Patofiziološke osnove i indikacijsko područje primjene lasera male snage u liječenju akutne i kronične boli

Ivan Šklebar, Tomislav Šklebar, Sanja Berić Lerotić

Cilj: Primjena lasera male snage u liječenju akutne i kronične boli datira unatrag 30 godina. Cilj su ovog članka opis spoznaja o mehanizmima djelovanja lasera na bol te upute za njegovu učinkovitiju primjenu u terapiji pojedinih bolnih stanja. Materijal i metode: Prema zadanim ključnim riječima, pregledali smo literaturu na engleskom i hrvatskom jeziku objavljenu od 1988. do 2018. godine u bazama Scopus, Medline, Embase, Web of Science i Cochrane Library. Izdvojeni su i citirani radovi primjereni ciljevima ovoga kratkog pregleda. Rezultati: Iako patofiziološki učinci laserske zrake na oštećeno tkivo nisu potpuno poznati ni danas, dosadašnje spoznaje upućuju na biostimulativne efekte koji potiču brže saniranje i regeneraciju oštećenih tkiva poboljšanjem dopreme energenata i kisika u stanice, smanjenje upalne komponente i edema, a time i smanjenje boli te oporavak funkcije. Velik je broj objavljenih kliničkih studija koje dokazuju djelotvornost lasera u terapiji različitih bolnih stanja, ali brojne dobro dizajnirane randomizirane studije pokazale su da su ti učinci često na razini placeba ili usporedivi s učinkom drugih metoda u fizikalnoj terapiji. Poseban problem u istraživanju čini velika paleta laserskih uređaja čije sonde isporučuju zrake različitih valnih duljina, od 600 do 1000 nm, u širokom rasponu snage od 5 do 500 mW te različitih modaliteta emitiranja, od kontinuiranoga do pulsirajućega. Da bismo postigli biostimulativno djelovanje na oštećeno tkivo, ono mora primiti odgovarajuću količinu energije od 1 do 2 J/cm2 pri akutnim stanjima odnosno od 4 do 8 J/cm2 kod kroničnih stanja. Zaključak: Da bi primjena lasera bila djelotvorna komplementarna metoda liječenja boli, moraju se optimizirati parametri valne duljine, snaga sonde i modalitet emitiranja.

The aim: The application of low level lasers in the treatment of acute and chronic pain dates 30 years back. The aim of this article is to describe what is known about the mechanisms of action of lasers on pain conditions and to provide guide for more effective use of lasers in the pain treatment. Materials and Methods: A review of English and Croatian language literature contained in the Scopus, Medline, EMBASE, Web of Science and Cochrane libraries from 1998 to 2018 was conducted according to selected key words. Papers appropriate for the purposes of this brief review have been selected and cited. Results: Although the pathophysiological effects of
laser beam on damaged tissue are not fully understood, present findings suggest that photobiomodulation affects promotion of faster repair and regeneration of damaged tissues by improving nutrient and oxygen delivery to the cells, as well as reduction in inflammation and edema, thereby reducing pain and recovering normal functions. There are a number of published clinical studies that favor the effectiveness of laser in the treatment of various pain conditions. However, other well-designed randomized studies have shown that these effects are often at the placebo level or comparable to the effects of some other methods in physical therapy. A particular problem in research is a large variety of laser devices ranging from various probes which emit light at different wavelengths (600 to 1000 nm), power outputs (5 to 500 mW) and various emission modalities (continuous or pulsating). For a photobiomodulation effect, target tissues must receive an adequate amount of energy ranging from 1–2 J / cm2 for acute conditions and up to 4–8 J / cm2 for chronic conditions. Conclusion: In order to make laser application an effective complementary method of pain management, parameters of wavelength, probe power, and emission modality must be optimized.