Evaluating The Use of High Intensity Laser Therapy For Patients With Chronic Pain
Amir Jafari DO, Nevinson Sam DO, Lily Valad BS, Ranganathan Govindaraj, MD
university of Texas Medical Branch, Galveston, Texas
High Intensity Laser Therapy has effects that stimulate mitochondrial oxidation and ATP creation by delivering high energy output inside tissues. Consequently, metabolism and blood circulation are increased allowing for the rapid absorption of edema and the removal of exudates (Santamato et al, 2009).
Three randomized controlled studies regarding the use of HILT for the treatment of chronic pain were compared.
The first study, with a total of 72 male participants, examined the effects of HILT on patients with chronic low back pain. Patients were randomly assigned into three groups and treated with HILT plus exercise (HILT + EX), placebo laser plus exercise (PL + EX), or HILT alone in groups 1, 2, and 3, respectively. The outcomes measured included pain level by visual analog scale (VAS), lumbar range of motion (ROM), and functional disability by both the Modified Oswestry Disability Questionnaire (MODQ) and Roland Disability Questionnaire (RDQ).
The second study investigated the analgesic effect of HILT in knee osteoarthritis. In this experiment, 20 patients were equally divided into the control group (n=10), which would receive conservative physical therapy (CPT), and the experimental group (n=10), which would receive effects of high intensity laser therapy after conservative physical therapy. All subjects received their respective therapies three times a week over a four-week period. The high intensity laser therapy was applied to each patient in the tibia and femoral epicondyle for five minutes, while the patient’s knee joint was bent at around 30° with the separation distance between the skin and the hand piece maintained at around 1 cm. Pain level was measured with the visual analogue scale and functional evaluations were accomplished using the Korean Western Ontario and McMaster Universities Osteoarthritis Index. The results showed a statistically significant decrease in VAS after the treatment (p < 0.001). This indicates that HILT enables prompt analgesic effects in knee osteoarthritis and is a reliable option in KOA treatment.
The third study investigated the effects of HILT as treatment for patients with chronic neck pain (CNP) and measurable outcomes included, cervical range of motion (ROM), pain, and functional activity. Sixty male subjects participated in this study with a mean age of 35.5 years. Two groups of patients were created based on random selection and treated with HILT plus exercise (HILT + EX) or placebo laser plus exercise (PL + EX) in groups 1 and 2, respectively. The outcomes measured included pain level by visual analog scale (VAS), cervical ROM, and functional activity by neck disability index (NDI) score.
In the study of HILT for chronic low back pain, the results were as followed:
Statistical analyses were used to compare the differences between baseline and post-treatment measurements with a statistical significance level set at P < 0.05. There was a significant increase in ROM after 4 weeks of treatment in all groups followed by a significant decrease after 12 weeks of follow-up. However, ROM was still significantly greater than the baseline value in groups 1 and 2. MODQ, VAS, and RDQ results indicated a significant decrease in all groups post-treatment, although the RDQ and MODQ results were not significantly different between groups 2 and 3. HILT combined with exercise seems to be more effective in patients with CLBP than either HLLT alone or placebo laser with exercise.
In the study of HILT therapy and knee osteoarthritis, the results were as followed:
When comparing the differences in measurements taken before and after the experiment within each group, a statistically significant decline in both the VAS and the K-WOMAC was discovered. The comparison showed that the high intensity laser therapy group had statistically significant lower scores in both the visual analogue scale and the Korean Western Ontario and McMaster Universities Osteoarthritis Index than the conservative physical therapy group.
In the study of HILT therapy for chronic neck pain, the results were as followed:
Statistical analyses were used to compare the differences between baseline and post-treatment with the level of statistical significance set at p < 0.05. Cervical ROM significantly increased after 6 weeks of treatment in all groups and VAS and NDI results showed a significant decrease in both groups post-treatment. HILT + EX effectively increased cervical ROM and decreased VAS and NDI scores after 6 weeks of treatment compared to PL + EX. When comparing the two groups, HILT + EX is an effective physical therapy modality for patients with CNP versus PL + EX therapy. HILT + EX effectively increased cervical ROM, functional activity, and reduced pain after 6 weeks of treatment.
From the analyses of the aforementioned studies, it can be concluded that HILT is an effective additive modality for the treatment of chronic pain. Treatment was found to be more successful when HILT was combined with exercise in the case of chronic lower back pain and chronic neck pain. In the treatment of knee osteoarthritis, there was a significant level of improvement in pain and functional evaluation when HILT was combined with conservative physical therapy versus conservative physical therapy alone.
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