CLINICAL RESEARCH – LIGHT THERAPY RESEARCH

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Improvement of pain and disability in elderly patients with Degenerative Osteoarthritis of the knee treated with Narrow-Band Light Therapy.

Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD, Michal Rosenthal, MD, Iulian Abramovici, MD, Nathalia Kutok, MD, and Auni Khahil, MD

Objective: To evaluate the effects of low-power light therapy on pain and disability in elderly patients with degenerative osteoarthritis in the knee.

Design: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters.

Patients: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients) and placebo (17 patients). Infrared and placebo emitters were double-blinded.

Interventions: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.

Main Outcome Measures: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient’s request to be retreated was summed up 1 year after the trial.

Results: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red and infrared treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo respectively).

Conclusions: Low-power light therapy is effective in relieving pain and disability in degeneratvie osteoarthritis of the knee. J Am Geriatr Soc 40:23-26, 1992.
Degenerative osteoarthritis (DOA) is the most common rheumatic disorder of man and causes pain and disability especially in elderly people. 1 Autopsy surveys show that degenerative changes in joints begin as early as the second decade of life. 2 Roentgenographic studies conducted in the United States showed osteoarthritic changes in 4 percent of persons under 24 years of age in 85 percent at 75 to 79 years of age. Symtomatic manifestations of osteoarthritis increase with aging, reflecting disease changes that begin in early life and progress slowly over a period of many decades. 3-4

Pain relief is the most important goal in management of DOA. To provide optimal analgesic care the treatment should be individualized. Attention must be paid to the pharmacokinetis and pharmacodynamics of drugs in the elderly, especially interactions with other medications and adverse effects of concomitant diseases. 5-7 To avoid or to reduce difficulties concerned with drug therapy, non-pharmacologic methods such as heat or cold treatment, TENS therapy, biofeedback, and physical exercises are frequently used.

Principles of phototherapy were established at the end of the nineteenth century by N.R. Finsen, a Nobel Prize winner, for application of light treatment in skin diseases. 8 Phototherapy is now employed in the treatment of psoriasis, 9 kernicterus, 10 and as photodynamic therapy (PDT) in the treatment of cancer. 11 Phototherapy was advanced with the introduction of laser treatments, initially in surgery. 12 The development of the infrared (830nm) gallium-aluminium-arsenide and of the red (633 nm) helium-neon-low-power laser, introduced phototherapy in wound healing and analgesia. Many investigators have described successful pain treatment in a variety of diseases. 13-14

The purpose of this study was to evaluate the impact of red or infrared light emitters on pain relief, functional disability, and sparing of analgesic drug therapy in elderly patients with DOA of the knee.

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