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Clinical Pain Abstracts:

EFFICACY OF LASER IRRADIATION ON THE AREA NEAR THE STELLATE GANGLION IS DOSE-DEPENDENT: DOUBLE-BLIND CROSSOVER PLACEBO-CONTROLLED STUDY

Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan.

In the present study we evaluate the effects of laser irradiation on the area near the stellate ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover and placebo-controlled study was designed to deny the placebo effect of laser irradiation. Eight inpatients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three session s of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS). Measurement were performed before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no changes in VAS were obtained by placebo treatment. These changes in the temperature and VAS were further dependent on the energy density, i.e the dose. Results demonstrate that laser irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Addressee for Correspondance:

Toshikazu Hashimoto MD,

Department of Anesthesia, I Hokkaido University I Hospital N15,

W7, Kita-ku Sapporo, Japan 060.

3/97 Rep US $ 8-10 12

LASER THERAPY 1997:9:7-- 12

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THE EFFECT OF INFR-ARED LASER IRRADIATION ON THE DURATION AND SEVERITY OF POSTOPERATIVE PAIN: A DOUBLE BLIND TRIAL

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank

Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K., General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of postoperative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6-8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand postoperative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups. Controls n = 5.5: LLLT n = 2.5. No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group. Controls n = 9: LLLT n = 4. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

Addressee for correspondence: Dr K. C. Moore, Department of Anaesthesia, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, U.K.

0898-5901/92/040145-05$07.50 @) 1992 by John Wiley & Sons, Ltd.

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Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality- application of low level laser

E. Wong G LEE J. Zu CHERMAN and D. P. MASON

Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract. Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury'' (RSI) or "carpal tunnel syndrome'' (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 - T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser ( 100 mW) was used and directed at the tips of the spinous processes C5 - Tl. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers. and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labeled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. cervical collars, and clavicle harnesses as well as improved work ergonomics.

Manuscript received: July, 1997

Accepted for publication: September, 1997

LASER THERAPY, 1997:9: 131- 136

09/97 Rep. US $ 10-12-14

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CAN LOW REACTIVE-LEVEL LASER THERAPY BE USED IN THE TREATMENT OF NEUROGENIC FACIAL PAIN? A DOUBLE-BLIND, PLACEBO CONTROLLED INVESTIGATION OF PATIENTS WITH TRIGEMINAL NEURALGIA

ArneEckerdal and and Lehmann Bastian

Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a double-blind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks. The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year only one patient was still completely free from pain. The use of analgesics was recorded and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Addressee for Correspondence: Arne Eckerdal DDS DOS Consultant, Department of Oral and Maxillofacial Surgery & Oral Medicine, Odense University Hospital, DK-5000 Odense' Denmark.

12/96 Rep. US X 8-10-12

LASER THERAPY, 1996:: 8: 247-252

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DOUBLE BLIND CROSSOVER TRIAL OF LOW LEVEL LASER THERAPY IN THE TREATMENT OF POST HERPETIC NEURALGIA

Kevin C Moore Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar and Toshio Ohshiro

Post herpetic. neuralgia can he an extremely painful condition which in many cases proves resistant lo all the accepted forms of treatment. II is frequently most severe in the elderly and may persist for years with no predictable course.

This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with . established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received tour consecutive laser treatments. The results ides demonstrate a significant reduction in troth pain intensity and distribution following a course of low level laser therapy.

by John Wiley & Sons. Ltd.

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EFFICACY OF LOW REACTIVE-LEVEL LASER THERAPY FOR PAIN ATTENUATION OF POSTHERPETIC NEURALGIA

Osamu Kemmotsu, Kenichi Sato,Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan.

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males. 38 females with an average age of 69 years) managed at our pain clinic over the past four years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). Pain scores (PS) were obtained using a linear analog scale (i) to 10))) before and after LLLT. The immediate effect after the initial LLLT was very good (PS: (}3) in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 + 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a noninvasive, painless and safe method of therapy, it is well acceptable by patients.

Addressee for correspondence: Osamu Kemmotsu, Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan.

0898-5901/91/020071-05$05.00 Ì 1991 by John Wiley & Sons, Ltd.

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MECHANISTIC APPROACH TO GaAIAs DIODE LASER EFFECTS ON PRODUCTION OF REACTIVE OXYGEN SPECIES FROM HUMAN NEUTROPHILS AS A MODEL FOR THERAPEUTIC MODALITY AT CELLULAR LEVEL

Makoto Yamaya*, Chiyuki Shiroto', Hiroki Kobayashi*, Shinji Naganuma*, Jyuichi Sakamoto*, Koh-Jun Suzuki*, Shigeyuki Nakaji*, Kazuo Sugawara* and Takashi Kumae *Department of' Hygiene, Hirosaki University School of Medicine. Hirosaki; .-Shiroto Clinic Coshogawara, Aomori: Department of Industrial Health. The Institute of Public Health, Tokyo. Japan

There have been many reports on the applications of low reactive level laser (LLL) therapy for pain attenuation or pain removal. Our group has reported previously on the effects of in vitro irradiation of LLLT particularly on the phagocytic activity of human Neutrophils. using luminol-dependent chemiluminescence (LmCL) for measurement of reactive oxygen species (ROS) production from human Neutrophils. But the mechanisms of the attenuation of phagocytic activity of NEUTROPHILS by LLL irradiation is not yet full understood,

In this study. we used luminol-dependent and lucigenin-dependent chemiluminescence (LgCL) for detection of affected ROS producing process of human Neutrophils by LLL irradiation. Two soluble action stimuli. N-formyl-Met-Leu-Phc (fMLP) and phorbol myristate acetate (PMA) were used to avoid the possible influence of lag-time from recognition to uptake of particles at the ROS production.

In case of using fMLP as a stimulus, the maximum luminescence intensity of LULL was increased hut LgCL luminescence was decreased by LLL irradiation. When PMA was used as a stimulus, the times to reach the maximum luminescence intensity of LmCL and LgCL were shortened by LLL irradiation but there was no effect on the maximum luminescence intensity of both.

These results suggest that LLL irradiation enhances the ROS production activity of human Neutrophils by the activation of the superoxide converting system, the active clement in which is mainly myeloperoxidase. LLL irradiation enabled a more rapid activation of the superoxide production system, NADPH -oxidase.

LASER THERAPY 1993: 5: 111-116

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Laser Therapy in Post Herpetic Neuralgia,

Dr KC Moore

The clinical application of low incident power density laser radiation for the treatment of acute and chronic pain is now a well established procedure. This paper reviews the currently available English speaking literature and summarises a selection of serious scientific papers which report a beneficial effect following the treatment of a wide variety of acute and chronic syndromes whose main presenting symptom is pain. Read Full Abstract

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Low Intensity Laser Therapy (LILT) for Head, Neck and Facial Pain,

Prof P.F. Bradley

Head and Neck Clinical Applications of LILT
LILT is proving useful in a wide variety of painful conditions in the Head and Neck but the following are particular applications:

1. TM Joint Pain Dysfunction
2. Post Herpetic Neuralgia
3. Trigeminal Neuralgia
4. Painful Ulcerative Conditions
5. Pain of Advanced Oro Facial Cancer
Read Full Abstract

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The Ability of Low Level Laser Therapy (LLLT) to Mitigate Fibromyalgic Pain

The CFIDS Chronicle Physicians' Forum Fall 1993

Douglas Ashendorf, MD, FAAPMR Newark, New Jersey

Results have suggested that the pain relieving properties of LLLT have been the most consistent benefit. The duration of benefit has varied from one hour to one week, and seems to increase as treatment progresses. In no case has pain relief been permanent. Other areas of improvement were not as clear. Improvement in sleep was observed with some regularity although this was undoubtedly due in part to decreased pain. The "non-restorative" sleep complaints were less regularly improved. Improvement with regard to abnormal sensations in the limbs (paresthesia and subjective swelling) appears to be fairly consistent. Improvements in fatigue, mood and headache.

Although the pilot study is incomplete, I believe that these early findings warrant the further investigation of laser therapy for patients with fibromyalgia. This is further supported by the relatively few and harmless side effects of this therapy, the fact that equipment and operating costs are reasonable, and the reality that there are few effective alternative treatments for fibromyalgia patients. Read Full Article

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Carpal Tunnel Study Results Released

Laser Focus World

A physician at UMDNJ-Robert Wood Johnson Medical School is evaluating a "cold" laser to treat patients with carpal tunnel syndrome, a debilitating nerve condition that causes severe pain and numbness in the hand.

Clinical results of a double-blind study of 11 patients afflicted with carpal tunnel syndrome who were treated with a diode-laser device manufactured by Lasermedics (Missouri City, TX) showed that after six to 15 treatments, nine of the 11 patients experienced relief of pain and other associated symptoms as well as normalization of abnormal latencies. The study was conducted by Michael L. Weintraub, a neurologist from Briarcliff, NY, and reported in the February 1996 issue of Neurology. The patients all used a 30mW 830nm, a hand-held, battery-operated, nonsurgical laser device that employs the process of photo-biostimulation. Dr. Weintraub concluded that the results of his study support the efficacy and safety of laser-light treatment in carpal tunnel syndrome.

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Physiotherapist Shows Lasers Relieve Pain

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person's primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats. In the study, Laakso applied different doses and wavelengths of a laser diode to "trigger points" on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief--most likely a placebo effect--but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

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Laser therapy takes pain, discomfort out of post-cancer condition

LOW-LEVEL laser therapy promises to be a valuable weapon in the fight against lymphoedema, the painful and permanent swelling of an arm which frequently follows breast cancer operations. Doctors at Adelaide's Flinders University (FU) have conducted trials which have produced the first clinical evidence that infra-red laser can improve tissue conditions rapidly in the affected area. Associate professor Neil Piller told the university magazine, Flinders Journal, that loosening the tissue encouraged the regrowth of lymph vessels. The results are very exciting," Dr Piller said. "This is the first time anyone specifically has set out to trial lasers in this way. Previously, information about the possible efficacy of lasers has come as a by-product of research into such areas as wound treatment and arthritic conditions, and even then there has been very little work done." Lymphoedema results from deliberate or accidental removal of lymph nodes or vessels. It affects about 15 per cent of women sometime after a breast cancer operation. In the FU trials, 15 women with prolonged or severe lymphoedema were given 16 half-hour laser treatments over 10 weeks. ". All had arms swollen to between 140 and 180 per cent of normal volume. A scanning laser, focusing 2-4 joules of power to each square centimeter, was applied to the entire arm. In all cases, the treatment reduced the amount of oedema, the volume of fluid and the circumference of the arm above the elbow. Tissues in the upper and lower arm were softened and patients reported less pain, tightness and heaviness, and far greater mobility. "Giving them 16 treatments actually was overkill," Dr Piller said. "Since the trial ended, we have achieved significant results from just three or four treatments, or in some cases one or two."

Musculoskeletal Abstracts

Diode Laser in Cervical Myofascial Pain: A Double-Blind Study versus Placebo

* F. Ceccherelli, * L. Altafini, * G. Lo Castro, * A. Avila, *F. Ambrosio, and * G. P. Giron

*Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione Italiana per la Ricerca e, l'Aggiornamento Scientif co, Padua, Italy

Summary: We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questionnaire and the ScottHuskisson visual analogue scale. The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination.

Key Words: Laser&emdash;Infrared laser beam&emdash;Pain&emdash;Chronic pain&emdash;Placebo&emdash;Double blind study.

Address correspondence and repent requests to Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

Wave- length	Power	Energy Density	Power Density	Energy per point	Pulses
904nm	5mW av (25Wpeak)	(not given)	(not given)	1 J	1KHz x 200nS

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PAIN SCORES AND SIDE EFFECTS IN RESPONSE TO LOW LEVEL LASER THERAPY (LLLT) FOR MYOFASCIAL TRIGGER POINTS

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

Clinically, Low Level Laser Therapy - LLLT has been used successfully in the treatment of chronic pain but many have questioned the scientific basis for its use. Many studies have been poorly designed or poorly controlled. A double-blind, placebo-controlled, random allocation study was designed to analyse the effect of second daily infrared (JR) laser (820 nm, 25 mW) and visible red laser (670 nm, 10 mW) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting subjects with chronic pain conditions exhibiting myofascial trigger points in the neck and upper trunk region underwent five treatment sessions over a two week period. To assess progress, pain scores were measured using visual analogue scales before and after each treatment. The incidence of side effects was recorded. All groups demonstrated significant reductions in pain over the duration of the study with those groups which received infrared (820 nm) laser at I J/cm2 and 5 J/cm2. demonstrating the most significant effects (p < 0.001). Only those subjects who had active laser treatment experi enced side effects. Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependant on power output, dose and/or wavelength.

Key words: chronic pain, Visual Analogue Scal, LLLT, side effects, phototherapy.

Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029.

LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with the lower powered red laser

Wave- length	Average Power	Energy Density	Power Density	Energy	Pulses	Time	Beam Spot size
820	25mW	5 J/Cm2	0.89 W/Cm2	0.14 J	5,000Hz	5.62 secs	0.89Cm2

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LOW LEVEL LASER THERAPY ( LLLT) OF TENDINITIS AND MYOFASCIAL PAINS A RANDOMIZED, DOUBLE-BLIND, CONTROLLED STUDY

Mimmi Logdberg-Anderssont1, Sture Mutzell2, and Ake Hazel3

1: Akersberga Health Care Centre, 2: Danderyd University Hospital, Danderyd, and

3: Vaxholm Health Care Centre, Stockholm, Sweden.

The purpose of this randomised, double-blind study was to examine the effect of GaAs laser therapy for tendinitis and myofascial pain in a sample from the general population of Akersberga in the northern part of Greater Stockholm. 176 patients (of an original group of 200) completed the scheduled course of treatment. The patients were assigned randomly to either a laser group (92 patients, of whom 74 had tendinitis, completed the study) or a placebo group (84 patients, of whom 68 had tendinitis, completed the study). All 176 patients received six treatments during a period of 3-4 weeks. Their pain was estimated objectively using a pain threshold meter, and subjectively with a visual analogue scale before, at the end of, and four weeks after the end of treatment. Laser therapy had a significant, positive effect compared with placebo measured from the first assessment to the third assessment, four weeks after the end of treatment. Laser treatment was most effective on acute tendinitis.

Addressee for Correpondance, Sture Mutzell, Danderyd University Hospital 5-182 87 Danderyd, Sweden.

03/07 Rep US 10-12-14 , 1997 By LT Publishers, U.K., Ltd., LASER THERAPY, 1997:9: 79-86

Wave- length	Power	Energy Density	Power Density	Energy per point	Pulses
904nm	8mW av (10Wpeak)	0.5-1.0 J/Cm2	(not given)	1J	4KHz x 180nS

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THE EFFICACY OF LASER THERAPY FOR MUSCULOSKELETAL AND SKIN DISORDERS:

A CRITERIA-BASED META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Beckerman H, de Bie RA, Bouter LM, et al.

The efficacy of laser therapy for musculoskeletal and skin disorders has been assessed on the basis of the results of 36 randomized clinical trials (RCTs) involving 1,704 patients. For this purpose, a criteria-based meta-analysis that took into account the methodological quality of the individual trials was used. The studies with a positive outcome were generally of a better quality than the studies with a negative outcome. No clear relationship could be demonstrated between the laser dosage applied and the efficacy of laser therapy, or between the dosage and the methodological score. In general, the methodological quality of these studies appeared to be rather low. Consequently, no definite conclusions can be drawn about the efficacy of laser therapy for skin disorders. The efficacy of laser therapy for musculoskeletal disorders seems, on average, to be larger than the efficacy of a placebo treatment. More specifically, for rheumatoid arthritis, post-traumatic joint disorders, and myofascial pain, laser therapy seems to have a substantial specific therapeutic effect. Further RCTs, avoiding the most prevalent methodological errors, are needed in order to enable the benefits of laser therapy to be more precisely and validly evaluated.

Physical Therapy. 72(7):483-91, 1992 Jul. (60 ref)

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LLLT USING A DIODE LASER IN SUCCESSFUL TREATMENT OF A HERNIATED LUMBAR/SACRAL DISC, WITH MAGNETIC RESONANCE IMAGING (MRI) ASSESSMENT: A CASE REPORT

Tatsuhide Abe

Abe Orthopaedic Clinic Futuoka City Fukuoka Prefecture Japan X12'

A 40-year-old woman presented at the Abe Orthopedic Clinic with a 2-year history of lower hack pain and pain in the left hip and leg diagnosed as a ruptured disc between the 5th lumbar/lst sacral vertebrae. The condition had failed to respond to conventional treatment methods including pelvic traction, nonsteroid anti-inflammatory drugs and aural block anesthetic injections. MRI scans were made of the affected disc, showing it protruding on the left side through the aural membrane. The gallium aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW) was used in outpatient therapy. and after 7 months, the patient's condition had dramatically improved. demonstrated by motility exercises. This improvement was confirmed by further MRI scans, which showed clearly the normal condition of the previously herniated L5/SI disc.

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CLINICAL APPLICATION OF GaAIAs 830 NM DIODE LASER IN TREATMENT OF RHEUMATOID ARTHRITIS

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu

Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient's quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient's QOL at a reasonable level. The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data). From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement). For pain attenuation, scores were: excellent&emdash;59.6%; good&emdash;30.4%; unchanged&emdash;10%. For ROM improvement the scores were: excellent&emdash;12.6%; good&emdash;43.7%; unchanged&emdash;43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

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Laser's Effect on Bone and Cartilage Change Induced by Joint Immobilization An Experiment With Animal Model

Masami Akai, MD,1* Mariko Usuba, RPT,1 Toru Maeshima, Yoshio Shirasaki,2 and Shozo Yasuaka, MD3 'Department of Physical Therapy Tsukuba College of Technology, Tsukuba, Ibaraki, Japan Mechanical Engineering Laboratory, Agency of Industrial Science and Technology, TsuPuba, Ibaraki Japan. Yasuoka Orthopaedic Clinic, Mitaka, Tokyo, Japan

Objective: Influence of low-level (810nm, Ga-Al-As semiconductor) laser on bone and cartilage during joint immobilization was examined with rats' knee model.

Materials and Methods: The hind limbs of 42 young Wistar rats were operated on in order to immobilise the knee joint. One week after operation they were assigned to three groups; irradiance 3.9W/cm2, 5.8W/cm2, and sham treatment. After 6 times of treatment for another 2 weeks both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions.

Results and Conclusions: The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8W/cm2 therapy. Soft laser treatment has a possibility for prevention of biomechanical changes by immobilisation. Lasers Surg. Med. 21:480-484, 1997. C) 1997 Wiley-Liss, Inc.

Correspondence to: Masami Akai, M.D., Department of Central Rehabilitation Service University Hospital, Faculty of Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.

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Histological and Clinical Responses of Articular Cartilage to Low-level Laser Therapy: Experimental Study

I. RUIZ CALATRAVA, J.M.SANTISTEBAN VALENZUELA, R.J.G0MEZ-VILLAMANDOS J.I.REDONDO, J.C.G0MEZ-VILLAMANDOS, l.AVIGA JURADO

Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Spain. Correspondence to 1. Ruiz Calatrava, Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Avda. Medina Azahara, 9, 14005 Cordoba, Spain

Abstract. This study was carried out to evaluate the effects of low-level laser irradiation on experimental lesions of articular cartilage. A standard lesion was practised on the femoral trochlea of both hind limbs of 20 clinically normal Californian rabbits. These animals were divided into two groups of 10 individuals each, depending on the laser equipment used for treatment. One group was treated with HeNe laser (8 J cm - 2, 632.8 nm wavelength) and the other with infra-red (JR) laser (8 J cm - 2, 904 nm wavelength). In both groups, five points of irradiation to the right limb alone were irradiated per session for a total of 13 sessions, applied with an interval of 24 h between sessions. These points were the following: left and right femoral epicondyles, left and right tibial condyles and the centre of articulation. The distance between these points was approximately 1 cm. The untreated left limb was left as a control. During treatment, extension angle and periarticular thickness were considered. At the end of the treatment, samples were collected for histopathological study and stained with: Haematoxylin-Eosin, PAS and Done. The results show a statistically higher anti-inflammatory capacity of the IR laser ( p<0.0001). The functional recovery was statistically similar for both treatments (p<0.176). Histological study showed, at the end of the treatment, hyaline cartilage in the IR group, fibrocartilage in the HeNe group and granulation tissue in the control limbs. Clinical and histological results indicated that this laser treatment had a clear anti-inflammatory effect that provided a fast recuperation and regeneration of the articular cartilage.

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Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality- application of low level laser

E. Wong G LEE J. Zu CHERMAN and D. P. MASON

Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract. Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury'' (RSI) or "carpal tunnel syndrome'' (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 - T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser ( 100 mW) was used and directed at the tips of the spinous processes C5 - Tl. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers. and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labeled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. cervical collars, and clavicle harnesses as well as improved work ergonomics.

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Laser Therapy Studies

LLLT and wound healing

Normal wound healing requires both destructive and reparative processes in controlled balance. Proteases and growth factors play an important role in regulating this balance, and if disrupted in favour of degradation then delayed healing ensues, which is a trait of chronic wounds (Cullen et al, 2002). It has been shown that low-level laser irradiation at certain fluences and wavelengths can enhance the release of growth factors and stimulate cell proliferation (Yu et al, 2001).

The effects of LLLT include wound epithelialisation, reduction of oedema and inflammation, and re-establishment of arterial, venous and lymph microcirculation. Increased rates of ATP, RNA and DNA synthesis are also observed (Takac and Stojanovic, 1998). Major changes seen in wounds treated with LLLT include increased granulation tissue, early epithelialisation, increased fibroblast proliferation, increased extracellular matrix synthesis and enhanced neovascularisation (Walsh, 1997), all of which lead to better tissue oxygenation and nutrition, and, in turn, enhanced wound healing. The effects of LLLT on wound healing are summarised in Table 1.

It has been shown that low-level irradiation of fibroblasts stimulates the production of basic fibroblast growth factor and stimulates the transformation of fibroblasts into myofibroblasts (Walsh, 1997). LLLT also affects immune cells, and acts directly and selectively on the immune system (Tadakuma, 1993). Stimulation of the immune system means that infected wounds can be cleared more readily. The use of low-level lasers in wound healing has been shown to speed up the healing of leg ulcers and burn wounds; it has also been shown to improve skin-healing capabilities (Ribeiro et al, 2002).

LLLT Research Abstracts

LIGHT THERAPY (LLLT) ALTERS GENE EXPRESSION AFTER ACUTE SPINAL CORD INJURY

K.R. Byrnes 1, R.W. Waynant 2, I.K. Ilev 2, B. Johnson 1, Pollard H. 1, Srivastava M. 1, Eidelman O. 1, Huang, W. 1, J.J. Anders1

1. Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA;
2. Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD, USA

Secondary injury in the spinal cord, which results in axonal degeneration, scar and cavity formation and cell death, occurs around the site of the initial trauma and is a primary cause for the lack of axonal regeneration observed after spinal cord injury (SCI). The immune response after SCI is under investigation as a potential mediator of secondary injury. Treatment of SCI with 810 nm light suppresses the immune response and improves axonal regeneration.

We hypothesize that these beneficial effects observed in the injured spinal cord are accompanied by alterations in gene expression within the spinal cord, particularly of those genes involved in secondary injury and the immune response. To test this hypothesis, a dorsal hemisection at vertebral level T9 was performed. The injured spinal cord from rat was then exposed to laser light (810nm, 150mW, 2,997 seconds, 0.3cm2 spot area, 1589 J/cm2) and spinal cord samples, including the injury site, were harvested at 6 and 48 hours and 4 days post-injury. Total RNA was extracted and purified from the lesioned spinal cord and cDNA copies were either labeled with [32P] for microarray analysis or amplified and analyzed with a polymerase chain reaction (PCR).

Microarray results revealed a suppression of genes involved in the immune response and excitotoxic cell death at 6 hours post-injury, as well as cell proliferation and scar formation at 48 hours post-injury in the light treated group. Analysis of the PCR products revealed that light treatment resulted in a significant suppression of expression of genes that normally peak between 6 and 24 hours post-injury, including the pro-inflammatory cytokine interleukin 6 (IL6), the chemokine monocyte chemoattractant protein 1 (MCP-1) and inducible nitric oxide synthase (iNOS; p<0.05). Genes expressed earlier than 6 hours post-injury, such as IL1b, tumor necrosis factor a (TNFa) and macrophage inflammatory protein 1a (MIP-1a) were not affected by light treatment.

Although the precise role some of these genes play in axonal regeneration after spinal cord injury is currently unclear, these data demonstrate that light therapy has an anti-inflammatory effect on the injured spinal cord, and may reduce secondary injury, thus providing a possible mechanism by which light therapy may result in axonal regeneration.

[World Association for Laser Therapy]

EFFECTS OF PHOTOTHERAPY (LLLT) ON PRESSURE ULCER HEALING IN ELDERLY PATIENTS AFTER A FALLING TRAUMA. A PROSPECTIVE, RANDOMIZED, CONTROLLED STUDY.

Schubert V. - Karolinska Institute, Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Huddinge University Hospital, Stockholm, Sweden.

BACKGROUND: The effects of infrared and red pulsed monochromatic light, with varied pulsations and wavelengths, on the healing of pressure ulcers were evaluated in this prospective, randomized, controlled study.

METHODS: Elderly patients (> or =65 years) with Stage 2 or 3 skin ulcers were enrolled and assigned to one of two groups. Both groups were given the same standard ulcer therapy. One group was also given phototherapy with pulsed monochromatic infrared (956 nm) and red (637 nm) light. Treatments lasted 9 min each time using a regimen with pulse repetition frequency varied between 15.6 Hz and 8.58 kHz. Patients were followed for 10 weeks or until the ulcer was healed, whichever occurred first. The ulcer surface area was traced weekly.

RESULTS: Patients treated with pulsed monochromatic light had a 49% higher ulcer healing rate, and a shorter time to 50% and to 90% ulcer closure compared with controls. Their mean ulcer area was reduced to 10% after 5 weeks compared with 9 weeks for the controls.

CONCLUSION: The results are encouraging as pulsed monochromatic light increased healing rate and shortened healing time. This will positively affect the quality of life in elderly patients with pressure ulcer.

Photodermatol Photoimmunol Photomed. 2001 Feb;17(1):32-8.

LOW LEVEL LASER THERAPY (LLLT) IN AMBULATORY PATIENTS WITH VENOUS STASIS ULCERS

D. Lichtenstein FICA, B Morag, Maccabi Health Care Services and Department of Vascular Surgery, Sourasky Medical Center, Sakler Faculty of Medicine, Tel Aviv Israel

The effectiveness of Laser Therapy (LLLT) in accelerating wound healing has been clinically well documented. We used two devices: one, a He-Ne laser with a wavelength of 632.8nm and power output of 120mW. The indication for treatment was stasis ulcers (Ulcer cruris) due to chronic venous insufficiency syndrome. Sixty-two patients were treated in this study. The challenge of obtaining good results when treating patients with long-standing vascular ulcers and wounds caused us to explore this technique.. These findings indicate that appropriate doses of laser can be beneficial in promoting tissue repair. We achived complete healing, classified as good, in 53 patients (85.48%) of the patients during a two week period of treatment, and moderate partial wound closure with clinical improvement in 4 patients (6.46%) with chronic long-term venous leg ulcers. The efficacy of the treatment was (91.94%). No patient had to stop treatment because of adverse side effects. Two patients (3.2%) had recurrent ulcers

Laser Therapy Vol 11 - 2

THE USE OF INFRARED LASER THERAPY (LLLT) IN THE TREATMENT OF VENOUS ULCERATION

M.E. Sugrue, FRCSI, J. Carolan, BSc, E.J. Leen, MB, T.M. Feeley, FRCSI, D.J. Moore, FRCSI, G.D. Shanik, FRCSI, Dublin Ireland.

Management of intractable venous ulceration remains an unrewarding task, which is increasingly delegated to the realm of the vascular surgeon. The purpose of this pilot study was to assess the ulcer-healing effects of the newest form of biostimilation—the low power laser (LLLT). Twelve patients with chronic venous ulcers unresponsive to conservative measures were treated with infrared laser irradiation for twelve weeks. Two ulcers healed completely and there was a 27% (p<0.01) reduction in size of the remaining ulcers. Treatment resulted in a 44% (p<0.01) increase in ulcer floor area occupied by healthy granulation tissue. The most dramatic effect of laser treatment was the reduction in ulcer pain, from 7.5 to 3.5 (linear analogue scale) (p<0.001). Laser irradiation had no effect on TcPO2, number of skin capillaries of pericapillary fibrin deposition in the lipodermatosclerotic area around the ulcer. The results of this pilot study are encouraging and a carefully controlled randomized study is indicated to compare low power laser irradiation to conventional treatment in the management of venous ulcers.

(Ann Vasc Surg 1990;4:179-181).

THE USE OF LOW INTENSITY LASER THERAPY (LLLT) FOR THE TREATMENT OF OPEN WOUNDS IN PSYCHOGERIATRIC PATIENTS: A PILOT STUDY.

Physical and Occupational Therapy in Geriatrics. 2000, 18/2 (1-19) Verdote-Robertson-R, Munchua-M-M, Reddon-J-R.

The effect of low intensity laser therapy (LLLT) on wound healing in a largely psychogeriatric population was assessed over a period of 6 years (1991-1996). In total, 84 psychiatric patients were referred for the treatment of open wounds of varying severity and etiology. The wound status, nutritional status, walking status, and psychiatric condition of each patient were assessed prior to the administration of laser therapy treatment. Traditional wound care management was also used in addition to laser therapy. According to laser therapy treatment protocol for open wounds, a single diode laser probe was used for biostimulation of the wound bed and the wound periphery. Pre- and post-treatment measurements of wound size were obtained periodically for a total of 188 open wounds. 84% of these wounds completely healed, 11.2% partially healed, 2.1% did not change, and 2.7% got worse. The number of treatments for the 158 completely-healed wounds ranged from 3 to 133 (mean 18.5) and the treatment period ranged from 5 to 383 days (mean 47.7). Wound healing was found to be related to nutritional status but neither walking status nor wound size. Results indicate that LILT is effective in the treatment of open wounds when it is used as a component of a total wound management program.

A SYSTEMATIC REVIEW OF LOW LEVEL LASER THERAPY (LLLT) WITH LOCATION-SPECIFIC DOSES FOR PAIN FROM CHRONIC JOINT DISORDERS.

Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. jmb@hib.no

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

Aust J Physiother 2003;49(2):107-16

THE CLINICAL EFFICACY OF LOW-POWER LASER THERAPY (LLLT) ON PAIN AND FUNCTION IN CERVICAL OSTEOARTHRITIS.

Ozdemir F, Birtane M, Kokino S.

Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.

Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LLLT) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

Clin Rheumatol 2001;20(3):181-4

IMPROVEMENT OF PAIN AND DISABILITY IN ELDERLY PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS OF THE KNEE TREATED WITH NARROW-BAND LIGHT THERAPY (LLLT).

Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD, Michal Rosenthal, MD, Iulian Abramovici, MD, Nathalia Kutok, MD, and Auni Khahil, MD

Objective: To evaluate the effects of low-power light therapy (LLLT) on pain and disability in elderly patients with degenerative osteoarthritis in the knee.

Design: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters.

Patients: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients) and placebo (17 patients). Infrared and placebo emitters were double-blinded.

Interventions: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.

Main Outcome Measures: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient’s request to be retreated was summed up 1 year after the trial. Results: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red and infrared treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo respectively)

Conclusions: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee. Degenerative osteoarthritis (DOA) is the most common rheumatic disorder of man and causes pain and disability especially in elderly people.1 Autopsy surveys show that degenerative changes in joints begin as early as the second decade of life. 2 Roentgenographic studies conducted in the United States showed osteoarthritic changes in 4 percent of persons under 24 years of age in 85 percent at 75 to 79 years of age. Symptomatic manifestations of osteoarthritis increase with ageing, reflecting disease changes that begin in early life and progress slowly over a period of many decades. 3-4

J Am Geriatr Soc. 1992; 40: 23-26

INFARED DIODE LASER IN LOW REACTIVE-LEVEL LASER THERAPY (LLLT) FOR KNEE OSTEOARTHROSIS

M. A. Trelles, J. Rigau, P. Sala, G. Calderhead and T. Ohshiro

Degenerative joint disease (DJD) in particular in the knee. is difficult to, cure successfully at present often requiring surgical intervention. In addition the chronic DJD patient often exhibits symptoms cl both a physiological and psychological nature. A study is presented using high reactive-level laser therapy (LLLT) with an 830 nm infra red continuous wave gallium aluminium (or aluminium) arsenide (GaAlAs) diode laser with an output power of 60 mW. in light contact Laser therapy for a population of 40 patients (power density of approximately 3 W/cm2). Four points around the patella were irradiated for 60 s each (energy density of 18 J/cm2 per point. total of 72 J/cm2 per session) two sessions per week for eight weeks. Radiological, pain score and joint mobility assessments were made before the first session, immediately after at 4 months after the final LLT session. All other medication and physical therapy was discontinued at least 15 days prior to the first treatment session. Thirty-three patients (82%) reported significant removal of pain and recovery of articular joint mobility. The remaining seven patients felt there was no significant effect following LLLT and returned to their original pretherapy medication. The side effects were minimal LLLT is concluded to to be safe, effective and non-invasive alternative to conventional surgical and medical treatment modalities for DJD patients.

Laser Therapy 1991, 3:149-153

CLINICAL APPLICATION OF GaAlAs 830 NM DIODE LASER (LLLT) IN TREATMENT OF RHEUMATOID ARTHRITIS

Kanji Aoada, Yasutaka Ytani, Akira Sakawa and Akira Shimazu - Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected Joints, thereby seriously restricting the patient's quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient's QOL at a reasonable level. The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognised in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data). From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAIAs diode laser system (830 nm, 60 mW CIW). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement?, good (clearly apparent improvement), and unchanged (little or no improvement). For, pam attenuation, scores were: excellent — 59.6%; good — 30.4%; unchanged — 10%. For ROM improvement the scores were: excellent — 12.6%; good — 43.7%; unchanged — 43.7 Yo. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

DOUBLE BLIND CROSSOVER TRIAL OF LOW LEVEL LASER THERAPY (LLLT) IN THE TREATMENT OF POST HERPETIC NEURALGIA

Kevin C Moore MB ChB FRCA Naru Hira. Parswanath Kramer, Copparam Jayakumar & Toshio Ohshiro

Department of Anaesthesia, The Royal Oldham Hospital,

Post herpetic neuralgia can be an extremely painful condition which in many cases proves resistant lo all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course. This trial was designed as a double blind assessment of the efficacy of low level laser therapy (LLLT) in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received four consecutive laser treatments. The results demonstrate a significant reduction in the pain intensity and distribution following a course of low level laser therapy.

Laser Therapy. 1988; 1: 7.

EFFICACY OF LOW REACTIVE-LEVEL LASER THERAPY (LLLT) FOR PAIN ATTENUATION OF POSTHERPETIC NEURALGIA

Osamu Kemmotsu, Kenichi Sato, Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Sigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males, 38 females with an average age of 69 years) managed at our pain clinic over the past 4 years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminium arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave) Pain scores (PS) were obtained using a linear analog scale (0 to 10) before and after LLLT. The immediate effect after the initial LLLT was very good (PS: 0-3) in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 +/- 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a non invasive, painless and safe method of therapy, it is well acceptable by patients.

0898-5901/91/020071-05$05.00 Ì 1991 by John Wiley & Sons, Ltd.

THE EFFECT OF INFR-ARED LASER IRRADIATION (LLLT) ON THE DURATION AND SEVERITY OF POSTOPERATIVE PAIN: A DOUBLE BLIND TRIAL

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K., General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of postoperative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6- 8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand postoperative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups. Controls n = 5.5: LLLT n = 2.5. No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group. Controls n = 9: LLLT n = 4. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

0898-5901/92/040145-05$07.50 @) 1992 by John Wiley & Sons, Ltd.

CAN LOW REACTIVE-LEVEL LASER THERAPY (LLLT) BE USED IN THE TREATMENT OF NEUROGENIC FACIAL PAIN? A DOUBLE-BLIND, PLACEBO CONTROLLED INVESTIGATION OF PATIENTS WITH TRIGEMINAL NEURALGIA

ArneEckerdal and and Lehmann Bastian

Department of Oral and Maxillofacial Surgery and Oral Medicine,
Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a doubleblind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks. The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year only one patient was still completely free from pain. The use of analgesics was recorded and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Laser Therapy, 1996:: 8: 247-252

www.laserpartner.org

Lasers and Pain Treatment

Dr. Kevin Moore

Department of Anaesthesia

The Royal Oldham Hospital, UK

Summary

The clinical application of low incident power density laser radiation for the treatment of

acute and chronic pain is now a well established procedure. This paper reviews the

currently available English speaking literature and summarises a selection of serious

scientific papers which report a beneficial effect following the treatment of a wide variety

of acute and chronic syndromes whose main presenting symptom is pain.

Introduction

The Helium-Neon (He-Ne) laser at a wavelength of 632.8 nm has proved very successful

in promoting wound healing particularly in indolent ulcers resistant to conventional

methods of therapy. However, its limited depth of penetration and low power output have

rendered it less effective when treating more deep seated causes of pain. The laser more

frequently used for pain therapy is the Gallium Aluminium Arsenide (GaAlAs) diode

emitting coherent light in the near infra-red waveband, usually 820 - 830 nm, and with a

continuous wave power output of some 60 mW. The optoelectronic rationale for

choosing these parameters has been discussed byMoore and Calderhead (1).

During the past 15 years experimental research has greatly added to our knowledge of the

response of tissue radiation. Figure 1 summarises some 10 years work by Karu (2) into

the cellular response to photon energy. Additional research at the Tissue Repair Research

Unit at Guy`s Hospital, London, has detailed the local tissue changes following exposure

to laser light. The current concept is one of a dual response to laser bioactivation.

The immediate or primary effect is a local tissue response to direct irradiation and

comprises vasodilatation with increased circulatory flow: enhanced lymphatic drainage;

increased neutrophil, macrophage and fibroblast activity; and an improved metabolic

function in depressed or damaged cells. The delayed or secondary response consists of a

systemic effect caused by circulating photoproducts of irradiation in the blood and

lymphatic systems. Increased plasma concentrations of certain types of prostaglandins,

enkephalins and endorphins have all been identified and most probably play a major role

in the mechanism of pain attenuation.

Figure 1: Cellular response to laser irradiation

IRRADIATION

PHOTORECEPTORS ON MITOCHONDRIAL CHAINS

ELECTRON TRANSPORT CHAINS PROTON MOTIVE FORCES

RESPIRATION CHAIN ACTIVITY OXIDATION OF NADH POOL

REDOX CHANGES IN MITOCHONDRIA AND CYTOPLASM

CELL MEMBRANE ACTIVITY

MEMBRANE TRANSPORT MECHANISMS

CYTOPLASM CHANGES

H+ ph Ca++ cAMP

DNA : RNA SYNTHESIS

GROWTH AND PROLIFERATION

Acute pain therapy

Acute trauma is invariably associated with a degree of soft tissue injury comprising

swelling, haematoma, pain, reduced mobility and in the lower limbs impaired weight

bearing. Sporting injuries and domestic accidents usually involve damage to muscles,

joint ligaments and tendons. Examples include a sprained ankle or wristed or a twisted

knee. Most extensive soft tissue damage tends to result from industrial crush injuries or

road traffic accidents. In the absence of bone fracture or other injury demanding priority

treatment laser therapy should be instituted at the earliest opportunity. Kumar (3)

reported a comparative study in 50 patients with inversion injuries of the ankle. He found

that compared to conventional physiotherapy the laser treated patients showed a more

rapid resolution of symptoms and an earlier return to full weight bearing. Patients were

treated with a GaAlAs diode laser (830 nm: 60 mW) at 48 hour intervals on a maximum

of 3 occasions. A similar therapeutic regime has been described for whiplash injuries of

the cervical spine (4). Ben Hatit and Lammens (5) used a defocussed CO2 laser to treat a

variety of acute musculoskeletal problems. The energy density varied between 40 - 70

J/cm2. Patients were treated twice a week for up to 10 sessions.

Beneficial effects of laser therapy in acute small joint inflammation in rheumatoid

arthritis has been described by Asada et al (6). Multiple point irradiation using a GaAlAs

diode (830 nm:60 mW) was applied for 15 seconds to each point. Pain was reduced by up

to 66 % together with an improvement in the measured range of movement (ROM).

In a similar report involving 938 patients with osteoarticular pain Soriano (7) found pain

attenuation of 88 % when treating a variety of acute conditions such as tendosynovitis,

lumbago and cervical pain. He used a GaAs diode (940 nm: pulsed 10,000 Hz: average

power 40 mW) to treat patients twice weekly for a maximum of 10 sessions. The energy

density delivered was 6 - 10 J/cm2 per irradiated point.

Laser therapy also proved helpful in reducing the severity and duration of postoperative

pain. In a comparative study involving 20 patients undergoing elective cholecystectomy

Moore et al (8) reported a 50 % reduction in the postoperative pain experienced by the

laser treated patients together with a concomitant reduction in analgesie requirements.

Chronic pain syndromes

Chronic pain, as the name implies, may last for months or years. Pain may arise as a

result of damage caused by trauma or surgery or be manifested as a symptom of a

systemic desease process. In later life pain due to musculoskeletal "wear and tear" is very

common. Finally neuralgic pain such as postherpetic or trigeminal neuralgia can cause

prolonged problems to sufferers. A high percentage of patients referred for laser therapy

will have already shown little or no response to conventional methods of treatment.

In rheumatoid arthritis (RA) laser therapy can benefit not only the pain of acute small

joint inflammation but also the more established chronic pain of the disease. Gartner (9)

in an excellent review article on rheumatology considered some 18 papers published over

a 10 year period. All involved double blind trials of therapy with 5 having a cross-over

element. In considering the effect of laser therapy in chronic rheumatoid and associated

musculoskeletal conditions all but one of the reports noted a significant improvement in

pain. In his own work Gartner used a 904 nm infra-red laser to treat a variety of

tendinopathies with a better than 80 % success rate in relieving pain. He compared this to

a similar rate of pain attenuation using anti-inflammatory drugs

(NSAIDs) but noted that whilst laser therapy was free of side effects some 20 % of

patients treated with NSAIDs suffered unacceptable side effects of medication. Asada

and his colleagues (10) in a further study of some 170 patients with rheumatoid arthritis

used similar laser parameters and treatment protocols to their earlier reported work. The

group achieved pain attenuation of up to 90 % and improvement in ROM of up to 56 %.

In a report of some 1000 treatments using a GaAlAs diode laser (830 nm: 60 mW) for a

wide variety of chronic pain syndromes Moore (11) noted an overall reduction in pain

levels of some 70 %. Trelles et al (12) used a similar diode laser to treat 40 patients with

degenerative joint disease to the knee. They delivered 18 J/cm2 to each of 4 points around

the knee twice a week for 8 weeks and reported a significant pain reduction in 82 % with

improved joint mobility. Li (13) used a 25 mW combined CO2/HeNe laser to treat 90

patients with cervical spondylosis. Laser therapy was administered to a variety of

acupuncture points for 10 minutes daily for 2 periods each of 10 days with an intervening

rest period of 10 days. 90 % of patients showed symptoms improvement with an

excellent result in 43 %.

Fender and Diffee (14) reported an interesting trial involving patients suffering from

chronic generalized musculoskeletal pain. They irradiated the stellete ganglion using a

HeNe laser with an initial exposure of 6 minutes (36 J/cm2) gradually increasing over 4 -

6 weeks to a maximum of 15 minutes (90 J/cm2). They postulated a mechanism of

reduced sympathetic irritability causing a stabilisation of the response loop and a

breaking of the pain cycle. In resistant cases they also treated segmental dermatomes and

site specific trigger points.

Patients suffering from postherpetic neuralgia (PHN) have shown a good response to

laser therapy. In a double blind cross-over trial Moore et al (15) reported a mean

reduction in pain levels of 74 %. Patients were treated with a GaAlAs diode (830 nm: 60

mW) with the laser applied in contact mode to the centre of each 2 cm2 grid over the

affected area giving 24 - 30 J/cm2 to each point. Treatment was given twice a week for 4

weeks. Using an identical treatment protocol but an extended regime of some 12 weeks

Kemmotsu et al (16) reported at the end of treatment pain attenuation of 89 %. Otsuka

and colleagues (17) used an 8.5 mW HeNe scanner to treat the acute rash of herpes

zoster. Once the skin rash has subsided treatment was continued using a GaAlAs laser

(830 nm: 60 mW). Within 1 month pain had been reduced by 76 % with a final end

treatment improvement of 97 %. The early introduction of laser therapy produced a rapid

resolution of acute herpes zoster rash and a reduced incidence of PHN.

Discussion

Laser therapy is effective for a wide variety of acute and chronic pain syndromes. During

the past 7 years the Laser Therapy Journal has featured some 30 papers on the subject.

The preferred laser is the GaAlAs diode emitting light in the near infra-red usually at 830

nm. The majority of reports detail a power output of 60 mW continuous wave. Recently,

however, researchers have been assessing the use of higher output powers in the range of

150 - 300 mW.

In a prelim inary trial Yamada and Ogawa (18) compared the results of treating PHN

with 60 and 150 mW. They found that the higher output power reduced both the

frequency and duration of the treatment sessions and improved pain attenuation by some

25 %. Ohshiro (19) has devised an ingenious protocol for a computer controlled double

blind comparative trial which compensates for the placebo effect of treatment and for

patient and therapist bias. In a paper comparing the therapeutic outcomes in 2

geographically separate but otherwise identical clinics Shiroto (20) described how a

positive therapist attitude motivated by enthusiasm and commitment can improve the

results of therapy by 15 - 20 %.

There remains a need for more scientific studies based on well constructed double blind

comparative trials. Nevertheless the bulk of published work to date supports the use of

laser therapy for the treatment of pain. In a repor of the cost-effective benefits of using

laser therapy to treat PHN Moore (21) noted that, compared with conventional methods

of treatment, laser proved to be not only more effective but more economical as well. The

added advantage of absence of side effects, non-invasive nature of therapy and the case

of application ensured good patient acceptance of the treatment modality.

Editore, 1992

***

Joint International Laser Conference in Edinburgh

In September, 2003, the Edinburgh International Conference Centre in Scotland hosted

the Joint International Laser Conference, organized jointly by the American Society for

Laser Medicine and Surgery, European Laser Association and British Medical Laser

Association. More than 500 registered participants had the opportunity of seeing not only

the most advanced laser medical technology presented by 39 exhibitors, but also of

attending numerous meetings and presentations, getting acquainted with top issues of

laser surgery and therapy. A significant portion of scientific papers and posters dealt

with laser therapy (LLLT), and theory was well supplemented with a series of

educational courses called "How I do it". The organizers provided Laser Partner with full

text of some of the lectures and now we bring the first one.

Low Level Laser-Therapy in pain treatment of the ambulatory system

Dr. med. Matteo Rossetto M.D.,Basel

Zusammenfassung

Summary

In spring 1995 we expanded our treatment methods with Low Level Laser Therapy. We

decided to test the effectiveness of this kind of therapy through a study on 41 consecutive

patients with ailments of the ambulatory system. For each case respective parameters,

such as diagnosis, localisation, number of treatment points and output of the applied laser

energy, were listed on a individual protocol where the patient also had to assess his pain

(before and after the treatment) to a number on the so called visual-analog pain scala

(rating from 1 to 10). Furthermore the doctor had to note objective parameters like

mobility, inflamation and swellings before and after the laser therapy. The indications

concerned exclusively pain of the ambulatory system, especially epicondylitis and other

posttraumatic or stress induced pain of tendons and articulations, but also some

degenerative changes of joints (arthrosis of knee and shoulder).

During this study no other therapy method or drugs were applied, in order to allow a

reliable judgement of the effectiveness of laser therapy. Conventional methods were only

used if the treatment by laser light was not sufficiently effective.

Generally, the results obtained with laser therapy were very good - both subjectively and

objectively rated. Only 12 percents of the patients felt no pain release, one patient had to

stop the laser therapy after two applications because of an increasing subjective pain. 73

percent of the patients felt a good or very good effect of the therapy. The treated patients

liked laser therapy very much, because there are no side effects, the treatment is painless

and the ailment decreases rapidly.

Pain Relief by Phototherapy:By Mary Dyson PhD, FCSP(Hon), FAIUM (Hon) & Joe Tafur MD

Pain associated with tissue repair

When tissue is injured it generally repairs. This repair consists of three overlapping phases:

Acute inflammation, when dead or damaged tissue and infective organisms are removed from the site of injury and when cytokines, growth factors essential for repair, are secreted. It is characterized by calor (heat), rubor (redness), turgor (swelling due to edema) and dolor (acute pain that normally ends when the inflammation resolves). It is not a disease but the normal response of the body to injury. Chronic inflammation, in contrast, is a disease associated with chronic pain.
Proliferation, when granulation tissue rich in blood vessels, cytokine- producing macrophages, and fibroblasts develops at the wound site. The cytokines stimulate mitogenesis (cell division) and angiogenesis (blood vessel formation). At first this is pain free though there may be some pain during the growth of nerve fibers into the granulation tissue.
Remodeling, the replacement of granulation tissue by scar tissue, may be painful if nerve fibers become trapped in the scar tissue or if a neuroma develops. This pain can become chronic.

How does phototherapy relieve acute pain?

Phototherapy can accelerate the resolution of acute inflammation. The swelling and pain are therefore reduced more quickly than would occur without treatment. The value of acute inflammation is that during it the cytokines necessary for the onset of the proliferative phase are secreted by macrophages and other cells. Phototherapy accelerates this secretion. In contrast, anti-inflammatory drugs, though they reduce edema and relieve acute pain, can inhibit the secretion of some cytokines and produce other adverse side effects. Phototherapy is therefore preferable to treatment of acute inflammation with anti-inflammatory drugs, unless this treatment is of short duration.

The following are examples of conditions producing acute pain which can be treated successfully with phototherapy¹:

Acute wounds
Viral infections (e.g. cold sores and shingles)
Sports injuries
Whiplash-associated injuries

How does phototherapy relieve chronic pain?

Chronic pain is dependent upon nerve conduction and is often associated with chronic inflammation. The following are examples of conditions producing chronic pain which can be treated successfully with phototherapy¹:

Carpal tunnel syndrome
Chronic wounds
Epicondylitis
Fibrositis/Fibromyalgia
Headache/Migraine
Plantar fasciitis
Tendonitis/Bursitis
Neck/Back pain
Trigeminal Neuralgia
Whiplash associated injuries.

There is extensive documentation in support of the use of phototherapy in the treatment of these conditions¹. Studies investigating the use of phototherapy for the treatment of both acute and chronic pain draw upon parameters defined by in vitro research which have been extrapolated, with variable results, to clinical settings. A biostimulatory window has been found; the parameters of the window include wavelength (nm), power density (W/cm²) and energy density or dose (J/cm²). If power densities and doses are too low they are ineffective and if too high they are damaging. In vivo, more parameters enter the picture, modifying this window. For example, the depth of the target injury affects how much energy must be applied at the surface because the intervening tissue will absorb some of the energy. The deeper the tissue, the more the energy that must be applied at the surface to ensure that a locally effective dose reaches the target. Phototherapy also produces systemic effects on, for example, the vascular, immune, endocrine and nervous systems which permits it to affect deep targets indirectly without photons actually reaching these targets. The best results are achieved by a combination of local and systemic effects. Sometimes the systemic effects are not considered by investigators; this has led to misinterpretation of the significance of some clinical observations, as described below.

Clinical examples

1. Arthritis

(a) In 1993, Heussler et al ⁸published a double bind randomized study in which they deduced that near-infrared low intensity (power) lasers were ineffective in the treatment of rheumatoid arthritis at a dose of 12 J/cm² even though 72% of the patents reported pain relief. This analgesia was dismissed by the authors as a powerful placebo effect, in part because pain relief was reported in both the treated and untreated hand. Similar bilateral effects have been found in many clinical investigations and in wound healing studies conducted on animals. It is now appreciated that phototherapy produces both local and systemic effects on the vascular, immunological, endocrinological and nervous systems; these systemic effects may help to explain how bilateral improvements can occur. In the light of this the deduction of ineffectiveness is can be seen to be incorrect.

(b) In 1992 Stelian et al ⁹published a study reporting that low-power light therapy was effective in relieving pain and disability in degenerative osteoarthritis of the knee. In this study, red and near infrared lasers with intensities in the milliwatt range were used at doses of 5-6 J/cm².

(c) In 2000, Brosseau et al ¹⁰ published a meta-analysis of the effects of low level laser therapy on osteoarthritis and rheumatoid arthritis. They concluded that for rheumatoid arthritis low level laser therapy ‘should be considered for short term relief of pain and morning stiffness since it has few side effects’. For osteoarthritis it was concluded that the results were conflicting and ‘may depend on the method of application and other features of the low level laser therapy.

2. Carpal tunnel syndrome

In March 2007 Elwakil et al ¹¹ reported a comparison of low LLLT (632 nm, 12 mW, 3 J/cm², 12 biweekly treatments) with open carpal tunnel release surgery. Their conclusion after a 6 month follow-up was that LLLT had ‘proven to be effective and noninvasive for early and mild-to-moderate cases where pain is the main presenting symptom, whereas as surgery could be reserved for advanced and chronic cases’. We suggest that surgery be followed by phototherapy as soon as possible to resolve the inflammatory phase of the repair process initiated by the surgery and to relieve the acute pain associated with it.

CONCLUSIONS

Phototherapy can relieve pain and can help injuries heal.
Inflammation is resolved more rapidly than in injuries not treated with it and the proliferative phase of healing begins earlier.
Ideally, phototherapy should be applied as soon as possible after injury or infection so that chronic conditions are avoided.
Both local and systemic effects are induced by phototherapy
More investigations are needed to find the best treatment parameters. These parameters will vary with the clinical status of the patient.

We recommend that more pain practitioners have access to training in phototherapy. The quality of life of more patients would be improved, and time and money saved, by replacing less effective pharmaceutical treatment and unnecessary surgery with phototherapy.

Mary Dyson PhD, FCSP(Hon), FAIUM(Hon), CBiol, MIBiol

Emeritus Reader in the Biology of Tissue Repair, KCL, University of London, UK

Executive Vice-President, Longport Inc., Glen Mills, PA19342, USA

Joe Tafur MD

Stress Physiology Lab, UCSD Department of Psychiatry

Family Physician, Kaiser Urgent Care

Photomedicine and Laser SurgeryVolume 26, Number 6, 2008

Carpal Tunnel Syndrome Treated with a Diode Laser:

A Controlled Treatment of the Transverse Carpal Ligament

Wen-Dien Chang, M.S.,1,2 Jih-Huah Wu, Ph.D.,3 Joe-Air Jiang, Ph.D., P.E.,1

Chun-Yu Yeh, Ph.D.,4 and Chien-Tsung Tsai, M.S.2

Abstract

Objective: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830- nm diode laser on carpal tunnel syndrome (CTS). Background Data: Many articles in the literature have dem- onstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT. Materials and Methods: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm2, at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser ir- radiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up. Results: Before treatment, there were no significant differ- ences between the two groups for all assessments (p 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p 0.05). After 2 wk of treatment, no sig- nificant differences were found in grip strengths or for symptoms and functional assessments (p 0.05). How- ever, there were statistically significant differences in these variables at 2-wk follow-up (p 0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2- wk follow-up. Conclusions: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.

Články

Zhrnutie

Existujú 2 typy laserov: medicínsky a kozmetický laser.

Kozmetické lasery slúžia sa skrášľovanie, t.j. lasery na odstraňovanie vrások, lasery na depiláciu, lasery na liečbu akné atď. Aplikácia je povrchové ožarovanie pokožky.

Medicínske lasery slúžia na liečbu a prevenciu ochorení. Medzi najefektívnejšie metódy patria ožarovanie nosnej dutiny a vnútrožilové ožarovanie.