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  • Effects of photobiomodulation therapy in patients with chronic non-specific low back pain: protocol for a randomised placebo-controlled trial

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Effects of photobiomodulation therapy in patients with chronic non-specific low back pain: protocol for a randomised placebo-controlled trial
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  • Published on: 6 March 2019
    In response to Dr. Mark F. Sheehan, MD on his comment titled: Is the dose of PBM appropriate in this study
    • Shaiane Silva Tomazoni, PT, PhD Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil

    Thank you for your comments, Dr Sheehan. Be assured, we have taken great care in the development of this study and dose selection was a crucial component. While Dr. Sheehan cites a “recommended” dose for our study, there is no citation presented that validates his clinically suggested dose for a very different device. In fact, dosage at the “target” is not considered the standard means of dose measurement [1]. The suggestion that the use of a Class 4 laser at 60 to 80 J/cm2 at the surface would result in better outcomes and match your suggested dose range at target does not have validity. Anders, et al. [2] found that only about 2.5% of the light penetrated to the level of the muscles and it was through white albino rabbit skin. Even negating the effects of skin pigmentation, the resulting dose of 1.5 to 2 J/cm2 would be approximately half of the dose suggested by Dr. Sheehan. It should be noted that doses for high-powered lasers has not been established in the literature and specifically for low back conditions.

    In fact, most of the claims by the class 4 industry are not scientifically supported, and head to head comparisons have showed better outcomes in favor of low-powered devices (class 3B and/or below) when compared to high-powered devices (class 4) [3].
    Furthermore, the selection of our study dose was based upon guidelines suggestions by the World Association for Laser Therapy [4], consultation with the research group that performed a similar study for...

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    Conflict of Interest:
    None declared.
  • Published on: 1 March 2019
    Is the dose of PBM appropriate in this study

    I note from this study that the the fluence and power density being used in this study is extremely low. The therapeutic range is 3 to 10 J/cm2 at the target tissue. The absorption of the energy as it goes through the layers of back is enormous. Although the Arndt Schulz principle applies to irradiated tissue the only adverse effect with PBM is a thermal effect. We are exposed to much higher natural near infra red radiation in nature. I am a practitioner with a number of years experience with class 4 lasers using 60 to 80 J/cm2 on the skin surface to effect any result on the deeper tissue in the back (facet joints being several cm deep) I cannot see these doses having any impact on the tissue in question whatsoever. No rational explanation for the dose chosen has been given. I feel inadequate attention to appropriate dosing is a significant flaw with the study design.

    Conflict of Interest:
    None declared.