Effectiveness of photobiomodulation therapy for nipple pain or nipple trauma in lactating women: a systematic review protocol.

OBJECTIVE: The objective of this protocol is to evaluate the effectiveness of photobiomodulation therapy for the treatment of nipple pain or nipple trauma in women during the breastfeeding period. INTRODUCTION: One approach that has been reported on the management of nipple pain or nipple trauma in lactating women is the use photobiomodulation therapy to heal the injury or to decrease pain intensity. However, studies have achieved different results, due to variations in the treatment protocol, such as the source of light used, the application mode, the irradiation, or the light dose parameters, leading to varying outcomes. INCLUSION CRITERIA: This review will consider studies that evaluate photobiomodulation therapy for the treatment of nipple pain or nipple trauma in lactating women in the postpartum period that compare the intervention to standard care, placebo, or other type of treatment. The following outcomes will be considered: intensity of nipple pain, healing of nipple trauma, exclusive breastfeeding rate, quality of life, and satisfaction of the women with treatment. There will be no publication time limit, and studies published in any language will be considered for inclusion. METHODS: This review will be conducted in accordance with JBI methodology for systematic reviews of effectiveness. The search strategy will search both published and unpublished studies, and the process of study selection, critical appraisal, data extraction, and data synthesis will be performed in accordance to the JBI approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019147401.

Photobiomodulation reduces nociception and edema in a CFA-induced muscle pain model: effects of LLLT and LEDT.

Photobiomodulation therapy (PBMT) is an effective therapeutic strategy and a noninvasive method to improve the regulation of inflammation and pain. Our aim was to examine the effects of different doses of PBMT on improvement of edematogenic and nociceptive responses in a myositis model in rats. We administered complete Freund's adjuvant (CFA) into the gastrocnemius muscle (GS) of rats to induce myositis and observe the effect of PBMT using different doses of energy and two types of light sources, a low-level laser (LLL) and light emitting diodes (LED). For this, we evaluated the effects of these different energies to improve nociceptive and edematogenic responses using behavioural tests. In addition, we analysed histological images in animals with myositis induced by CFA. The administration of CFA to the GS induced increased cellular infiltrates, edema and a nociceptive response when compared to animals without myositis. When we treated the CFA-induced myositis animals with PBMT (LLLT or LEDT), we observed a decrease in nociception and edema formation. Our results demonstrated that only the major energy for both the LED and LLL was able to remain in a homogeneous form throughout the period analyzed. Based on our results, we suggest that both LLLT and LEDT using the highest dose (3 J) could be an alternative treatment for myositis in rats.

Pain management using photobiomodulation: Mechanisms, location, and repeatability quantified by pain threshold and neural biomarkers in mice.

Photobiomodulation (PBM) is a simple, efficient and cost-effective treatment for both acute and chronic pain. We previously showed that PBM applied to the mouse head inhibited nociception in the foot. Nevertheless, the optimum parameters, location for irradiation, duration of the effect and the mechanisms of action remain unclear. In the present study, the pain threshold in the right hind paw of mice was studied, after PBM (810 nm CW laser, spot size 1 or 6 cm2 , 1.2-36 J/cm2 ) applied to various anatomical locations. The pain threshold, measured with von Frey filaments, was increased more than 3-fold by PBM to the lower back (dorsal root ganglion, DRG), as well as to other neural structures along the pathway such as the head, neck and ipsilateral (right) paw. On the other hand, application of PBM to the contralateral (left) paw, abdomen and tail had no effect. The optimal effect occurred 2 to 3 hours post-PBM and disappeared by 24 hours. Seven daily irradiations showed no development of tolerance. Type 1 metabotropic glutamate receptors decreased, and prostatic acid phosphatase and tubulin-positive varicosities were increased as shown by immunofluorescence of DRG samples. These findings elucidate the mechanisms of PBM for pain and provide insights for clinical practice.

Time response of increases in ATP and muscle resistance to fatigue after low-level laser (light) therapy (LLLT) in mice.

Recently, low-level laser (light) therapy has been used to increase muscle performance in intense exercises. However, there is a lack of understanding of the time response of muscles to light therapy. The first purpose of this study was to determine the time response for light-emitting diode therapy (LEDT)-mediated increase in adenosine triphosphate (ATP) in the soleus and gastrocnemius muscles in mice. Second purpose was to test whether LEDT can increase the resistance of muscles to fatigue during intense exercise. Fifty male Balb/c mice were randomly allocated into two equal groups: LEDT-ATP and LEDT-fatigue. Both groups were subdivided into five equal subgroups: LEDT-sham, LEDT-5 min, LEDT-3 h, LEDT-6 h, and LEDT-24 h. Each subgroup was analyzed for muscle ATP content or fatigue at specified time after LEDT. The fatigue test was performed by mice repeatedly climbing an inclined ladder bearing a load of 150 % of body weight until exhaustion. LEDT used a cluster of LEDs with 20 red (630 ± 10 nm, 25 mW) and 20 infrared (850 ± 20 nm, 50 mW) delivering 80 mW/cm(2) for 90 s (7.2 J/cm(2)) applied to legs, gluteus, and lower back muscles. LEDT-6 h was the subgroup with the highest ATP content in soleus and gastrocnemius compared to all subgroups (P < 0.001). In addition, mice in LEDT-6 h group performed more repetitions in the fatigue test (P < 0.001) compared to all subgroups: LEDT-sham and LEDT-5 min (~600 %), LEDT-3 h (~200 %), and LEDT-24 h (~300 %). A high correlation between the fatigue test repetitions and the ATP content in soleus (r = 0.84) and gastrocnemius (r = 0.94) muscles was observed. LEDT increased ATP content in muscles and fatigue resistance in mice with a peak at 6 h. Although the time response in mice and humans is not the same, athletes might consider applying LEDT at 6 h before competition.