Background Chronic pain management in juvenile arthritis constitutes a special provocation not only for the medical doctors, but also for the patients and parents. Despite the extensive use of the biological agents with high efficacy, combined with the multimodal therapies, chronic pain still remains an important issue for the public health, with implications on the activities of daily living and the scholar performances. Lasers could be used for transmitting biological messages and initiating metabolic changes within living cells: no more pain, much more energy, will contribute to muscular and joints repair.
Objectives Aim of the present study was to evaluate the effects of photobiostimulation combined with DMARDs in patients with juvenile polyarthritis and chronic cervical pain.
Methods 62 patients diagnosed with juvenile polyarthritis (ILAR criteria), 11.4 years mean age were randomly divided in Group I (42 patients treated with local laser biostimulation and methotrexate), comparatively with a Group II - control (20 patients) treated with methotrexate and placebo laser, for a period of 9 months. Group I received local laser biostimulation with a dose of 2.5 J/cm2 in 14 latero-cervical painful points, corresponding to the 7 cervical vertebrae, 1 point on the insertion of sternocleido-mastoidian muscle on the styloid processus, and 1 point on each loco-regional submandibular lymphatic ganglions, using a GaAlAs laser probe of 670 nm, 25 mW output power and a modulation frequency of 10 Hz. 45 joules were applied daily as laser treatment, 10 sessions per month, repeated 3 times, in the 9 months. For all the patients, the main medication was methotrexate in a dose of 0.6 mg/kg (maximum 20 mg) per week, steroids and symptomatic drugs, when necessary. Tutors and the older children have signed the informed consent. Measurement of the subjective pain was on VAS (0 – 100 mm), and objective pain was assessed with an electronic device, the Algometer Commender. The range of motion for flexion/extension, and the rotation to the left/right of the cephalic extremity was measured with Dualer IQ Inclinometer.
Results In the end of study, the level of chronic pain estimated with Commander Algometer decreased by 74.6% in Group I, compared with only 41% in the control Group, and the range of motion in the affected cervical segment assessed with Dualer Inclinometer increased by 66% in the first Group, compared with only 34% in placebo group.
Conclusions Laser biostimulation proved to be an effective method for the complex management of chronic pain in juvenile polyarthritis.
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Disclosure of Interest None declared
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