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Low Level Laser Therapies for Low Back Pain



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May 24, 2010

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Low level laser (LLL) therapies pose numerous challenges for research due in part to the many dosage factors that can impact clinical use.  Among the variables are wavelengths, wattage, frequency, joules, treatment frequency, treatment area and other factors.  Each of these variables could have a potentially profound impact on clinical outcomes.  As a result, hundreds of clinical studies on LLL reflect a mix of positive and negative outcomes for the exact same condition.

Low Level Laser TherapyTwo 2010 studies look at the clinical outcomes of acute and chronic low back pain patients using LLL.  The first study used LLL for acute or chronic low back pain due to lumbar disc herniation.  There were four treatment groups; chronic with either laser or sham laser and acute patients with either laser or sham laser.  All patients were also given hot packs.  The patients were reassessed after three weeks and all groups had significant improvement.  However, “There were no differences between laser and placebo laser treatments on pain severity and functional capacity in patients with acute and chronic low back pain …” Essentially the LLL had no measurable effect on low back pain associated with disc herniation.

The second study was an RCT of 546 patients using three groups to compare an anti-inflammatory drug (nimesulide).  The first group received only the medication; a second group received the drug with LLL and a third group given the medication and placebo LLL.  All groups had improvement. The authors concluded that “The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.” 

The most recent (2008) Cochrane review summed up the current level of evidence supporting the effectiveness of LLL for low back pain by stating that “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.”  This does not necessarily mean that LLL is not effective for low back pain.  It does, however, demonstrate the need for more research to define the parameters with respect to type of laser therapy and dose as well as identifying the characteristics (clinical prediction rules) for patients that are most likely to respond favorably to LLL therapy.

Is low-level laser therapy effective in acute or chronic low back pain?  [LINK]

Clin Rheumatol. 2010 Apr 23. [Epub ahead of print]

Ay S, Dogan SK, Evcik D.
Department of Physical Rehabilitation and Medicine, Ufuk University School of Medicine, Ankara, Turkey, saimeay@yahoo.com.

The purpose of this study was to compare the effectiveness of low-level laser therapy (LLLT) on pain and functional capacity in patients with acute and chronic low back pain caused by lumbar disk herniation (LDH). LLLT has been used to treat acute and chronic pain of musculoskeletal system disorders. This study is a randomized, double-blind, placebo-controlled study. Forty patients with acute (26 females/14 males) and 40 patients with chronic (20 females/20 males) low back pain caused by LDH were included in the study. Patients were randomly allocated into four groups. Group 1 (acute LDH, n = 20) received hot-pack + laser therapy; group 2 (chronic LDH, n = 20) received hot-pack + laser therapy; group 3 (acute LDH, n = 20) received hot-pack + placebo laser therapy, and group 4 (chronic LDH, n = 20) received hot-pack + placebo laser therapy, for 15 sessions during 3 weeks. Assessment parameters included pain, patients' global assessment, physician's global assessment, and functional capacity. Pain was evaluated by visual analog scale (VAS) and Likert scale. Patients' and physician's global assessment were also measured with VAS. Modified Schober test and flexion and lateral flexion measures were used in the evaluation of range of motion (ROM) of lumbar spine. Roland Disability Questionnaire (RDQ) and Modified Oswestry Disability Questionnaire (MODQ) were used in the functional evaluation. Measurements were done before and after 3 weeks of treatment. After the treatment, there were statistically significant improvements in pain severity, patients' and physician's global assessment, ROM, RDQ scores, and MODQ scores in all groups (p < 0.05). However, no significant differences were detected between four treatment groups with respect to all outcome parameters (p > 0.05). There were no differences between laser and placebo laser treatments on pain severity and functional capacity in patients with acute and chronic low back pain caused by LDH.

Acute Low Back Pain with Radiculopathy: A Double-Blind, Randomized, Placebo-Controlled Study.  [LINK]

Photomed Laser Surg. [Epub ahead of print]

Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND.
1 Clinic for Rehabilitation, Medical School , Belgrade, Serbia.

Abstract Objective: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.

Background Data: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.

Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.

Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005). Conclusions: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.

Low level laser therapy for nonspecific low-back pain.  [LINK]

Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005107.

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.
Tehran University of Medical Sciences, Centre for Academic and Health Policies, P.O. Box 13145-967, Tehran, Iran. ryousefi@razi.tums.ac.ir

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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