Efficacy of Low Level Laser Therapy in Lumbar Discopathy Pain (Randomized Controlled Study)

Abstract

Introduction Finding evidence based and effective method of managing low back pain (LBP) has been always a major dilemma in the field of neuromusculoskeletal system. The focus of this investigation is to establish a treatment regime for the discopathy origin of LBP using low level laser (LLL). This type of LBP is the cause of a significant number of days of sick leave in many countries. LLLT has not yet been fully adopted as a treatment method. Results of studies on LLL suggest that it reduces pain by a range of physiologic responses, such as increase in b-endorphins and depolarization blockage of c-fiber afferent nerves. The purpose of this study is evaluating the effect of LLLT on LBP due to discopathy. Materials and Methods Patients A total of 42 patients between 25 and 65 years old recruited from out-patient clinics with complaints of lumbar chronic pain(at least 6 month). Randomized from all out-patients referred to our department were in both sex (female and male). The diagnosis by MRI and EMG, NCV was discopathy. Environment temperature was 25 degrees. Laser type: scanner semiconductor GA-AS 808 nm. With maximum power output of 400 MW and maximum energy density of 10 J/cm2. polaris2. Methods Subjects sampling selection was by randomization in two groups with 21 patients in each group. G1: LLLT + PT G2: PT Treatment protocol: 2 weeks, five sessions per week, time: 1600 to 1900, time of study: from October 1, 2011 to March 1, 2012. Tests: 1, Trigger point palpation pain. 2. VAS. 3, NHP: Nottingham health profile (NHP). 4, NPAINAD (nonverbal pain assessment in advanced dementia). Time of tests: 1, before treatment. 2, after 2 weeks (end of treatment). 3, follow-up: 2 weeks after end of treatment: First: first pain assessment: before treatment. Second: pain assessment after end of treatment (after 2 weeks). Third: pain assessment 2 weeks after end of treatment (follow-up). Results There was no significant difference between two groups before treatment. There was significant improvement in G1 at the end of treatment and 2 weeks after completion treatment ( p < 0.01). G2: PT alone seemed to aid relieving pain significantly while G2: LLLT with PT had superior significant effect in reducing pain of discopathy within 2 weeks follow-up. G1 *1st and *2nd: p = 0.002 2nd and *3rd: p = 0.001 1st and 3rd: p = 0.001 G2 1st and 2nd: p = 0.005 2nd and 3rd: p = 0.018 1st and 3rd: p = 0.005 Conclusion Therapeutic laser offers a safe often effective, easily utilized primary or adjunctive therapy that is relatively cost effective for clinician and patient. LLLT is more effective in pain relief and in the improvement of functional ability and quality of life thus LLLT can be an important adjunct especially in patients with adverse side effects to drugs and invasive treatment. Disclosure of Interest None declared References Jamal AK, Yaacob WA, Din LB. A Chemical study on Phyllanthus Columnaris. European Journal of Scientific Research 2009;28(1):76-81 Kneebone WJ. Therapeutic laser for chronic low back pain. Practical Pain Management 2007;38–41 Hakgüder A, Birtane M, Gürcan S, Kokino S, Turan FN. Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation. Lasers Surg Med 2003;33(5):339–343 Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003;4(1):9–15 Logdberg-Andersson M, Mutzell S, Hazel A. Low level laser therapy (LLLT) of tendinitis and myofascial pains: a randomized, double-blind, controlled study. Laser Therapy 1997;9(2):79-85 Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13(4):227-236 Labbe RF, Skogerboe KJ, Davis HA, Rettmer RL. Laser photobioactivation mechanisms: in vitro studies using ascorbic acid uptake and hydroxyproline formation as biochemical markers of irradiation response. Lasers Surg Med 1990;10(2):201–207