Long-term effects of pulsed high-intensity laser therapy in the treatment of post-burn pruritus: a double-blind, placebo-controlled, randomized study

Abstract

We assessed the long-term effects of pulsed high-intensity laser therapy (HILT) in post-burn pruritus treatment. A total of 49 adult burn patients with mean age of 31.53 ± 10.14 years participated, with 24 patients randomly assigned to the active laser group (ALG) and 25 in the placebo laser group (PLG). The ALG received HILT three times per week for 6 weeks, while the PLG received placebo HILT. Both groups received 10-mg cetirizine tablets twice daily and 10 mg at bedtime. All patients were advised to massage their burn scars with coconut oil for 5 min four times daily. The outcomes measured were the itch severity scale (ISS), impairment of pruritus-related quality of life (QoL), pain level by the visual analog scale (VAS), hand grip strength by handheld dynamometer, and daily cetirizine intake. Repeated-measures ANOVA was used to compare the baseline and post-treatment measurements and after 12 weeks of follow-up. Statistical significance was set at P < 0.05. ISS decreased significantly in the ALG after 6 weeks of treatment and after 12 weeks of follow-up compared with the PLG. The QoL results showed a significant improvement in the ALG compared with the PLG, which continued after 12 weeks. VAS results significantly decrease, hand grip strength significantly improved, and cetirizine intake significantly decreased post-treatment in the ALG relative to the PLG. HILT combined with cetirizine seems more effective in patients with post-burn pruritus than a placebo laser procedure with cetirizine.

Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis

“…In the present work, 13 studies investigated burn scars. These included seven studies with burn scars, [22][23][24][25][26][27][28][29] five with hypertrophic burn scars, 28,[30][31][32][33] and one with hypertrophic scars after burns, scalds, or other skin traumata. 34 Five studies focused on postsurgical scars, [35][36][37][38][39] of which one concentrated specifically on hypertrophic and keloid scars.…”

“…40 Seven studies divided the scars into two or three halves to perform the intervention and control treatment on the same subject, 13,29,32,[36][37][38]40 whereas the other 12 studies analyzed scars of independent groups of subjects. 22,[24][25][26][27][28]30,31,[33][34][35]41 The intervention methods can be categorized into (1) mechanotherapy (massage, [26][27][28]30,33 extracorporeal shockwave therapy (ESWT) 24,25 ), (2) occlusion and hydration therapy (silicone application, 31,32,34 moisturizing cream with protease enzymes 41 ), and (3) light therapy (noninvasive laser 22,29,[35][36][37][38][39][40]. Table 2 gives a summary of the included studies.…”

“…22,24,25,27,29,30,32,34,35 Of these, six studies measured pain with the visual analog scale (VAS), 22,25,27,30,34,35 two applied the Vancouver scar scale (VSS), 29,32 and one the numeric rating scale. 24 Two studies each treated the scars with massage therapy, 27,30 ESWT, 24,25 laser therapy, 22,35 and gel sheets, 32,34 and one study with a CO 2 laser. 29 To test the hypothesis that physical therapy interventions had an enhancing effect to decrease pain as compared with control, an overall meta-analysis was conducted.…”

“…24,25 Different types of light therapy also demonstrated to be effective interventions for pain reductions in the treatment of burn scars. 22,29 Using a CO 2 laser led to a significant and moderate pain reducing effect (Hedges' g = -0.65), 29 whereas pulsed high-intensity laser therapy (HILT) showed a significant and large pain reducing effect (Hedges' g = -1.13). 22 Published studies already reported that the higher intensity and the greater depth reached by HILT might be one reason for its effectiveness to relieve pain compared with low-level laser treatments.…”

“…22,29 Using a CO 2 laser led to a significant and moderate pain reducing effect (Hedges' g = -0.65), 29 whereas pulsed high-intensity laser therapy (HILT) showed a significant and large pain reducing effect (Hedges' g = -1.13). 22 Published studies already reported that the higher intensity and the greater depth reached by HILT might be one reason for its effectiveness to relieve pain compared with low-level laser treatments. [45][46][47] The reduction of pain levels by HILT is probably based on the inhibition of Ad-and C-fiber transmission 48 and by enhancing the production and release of endorphins.…”