光生物调节治疗对儿童局部麻醉疼痛感知的疗效：系统回顾和荟萃分析

IF 4.1 4区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Evidence-Based Dental Practice Pub Date : 2025-04-10 DOI:10.1016/j.jebdp.2025.102143

MARYAM EMAMI , MEHDI AZIZMOHAMMAD LOOHA , KEITH DA-SILVA , MOHAMMADJAVAD SHIRANI

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引用次数: 0

摘要

本系统综述和荟萃分析首次评价了光生物调节疗法（PBMT）对3-12岁儿童局麻注射疼痛客观和生理指标的影响。方法本综述遵循系统评价和荟萃分析方案的首选报告项目（PRISMA）指南，并在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024549936。系统检索Embase、PubMed和Cochrane图书馆2000年1月至2024年9月的相关随机临床试验（RCTs）。研究筛选、数据提取、偏倚风险评估和证据分级确定性由2位审稿人独立完成。meta分析主要采用以下测量方法进行疼痛评估：Wong-Baker面部疼痛评定量表（PRS）、声音、眼睛和运动量表（SEM）、面部、腿部、活动、哭泣、安慰量表（FLACC）和心率（HR）。敏感性分析采用留一项研究的方法来评估研究结果的稳健性，而发表偏倚和异质性通过既定的统计方法进行评估。结果在1322项纳入的研究中，有7项rct符合纳入标准。通过客观FLACC量表（SMD = - 0.41,95% CI: - 0.72, - 0.09, P = .011）和生理HR法（SMD = - 0.50,95% CI: - 0.86, - 0.14, P = .006）测量，PBMT显著减轻疼痛，具有中等确定性，分别显示中度和无异质性。然而，使用PRS （SMD = −0.66,95% CI:−1.63,0.32,P = .185）和SEM （SMD = 0.18,95% CI:−1.09,1.45,P = .780）量表的主观测量没有统计学上的显著影响。5项研究的偏倚风险较低，GRADE分析显示确定性极低至中等。漏斗图显示，除了PRS有轻微的不对称外，发表偏倚最小。结论spbmt显示了作为一种非药物方法减少儿童注射疼痛的潜力，这反映在FLACC和HR结果中。然而，在扫描电镜量表上没有观察到PBMT的显著影响。需要进一步的研究来阐明其对主观疼痛测量（PRS）的影响，并优化PBMT方案。

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EFFICACY OF PHOTOBIOMODULATION THERAPY ON PAIN PERCEPTION DURING LOCAL ANESTHESIA IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

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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来源期刊

Journal of Evidence-Based Dental Practice DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

6.00

自引率

16.70%

发文量

105

审稿时长

28 days

期刊介绍： The Journal of Evidence-Based Dental Practice presents timely original articles, as well as reviews of articles on the results and outcomes of clinical procedures and treatment. The Journal advocates the use or rejection of a procedure based on solid, clinical evidence found in literature. The Journal''s dynamic operating principles are explicitness in process and objectives, publication of the highest-quality reviews and original articles, and an emphasis on objectivity.