O uso da terapia laser no tratamento da dor crônica difusa: uma revisão sistemática
DOI:
https://doi.org/10.11606/issn.2317-0190.v28i3a183314Palavras-chave:
Terapia a Laser, Fototerapia, Dor Crônica, ReabilitaçãoResumo
As terapias a laser são técnicas não invasivas, indolores, seguras e de baixo custo e de utilidade no tratamento da dor crônica. Nenhuma revisão sistemática avaliou os efeitos do laser no tratamento da dor crônica em múltiplos locais simultâneos. Objetivo: Avaliar os efeitos do laser no tratamento da dor crônica multifocal generalizada. Métodos: Revisão sistemática PRISMA sobre o uso do laser em pacientes com dor crônica multifocal de diversas etiologias. Este protocolo foi registrado no site PROSPERO antes da extração dos dados (registro nº. CRD42019152345). Resultados: 1.391 artigos atenderam aos critérios de inclusão e 15 estudos foram selecionados para a extração de dados, sendo 12 estudos em pacientes com fibromialgia, 01 estudo sobre síndrome dolorosa miofascial, 01 estudo sobre artrite reumatoide e 01 estudo sobre polineuropatia sensório-motora diabética. Não foi encontrada homogeneidade nos protocolos do laser, nos métodos de avaliação ou nos grupos controlados, mas em conjunto os estudos sugeriram que o laser poderia ter benefícios no tratamento da intensidade da dor, qualidade de vida, fadiga, rigidez, depressão e ansiedade em comparação com placebo e outras terapias para fibromialgia e para dor na artrite reumatóide e polineuropatia diabética. A terapia a laser mais o exercício padronizado ou amitriptilina não proporcionou nenhuma vantagem extra no alívio dos sintomas da fibromialgia. Para dor miofascial DTM, nenhum benefício foi encontrado. Conclusão: Os estudos mostraram vários pontos e locais diferentes de aplicação de luz, mas nenhum dos estudos selecionados usou a estimulação espinhal como local de aplicação do laser.
Downloads
Referências
GBD 2016 Brazil Collaborators. Burden of disease in Brazil, 1990-2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10149):760-75. Doi: https://doi.org/10.1016/S0140-6736(18)31221-2
Maetzel A, Li LC, Pencharz J, Tomlinson G, Bombardier C. The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis. 2004;63(4):395-401. Doi: https://doi.org/10.1136/ard.2003.006031
MacFarlane GJ, Croft PR, Schollum J, Silman AJ. Widespread pain: is an improved classification possible? J Rheumatol. 1996 Sep;23(9):1628-32.
Hunt IM, Silman AJ, Benjamin S, McBeth J, Macfarlane GJ. The prevalence and associated features of chronic widespread pain in the community using the 'Manchester' definition of chronic widespread pain. Rheumatology (Oxford). 1999;38(3):275-9. Doi: https://doi.org/10.1093/rheumatology/38.3.275
Andrews P, Steultjens M, Riskowski J. Chronic widespread pain prevalence in the general population: A systematic review. Eur J Pain. 2018;22(1):5-18. Doi: https://doi.org/10.1002/ejp.1090
Pereira D, Ramos E, Branco J. Osteoarthritis. Acta Med Port. 2015;28(1):99-106. Doi: https://doi.org/10.20344/amp.5477
Ezzati K, Laakso EL, Salari A, Hasannejad A, Fekrazad R, Aris A. The beneficial effects of high-intensity laser therapy and co-interventions on musculoskeletal pain management: a systematic review. J Lasers Med Sci. 2020;11(1):81-90. Doi: https://doi.org/10.15171/jlms.2020.14
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. Doi: https://doi.org/10.1186/2046-4053-4-1
International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) adopts Consolidated Guideline on Good Clinical Practice in the Conduct of Clinical Trials on Medicinal Products for Human Use. Int Dig Health Legis. 1997;48(2):231-4.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. Doi: https://doi.org/10.1136/bmj.l4898
Armagan O, Tascioglu F, Ekim A, Oner C. Long-term efficacy of low level laser therapy in women with fibromyalgia: A placebo-controlled study. J Back Musculoskelet Rehabil. 2006;19(4):135-40. Doi: https://doi.org/10.3233/BMR-2006-19405
Fernández García R, Suárez Holgado JD, Formieles Ortiz I, Zurita Ortega F, Valverde Cepeda M, Fernández Sánchez M. Using a laser based program in patients diagnosed with fibromyalgia. Reumatol Clin. 2011;7(2):94-7. Doi: https://doi.org/10.1016/j.reuma.2010.01.007
Germano Maciel D, Trajano da Silva M, Rodrigues JA, Viana Neto JB, França IM, Melo ABM, et al. Low-level laser therapy combined to functional exercise on treatment of fibromyalgia: a double-blind randomized clinical trial. Lasers Med Sci. 2018;33(9):1949-59. Doi: https://doi.org/10.1007/s10103-018-2561-2
Gür A, Karakoc M, Nas K, Cevik R, Sarac J, Ataoglu S. Effects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: a single-blind, placebo-controlled trial. Rheumatol Int. 2002;22(5):188-93. Doi: https://doi.org/10.1007/s00296-002-0221-z
Gür A, Karakoç M, Nas K, Cevik R, Saraç J, Demir E. Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial. Lasers Med Sci. 2002;17(1):57-61. Doi: https://doi.org/10.1007/s10103-002-8267-4
Matsutani LA, Marques AP, Ferreira EA, Assumpção A, Lage LV, Casarotto RA, et al. Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Clin Exp Rheumatol. 2007;25(3):410-5.
Magri LV, Carvalho VA, Rodrigues FC, Bataglion C, Leite-Panissi CR. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci. 2017;32(2):419-28. Doi: https://doi.org/10.1007/s10103-016-2138-x
Panton L, Simonavice E, Williams K, Mojock C, Kim JS, Kingsley JD, et al. Effects of Class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. J Altern Complement Med. 2013;19(5):445-52. Doi: https://doi.org/10.1089/acm.2011.0398
Ruaro JA, Fréz AR, Ruaro MB, Nicolau RA. Low-level laser therapy to treat fibromyalgia. Lasers Med Sci. 2014;29(6):1815-9. Doi: https://doi.org/10.1007/s10103-014-1566-8
Silva MM, Albertini R, Tarso Camillo de Carvalho P, Leal-Junior ECP, Bussadori SK, Vieira SS, et al. Randomized, blinded, controlled trial on effectiveness of photobiomodulation therapy and exercise training in the fibromyalgia treatment. Lasers Med Sci. 2018;33(2):343-51. Doi: https://doi.org/10.1007/s10103-017-2388-2
Vayvay ES, Tok D, Turgut E, Tunay VB. The effect of Laser and taping on pain, functional status and quality of life in patients with fibromyalgia syndrome: A placebo- randomized controlled clinical trial. J Back Musculoskelet Rehabil. 2016;29(1):77-83. Doi: https://doi.org/10.3233/BMR-150600
Walker JB, Akhanjee LK, Cooney MM, Goldstein J, Tamayoshi S, Segal-Gidan F. Laser therapy for pain of rheumatoid arthritis. Clin J Pain. 1987;3(1):54-9.
Zinman LH, Ngo M, Ng ET, Nwe KT, Gogov S, Bril V. Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy: a controlled trial. Diabetes Care. 2004;27(4):921-4. doi: https://doi.org/10.2337/diacare.27.4.921
Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH, Kuan YC. Low-level laser therapy for fibromyalgia: a systematic review and meta-analysis. Pain Physician. 2019;22(3):241-54.
Ricci NA, Dias CNK, Driusso P. A utilização dos recursos eletrotermofototerapêuticos no tratamento da síndrome da fibromialgia: uma revisão sistemática. Rev Bras Fisioter. 2010;14(1):1-9. Doi: https://doi.org/10.1590/S1413-35552010000100002
Kingsley JD, Demchak T, Mathis R. Low-level laser therapy as a treatment for chronic pain. Front Physiol. 2014;5:306. Doi: https://doi.org/10.3389/fphys.2014.00306
Hamblin MR. Photobiomodulation or low-level laser therapy. J Biophotonics. 2016;9(11-12):1122-4. Doi: https://doi.org/10.1002/jbio.201670113
Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys. 2017;4(3):337-61. Doi: https://doi.org/10.3934/biophy.2017.3.337
Hamblin MR. Photobiomodulation, photomedicine, and laser surgery: a new leap forward into the light for the 21st century. Photomed Laser Surg. 2018;36(8):395-6. Doi: https://doi.org/10.1089/pho.2018.29011.mrh
Hamblin MR, Hasan T. Photodynamic therapy: a new antimicrobial approach to infectious disease? Photochem Photobiol Sci. 2004;3(5):436-50. Doi: https://doi.org/10.1039/b311900a
Berta T, Qadri Y, Tan PH, Ji RR. Targeting dorsal root ganglia and primary sensory neurons for the treatment of chronic pain. Expert Opin Ther Targets. 2017;21(7):695-703. Doi: https://doi.org/10.1080/14728222.2017.1328057
Holanda VM, Chavantes MC, Silva DF, Holanda CV, Oliveira Junior JO, Wu X, et al. Photobiomodulation of the dorsal root ganglion for the treatment of low back pain: A pilot study. Lasers Surg Med. 2016;48(7):653-9. Doi: https://doi.org/10.1002/lsm.22522
Krames ES. The dorsal root ganglion in chronic pain and as a target for neuromodulation: a review. Neuromodulation. 2015;18(1):24-32. Doi: https://doi.org/10.1111/ner.12247
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2021 Acta Fisiátrica
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.