• Logo
  • SBMUJournals

The Effects of Photobiomodulation Therapy on Post-Surgical Pain

Kamran Ezzati, Reza Fekrazad, Zeinab Raoofi
476

Views

PDF

Abstract

Introduction: One of the major complains after surgery is pain. Recent advances in the prevention and reduction of postoperative pain have provided several modalities. One of them is the use of laser irradiation on the surgical area.
Objectives: To evaluate the effects of low level laser therapy (LLLT) on pain and side effects after surgery.
Methods: In this research, databases such as: PubMed, Science Direct, Google Scholar, Springer and Cochrane were used and the words of laser therapy, photobiomodulation, therapeutic laser, low level laser therapy, surgery and pain were searched. Articles, including systematic reviews, original articles, case series, and clinical intervention studies related to these words, were studied. The language of all articles was English and consists of papers from 2009 until 2017.
Results: A total of 370 papers were studied and 10 articles that met inclusion criteria were selected for this review. Few of these articles were followed up. Surgery included a wide range of surgeries including mastectomy, breast augment post-fracture, episiotomy, tonsillectomy and hernia. The methodological quality score on the PEDro scale was between 5 and 11. 8 trials reported positive effects and 2 trials reported negative effects. In order to study clinical effect size of laser therapy after surgery, only 4 papers met entry criteria and the mean effect sizes were 0.13 to 2.77. Accordingly, the best treatment protocol included a red laser dose of 4 J/cm2 for the post-operative pain of tonsillectomy, which was irradiated through the infra mandibular angle on the tonsils.
Conclusion: LLLT may be an appropriate modality for reducing pain after surgery, nevertheless the effect size of this modality is variable. Therefore, further research based on proper protocols for these patients and follow-up of therapeutic course should be designed and implemented.

Keywords

Photobiomodulation; Low level laser therapy; Surgery; Pain.

References

Carr DB, Goudas LC. Acute pain. The Lancet. 1999;353(9169):2051-8.

Breivik H. Postoperative pain management: why is it difficult to show that it improves outcome? European Journal of Anaesthesiology (EJA). 1998;15(6):748-51.

Imani F, Rahimzadeh P. Gabapentinoids: gabapentin and pregabalin for postoperative pain management. Anesthesiology and pain medicine. 2012;2(2):52.

Nayman J. Measurement and control of postoperative pain. Annals of the Royal College of Surgeons of England. 1979;61(6):419.

Sieber FE, Mears S, Lee H, Gottschalk A. Postoperative opioid consumption and its relationship to cognitive function in older adults with hip fracture. Journal of the American Geriatrics Society. 2011;59(12):2256-62.

Breivik H, Högström H, Niemi G, Stalder B, Hofer S, Fjellstad B, et al. 2 Safe and effective post-operative pain relief: introduction and continuous quality-improvement of comprehensive post-operative pain management programmes. Baillière's clinical anaesthesiology. 1995;9(3):423-60.

McDonald GJ, Lord SM, Bogduk N. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery. 1999;45(1):61-8.

Chaney MA. Side effects of intrathecal and epidural opioids. Canadian Journal of Anaesthesia. 1995;42(10):891-903.

Asnaashari M, Safavi N. Application of low level lasers in dentistry (endodontic). Journal of lasers in medical sciences. 2013;4(2):57.

Prabhu V, Rao S, Chandra S, Kumar P, Rao L, Guddattu V, et al. Spectroscopic and histological evaluation of wound healing progression following Low Level Laser Therapy (LLLT). Journal of biophotonics. 2012;5(2):168-84.

Fernando S, Hill C, Walker R. A randomised double blind comparative study of low level laser therapy following surgical extraction of lower third molar teeth. British Journal of Oral and Maxillofacial Surgery. 1993;31(3):170-2.

Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Harkness LE, Woodruff LD. The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomedicine and Laser Therapy. 2004;22(4):323-9.

Albertini R, Villaverde A, Aimbire F, Salgado M, Bjordal J, Alves L, et al. Anti-inflammatory effects of low-level laser therapy (LLLT) with two different red wavelengths (660nm and 684nm) in carrageenan-induced rat paw edema. Journal of Photochemistry and Photobiology B: Biology. 2007;89(1):50-5.

Medrado AR, Pugliese LS, Reis SRA, Andrade ZA. Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers in surgery and medicine. 2003;32(3):239-44.

Aras MH, Ömezli MM, Güngörmüş M. Does low-level laser therapy have an antianesthetic effect? A review. Photomedicine and laser surgery. 2010;28(6):719-22.

Mizutani K, Musya Y, Wakae K, Kobayashi T, Tobe M, Taira K, et al. A clinical study on serum prostaglandin E2 with low-level laser therapy. Photomedicine and Laser Therapy. 2004;22(6):537-9.

Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RAB. Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomedicine and Laser Therapy. 2006;24(2):158-68.

Brugnera Júnior A, Santos AEC, Bologna ED, Ladalardo TCC. Atlas de laserterapia aplicada à clínica odontológica. Atlas de laserterapia aplicada à clínica odontológica: Ed. Santos; 2003.

Fikácková H, Dostálová T, Navrátil L, Klaschka J. Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study. Photomedicine and laser surgery. 2007;25(4):297-303.

Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Australian Journal of Physiotherapy. 2003;49(2):107-16.

Rankin IA, Sargeant H, Rehman H, Gurusamy KS. Low‐level laser therapy for carpal tunnel syndrome. The Cochrane Library. 2017.

Brosseau L, Welch V, Wells G, Tugwell P, De Bie R, Gam A, et al. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a metaanalysis. The Journal of rheumatology. 2000;27(8):1961-9.

Gür A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E. Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial. Lasers in medical science. 2002;17(1):57-61.

Nesioonpour S, Mokmeli S, Vojdani S, Mohtadi A, Akhondzadeh R, Behaeen K, et al. The effect of low-level laser on postoperative pain after tibial fracture surgery: a double-blind controlled randomized clinical trial. Anesthesiology and pain medicine. 2014;4(3).

Kozanoglu E, Basaran S, Paydas S, Sarpel T. Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial. Clinical rehabilitation. 2009;23(2):117-24.

Jackson RF, Roche G, Mangione T. Low-level laser therapy effectiveness for reducing pain after breast augmentation. The American Journal of Cosmetic Surgery. 2009;26(3):144-8.

Carvalho RLdP, Alcântara PS, Kamamoto F, Cressoni MDC, Casarotto RA. Effects of low-level laser therapy on pain and scar formation after inguinal herniation surgery: a randomized controlled single-blind study. Photomedicine and laser surgery. 2010;28(3):417-22.

Neiva FC, Vieira FMJ, Figueiredo CR, Stamm AEC, Weckx LLM, Pignatari SSN. Therapeutic laser for pain relief after tonsillectomy. Revista Paulista de Pediatria. 2010;28(3):322-8.

de Oliveira Santos J, de Oliveira SMJV, Nobre MRC, Aranha ACC, Alvarenga MB. A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: A pilot study. Midwifery. 2012;28(5):e653-e9.

Santos JdO, de Oliveira SM, da Silva F, Nobre MR, Osava RH, Riesco ML. Low‐level laser therapy for pain relief after episiotomy: a double‐blind randomised clinical trial. Journal of clinical nursing. 2012;21(23-24):3513-22.

Aghamohammadi D, Eidi M, Lotfi A, Hosseinzadeh H, Movasaghi R, Motighini N, et al. Effect of low level laser application at the end of surgery to reduce pain after tonsillectomy in adults. Journal of lasers in medical sciences. 2013;4(2):79.

Karlekar A, Bharati S, Saxena R, Mehta K. Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study. Annals of cardiac anaesthesia. 2015;18(3):317.

Fernandes GA, Júnior RdBA, Lima ACG, Gonzaga ICA, de Oliveira RA, Nicolau RA. Low-intensity laser (660 NM) has analgesic effects on sternotomy of patients who underwent coronary artery bypass grafts. Annals of cardiac anaesthesia. 2017;20(1):52.

Colombo F, Neto AdAPV, Sousa APCd, Marchionni AMT, Pinheiro ALB, Reis SRdA. Effect of low-level laser therapy (660 nm) on angiogenesis in wound healing: a immunohistochemical study in a rodent model. Brazilian dental journal. 2013;24(4):308-12.

Dos Santos SA, Alves ACA, Leal-Junior ECP, Albertini R, de Paula Vieira R, Ligeiro AP, et al. Comparative analysis of two low-level laser doses on the expression of inflammatory mediators and on neutrophils and macrophages in acute joint inflammation. Lasers in medical science. 2014;29(3):1051-8.

Brosseau L, Welch V, Wells G, Tugwell P, Gam A, Harman K, et al. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a metaanalysis. 2000.

Schindl A, Schindl M, Schön H, Knobler R, Havelec L, Schindl L. Low-intensity laser irradiation improves skin circulation in patients with diabetic microangiopathy. Diabetes care. 1998;21(4):580-4.

Yu W, Naim JO, McGowan M, Ippolito K, Lanzafame RJ. Photomodulation of oxidative metabolism and electron chain enzymes in rat liver mitochondria. Photochemistry and photobiology. 1997;66(6):866-71.

Fekrazad R. The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators. -. 2013.

Fulop AM, Dhimmer S, Deluca JR, Johanson DD, Lenz RV, Patel KB, et al. A meta-analysis of the efficacy of laser phototherapy on pain relief. The Clinical journal of pain. 2010;26(8):729-36.

Hamblin MR, Demidova TN, editors. Mechanisms of low level light therapy. Mechanisms for low-light therapy; 2006: International Society for Optics and Photonics.

Rastgar Koutenaei F, Mosallanezhad Z, Naghikhani M, Ezzati K, Biglarian A, Nouroozi M, et al. The Effect of Low Level Laser Therapy on Pain and Range of Motion of Patients With Knee Osteoarthritis. Physical Treatments. 2017; 7(1):13-28.

Alghadir A, Omar MTA, Al-Askar AB, Al-Muteri NK. Effect of low-level laser therapy in patients with chronic knee osteoarthritis: a single-blinded randomized clinical study. Lasers in medical science. 2014;29(2):749-55.

Fukuda VO, Fukuda TY, Guimarães M, Shiwa S, de Lima BDC, Martins RÁBL, et al. Short-term efficacy of low-level laser therapy in patients with knee osteoarthritis: a randomized placebo-controlled, double-blind clinical trial. Revista Brasileira de Ortopedia (English Edition). 2011;46(5):526-33.

Kwon K, Son T, Lee K-J, Jung B. Enhancement of light propagation depth in skin: cross-validation of mathematical modeling methods. Lasers in medical science. 2009;24(4):605-15.

Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Journal of Physiotherapy. 2003;49(2):107-16.

Fekrazad R, Chiniforush N, Bouraima SA, Valipour M, Aslani M, Zare M, et al. Low level laser therapy in management of complications after intra oral surgeries. Journal of Lasers in Medical Sciences. 2012;3(4):135.




DOI: https://doi.org/10.22037/jlms.v10i2.20873