Of 221 studies, seven RCTs (one triple-blind, four double-blind, one single-blind, one not mentioning blinding, totaling 394 patients) met the criteria for inclusion. Based on five studies, the WMD in visual analog scale (VAS) pain outcome score after treatment was significantly lower in the LLLT group compared with placebo (WMD = -13.57 [95 % CI = -17.42, -9.72], I(2) = 0 %). No significant treatment effect was identified for disability scores or spinal range of motion outcomes. CONCLUSIONS Our findings indicate that LLLT is an effective method for relieving pain in NSCLBP patients. However, there is still a lack of evidence supporting its effect on function.
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Affiliation(s)
- ZeYu Huang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan Province, People's Republic of China.
- Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, PO Box 104775, Room 51-205, Carmichael Building, 300 North Duke Street, Durham, 27701-2047, NC, USA.
| | - Jun Ma
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan Province, People's Republic of China.
| | - Jing Chen
- West China School of Stomatology, Sichuan University, No. 14, Third Section, Renmin Road South, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Bin Shen
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan Province, People's Republic of China.
| | - FuXing Pei
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan Province, People's Republic of China.
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, PO Box 104775, Room 51-205, Carmichael Building, 300 North Duke Street, Durham, 27701-2047, NC, USA.
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA.
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Responder analyses in randomised controlled trials for chronic low back pain: an overview of currently used methods. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:772-8. [PMID: 24419902 DOI: 10.1007/s00586-013-3155-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To provide an overview and a critical appraisal of the use of responder analyses in published randomised controlled trials (RCTs) of interventions for chronic low back pain (LBP). The methodology used for the analyses, including the justification, as well as the implications of responder analyses on the conclusions was explored. METHODS A convenience sample of four systematic reviews evaluating 162 RCTs of interventions for chronic LBP was used to identify individual trials. Randomised trials were screened by two reviewers and included if they performed and reported a responder analysis (i.e. the proportion of participants achieving a pre-defined level of improvement). The cutoff value for responders, the period of follow-up, and the outcome measure used were extracted. Information on how RCT authors justified the methodology of their responder analyses was also appraised. RESULTS Twenty-eight articles (17%) using 20 different definitions of responders were included in this appraisal. Justification for the definition of responders was absent in 80% of the articles. Pain was the most frequently used domain for the definition of response (50%), followed by back-specific function (30%) and a combination of pain and function (20%). A reduction in pain intensity ≥50% was the most common threshold used to define responders (IQR 33-60%). CONCLUSIONS Few RCTs of interventions for chronic LBP report responder analyses. Where responder analyses are used, the methods are inconsistent. When performing responder analyses authors are encouraged to follow the recommended guidelines, using empirically derived cutoffs, and present results alongside mean differences.
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Manca A, Limonta E, Pilurzi G, Ginatempo F, De Natale ER, Mercante B, Tolu E, Deriu F. Ultrasound and Laser as Stand-Alone Therapies for Myofascial Trigger Points: A Randomized, Double-Blind, Placebo-Controlled Study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2014; 19:166-75. [DOI: 10.1002/pri.1580] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/09/2013] [Accepted: 11/27/2013] [Indexed: 11/09/2022]
Affiliation(s)
- A. Manca
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - E. Limonta
- Department of Biomedical Sciences for Health; University of Milan; Milan Italy
| | - G. Pilurzi
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
- Department of Clinical and Experimental Medicine; University of Sassari; Italy
| | - F. Ginatempo
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - E. R. De Natale
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - B. Mercante
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - E. Tolu
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - F. Deriu
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
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17
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Affiliation(s)
- Kevin C Moore
- Former Consultant Anaesthetist and Director Pain & Laser Therapy Clinic, The Royal Oldham Haspital , Oldham, UK ; Medical Director and Chief Executive, Dr Kershaw's Hospice, Oldham, UK; and Honorary Treasurer and Member of Executive Council, World Association for Laser Therapy
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18
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Short-term therapeutic effects of 890-nanometer light therapy for chronic low back pain: a double-blind randomized placebo-controlled study. Lasers Med Sci 2013; 29:671-9. [DOI: 10.1007/s10103-013-1378-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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19
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Effect of low-level laser stimulation on EEG. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:951272. [PMID: 22973409 PMCID: PMC3438917 DOI: 10.1155/2012/951272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 11/21/2022]
Abstract
Conventional laser stimulation at the acupoint can induce significant brain activation, and the activation is theoretically conveyed by the sensory afferents. Whether the insensible low-level Laser stimulation outside the acupoint could also evoke electroencephalographic (EEG) changes is not known. We designed a low-level laser array stimulator (6 pcs laser diode, wavelength 830 nm, output power 7 mW, and operation frequency 10 Hz) to deliver insensible laser stimulations to the palm. EEG activities before, during, and after the laser stimulation were collected. The amplitude powers of each EEG frequency band were analyzed. We found that the low-level laser stimulation was able to increase the power of alpha rhythms and theta waves, mainly in the posterior head regions. These effects lasted at least 15 minutes after cessation of the laser stimulation. The amplitude power of beta activities in the anterior head regions decreased after laser stimulation. We thought these EEG changes comparable to those in meditation.
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20
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Bicakci AA, Kocoglu-Altan B, Toker H, Mutaf I, Sumer Z. Efficiency of low-level laser therapy in reducing pain induced by orthodontic forces. Photomed Laser Surg 2012; 30:460-5. [PMID: 22775467 DOI: 10.1089/pho.2012.3245] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on reducing post-adjustment orthodontic pain via evaluation of gingival crevicular fluid (GCF) composition changes at the level of prostaglandin-E(2) (PGE(2)) and visual analogue scale (VAS). BACKGROUND DATA LLLT has been found to be effective in pain relief. PGE(2) has the greatest impact on the process of pain signals and can be detected in GCF in order to investigate the response of dental and periodontal tissues in a biochemical manner. MATERIALS AND METHODS Nineteen patients (11 females and 8 males; mean age 13.9 years) were included in this study. Maxillary first molars were banded and then a randomly selected first molar at one side was irradiated (λ820 nm; continuous wave; output power: 50 mW; focal spot: 0.0314 cm(2); exposure duration: 5 sec; power density: 1.59 W/cm(2); energy dose: 0.25 J; energy density: 7.96 J/cm(2) for each shot), while the molar at the other side was served as placebo control. The GCF was collected from the gingival crevice of each molar to evaluate PGE(2) levels, before band placement, 1 and 24 h after laser irradiation. Pain intensity was analyzed at 5 min, 1 h, and 24 h after band placement by using VAS. RESULTS Although no difference was found in pain perception at 5 min and 1 h, significant reduction was observed with laser treatment 24 h after application (p<0.05). The mean PGE(2) levels were significantly elevated in control group, whereas a gradual decrease occurred in laser group. The difference in PGE(2) levels at both 1 and 24 h were statistically significant between two groups (p<0.05). CONCLUSIONS The significant reductions in both pain intensity and PGE(2) levels revealed that LLLT was efficient in reducing orthodontic post-adjustment pain.
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Affiliation(s)
- Ali Altug Bicakci
- Department of Orthodontics, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
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21
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Jang H, Lee H. Meta-analysis of pain relief effects by laser irradiation on joint areas. Photomed Laser Surg 2012; 30:405-17. [PMID: 22747309 DOI: 10.1089/pho.2012.3240] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Laser therapy has been proposed as a physical therapy for musculoskeletal disorders and has attained popularity because no side effects have been reported after treatment. However, its true effectiveness is still controversial because several clinical trials have reported the ineffectiveness of lasers in treating pain. METHODS In this systematic review, we investigate the clinical effectiveness of low-level laser therapy (LLLT) on joint pain. Clinical trials on joint pain satisfying the following conditions are included: the laser is irradiated on the joint area, the PEDro scale score is at least 5, and the effectiveness of the trial is measured using a visual analogue scale (VAS). To estimate the overall effectiveness of all included clinical trials, a mean weighted difference in change of pain on VAS was used. RESULTS MEDLINE is the main source of the literature search. After the literature search, 22 trials related to joint pain were selected. The average methodological quality score of the 22 trials consisting of 1014 patients was 7.96 on the PEDro scale; 11 trials reported positive effects and 11 trials reported negative effects. The mean weighted difference in change of pain on VAS was 13.96 mm (95% CI, 7.24-20.69) in favor of the active LLLT groups. When we only considered the clinical trials in which the energy dose was within the dose range suggested in the review by Bjordal et al. in 2003 and in World Association for Laser Therapy (WALT) dose recommendation, the mean effect sizes were 19.88 and 21.05 mm in favor of the true LLLT groups, respectively. CONCLUSIONS The review shows that laser therapy on the joint reduces pain in patients. Moreover, when we restrict the energy doses of the laser therapy into the dose window suggested in the previous study, we can expect more reliable pain relief treatments.
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Affiliation(s)
- Ho Jang
- Department of Information and Communications, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
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22
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Lee JH, Lee SM. The immediate effects of 830-nm low-level laser therapy on the myofascial trigger point of the upper trapezius muscle in visual display terminal workers: A randomized, double-blind, clinical trial. INTERNATIONAL JOURNAL OF CONTENTS 2011. [DOI: 10.5392/ijoc.2011.7.2.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:19-39. [PMID: 20640863 PMCID: PMC3036018 DOI: 10.1007/s00586-010-1518-3] [Citation(s) in RCA: 425] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 06/21/2010] [Accepted: 07/03/2010] [Indexed: 12/11/2022]
Abstract
Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥ 18 years) population with chronic (≥ 12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain. Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP.
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Affiliation(s)
- Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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24
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Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND. Acute Low Back Pain with Radiculopathy: A Double-Blind, Randomized, Placebo-Controlled Study. Photomed Laser Surg 2010; 28:553-60. [DOI: 10.1089/pho.2009.2576] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
| | | | | | | | | | - Viktorija G. Savic
- Department for Physical Medicine, Institute for Rheumatology, Belgrade, Serbia
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25
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Is low-level laser therapy effective in acute or chronic low back pain? Clin Rheumatol 2010; 29:905-10. [DOI: 10.1007/s10067-010-1460-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/27/2010] [Accepted: 04/01/2010] [Indexed: 11/26/2022]
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Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009; 374:1897-908. [PMID: 19913903 DOI: 10.1016/s0140-6736(09)61522-1] [Citation(s) in RCA: 336] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. METHODS We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. FINDINGS We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo. INTERPRETATION We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. FUNDING None.
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Affiliation(s)
- Roberta T Chow
- Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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27
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Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri SA, Mortaz Hejri SO, Jonaidi A. Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev 2008; 2008:CD005107. [PMID: 18425909 PMCID: PMC9044120 DOI: 10.1002/14651858.cd005107.pub4] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low-back pain (LBP) is a major health problem and a major cause of medical expenses and disablement. Low level laser therapy (LLLT) can be used to treat musculoskeletal disorders such as back pain. OBJECTIVES To assess the effects of LLLT in patients with non-specific LBP. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE, CINAHL, EMBASE, AMED and PEDro from their start to November 2007 with no language restrictions. We screened references in the included studies and in reviews and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts. SELECTION CRITERIA Randomised controlled clinical trials (RCTs) investigating LLLT to treat non-specific low-back pain were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Studies were qualitatively and quantitatively analysed according to Cochrane Back Review Group guideline. MAIN RESULTS Seven heterogeneous English language RCTs with reasonable quality were included. Three small studies (168 people) separately showed statistically significant but clinically unimportant pain relief for LLLT versus sham therapy for sub-acute and chronic low-back pain at short-term and intermediate-term follow-up (up to six months). One study (56 people) showed that LLLT was more effective than sham at reducing disability in the short term. Three studies (102 people) reported that LLLT plus exercise were not better than exercise, with or without sham in the short-term in reducing pain or disability. Two studies (90 people) reported that LLLT was not more effective than exercise, with or without sham in reducing pain or disability in the short term. Two small trials (151 people) independently found that the relapse rate in the LLLT group was significantly lower than in the control group at the six-month follow-up. No side effects were reported. AUTHORS' CONCLUSIONS Based on the heterogeneity of the populations, interventions and comparison groups, we conclude that there are insufficient data to draw firm conclusions on the clinical effect of LLLT for low-back pain. There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, wavelengths and dosages.
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Affiliation(s)
- R Yousefi-Nooraie
- Tehran University of Medical Sciences, Centre for Academic and Health Policies, P.O. Box 13145-967, Tehran, Iran.
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Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri SA, Mortaz Hejri SO, Jonaidi A. WITHDRAWN: Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev 2007:CD005107. [PMID: 17943838 DOI: 10.1002/14651858.cd005107.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Low-back pain (LBP) and related disabilities are major public health problems and a major cause of medical expenses, absenteeism and disablement. Low level laser therapy (LLLT) can be used as a therapeutic intervention for musculoskeletal disorders such as back pain. OBJECTIVES To assess the effects of LLLT in patients with non-specific low-back pain and to explore the most effective method of administering LLLT for this disorder. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE and CINAHL from their start to January 2007 and EMBASE, AMED and PEDro from their start to 2005 with no language restrictions. We screened references in the included studies and in reviews of the literature and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts. SELECTION CRITERIA Only randomised controlled clinical trials (RCTs) investigating low level laser therapy as a light source treatment for non-specific low-back pain were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Consensus was used to resolve disagreements. Clinically and statistically homogeneous studies were pooled using the fixed-effect model; clinically homogeneous and statistically heterogeneous studies were pooled using the random-effects model. MAIN RESULTS Six RCTs with reasonable quality were included in the review. All of them were published in English. Because of clinical heterogeneity in study populations, interventions used and reported outcomes, meta-analysis was not possible to determine an overall effect for pain, disability and range of motion. Three studies (n=168) separately showed a significant pain relief effect of LLLT compared to sham therapy for sub-acute and chronic low-back pain. These effects were only observed at short-term and intermediate-term follow-ups. Long-term follow-ups were not reported. There was insufficient evidence to investigate the difference between LLLT and comparison groups for pain-related disability. There is insufficient evidence to determine the effectiveness of LLLT on anterior-posterior lumbar range of motion compared to control group in short-term follow-up. The relapse rate in the LLLT group was significantly lower than in the control group at six months follow-up period according to the findings of two trials. One study (n=50) reported a significant improvement in pain in LLLT group versus exercise therapy. AUTHORS' CONCLUSIONS No side effects were reported. However, we conclude that there are insufficient data to draw firm conclusions. There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, different wavelengths and different dosages. Comparison of different LLLT treatments will be more reasonable if dose calculation methods are harmonized.
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Affiliation(s)
- R Yousefi-Nooraie
- Tehran University of Medical Sciences, Centre for Academic and Health Policies, P.O. Box 13145-967, Tehran, Iran.
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Relf I, Chow R, Pirotta M. Blinding techniques in randomized controlled trials of laser therapy: an overview and possible solution. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2007; 5:383-9. [PMID: 18955233 PMCID: PMC2586311 DOI: 10.1093/ecam/nem085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Low-level laser therapy has evidence accumulating about its effectiveness in a variety of medical conditions. We reviewed 51 double blind randomized controlled trials (RCTs) of laser treatment. Analysis revealed 58% of trials showed benefit of laser over placebo. However, less than 5% of the trials had addressed beam disguise or allocation concealment in the laser machines used. Many of the trials used blinding methods that rely on staff cooperation and are therefore open to interference or bias. This indicates significant deficiencies in laser trial methodology. We report the development and preliminary testing of a novel laser machine that can blind both patient and operator to treatment allocation without staff participation. The new laser machine combines sealed preset and non-bypassable randomization codes, decoy lights and sound, and a conical perspex tip to overcome laser diode glow detection.
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Affiliation(s)
- Ian Relf
- Department of General Practice, University of Melbourne, 200 Berkeley Street Carlton 3053, Victoria, Australia.
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30
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Chow RT, David MA, Armati PJ. 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst 2007; 12:28-39. [PMID: 17374099 DOI: 10.1111/j.1529-8027.2007.00114.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the formation of 830 nm (cw) laser-induced, reversible axonal varicosities, using immunostaining with beta-tubulin, in small and medium diameter, TRPV-1 positive, cultured rat DRG neurons. Laser also induced a progressive and statistically significant decrease (p<0.005) in MMP in mitochondria in and between static axonal varicosities. In cell bodies of the neuron, the decrease in MMP was also statistically significant (p<0.05), but the decrease occurred more slowly. Importantly we also report for the first time that 830 nm (cw) laser blocked fast axonal flow, imaged in real time using confocal laser microscopy and JC-1 as mitotracker. Control neurons in parallel cultures remained unaffected with no varicosity formation and no change in MMP. Mitochondrial movement was continuous and measured along the axons at a rate of 0.8 microm/s (range 0.5-2 microm/s), consistent with fast axonal flow. Photoacceptors in the mitochondrial membrane absorb laser and mediate the transduction of laser energy into electrochemical changes, initiating a secondary cascade of intracellular events. In neurons, this results in a decrease in MMP with a concurrent decrease in available ATP required for nerve function, including maintenance of microtubules and molecular motors, dyneins and kinesins, responsible for fast axonal flow. Laser-induced neural blockade is a consequence of such changes and provide a mechanism for a neural basis of laser-induced pain relief. The repeated application of laser in a clinical setting modulates nociception and reduces pain. The application of laser therapy for chronic pain may provide a non-drug alternative for the management of chronic pain.
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Affiliation(s)
- Roberta T Chow
- Castle Hill Medical Centre, Discipline of Medicine, The University of Sydney, Sydney, Australia.
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Naeser MA. Photobiomodulation of Pain in Carpal Tunnel Syndrome: Review of Seven Laser Therapy Studies. Photomed Laser Surg 2006; 24:101-10. [PMID: 16706688 DOI: 10.1089/pho.2006.24.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
In this review, seven studies using photoradiation to treat carpal tunnel syndrome (CTS) are discussed: two controlled studies that observed real laser to have a better effect than sham laser, to treat CTS; three openprotocol studies that observed real laser to have a beneficial effect to treat CTS; and two studies that did not observe real laser to have a better effect than a control condition, to treat CTS. In the five studies that observed beneficial effect from real laser, higher laser dosages (9 Joules, 12-30 Joules, 32 J/cm(2), 225 J/cm(2)) were used at the primary treatment sites (median nerve at the wrist, or cervical neck area), than dosages in the two studies where real laser was not observed to have a better effect than a control condition (1.8 Joules or 6 J/cm(2)). The average success rate across the first five studies was 84% (SD, 8.9; total hands = 171). The average pain duration prior to successful photoradiation was 2 years. Photoradiation is a promising new, conservative treatment for mild/moderate CTS cases (motor latency < 7 msec; needle EMG, normal). It is cost-effective compared to current treatments.
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Affiliation(s)
- Margaret A Naeser
- Department of Neurology, Boston University School of Medicine, MA 02130, USA.
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Soriano F, Campana V, Moya M, Gavotto A, Simes J, Soriano M, Soriano R, Spitale L, Palma J. Photobiomodulation of Pain and Inflammation in Microcrystalline Arthropathies: Experimental and Clinical Results. Photomed Laser Surg 2006; 24:140-50. [PMID: 16706692 DOI: 10.1089/pho.2006.24.140] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This article presents the results of laser therapy in crystal (hydroxyapatite, calcium pyrophosphate, and urates) deposition-induced arthritis in rats and the clinical applications in humans. BACKGROUND DATA Microcrystalline arthropathies are prevalent among geriatric patients, who are more vulnerable to the side effects of drugs. The effectiveness of laser therapy for pain relief, free of side effects, has been reported in painful conditions. METHODS Two milligrams of each of the above-mentioned crystals was injected in both joints of the back limbs in three groups of rats; these groups were then treated with laser irradiation. Three other groups received no treatment after the injections. We determined the plasmatic levels of inflammatory markers (fibrinogen, prostaglandin E2, and TNF(alpha)), tissues (prostaglandin E(2)) and conducted anatomopathological studies. Twenty-five patients with acute gout arthritis were randomized into two groups and treated over 5 days: group A, diclofenac 75 mg orally, twice a day; and group B, laser irradiation once a day. Forty-nine patients with knee chronic pyrophosphate arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day. Thirty patients with shoulder chronic hydroxyapatite arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day. RESULTS Fibrinogen, prostaglandin E(2), and TNF(alpha) concentrations in the rats injected with crystals and treated with laser decreased significantly as compared with the groups injected with crystals without treatment. Both laser therapy and diclofenac achieved rapid pain relief in patients with acute gouty arthritis without significant differences in efficacy. Laser therapy was more effective than diclofenac in patients with chronic pyrophosphate arthropathy and in patients with chronic apatite deposition disease. CONCLUSION Laser therapy represents an effective treatment in the therapeutic arsenal of microcrystalline arthropathies.
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Affiliation(s)
- F Soriano
- Instituto Argentino de Medicina Láser (IAMEL), Rosario, Argentina.
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Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Sanford LE, Woodruff LD. The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg 2004; 22:323-9. [PMID: 15345176 DOI: 10.1089/pho.2004.22.323] [Citation(s) in RCA: 217] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We used statistical meta-analysis to determine the overall treatment effects of laser phototherapy on tissue repair and pain relief. BACKGROUND DATA Low-power laser devices were first used as a form of therapy more than 30 years ago. However, their efficacy in reducing pain or promoting tissue repair remains questionable. METHODS Following a literature search, studies meeting our inclusion criteria were identified and coded. Then, the effect size of laser treatment, that is, Cohen's d, was calculated from each study using standard meta-analysis procedures. RESULTS Thirty-four peer-reviewed papers on tissue repair met our inclusion criteria and were used to calculate 46 treatment effect sizes. Nine peer-reviewed papers on pain control met the inclusion criteria and were used to calculate nine effect sizes. Meta-analysis revealed a positive effect of laser phototherapy on tissue repair (d = +1.81; n = 46) and pain control (d = +1.11; n = 9). The positive effect of treatment on specific indices of tissue repair was evident in the treatment effect sizes determined as follows: collagen formation (d = +2.78), rate of healing (d = +1.57), tensile strength (d = +2.13), time needed for wound closure (d = +0.76), tensile stress (d = +2.65), number and rate of degranulation of mast cells (d = +1.87), and flap survival (d = +1.95). Further, analysis revealed the positive effects of various wavelengths of laser light on tissue repair, with 632.8 nm having the highest treatment effect (d = +2.44) and 780 nm the least (d = 0.60). The overall treatment effect for pain control was positive as well (d = +1.11). The fail-safe number-that is, the number of studies in which laser phototherapy has negative or no effect-needed to nullify the overall outcome of this analysis was 370 for tissue repair and 41 for pain control. CONCLUSIONS These findings mandate the conclusion that laser phototherapy is a highly effective therapeutic armamentarium for tissue repair and pain relief.
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Affiliation(s)
- Chukuka S Enwemeka
- School of Health Professions, Behavioral and Life Sciences, New York Institute of Technology, Old Westbury, NY 11568-8000, USA.
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Abstract
It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future.
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Affiliation(s)
- C G Maher
- School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, New South Wales 1825, Australia.
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Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2003; 49:107-16. [PMID: 12775206 DOI: 10.1016/s0004-9514(14)60127-6] [Citation(s) in RCA: 353] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.
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Affiliation(s)
- Jan M Bjordal
- Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway.
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Castro-e-Silva O, Zucoloto S, Marcassa LG, Marcassa J, Kurachi C, Melo CAS, Ramalho FS, Ramalho LNZ, Bagnato VS. Spectral response for laser enhancement in hepatic regeneration for hepatectomized rats. Lasers Surg Med 2003; 32:50-3. [PMID: 12516071 DOI: 10.1002/lsm.10141] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The low intensity laser therapy (LILT) has been widely used in all medical fields due to its therapeutic effects in reparative process, pain relief, and biostimulation. Even though there is a therapeutic window of wavelengths for clinical application, little has been done concerning the frequency spectrum response to biological effects. In this work, we investigate the dependence of different wavelengths irradiation in the enhancement of the tissue regeneration after partial hepatectomy in Wistar rats. STUDY DESIGN/MATERIALS AND METHODS The proliferating cell nuclear antigen (PCNA) labeling index and the respiratory control (oxygen consumption in extracted mitochondria) were the tests used to evaluate the liver regeneration after laser irradiation with different wavelengths. RESULTS AND CONCLUSIONS The results show a correlated spectral response that can be explained based on the combined effect of light penetration on biological tissues and the biomolecular excitation efficiency for each wavelength used.
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Affiliation(s)
- O Castro-e-Silva
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. dos Bandeirantes 3900, 14048-900 Ribeirão Preto, São Paulo, Brazil
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Naeser MA, Hahn KAK, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Arch Phys Med Rehabil 2002; 83:978-88. [PMID: 12098159 DOI: 10.1053/apmr.2002.33096] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether real or sham low-level laser therapy (LLLT) plus microamperes transcutaneous electric nerve stimulation (TENS) applied to acupuncture points significantly reduces pain in carpal tunnel syndrome (CTS). DESIGN Randomized, double-blind, placebo-control, crossover trial. Patients and staff administered outcome measures blinded. SETTING Outpatient, university-affiliated Department of Veterans Affairs medical center. PARTICIPANTS Eleven mild to moderate CTS cases (nerve conduction study, clinical examination) who failed standard medical or surgical treatment for 3 to 30 months. INTERVENTION Patients received real and sham treatment series (each for 3-4wk), in a randomized order. Real treatments used red-beam laser (continuous wave, 15mW, 632.8nm) on shallow acupuncture points on the affected hand, infrared laser (pulsed, 9.4W, 904nm) on deeper points on upper extremity and cervical paraspinal areas, and microamps TENS on the affected wrist. Devices were painless, noninvasive, and produced no sensation whether they were real or sham. The hand was treated behind a hanging black curtain without the patient knowing if devices were on (real) or off (sham). MAIN OUTCOME MEASURES McGill Pain Questionnaire (MPQ) score, sensory and motor latencies, and Phalen and Tinel signs. RESULTS Significant decreases in MPQ score, median nerve sensory latency, and Phalen and Tinel signs after the real treatment series but not after the sham treatment series. Patients could perform their previous work (computer typist, handyman) and were stable for 1 to 3 years. CONCLUSIONS This new, conservative treatment was effective in treating CTS pain; larger studies are recommended.
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Affiliation(s)
- Margaret A Naeser
- Department of Neurology, Boston University School of Medicine, Psychology Research Service, MA, USA.
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Chow R. EBM in action: is laser treatment effective and safe for musculoskeletal pain? Med J Aust 2002; 176:194-5. [PMID: 11913929 DOI: 10.5694/j.1326-5377.2002.tb04366.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2001] [Accepted: 10/31/2001] [Indexed: 11/17/2022]
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Chow RT. DOSE DILEMMAS IN LOW LEVEL LASER THERAPY - THE EFFECTS OF DIFFERENT PARADIGMS AND HISTORICAL PERSPECTIVES. Laser Ther 2000. [DOI: 10.5978/islsm.13.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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