Photobiomodulation using high- or low-level laser irradiations in patients with lumbar disc degenerative changes: disappointing outcomes and remarks

Abstract

BackgroundLaser therapy seems to be a beneficial physical agent for chronic low back pain (LBP), and it is commonly used in the clinical rehabilitation practice. However, there are still no indisputable and clearly defined protocols and practical guidelines, and further, the methodology of the previous reports leaves many unsatisfied and raises some reservations.ObjectiveThe aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in patients with lumbar disc degenerative changes based on the analysis of the short- and long-term results and in comparison with the placebo effect.DesignThis study was a prospective and placebo-controlled clinical trial.Materials and methodsA group of 68 participants were qualified for the therapy and were assigned to four comparative groups in the order they volunteered: HILT of 1,064 nm, 60 J/cm2, 10 minutes (HILT); sham (HILT placebo); LLLT of 785 nm, 8 J/cm2, 8 minutes; and sham (LLLT placebo). The following tests were used to assess the effectiveness of treatment: 1) the visual analogue scale; 2) the Laitinen Questionnaire Indicators of Pain; 3) the Oswestry Disability Index; 4) the Roland–Morris Disability Questionnaire; 5) Lasegue test; and 6) Schober’s test. All measurements were carried out before and after irradiations (3 weeks) and in follow-ups (1 and 3 months).ResultsAfter applying verum or placebo laser irradiation, therapeutic progress was observed in all comparative groups; however, no statistically significant differences were observed among the procedures.ConclusionThe high- and low-energy laser therapy methods used in the present article are ineffective in relation to patients with lumbar disc degenerative changes in both the short- and long-term perspectives and do not show a significant advantage over the placebo effect.

The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review

“…In the first group of classification (HILT and exercise) 4 studies 14,32,34,35 were about spinal pain which were matched to another group. [16][17][18]20 The average of the effect size differences was higher in the first group (1/08) for spinal pain patients.…”

“…A score of ≥ 7 is considered to be a study of high methodological quality, while a score of ≤ 5 is considered to be of low methodological quality. 14,22 The methodological assessment was performed by two independent reviewers (KE, AH) and the results were compared. If there was a disagreement, the reviewers discussed the quality of the articles until they reached a final consensus and if necessary, a third reviewer made the decision (RF).…”

“…[11][12][13] A recent systematic review indicated that HILT is effective in reducing musculoskeletal pain. 14 Adding therapeutic interventions to laser therapy is usual in clinical practice. 3,[15][16][17][18][19] Bjordal et al showed that the overall effects of lowpower laser therapy and anti-inflammatory drugs cointerventions, were poorer than those studies without these co-interventions.…”

Effect of Radial Extracorporeal Shock Wave Therapy on Pain Intensity, Functional Efficiency, and Postural Control Parameters in Patients with Chronic Low Back Pain: A Randomized Clinical Trial

“…The use of various nonpharmacological supportive and conservative methods in LBP management is well-known, including exercise training [5,6], manual therapies [6,7], or myofascial techniques [8]. However, effective physical agents are also needed [9][10][11].…”

Low‐Intensity Photobiomodulation Decreases Neuropathic Pain in Paw Ischemia‐Reperfusion and Spared Nervus Ischiadicus Injury Experimental Models

“…Photobiomodulation with infrared light has gained increasing attention through studies that demonstrate its effectiveness in the treatment of rheumatic diseases such as rheumatoid arthritis, fibromyalgia, and postoperative pain and in the reduction of the acute and chronic phases of pain. [9][10][11][12][13][14] Since this therapeutic tool does not provoke side effects, many patients have requested it, particularly those who have been unsuccessfully treated with drugs. However, photobiomodulation does not yet have guidelines regarding its recommended dosage, duration, and frequency of the treatment.…”