Short- and long-term effects of whole-body photobiomodulation on pain, functionality, tissue quality, central sensitisation and psychological factors in a population suffering from fibromyalgia: protocol for a triple-blinded randomised clinical trial

Santiago Navarro-Ledesma, Ana Gonzalez-Muñoz, James Carroll, Patricia Burton, Santiago Navarro-Ledesma, Ana Gonzalez-Muñoz, James Carroll, Patricia Burton

Abstract

Background: The development of an integral and global treatment to improve the quality of life in those with fibromyalgia syndrome (FMS) is challenging. The aim of this study is to investigate the impact of whole-body photobiomodulation (PBM) on pain perception, functionality, quality of soft tissue, central sensitisation and psychological factors in patients suffering with FMS.

Methods: This study is a randomised, placebo-controlled clinical trial. A total of 44 participants will be recruited in a private care practice and randomised to receive either a whole-body PBM therapy programme or placebo in the same care centre. The parameters of the PBM programme are as follows: wavelengths of red and near-infrared LEDs 50:50 ratio with 660-850 nanometers; fluence of 25.2 J/cm2; treatment time of 1200 s and a total power emitted of 967 W. Treatment sessions will be 3 times weekly for a period of 4 weeks, totalling 12 treatment sessions. Primary outcome will be pain (Numeric Pain Rating Scale; Widespread Pain Index; Symptom Severity Score). Secondary outcomes will be functionality (Fibromyalgia Impact Questionnaire; the Leisure Time Physical Activity Instrument), quality of soft tissue (elastography), central sensitisation (pain pressure threshold and the Autonomic Symptom Profile) and psychological factors (Pain Catastrophising scale, Tampa Scale, Self-Efficacy questionnaire). Assessments will be at baseline (T1), after session 6 (T2), after treatment (T3) and 2 weeks (T4), 3 (T5) and 6 (T6) month follow-up.

Discussion: PBM therapy has been shown to reduce pain and inflammation and to increase the rate of tissue repair for a wide range of conditions, but its potential use as a whole-body treatment in FM is yet to be explored. This trial will investigate whether whole-body PBM therapy is effective at reducing pain intensity, improving functionality, quality of soft tissue, central sensitisation symptoms and psychological measurements. Furthermore, 3- and 6-month follow-up will investigate long-term efficacy of this treatment.

Trial registration: NCT04248972. Registered on January 29, 2020, https://ichgcp.net/clinical-trials-registry/NCT04248972?term=navarro-ledesma+santiago&draw=2&rank=2.

Keywords: chronic pain; elasticity imaging techniques; fibromyalgia; pain perception; photobiomodulation therapy; pressure algometry; pressure pain threshold; psychology; ultrasonography.

Conflict of interest statement

Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: James Carroll is the owner of THOR Photomedicine, a company which sells LLLT devices. Patricia Burton affiliation is THOR Photomedicine.

© The Author(s), 2022.

Figures

Figure 1.
Figure 1.
NovoTHOR bed.
Figure 2.
Figure 2.
NovoTHOR randomising switch box.
Figure 3.
Figure 3.
Flow diagram illustrating the assessment times.
Figure 4.
Figure 4.
Location of tender points established as criteria for fibromyalgia syndrome (FMS) diagnosis by the American College of Rheumatology (ACR). Image based on the original ‘The Three Graces’ by the French 154 painter Jean-Baptiste Regnault (1793).

References

    1. Mas AJ, Carmona L, Valverde M, et al.. Prevalence and impact of fibromyalgia on function and quality of life in individuals from the general population: results from a nationwide study in Spain. Clin Exp Rheumatol 2008; 26: 519–526.
    1. Bellato E, Marini E, Castoldi F, et al.. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat 2012; 2012: 426130.
    1. Wolfe F, Smythe HA, Yunus MB, et al.. Criteria for the classification of fibromyalgia. Arthritis Rheumat 1990; 33: 71–73.
    1. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311: 1547–1555.
    1. García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, et al.. Effectiveness of health education in patients with fibromyalgia: a systematic review. Eur J Phys Rehabil Med 2019; 55: 301–313.
    1. Yeh SW, Hong CH, Shih MC, et al.. Low-level laser therapy for fibromyalgia: a systematic review and meta-analysis. Pain Physician 2019; 22: 241–254.
    1. Salehpour F, Mahmoudi J, Kamari F, et al.. Brain photobiomodulation therapy: a narrative review. Mol Neurobiol 2019; 55: 6601–6636.
    1. Karu TI, Pyatibrat LV, Kolyakov SF, et al.. Absorption measurements of a cell monolayer relevant to phototherapy: reduction of cytochrome c oxidase under near IR radiation. J Photochem Photobiol B Biol 2005; 81: 98–106.
    1. Karu TI, Pyatibrat LV, Kolyakov SF, et al.. Absorption measurements of cell monolayers relevant to mechanisms of laser phototherapy: reduction or oxidation of cytochrome c oxidase under laser radiation at 632.8 nm. Photomed Laser Surg 2008; 26: 593–599.
    1. Gur A, Karakoc M, Cevik R, et al.. Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers Surg Med 2003; 32: 233–238.
    1. Fernández García R, Suárez Holgado JD, Formieles Ortiz I, et al.. Utilización de un programa con láser en pacientes diagnosticados de fibromialgia. Reumatol Clin 2011; 7: 94–97.
    1. Honda Y, Sakamoto J, Hamaue Y, et al.. Effects of physical-agent pain relief modalities for fibromyalgia patients: a systematic review and meta-analysis of randomized controlled trials. Pain Res Manag 2018; 2018: 2930632.
    1. Ghigiarelli JJ, Fulop AM, Burke AA, et al.. The effects of whole-body photobiomodulation light-bed therapy on creatine kinase and salivary interleukin-6 in a sample of trained males: a randomized, crossover study. Front Sports Act Living 2020; 2: 48–13.
    1. Chung H, Dai TK, Sharma S, et al.. The nuts and Bolts of low-level laser (light) therapy. Ann Biomed Eng 2012; 40: 516–533.
    1. Kisselev SB, Moskvin SV. The use of laser therapy for patients with fibromyalgia: a critical literary review. J Lasers Med Sci 2019; 10: 12–20.
    1. Sigrist RMS, Liau J, Kaffas A, et al. Ultrasound elastography: review of techniques and clinical applications. Theranostics 2017; 7: 1303–1329.
    1. Bamber J, Cosgrove D, Dietrich CF, et al.. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 2013; 34: 169–184.
    1. Alvarez-Gallardo I, Soriano-Maldonado A, Segura Jiménez V, et al.. High levels of physical fitness are associated with better health-related quality of life in women with fibromyalgia: the al-Ándalus project. Phys Ther 2019; 25: 1481–1494.
    1. Góes SM, Leite N, Shay BL, et al.. Functional capacity, muscle strength and falls in women with fibromyalgia. Clin Biomech (Bristol, Avon) 2012; 27: 578–583.
    1. Lorente LC, Ríos MCG, Ledesma SN, et al.. Functional status and body mass index in postmenopausal women with fibromyalgia: a case–control study. Int J Environ Res Public Health 2019; 16: 4540.
    1. de Felipe García-Bardón V, Castel-Bernal B, Vidal-Fuentes J. Evidencia científica de los aspectos psicológicos en la fibromialgia. Posibilidades de intervención. Reumatol Clin 2006; 2: 38–43.
    1. Villarraga AR, Ligia A, Castellanos Z, et al.. Predictores de calidad de vida en pacientes. Revista Colombiana de Reumatología 2005; 12: 295–300,
    1. Chan A, Tetzlaff J, Gotzsche P, et al.. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013; 8: e7586.
    1. Han C, Lee SJ, Lee SY, et al.. Available therapies and current management of fibromyalgia: focusing on pharmacological agents. Drugs Today 2011; 47: 539–557.
    1. Yamato T, Maher C, Saragiotto B, et al.. The TIDieR checklist will benefit the physiotherapy profession. Physiother Theory Pract 2017; 33: 267–268.
    1. Huang YY, Sharma SK, Carroll J, et al.. Biphasic dose response in low level light therapy – an update. Dose Response 2011; 9: 602–618.
    1. Jensen MP, Turner JA, Romano JM, et al.. Comparative reliability and validity of chronic pain intensity measures. Pain 1999; 83: 157–162.
    1. Bennett RM, Friend R, Jones KD, et al.. The revised fibromyalgia impact questionnaire (FIQR): validation and psychometric properties. Arthritis Res Ther 2009; 11: 1–14.
    1. Segura-Jiménez V, Aparicio VA, Álvarez-Gallardo IC, et al.. Validation of the modified 2010 American College of Rheumatology diagnostic criteria for fibromyalgia in a Spanish population. Rheumatology 2014; 53: 1803–1811.
    1. Mannerkorpi K, Hernelid C. Leisure time physical activity instrument and physical activity at home and work instrument. Development, face validity, construct validity and test-retest reliability for subjects with fibromyalgia. Disabil Rehabil 2005; 27: 695–701.
    1. Sletten DM, Suarez GA, Low PA, et al.. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc 2012; 87: 1196–1201.
    1. Navarro-Ledesma S, Gonzalez-Muñoz A. Short-term effects of 448 kilohertz radiofrequency stimulation on supraspinatus tendon elasticity measured by quantitative ultrasound elastography in professional badminton players: a double- blinded randomized clinical trial. Int J Hyperthermia 2021; 38: 421–427.
    1. Brage K, Hjarbaek J, Kjaer P, et al.. Ultrasonic strain elastography for detecting abnormalities in the supraspinatus tendon: an intra-and inter-rater reliability study. BMJ Open 2019; 9: 1–10.
    1. Darnall BD, Sturgeon JA, Cook KF, et al.. Development and validation of a daily pain catastrophizing scale. J Pain 2017; 18: 1139–1149.
    1. Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT. Psychometric properties of the Spanish version of the Tampa Scale for Kinesiophobia (TSK). J Pain 2011; 12: 425–435.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1997; 84: 191–215.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, MI: Lawrence Erlbaum Associates, 1988.
    1. Farrar JT, Young JP, Jr, LaMoreaux L, et al.. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94: 149–158.
    1. Bourgault P, Lacasse A, Marchand S, et al.. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLoS ONE 2015; 10: e0126324.
    1. Dworkin RH, Turk DC, Wyrwich KW, et al.. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008; 9: 105–121.
    1. Antonialli FC, De Marchi T, Tomazoni SS, et al.. Phototherapy in skeletal muscle performance and recovery after exercise: effect of combination of super-pulsed laser and light-emitting diodes. Lasers Med Sci 2014; 29: 1967–1976.
    1. Jonsjö MA, Åström J, Jones MP, et al.. Patients with ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) and chronic pain report similar level of sickness behavior as individuals injected with bacterial endotoxin at peak inflammation. Brain Behav Immun: Heal 2019; 2: 100028.
    1. Passarella S, Casamassima E, Molinari S, et al.. Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by helium-neon laser. FEBS Lett 1984; 175: 95–99.
    1. Loftus N, Dobbin N, Crampton JS. The effects of a group exercise and education programme on symptoms and physical fitness in patients with fibromyalgia: a prospective observational cohort study. Disabil Rehabil. Epub ahead 1 March 2021. DOI: 10.1080/09638288.2021.1891463.
    1. Wang C, Schmid CH, Fielding RA, et al.. Effect of Tai Chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ 2018; 360: 1–14.

Source: PubMed

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