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EFFICACY OF PHOTOBIOMODULATION THERAPY ON PAIN PERCEPTION DURING LOCAL ANESTHESIA IN CHILDREN: A SYSTEMATIC REVIEW
Maryam Emami1, Mehdi Azizmohammad Looha2, Keith DA-Silva3
1College of Dentistry, University of Saskatchewan, Saskatoon, Canada.
Insights
Photobiomodulation therapy (PBMT) shows promise in reducing injection pain in children, particularly on objective measures like the FLACC scale and heart rate. Further research is needed for subjective pain scales.
Area of Science:
- Pediatric Dentistry
- Pain Management
- Biomedical Engineering
Background:
- Local anesthesia injections are a common source of pain and anxiety for children.
- Nonpharmacological interventions are sought to manage procedural pain in pediatric patients.
- Photobiomodulation therapy (PBMT) utilizes light to modulate biological processes and may reduce pain perception.
Purpose of the Study:
- To systematically review and meta-analyze the impact of PBMT on objective and physiological measures of local anesthesia injection pain in children aged 3-12.
- To evaluate the efficacy of PBMT as a nonpharmacological pain management strategy.
- To assess PBMT's effect on various pain scales and physiological indicators.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines, registered in PROSPERO (CRD42024549936).
- Comprehensive search of Embase, PubMed, and Cochrane Library for Randomized Clinical Trials (RCTs) from January 2000 to September 2024.
- Meta-analyses focused on FLACC, HR, PRS, and SEM scales; sensitivity analyses and bias assessments were performed.
Main Results:
- Seven RCTs met inclusion criteria, evaluating PBMT's effect on injection pain in children.
- PBMT significantly reduced pain with moderate certainty on the objective FLACC scale (SMD: -0.41) and physiological HR (SMD: -0.50).
- No significant effect was found on subjective pain measures (PRS, SEM), with moderate to very low certainty of evidence.
Conclusions:
- PBMT shows potential as a nonpharmacological adjunct for reducing injection pain in children, evidenced by objective (FLACC) and physiological (HR) outcomes.
- The effectiveness of PBMT on subjective pain reporting (PRS) requires further investigation.
- Optimizing PBMT protocols is necessary to enhance its clinical application in pediatric pain management.
Objective:
This systematic review and meta-analysis is the first to evaluate the impact of photobiomodulation therapy (PBMT) on objective and physiological measures of local anesthesia injection pain in children aged 3-12.
Methods:
This review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines and is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024549936. A systematic search was conducted in Embase, PubMed, and the Cochrane Library to locate relevant Randomized Clinical Trials (RCTs) between January 2000 to September 2024. Study screening, data extraction, risk of bias evaluation, and certainty of evidence grading were performed independently by 2 reviewers. Meta-analyses focused on the pain assessment using following measures: Wong-Baker Faces Pain Rating Scale (PRS), Sound, Eye, and Motor Scale (SEM), Face, Legs, Activity, Cry, Consolability Scale (FLACC), and heart rate (HR). Sensitivity analyses were conducted using a leave-one-study-out approach to assess the robustness of the findings, while publication bias and heterogeneity were evaluated through established statistical methods.
Results:
Out of 1322 identified studies, 7 RCTs met inclusion criteria. PBMT significantly reduced pain, with moderate certainty, as measured by the objective FLACC scale (SMD = -0.41, 95% CI: -0.72, -0.09, P = .011) and the physiological HR method (SMD = -0.50, 95% CI: -0.86, -0.14, P = .006), demonstrating moderate and no heterogeneity, respectively. However, no statistically significant effect was observed on subjective measures using the PRS (SMD = -0.66, 95% CI: -1.63, 0.32, P = .185) and SEM (SMD = 0.18, 95% CI: -1.09, 1.45, P = .780) scales. Five studies had low risk of bias, and GRADE analysis indicated very low to moderate certainty. Funnel plots showed minimal publication bias, except for slight asymmetry in PRS.
Conclusions:
PBMT demonstrates potential as a nonpharmacological method to reduce injection pain in children, as reflected in FLACC and HR outcomes. However, no significant effect of PBMT was observed on the SEM scale. Further research is needed to clarify its impact on subjective pain measures (PRS) and to optimize PBMT protocols.
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