The Evolution of the Japan Laser Therapy Association (Jalta) Methods and Standards for Scoring Laser Therapy Pain Attenuation:A Retrospective two-year Overview

Abstract

The scoring of pain attenuation in laser therapy (and other modalities) has traditionally been accomplished by using the visual analog scale (VAS), recognized as a very subjective method and thus open to possibly severe patient-specific skewing of the scoring data. An easy to use but objective method has yet to be developed. Through special symposia in their 11th and 12th meetings, (1999 and 2000), the Japan Laser Therapy Association (JaLTA) sought to improve the objectivity of the method of pain attenuation scoring while maintaining ease-of-use and minimizing expense, by comparing the results of questionnaires to participating institutes using laser therapy in pain attenuation for a specific set of four pain types; shoulder, lumbar and knee pain, and postherpetic neuralgia (PHN). The VAS was initially used in combination with the pain relief score (PRS). Unlike the VAS, the PRS always has an initial value of 10 (maximum pain), and the patient's pain relief post-therapy is scored from 10 down to 0 (pain free). Ten sessions were set for both trials, and at the end of the tenth session, the patient's satisfaction index (SI) was recorded, in which the patients rated their satisfaction with the treatment over four grades in1999, (‘Very satisfied’, ‘Satisfied’, ‘Dissatisfied’ and ‘Exacerbation´), which was subsequently increased to five grades in 2000, with the addition of ‘Fairly satisfied’ inserted before ‘Dissatisfied’. In the 2000 meeting report, when the results of the five point SI were graphically compared with the overall PRS at the 10th treatment, a good statistical correlation was seen. In conclusion, it was decided that all JaLTA members should use the following assessment protocol: the VAS was to be used only at the initial consultation and the PRS exclusively hereafter, as the PRS incorporated VAS data but with the advantage of a standardized starting point and a larger movement on the scale; the SI should be assessed at the end of the 10th session, since the SI, while still subjective, in combination with the averaged results of the PRS, can provide a more objective overview of the efficacy of the particular treatment regimen. Finally it was pro-posed that, after a suggested period of 3-5 yrs, these data for all pain entities should be collected in summary from JaLTA members, together with the treatment regimens, and could well be useful in the formulation of guidelines for the ideal and most satisfactory laser therapy regimen for each pain entity. © 2000, International Phototherapy Association. All rights reserved.