Efficacy of Photobiomodulation Therapy in the Treatment of Pain and Inflammation: A Literature Review
Abstract
:1. Introduction
2. Methodology
2.1. Study Design
2.2. Sources of Information and Search Strategies
- Population: patients older than 18 years of age and with inflammation or pain lasting for more than 3 months.
- Intervention: reduction in the symptomology of pain or inflammation after a PBM intervention.
- Comparison: the use or not of PBM.
- Results: effectiveness of the PBM application strategies on chronic pain and inflammation.
2.2.1. PubMed
- Text accessibility: open-access or accessible to the University of Granada, Spain.
- Type of articles: RCTs and observational studies.
- Date of publication: 2017–2022.
- Species: human.
- Language: English.
2.2.2. ProQuest
- Text accessibility: open-access or accessible to the University of Granada, Spain.
- Type of articles: RCTs and observational studies.
- Date of publication: 2017–2022.
- Language: English.
2.2.3. Scopus
- Text accessibility: open-access or accessible to the University of Granada, Spain.
- Type of articles: articles.
- Subject: medicine and health professions.
- Date of publication: 2017–2022.
2.2.4. Web of Science
- Text accessibility: open-access or accessible to the University of Granada, Spain.
- Type of articles: articles (RCTs).
- Subject: medicine and health professions.
- Date of publication: 2017–2022.
2.2.5. PEDro
- Text accessibility: open-access or accessible to the University of Granada, Spain.
- Subject: chronic pain.
- Method: RCTs.
- Date of publication: 2017–2022.
2.3. Study Selection
2.3.1. Criteria for Inclusion
- Publication between January 2017 and May 2022.
- International publication in English and peer-reviewed.
- Designed as RCTs.
- Access to the complete text available.
- Conducted in humans over the age of 18.
- Suffer from acute pain or chronic pain.
- Suffer from some type of pathology that causes chronic pain.
- Suffer from edema/inflammation.
2.3.2. Exclusion Criteria
- Not meeting the inclusion criteria.
- Repeated in the databases.
- Does not assess chronic pain, inflammation or pathology or symptom prevention.
- Lack of PBMT implementation in people with pain or inflammation.
- No results were shown or no interpretation of the data.
2.4. Article Selection
2.5. Methodological Quality Assessment of the RCTs
2.6. RCTs Qualitative Synthesis
2.7. Management of the Identified Literature
3. Results
3.1. Study Selection
3.2. Methodological Quality Evaluation
3.3. Study Characteristics
3.4. Methodological Quality of the Collected Literature
3.5. Effects of Photobiomodulation Therapy on Health Improvement and Chronic Pain
3.5.1. Chronic Pain
3.5.2. Inflammation
3.5.3. Acute Pain
3.6. Questionnaires and Scales Used in the Articles
4. Discussion
4.1. Chronic Nonspecific Low Back Pain
4.2. Fibromyalgia
4.3. Temporomandibular Pain and Dysfunction
4.4. Oral Pain and Inflammation
4.5. Post-Surgery Pain and Swelling
4.6. Strengths and Weaknesses of the Study
4.7. Prospective
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author, Year | 1 * | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Eduardo C. et al., 2020 [16] | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 9/10 Excellent |
Luciana GL. et al., 2018 [17] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 Excellent |
Fernanda R. et al., 2018 [18] | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 6/10 Good |
Leyla K. et al., 2020 [19] | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 6/10 Good |
Mariana M. et al., 2018 [20] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 Excellent |
De Souza R. et al., 2018 [21] | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 6/10 Good |
Shaiane S. et al., 2021 [22] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 9/10 Excellent |
Chong R. et al., 2020 [23] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 Excellent |
Taradaj J. et al., 2019 [24] | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 9/10 Excellent |
Fang-Yin L. et al., 2020 [25] | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 8/10 Good |
Author, Year | 2 | 3 | 5 | 6 | 7 | 8 | 9 | IVS |
---|---|---|---|---|---|---|---|---|
Eduardo C. et al., 2020 [16] | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 6/7 High |
Luciana GL. et al., 2018 [17] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7/7 High |
Fernanda R. et al., 2018 [18] | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 3/7 Limited |
LeylaK. et al., 2020 [19] | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 3/7 Limited |
Mariana M. et al., 2018 [20] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7/7 High |
De Souza R. et al., 2018 [21] | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 4/7 Limited |
Shaiane S. et al., 2021 [22] | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 6/7 High |
Chong R. et al., 2020 [23] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7/7 High |
Taradaj J. et al., 2019 [24] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 6/7 High |
Fang-Yin L. et al., 2020 [25] | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 5/7 High |
Fernanda T. et al., 2018 [26] | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 4/7 Limited |
Author, Year | Type of Study | Experimental Group | Control Group | Interventions | Variables | Results |
---|---|---|---|---|---|---|
Nunes EC. et al., 2020 [16] | Randomized Clinical Trial | 35 people with post endodontic surgery pain. Men: 16 Women: 19 Age range: 20.8–37.2 Chronic illness: No Post operative pain: 1.3–2.9 Treatment time: 39.2–54.2 | 35 people with post endodontic surgery pain. Men: 15 Women: 20 Age range:18.4–42.2 Chronic illness: No Post operative pain: 1.4–3.2 Treatment time: 49.9–39.3 | EG: Received PBMT at 4 points (attached to mucosa) after endodontic treatment. CG: Received endodontic treatment and prescribed ibuprofen 600 mg, to be taken every 12 h daily. Received sham PBMT. | Verbal rating scale (VPRS) with ibuprofen. Verbal rating scale (VPRS) with PBMT. Numerical rating scale (NPRS) with ibuprofen. Numerical rating scale (NPRS) with PBMT. | There is a significant decrease in pain in the first 24 h with PBMT compared to the administration of ibuprofen 600mg (p < 0.001). |
Gonçalves Langella L. et al., 2018 [17] | Randomized Clinical Trial | 9 people in the post-surgical period of knee arthroplasty. | 9 people in the post-surgical period of knee arthroplasty. | EG: PBMT applied at 5 points along the scar of the operation. CG: Sham PBMT applied at 5 points along the scar of the operation. | Changes in color. Changes in IL-6. Changes in IL-8. Changes in TNF-α. | There was a significant change in the group treated with PBMT, with reduced pain and serum levels of proinflammatory cytokines (p < 0.05) (IL-6, IL-8, TNF-α). |
Fernanda R. et al., 2018 [18] | Randomized Clinical Trial | Group US + LLLT: 14 Caucasian women with knee osteoarthritis. Age range: 77–67 Group US + ET + LLLT: 14 Caucasian women with knee osteoarthritis. Age range: 71–61 | 14 Caucasian women with knee osteoarthritis. Age range: 69–61. | EG1 US + LLLT: US and LLLT applied to 5 specific points on the knee. EG2 US + ET + LLLT: US and LLLT applied to 5 specific points on the knee. In addition, performance of guided therapeutic exercise. CG: sham US and LLLT applied to 5 specific points on the knee. Subjects were blinded. | Changes in pain pressure threshold. Changes in the number of squats Radiological Evaluation (K-L Scale) | There was a significant increase in the pain pressure threshold (p < 0.01). The number of squats was higher in the experimental groups after treatment when compared to the CG (p < 0.0001). There were no radiological findings that differed between any of the groups. (p > 0.05). |
Leyla K. et al., 2020 [19] | Randomized Clinical Trial | 20 people with nonspecific chronic low back pain. Men: 7 Women: 13 Age range: 25–65 Average age: 47 | 20 people with nonspecific chronic low back pain. Men: 5 Women: 15 Age range: 28–69 Average age: 51 | EG: LLLT applied to the joint spaces of the spine (3 points per disc, 30 s each), adjacent paravertebral points, radiating pain zones, and tender and acupuncture points. CG: The same intervention as the experimental group but in the form of sham treatments. | Changes in pain intensity (VAS). Changes in the range of motion of the lumbar spine. Functional status of the patients (according to RMQ). Spinal tenderness. | Significant changes in pain, functional status (p < 0.001) and range of motion of the lumbar spine, with these benefits persisting during the 3-month treatment period (p < 0.001), unlike in the control group where there were only improvements during the first month. There were no significant differences between groups regarding spinal tenderness. |
Mariana M. et al., 2017 [20] | Randomized Clinical Trial | PBMT group: Formed of 2 groups, each containing 20 people with FM. ET group: Formed of 2 groups, each containing 20 people with FM. PBMT + ET group: Formed of 2 groups, each containing 20 people with FM. Set 1: Investigates the immediate effect of a single PBMT/ET session on chronic pain condition Age: 32–38 BMI (Kg/m2): 21–31 Set 2: Investigates the long-term effect (10 weeks) on the chronic pain condition and other FM symptoms Age: 38–42 BMI(Kg/m2): 23–31 | Divided into 2 groups, each containing 20 people with FM. Set 1: Investigates the immediate effect of a single PBMT/ET session on chronic pain condition Age: 32–38 BMI (Kg/m2): 21–31 Set 2: Investigates the long-term effect (10 weeks) on the chronic pain condition and other FM symptoms Age: 38–42 BMI (Kg/m2): 23–31 | EG1 (Set 1): Only one PBMT session was performed. These patients were evaluated at baseline and after 24 h. EG2 (Set 2): PBMT was applied 30 min before each exercise session. Outcome parameters were assessed at baseline (before group draw) and 48 h after the last day of intervention. PBMT: Applied for 300 s at each of 10 sensitive pain points. ET: Consisted of aerobic exercises and stretching 2 times/week for 10 weeks. They also performed TMJ exercises. PBMT + ET: They performed a combination of both protocols. | Changes in pain threshold. Changes in pain intensity (VAS). FIQ score. Sleep score. Mouth opening. | Pain threshold did not significantly improve after an exercise session; however, differences were noticeable with a PBMT session. Set 2 of the PBMT group showed similar results to Set 1. In Set 1, no additional benefits of the PBMT + ET combination were detected. The PBMT and PBMT + ET groups showed significant pain reduction versus the ET group and CG (Set 2). Furthermore, both combined therapies reduced the number of tender points. PBMT + ET had a beneficial role in anxiety, depression, and fatigue. |
De Souza R. et al., 2018 [21] | Randomized Clinical Trial | 66 people with FM. Age Range: 57.05–35.23 Average age: 46.14 (62 women and 4 men) Group A: 33 volunteers with FM and chronic pain. Group B: 33 volunteers with FM and chronic pain. | None. | 2 sessions/week for 6 weeks: Group A: GaAIAs diode laser irradiation for 40 s at each selected point. 780 nm wavelength. Power: 50 mW. Energy: 2 J. Point-skin distance: 1 cm. 1 session/week for 4 weeks: Group B: Anesthetic injection of 2% lidocaine without vasoconstrictor. Volume: 0.5 mL at each tender point. Stretching after infiltrations. | Intensity of orofacial pain (VAS). Tenderness in the facial muscles. Perception of efficacy and well-being of both treatments. | Significant decrease in pain (p = 0.0001), although without any noticeable difference between groups. There was a decrease in pain intensity in tender points with both treatments. All the muscles analyzed had a response except for the temporal post (p < 0.05). The perception of the patients and their well-being improved in both groups with a slight difference in favor of Group A. |
Shaiane S. et al., 2021 [22] | Randomized Clinical Trial | 9 people with chronic nonspecific low back pain. Women: 5 Men: 4 Age range: 20.51–47.05 Average age: 33.78 | 9 people with chronic nonspecific low back pain. Women: 6 Men: 3 Age range: 19.63–44.23 Average age: 31.44 | EG: A single PBMT session was applied with the following parameters: Area: 4 cm2. Frequency: 3000Hz. Time: 3 min at each sensitive point. Total energy radiated at each point (between the spinous processes of T11 and T12, L2 and L3, L5 and S1 and in the same direction but laterally, 3 sites to the left and another 3 to the right): 24.30 J. CG: Received the same therapy, but in a simulated way, in a single session. | Changes in PGE2. Pain intensity. Changes in IL-6. Changes in TNF-α. | With PBMT, PGE2 decreased significantly (p = 0.04) compared to the placebo group. The same did not happen with pain intensity, IL-6 or TNF-α, which did not show significant changes in relation to the CG. |
Chong R. et al., 2020 [23] | Randomized Clinical Trial | 27 people with orthodontic pain and periodontal inflammation. | 27 people with orthodontic pain and periodontal inflammation. | EG: For 6 months the use of PBMT on orthodontic pain and periodontal inflammation is examined. During the first 2 months the volunteers had braces/buccal tubes in the maxillary and/or mandibular dental arches, followed by thermal NiTi archwire treatment in the 3rd month. The teeth in the middle of the dental arch were treated with LLLT. With a quadrangular probe, the region was covered from the central incisor to the first molar. The probe was first directed at the level of the braces and the buccal gingival margin and then moved to the level of the buccal alveolar mucosa. Wavelength: 940 nm. Output power: 800 mW. Irradiation duration: 30 s. CG: Received the same treatment as the experimental group but with a sham LLLT. | Subjective pain assessment. Clinical periodontal status and supragingival bacterial load. FGC biomarkers associated with pain and inflammation. | In the comparison between groups, regarding subjective pain, the side irradiated with LLLT experienced less pain, but it was only significant at the 6- and 24 h intervals (p = 0.01) and marginally significant at the 3-day interval (p = 0.03). No differences were found between groups (p > 0.05). regarding the clinical periodontal status and the bacterial load. The LLLT group had significant improvements in both pain 1 h and 24 h later (p = 0.02) and gingival inflammation during the first 24 h (p = 0.00). |
Taradaj J. et al., 2019 [24] | Randomized Clinical Trial | TLAI group: 18 people with nonspecific chronic low back pain. Men: 10 Women: 8 Age range: 29–58. Average age: 44 LLLT group: 16 people with nonspecific chronic low back pain. Men: 8 Women: 8 Age range: 29–53 Average age: 45.50 | TLAI group: 17 people with nonspecific chronic low back pain. Men: 9 Women: 8 Age range: 26–51. Average age: 45 LLLT group: 17 people with nonspecific chronic low back pain. Men: 9 Women: 8 Age range: 22–76 Average age: 52 | EG: TLAI group: Received 15 daily high-intensity laser irradiations for 3 weeks. Area: 6 × 5 cm lumbar area with a 30 cm2 punctual applicator. Wavelength: 1064nm. Energy: 60 J/cm2. Duration: 10 min. LLLT group: Received 15 daily high-intensity laser irradiations for 3 weeks. Area: Paraspinal region of the lower back. Wavelength: 785nm. Energy: 8 J/cm2. Duration: 8 min. CG: The placebo TLAI group and the placebo LLLT group both received sham irradiation treatments of their respective types of lasers. | Roll path. Roll path along the Y axis. Roll path along the X axis. Average speed. Average frequency. Rolling area results. Tests are performed with eyes closed and eyes open. | The only non-significant changes were seen in the average frequency (p = 0.77 (Open Eyes); p = 0.68 (Closed Eyes)). Improvements did occur but were only significant in the short term (after 3 weeks of therapy). Analysis 1 and 3 months after therapy, without continuing stabilization exercises, showed the parameters to deteriorate over time. Therefore, the changes are observed over a short period of time. |
Fang-Yin L. et al., 2020 [25] | Randomized Clinical Trial | 16 people with knee osteoarthritis. Age range: 77.42–63.64. | 17 people with knee osteoarthritis. Age range: 76.64–62.82. | EG: Treated with LLLT 3 times a week for 4 weeks at points SP9, SP10 and EX.-LE2 on the knee. Wavelength: 780 nm (P: 50 mW) and 830 nm (P: 30 mW). Duration: 15 min CG: Receives the same treatment as the EG but in a simulated way. | Subjective pain assessment (VAS) (Static and in motion). Changes in the pain pressure threshold (over the goosefoot tendon). Knee OA severity index (Lequesne index). | For the EG, the conscious VAS to move the knees decreased each week, while in the CG it did not decrease significantly. The same thing happened with the knee at rest (p < 0.01, p < 0.0001). The pain pressure threshold improved significantly each week in the EG, while for the CG this threshold did not improve effectively (p < 0.001, p < 0.0001). The OA severity index also improved significantly for the EG (p < 0.0001, p < 0.001) |
Fernanda T. et al., 2018 [26] | Randomized Clinical Trial | Groups made up of 41 patients with temporomandibular pain and dysfunction (TMD). PBMT group: 14 patients. Women: 14 Age range: 30–61.4 MT group: 13 patients. Men: 1 Women: 12 Age Range: 20.9–61.5 Combined therapies (CTs) group: 14 patients. Men:1 Women: 13 Age range: 32.1–61.9. | None. | PBMT group: PBMT applied 3 times a week for 4 weeks. Wavelength: 808 nm. Dot size: 0.03 cm2. Power: 100 mW. Irradiation: 133 J/cm2. Irradiation time: 40 sec/point (12 points). MT group: Received 3 weekly session on intra- and extra- oral masticatory muscles (temporal, masseter, medial pterygoid on both sides) and TMJ for 4 weeks. CTs group: They underwent the MT and PBMT protocols 3 times a week for 4 weeks. | Pain assessment (VAS). Beck anxiety inventory (BAI). TMD classification. Assessment of psychosocial aspects. | All subjects experienced a significant reduction in pain (p < 0.001) although not between groups. All groups showed a reduction in anxiety (PBMT: p = 0.02; MT: 0.03; CTs: p < 0.001). The classification of the TMD, based on Axis I, revealed that all patients were diagnosed with GI and GIII and presented a combination of both myogenic aspects. MT promotes improvement in 2 impairments, PBMT in 5 and CTs in 1 (p < 0.001). The evaluation of psychosocial aspects, comparing baseline and follow-up in all treatment groups, revealed that the treatment did not modify the intensity of chronic pain (p > 0.05). |
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González-Muñoz, A.; Cuevas-Cervera, M.; Pérez-Montilla, J.J.; Aguilar-Núñez, D.; Hamed-Hamed, D.; Aguilar-García, M.; Pruimboom, L.; Navarro-Ledesma, S. Efficacy of Photobiomodulation Therapy in the Treatment of Pain and Inflammation: A Literature Review. Healthcare 2023, 11, 938. https://doi.org/10.3390/healthcare11070938
González-Muñoz A, Cuevas-Cervera M, Pérez-Montilla JJ, Aguilar-Núñez D, Hamed-Hamed D, Aguilar-García M, Pruimboom L, Navarro-Ledesma S. Efficacy of Photobiomodulation Therapy in the Treatment of Pain and Inflammation: A Literature Review. Healthcare. 2023; 11(7):938. https://doi.org/10.3390/healthcare11070938
Chicago/Turabian StyleGonzález-Muñoz, Ana, María Cuevas-Cervera, José Javier Pérez-Montilla, Daniel Aguilar-Núñez, Dina Hamed-Hamed, María Aguilar-García, Leo Pruimboom, and Santiago Navarro-Ledesma. 2023. "Efficacy of Photobiomodulation Therapy in the Treatment of Pain and Inflammation: A Literature Review" Healthcare 11, no. 7: 938. https://doi.org/10.3390/healthcare11070938