PTSLPRCTEuropean journal of physical and rehabilitation medicine2023

Effect of electromagnetic therapy versus low-level laser therapy on diabetic patients with trigeminal neuralgia: a randomized control trial.

Islam M Al-Azab, Tamer I Abo Elyazed, Amira M El Gendy and 4 others

PMID 36762919

WHAT IT FOUND

Low-level laser therapy added to standard medication reduced trigeminal neuralgia pain more than electromagnetic therapy or medication alone.

Laser patients dropped from 7.66 to 4.00 on a 10-point pain scale. Electromagnetic therapy helped less. Both added no side effects.

Key findings

01All three groups received the same medication regimen; the comparison was adding laser or electromagnetic therapy to that baseline.

02The primary outcome, temporalis muscle action potential, did not change significantly in the medication-only group (P=0.082) but improved significantly with laser (P=0.001) and electromagnetic therapy (P=0.026).

03Pain scores fell from 7.66 to 4.00 with laser and 7.53 to 5.66 with electromagnetic therapy, versus 7.73 to 6.66 with medication alone.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for SLPs

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What it does not show

The paper reports no blinding of participants or assessors, and no placebo arm for the physical modalities, so expectation effects cannot be ruled out. The control group received medication only, so the study does not show whether the physical treatments are better than a credible sham procedure. The age range was narrow (26-41), so results may not apply to older diabetic patients with trigeminal neuralgia. Six patients dropped out after randomization, and the paper does not state how missing data were handled in the analysis. The Discussion section contains extensive mechanistic speculation about nitric oxide and blood flow that is not supported by the trial data reported here.

The easy way to misread this

Do not read the between-group significance as proof that laser is superior to electromagnetic therapy in a head-to-head trial. The study compared each modality against a medication-only control, and the authors' claim that laser was 'more effective' rests on separate within-group and post-hoc comparisons rather than a pre-specified direct contrast with a sham procedure.

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