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      The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review Translated title: Os efeitos do laser de baixa intensidade no tratamento da síndrome da dor miofascial: revisão sistemática

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          Abstract

          ABSTRACT BACKGROUND AND OBJECTIVES: Among the approaches inherent to conservative treatment, the low-level laser therapy (LLLT) is one of the most used resources in the treatment of myofascial pain. This research sought to search the literature for the available evidence on the treatment of myofascial pain syndrome with LLLT in order to analyze the reported effects of this intervention. CONTENTS: Medline/PubMed, SCOPUS, Web of Science, Cochrane Central Registry of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) by Ebsco was used to search for articles on randomized clinical trials that related myofascial pain syndrome with LLLT. Studies were systematically selected by two reviewers independently, through title, abstract and, later, full text. Ten articles that met the criteria were included in this integrative review. In six of these articles, the improvement in pain compared to placebo group was presented right after LLLT session, although these results did not remain in the follow-ups of the studies that performed follow ups. CONCLUSION: LLLT seems to be a resource that decreases pain in patients with myofascial pain syndrome. Despite the positive results in reducing pain with the use of LLLT in some studies, this review admits the heterogeneity of studies with conficting results related to the effectiveness of LLLT. Research that defines the parameters and adequate therapeutic dosages are necessary for a better understanding of the real effects of LLLT on this clinical condition.

          Translated abstract

          RESUMO JUSTIFICATIVA E OBJETIVOS: Das abordagens inerentes ao tratamento conservador, o laser de baixa intensidade (LBI) é um dos recursos mais utilizados no tratamento da dor miofascial. Esta pesquisa buscou avaliar na literatura as evidências disponíveis sobre o tratamento da síndrome da dor miofascial com o LBI para analisar os efeitos reportados dessa intervenção. CONTEÚDO: Foram utilizadas as bases de dados Medline/Pubmed, SCOPUS, Web of Science, Registro Central Cochrane de Ensaios Controlados (CENTRAL) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), da Ebsco, para busca de artigos de ensaios clínicos randomizados que relacionassem síndrome da dor miofascial com LBI. Os estudos foram selecionados sistematicamente por dois revisores, independentemente, por meio do título, resumo e, posteriormente, texto completo. Dez artigos que se adequaram aos critérios foram incluídos nessa revisão sistemática. Em seis destes artigos, foi apresentada a melhora da dor comparada ao grupo placebo logo após a sessão de LBI, embora esses resultados não tenham permanecido nos acompanhamentos dos estudos que realizaram follow-ups. CONCLUSÃO: O LBI parece ser um recurso que diminui a dor em pacientes com síndrome da dor miofascial. Apesar dos resultados positivos na diminuição da dor com o uso do LBI em alguns estudos, esta análise admite a heterogeneidade dos estudos com resultados conflitantes relacionados à efetividade do LBI. Pesquisas que definam os parâmetros e dosagens terapêuticas adequadas são necessárias para um melhor entendimento sobre os reais efeitos do LBI sobre essa condição clínica.

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          Most cited references27

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          Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.

          Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo. We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. None.
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            Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials

            Objectives Low-level laser therapy (LLLT) is not recommended in major knee osteoarthritis (KOA) treatment guidelines. We investigated whether a LLLT dose–response relationship exists in KOA. Design Systematic review and meta-analysis. Data sources Eligible articles were identified through PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Central Register of Controlled Trials on 18 February 2019, reference lists, a book, citations and experts in the field. Eligibility criteria for selecting studies We solely included randomised placebo-controlled trials involving participants with KOA according to the American College of Rheumatology and/or Kellgren/Lawrence criteria, in which LLLT was applied to participants’ knee(s). There were no language restrictions. Data extraction and synthesis The included trials were synthesised with random effects meta-analyses and subgrouped by dose using the World Association for Laser Therapy treatment recommendations. Cochrane’s risk-of-bias tool was used. Results 22 trials (n=1063) were meta-analysed. Risk of bias was insignificant. Overall, pain was significantly reduced by LLLT compared with placebo at the end of therapy (14.23 mm Visual Analogue Scale (VAS; 95% CI 7.31 to 21.14)) and during follow-ups 1–12 weeks later (15.92 mm VAS (95% CI 6.47 to 25.37)). The subgroup analysis revealed that pain was significantly reduced by the recommended LLLT doses compared with placebo at the end of therapy (18.71 mm (95% CI 9.42 to 27.99)) and during follow-ups 2–12 weeks after the end of therapy (23.23 mm VAS (95% CI 10.60 to 35.86)). The pain reduction from the recommended LLLT doses peaked during follow-ups 2–4 weeks after the end of therapy (31.87 mm VAS significantly beyond placebo (95% CI 18.18 to 45.56)). Disability was also statistically significantly reduced by LLLT. No adverse events were reported. Conclusion LLLT reduces pain and disability in KOA at 4–8 J with 785–860 nm wavelength and at 1–3 J with 904 nm wavelength per treatment spot. PROSPERO registration number CRD42016035587.
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              Clinical effectiveness of laser acupuncture: a systematic review.

              The use of laser light as an alternative to needles to stimulate acupuncture points has been promoted for almost three decades. However, there has been no systematic assessment of the evidence to support the effectiveness of this form of acupuncture to date. A systematic review was therefore undertaken of RCTs evaluating laser acupuncture as a primary intervention. Relevant studies (n = 18) were identified using computer-based literature searches and selected hand searches. Evidence was found to support the use of laser acupuncture in the treatment of myofascial pain, postoperative nausea and vomiting and for the relief of chronic tension headache. Laser acupuncture would appear to represent an effective form of acupuncture for the management of these conditions and could be considered as a viable alternative to more traditional forms of acupuncture point stimulation.
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                Author and article information

                Journal
                brjp
                BrJP
                BrJP
                Sociedade Brasileira para o Estudo da Dor (São Paulo, SP, Brazil )
                2595-0118
                2595-3192
                January 2023
                : 6
                : 1
                : 83-89
                Affiliations
                [1] João Pessoa PB orgnameFederal University of Paraíba orgdiv1Department of Physical Therapy Brazil
                [2] Currais Novos RN orgnamePotiguar University orgdiv1Department of Physical Therapy Brazil
                Article
                S2595-31922023000100083 S2595-3192(23)00600100083
                10.5935/2595-0118.20230014-en
                0f0f4c40-81d1-4da2-9e2b-57a699ab4e1e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 15 November 2022
                : 24 February 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 7
                Product

                SciELO Brazil

                Categories
                Review Articles

                Pain,Trigger-points,Low-level laser therapy,Dor,Pontos-gatilho,Terapia com luz de baixa intensidade

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