RESUMEN
Introduction: Low back pain (LBP) is a very common musculoskeletal disorder. The big burden of disease necessitates investigating a more effective modality of treatments with more persistence and also fewer side effects. Low power laser has been proved as a pain reducing modality, but there is a lack of studies comparing it with other treatments and also among the Iranian race and society. The purpose of this study was to evaluate the effect of low-level laser on patients with LBP. Methods: Our study was a single-blind, randomized controlled trial. Forty subjects, aged between 20 to 70 with LBP participated in the study. Their pain severity scale was 3-10 according to the visual analogue scale of pain (VAS). They were randomly assigned to two groups, a case group (true laser) and a control group (sham laser). Naproxen was prescribed with a free dose (250-1000 mg/ daily) to both groups. We evaluated patients' subjective pain, functional status (using the Roland Morris disability questionnaire), spinal range of motion (ROM) and spinal tenderness at the basic time, one month and 3 months after treatment. The true laser group received 12 sessions of laser (160 mW) and the control group took 12 sessions of sham laser (the same laser instrument in off status). An infrared laser GaAlAs, wavelength 808 nm, power 160 mw and spot size 1 cm2 and power density 0.16 J/cm2 in continuous mode was used in treatment. We applied the laser to articular spaces of vertebral column, adjacent paravertebral points, pain radiating areas, tender points and also pain-controlling acupuncture points. Results: Of the 40 participants in the study, 6 persons were excluded and thus the data obtained from 34 participants were statistically analyzed. There was significant improvement in pain (P<0.001 for both groups), functional status (Case group: P <0.001; control group: P=0.004) and spinal ROM (Case group: P <0.001; control group: P =0.007) in both groups at the end of the first month, but these gains persisted for 3 months only in the case group (P <0.001). Regarding spinal tenderness, it was disappeared in 89.47% of the patients in the true laser group at the end of one month but remained unchanged in 73.33% of the subjects of the sham laser group. Conclusion: We concluded that laser therapy (in combination with NSAIDs) is an effective and long-lasting therapeutic strategy in bringing relief from LBP without any significant side effect.
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PURPOSE: To compare the efficacy of local ozone injection versus corticosteroid in plantar fasciopathy treatment. PATIENTS AND METHODS: This double-blinded randomized trial was performed on 44 adult patients with plantar fasciopathy. One group (23 patients) received local injection of 40 mg methylprednisolone, while a local injection of 3 cc oxygen-ozone solution was performed for the other group (21 subjects). Severity of pain, functional level, and pressure-pain threshold (PPT) were measured before treatment and 1, 4, and 12 weeks after injection using VAS, Foot and Ankle Ability Measure (FAAM) questionnaire, and algometer for PPT, respectively. RESULTS: The majority (65.9%) of the total 44 patients analyzed, were women. Both treatments efficiently relieved patients' pain and improved their functions at 1 and 3 months follow-up time-points. But one week after injection, the improvement in VAS (p<0.001) and FAAM (p<0.001) was significant only in the corticosteroid group. During the first month, VAS (p=0.35) and PPT (p=0.003) were still better in the corticosteroid group. However, FAAM revealed no remarkable difference between the two groups (p=0.083). Eventually, at the third month of follow-up, there was no remarkable preference between the treatments regarding any of the outcome measures (p>0.05). Nevertheless, both methods efficiently improved patients' symptoms, ie, over the 50% of pain reduction and 30% improvement in functional status. CONCLUSION: The present results showed no remarkable superiority between the two groups. In other words, although ozone injection showed a slower efficacy than methylprednisolone, it could be used in plantar fasciitis management as an appropriate alternative.
