Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD,
Michal Rosenthal, MD, Iulian Abramovici, MD,
Nathalia Kutok, MD, and Auni Khahil, MD
Objective: To
evaluate the effects of low-power light therapy on
pain and disability in elderly patients with
degenerative osteoarthritis in the knee.
Design: Partially
double-blinded, fully randomized trial comparing
red, infrared, and placebo light emitters.
Patients: Fifty
patients with degenerative osteoarthritis of both
knees were randomly assigned to three treatment
groups: red (15 patients), infrared (18 patients)
and placebo (17 patients). Infrared and placebo
emitters were double-blinded.
Interventions:
Self-applied treatment to both sides of the knee for
15 minutes twice a day for 10 days.
Main Outcome Measures:
Short-Form McGill Pain Questionnaire, Present Pain
Intensity, and Visual Analogue Scale for pain and
Disability Index Questionnaire for disability were
used. We evaluated pain and disability before and on
the tenth day of therapy. The period from the end of
the treatment until the patient’s request to be
retreated was summed up 1 year after the trial.
Results: Pain and
disability before treatment did not show
statistically significant differences between the
three groups. Pain reduction in the red and infrared
groups after the treatment was more than 50% in all
scoring methods (P < 0.05). There was no significant
pain improvement in the placebo group. We observed
significant functional improvement in red and
infrared treated groups (p < 0.05), but not in the
placebo group. The period from the end of treatment
until the patients required retreatment was longer
for red and infrared groups than for the placebo
group (4.2 3.0, 6.1 3.2, and 0.53 0.62 months, for
red, infrared, and placebo respectively)
Conclusions:
Low-power light therapy is effective in relieving
pain and disability in degeneratvie osteoarthritis
of the knee. J Am Geriatr Soc 40:23-26, 1992.
Degenerative osteoarthritis (DOA) is the most common
rheumatic disorder of man and causes pain and
disability especially in elderly people.1Autopsy
surveys show that degenerative changes in joints
begin as early as the second decade of life.2
Roentgenographic studies conducted in the United
States showed osteoarthritic changes in 4 percent of
persons under 24 years of age in 85 percent at 75 to
79 years of age. Symtomatic manifestations of
osteoarthritis increase with aging, reflecting
disease changes that begin in early life and
progress slowly over a period of many decades.3-4
Pain relief is the most important goal in management
of DOA. To provide optimal analgesic care the
treatment should be individualized. Attention must
be paid to the pharmacokinetis and pharmacodynamics
of drugs in the elderly, especially interactions
with other medications and adverse effects of
concomitant diseases.5-7
To avoid or to reduce difficulties concerned with
drug therapy, non-pharmacologic methods such as heat
or cold treatment, TENS therapy, biofeedback, and
physical exercises are frequently used.
Principles of phototherapy were established at the
end of the nineteenth century by N.R. Finsen, a
Nobel Prize winner, for application of light
treatment in skin diseases.8
Phototherapy is now employed in the treatment of
psoriasis,9
kernicterus,10
and as photodynamic therapy (PDT) in the treatment
of cancer.11Phototherapy
was advanced with the introduction of laser
treatments, initially in surgery.12
The development of the infrared (830nm) gallium-aluminium-arsenide
and of the red (633 nm) helium-neon-low-power laser,
introduced phototherapy in wound healing and
analgesia. Many investigators have described
successful pain treatment in a variety of diseases.
13-14
The purpose of this study was to evaluate the impact
of red or infrared light emitters on pain relief,
functional disability, and sparing of analgesic drug
therapy in elderly patients with DOA of the knee. |
