Efeito da fotobiomodulação vascular como adjuvante ao tratamento da dor lombar: ensaio clínico piloto randomizado triplo cego

Abstract

Low back pain (LBP) is a public health problem that directly impacts quality of life, being one of the main causes of functional disability, absenteeism from work, reduced social interaction, and high costs associated with long-term treatments, with the potential to affect the individual's mental health. Currently, the management of LBP involves the use of anti-inflammatory drugs, analgesics, physiotherapy, and, in specific cases, surgery. Recent studies indicate that Vascular Photobiomodulation (VPM), which prioritizes the irradiation of blood components, is a promising strategy, as it stimulates mitochondrial ATP (Adenosine Triphosphate) production, increasing blood oxygenation, promoting tissue repair, and exerting anti-inflammatory and analgesic effects. This study had as its primary objective to evaluate the efficacy of VPM in patients with low back pain. This was a pilot, randomized, triple-blind clinical trial. Participants were recruited through the principal investigator's contact network. Twenty individuals, aged between 18 and 65 years, presenting with complaints of low back pain lasting between the 1st and 5th week, were included in the study. Participants were randomly assigned to two groups (n=10 per group): Placebo Group (G1) and Treatment Group (G2). The treatment lasted four weeks, with two sessions per week (total of 8 sessions). Both groups received Manual Myofascial Release, lasting 15 minutes, and therapeutic mobility exercises for the lower and upper limbs and trunk. G1 was subjected to an inactive device (sham) that simulated light projection, and G2 received active MVFB application, with a wavelength of 660 nm; continuous mode; power of 100 mW; irradiated energy of 180 J per session; exposure time of 1800 seconds. Data collection included the application of the Oswestry Disability Index 2.0 and the Roland Morris Disability Questionnaire at the first and last consultations, and the Numerical Pain Scale (NPS) at all consultations before and after treatment. Data were collected and recorded in an Excel spreadsheet. For statistical analysis, the Student's t-test, adjustment to the Poisson distribution, Shapiro-Wilk test, Chi-square test, Wald multiple comparison, and repeated measures model were used. A significance level of 5% (α=0.05) was adopted for all analyses. The findings of this pilot study indicated a significant difference between the groups in the Oswestry Disability Index (p=0.0322) and the Roland Morris Disability Questionnaire (p=0.007), results that demonstrate that Vascular Photobiomodulation contributed to the improvement of the participants' functionality. In the pain analysis assessed through the NDS, no significant difference was found between the groups (p=0.1392). However, Group 2 (treatment), which started treatment with a higher average than Group 1 (placebo), showed a significant decrease in post-treatment pain scores during the initial sessions. Both groups showed a statistically significant intragroup difference in pain. Subsequent studies with a larger sample size are crucial for the validation and generalization of these preliminary findings.