LOW LEVEL LASER TREATMENT
PAIN AND INFLAMMATION
Giuseppe Tam, M. D. Specialist in Legal/Insurance Medicine, Laser Center Tolmezzo – Italy
Objective: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy.
Summary Background Data: Low power density laser acts on the Prostaglandins synthesis, increasing the change of PGG2 and PGH2 Periossidos into PGI2 (also called Prostaciclyn or Endoprostol). The last one is the main product of the Arachidonic acid into the endothelial cells and into the smooth muscular cells of the vessel walls having a vasodilating and anti-inflammatory action.
Methods: Treatment was carried out on 447 cases and 435 patients (250 women and 185 men) in the period between 20.05.1987 and 31.12.1999. The patients, whose age ranged from 25 to 70, with a mean age of 45 years, were suffering from rheumatic, degenerative and traumatic pathologies as well as cutaneous ulcers. The majority of the patients had been seen by orthopaedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy, with poor results. Two-thirds were experiencing acute symptomatic pain, while the others presented a chronic pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength. The frequency of treatment: 1 application per day for 5 consecutive days, followed by a 2-day interval. In the evaluation of the results, the following parameters have been considered: disappearance of spontaneous and induced pain, anatomic and functional evaluation of the joints, muscular growth, verbal rating scales, hand dinamometer, patient’s pain diary.
Results: Very good results were achieved especially with cases of symptomatic osteoarthritis of the cervical vertebrae, with sport-related injuries, with epicondylitis, and with cutaneous ulcers; also, last but not of least importance, with cases of osteoarthritis of the coxa.
Conclusions: Treatment with 904 nm diode laser has substantially reduced the symptoms as well as improved the quality of life of the patient, thus postponing the need for surgery.Rochkind S, Shahar A. Nevo Z.
Laser Therapy.1997; 9 (4): 151
An Israeli research group has investigated an innovative method of repairing injured spinal cords. In a rat model, the spinal cords were transected in 31 animals (betweenT7/T8). In vitro constructed composite implants were used in the transected area. These implants contained embryonal spinal cord neuronal cells dissociated from rat fetuses, cultured on biodegradable microcarriers. After being embedded in hyaluronic acid the implants were ready to be placed into the injured area. The whole lesion area was covered with a thin coagulated fibrin-based membrane. Control animals underwent the same laminectomy but did not receive an implant. In all animals, the wound was closed normally. Laser therapy was started immediately after surgery. It was continued daily for two weeks using 780 nm, 200 mW, 30 minutes daily. One group received the implant but no laser. During the 3-6 months follow up, 14 of the 15 animals that received laser(A) showed different degrees of active movements in one or both legs, compared to 4 of9 animals in the group who had received implants but no laser (B). In the group receiving no implant and no laser (C), 1 out of 7 showed some motor movements in one leg. Somatosensory evoked potentials were elicited in 10 of the 15 rats in group A at three months, and on one side in one animal in group B, Axon sprouting was observed as soon as three days post surgery, in group A only.
Núbia Cristina Rodrigues de Morais, Ana Maria Barbosa, Mariana Lima Vale, Antonio Balbin Villaverde, Carlos José de Lima, José Carlos Cogo, Stella Regina Zamuner.
-Not available-, ahead of print. doi:10.1089/pho.2008.2422
Objective: The aim of this work was to investigate the effect of low-level laser therapy (LLLT) and light-emitting diode (LED) on the formation of edema, increase in vascular permeability, and articular joint hyperalgesia in zymosan-induced arthritis.
Background Data: It has been suggested that low-level laser and LED irradiation can modulate inflammatory processes.
Material and Methods: Arthritis was induced in male Wistar rats (250-280g) by intra-articular injection of zymosan (1mg in 50ÂµL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1h, and 2h after zymosan administration with a semiconductor laser (685nm and 830nm) and an LED at 628nm, with the same dose (2.5J/cm2) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1h prior to the zymosan administration. Edema was measured by the wet/dry weight difference of the articular tissue, the increase in vascular permeability was assessed by the extravasation of Evans blue dye, and joint hyperalgesia was measured using the rat knee-joint articular incapacitation test.
Results: Irradiation with 685nm and 830nm laser wavelengths significantly inhibited edema formation, vascular permeability, and hyperalgesia. Laser irradiation, averaged over the two wavelengths, reduced the vascular permeability by 24%, edema formation by 23%, and articular incapacitation by 59%. Treatment with LED (628nm), with the same fluence as the laser, had no effect in zymosan-induced arthritis.
Conclusion: LLLT reduces inflammatory signs more effectively than LED irradiation with similar irradiation times (100sec), average outputs (20mW), and energy doses (2J) in an animal model of zymosan-induced arthritis. The anti-inflammatory effects of LLLT appear to be a class effect, which is not wavelength specific in the red and infrared parts of the optical spectrum.
Application of laser acupuncture in the treatment of periarthritis humeroscapularis.
spec. Sport’s med. Address Zavod za zdravstvenu zastitu radnika ZTP-a “Beograd”, 11000 Beograd, Slobodana Penezica Dr. 23 Yugoslavia
The effect of low-intensity semiconductor laser was used as treatment methods for periarthritis humeroscapularis. The CC laser (Computer Controlled laser) was applied. Laser therapy has positive biological effects and antiinflamatory, antioedema effects and analgesia. We treated 18 patients with periarthritis humeroscapularis, 14 were female patients.
The laser was locally applied at the AC points Sj 14, Sj 15, Li 15, Li 10, Sj 5, Si 3, three times a week for the first week and twice a week for the second and the third week. After the first treatment, 12 of patients had pain – alleviating effect. After 6-7 treatments, all had pain – alleviating effect and complete recovery of shoulder’s motor activity. Low-intensity therapy has its place for treatment of periarthritis humeroscapularis.
Lasers Med Sci. 2009 Feb 6
This study looked at the influence of laser on functional recovery of the sciatic nerve in rats following crushing lesion. With the aim of accelerating the regenerative processes, the objective was to study the influence of gallium-aluminum-arsenide (GaAlAs) laser on a functional and histomorphological recovery of the sciatic nerve in rats. The sciatic nerves of 12 Wistar rats were crushed divided into two groups: control and laser therapy. For the latter, GaAlAs laser was utilized, at three equidistant points on the lesion, for 20 days. Comparison of the sciatic functional index (SFI) showed that there was a significant difference only between the pre-lesion value of the laser therapy group and that after the 21st day in the control group. It was concluded that the parameters and methods utilized demonstrated positive results regarding the sciatic nerve improvement over the time period evaluated.
Tanzan Health Res Bull. 2007 Sep;9(3):196-201
Mastalgia or Breast Pain can range from minor discomfort to severely incapacitating pain. The most common type of breast pain is associated with the menstrual cycle and is nearly always hormonal. The pain can either be barely noticeable or so severe that the woman cannot wear tight-fitting clothing or tolerate close contact of any kind. The pain may be felt in only one breast or may be felt as a radiating sensation in the under-arm region. This study compared to laser therapy to traditional medical treatments and found that one of the most common drugs, bromocriptine, was less effective than laser therapy! In this double-blind study, a good response was observed in the laser group in 82.5% of patients, compared to 63.9% in the medication treated group. There was a significant difference before and after treatment (P<0.05). The authors did not postulate a mechanism, but it would make sense that laser could potentially help any syndrome that would benefit from a decrease in inflammation with an increase in normalization of cell function.
Biomed Sci Instrument 2008;44:34-40
Many practitioners use lasers over herniated and inflamed discs. However, there has never been a scientific study that demonstrated accelerated disc healing with LLLT (low-level laser therapy). In this study (Biomed Sci Instrument 2008;44:34-40) done at University of Mississippi Medical Center, the researchers investigated the effects of low power laser on the healing process of a traumatized disc in an animal model.
The rats received 830 nm wavelength laser treatment for a period of 4 weeks. The results of this study indicated that the discs of the laser treated animals healed more effectively than the sham group. Image analysis revealed that there was more disc formation in the laser irradiated animals than the sham.
increase in discs regeneration and healing following trauma. When researchers describe the results as “remarkable” it is worth watching. This is especially true in light of the research that shows that photons do penetrate deeply into the disc and spinal cord.
However, because the disc is very deep, a powerful, cold laser would probably be required for consistent success.
This study published in Clinical Rheumatology (2009 Sep;28(9):1059-65) compared LLLT to splinting. The patients with unilateral, mild, or moderate idiopathic carpal tunnel syndrome (CTS) who experienced symptoms over 3 months were included in the study. The LLLT (low-level laser therapy) group received ten sessions of laser therapy and splinting while S group was given only splints.
The grip strength of the splinting group was decreased significantly! 23% of the LLLT had a full recovery and 57% had a partial recovery, while only 4% of the splint group had a full recovery. It was concluded that laser therapy was more effective at stimulating nerve recovery than splinting.Claudia Reinoso Rubio, David Cremonezzi, Monica Moya, Fernando Soriano, Jose Palma, Vilma Campana.
Photomedicine and Laser Surgery. -Not available-, ahead of print. doi:10.1089/pho.2008.2472 Objective: A histological study of the anti-inflammatory effect of helium-neon laser in models of arthropathies induced by hydroxyapatite and calcium pyrophosphate in rats.
Background: Crystal deposition diseases are inflammatory pathologies induced by a cellular reaction to the deposit of crystals in the joints.
Methods: Fifty-six Suquia strain rats were distributed in seven groups. Two mg of each crystal diluted in 0.05ml physiologic solution was injected six times in each back limb joint, during two weeks on alternate days. Eight J/cm2 were applied daily to the crystal-injected joints on five consecutive days. The joints were cut and put in 10% formaldehyde, stained with hematoxylin-eosin and observed by light microscopy. The percentage of area with inflammatory infiltrates was determined in five optical microscopy photographs (100X) for each group and analyzed using the Axionvision 4.6 program. A Pearson’s Chi-Squared test was applied, with a significance level set at p < 0.05.Results: Both crystals produced an inflammatory process in the osteoarticular structures, consisting of predominantly mononuclear infiltration, fibrosis, and granulomas of foreign body-type giant cells containing phagocytosed remains of crystals. In the arthritic joints treated with laser, a marked decrease (p < 0.0001) was found in the percentage of area with inflammatory infiltrates, although the granulomas remained in a less ostensible form, with adipose tissue cells, fibrosis bands with light residual inflammation, and an absence of or very few crystals. Laser alone or physiologic solution injection did not produce histological changes.
Conclusions: Helium-neon laser reduced the intensity of the inflammatory process in the arthritis model induced by hydroxyapatite and calcium pyrophosphate crystals.
Lilic Alen, physiotherapist; Kozlevcar _ivec Maja, dr. med. spec.fiz.reh.med.; Marcan Radoslav, dr.med., spec.ortop.
In the present article, we will review a different kind of injuries in the alpine ski sport and we will concentrate on the injuries of the ligamentar part of the knees and meniscus in Slovenian ski team. After the description of the injuries follows a detailed presentation of the rehabilitation procedures from the first day of the injury till the return into the competition arena. We will try to explain the modalities of the rehabilitation procedures and their influence in the tissues, their main and side effects. Our main attention will be focused to the use of the bio stimulative laser of a higher power – 1,2 W and wavelength of 830 nm and it’s the influence on the velocity of recovery in the patients and their success in following competitions.
Pain Med. 2010 Aug;11(8):1169-78
There have been a lot of studies showing that laser helps neck pain, but this is the first that shows that it can help neck pain that radiates down the arm.
The objective of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute neck pain and radiculopathy. Sixty subjects received 15 treatments over 3 weeks with LLLT or placebo. LLLT was applied to the anatomical site of the spinal segment involved. Statistically significant differences between groups were found for intensity of arm pain and for neck range of motion.
Since it has been shown that low level lasers can help regenerate spinal discs and almost all connective tissues, it makes sense that it would help radiculopathy, sciatica, etc.
S. Rochkind, MD Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel, E-mail: [email protected]
Since our first publication (Rochkind 1978), we have been studying and testing low power laser irradiation as a means to treat peripheral nerves, using both in vitro and in vivo methods. We have reached the clinical stage and are treating a variety of peripheral nerve injuries. This study is a review of my personal experience over the last twenty-five years in the use of laser therapy in treating these conditions.
I. Influence of Low Power Laser Irradiation on Nerve Cells
A study was done using direct 632.8nm HeNe laser irradiation to determine the effect of focused laser beams on aggregates of rat fetal brain cells and rat adult brain. The direct HeNe laser irradiation 3.6J/cm2 caused a significant amount of sprouting of cellular processes outgrowth in aggregates, compared to small amounts produced by nonirradiated controls. This observation suggests that low power laser irradiation applied to the area of an experimentally injured nerve may induce axonal processes sprouting, thereby improving nerve tissue recovery. The mechanism of low power laser on nerve tissue is not completely understood, but some studies partially explain the photochemical effect of laser irradiation on the biological system. Cytochromes are affected, thereby stimulating redox activity in the cellular respiratory chain, thereby causing increases in ATP production which activates Na+, K+ -ATPase and other ion carriers, thereby increasing cell activation.
II. Animal Studies – influence of laser therapy on the severely injured peripheral nerve
A radiation method for treating lesions in both the peripheral and central nervous systems was proposed in 1978 by Rochkind and modified over the years. The model used in this work was the rat sciatic nerve. Low power laser irradiation then was delivered to the crushed nerve either transcutaneously or directly. The effects of this laser therapy were measured both in the short-term, i.e. minutes and in the long-term, i.e. days and months. Short-term model: direct irradiation of the nerve was done through the open wound directly to the crushed injured nerve and the compound nerve action potential was measured. A variety of wavelengths and powers were applied and 540nm, 632.8nm and 780nm were found most effective (p=0.01). Long-term model: We found electrophysiological activity dropped as expected in the non-irradiated nerves following the crush injury, but the use of low power laser irradiation prevented or decreased this phenomenon (p=0.001), both immediately after the crush and in the long term. Furthermore, this investigation showed that when laser treatment was delivered to both the crushed nerve and the corresponding segments of the spinal cord, the recovery time and the quality of regeneration of the crushed sciatic nerve improved, compared to the application of irradiation to the nerve alone. Histological studies supported the electrophysiological findings: low power laser irradiation was found to prevent or decrease scar tissue formation in the injured area. Laser irradiation enhanced axonal sprouting in the crush-injured sciatic nerve, thus accelerating recovery of the severely injured peripheral nerve. In addition, a beneficial effect of low power laser irradiation was found not only in the laser-treated nerve but in the corresponding segments of the spinal cord as well. Such laser treatment has been found to decrease significantly then degenerative changes in the corresponding neurons of the spinal cord and induce proliferation of neuroglia, both in astrocytes and oligodendrocytes. This suggests a higher metabolism in neurons and a better ability to produce myelin under the influence of laser treatment. Also, low power laser irradiation exerts pronounced systemic effects on severely injured peripheral nerves and corresponding regions of the spinal cord.
The therapeutic effect of low power laser irradiation on peripheral nerve regeneration after complete transection and direct anastomosis of the rat sciatic nerve was studied recently. A 780nm laser wavelength was applied transcutaneously 30 minutes daily for 21 consecutive days to corresponding segments of the spinal cord and to the injured sciatic nerve immediately after closing the wound. Positive somatosensory evoked responses were found in 55% of the irradiated rats and in 11% of the non-irradiated rats. Immuno-histochemical staining in the laser-treated group showed more intensive axonal growth and better quality of the regenerative process due to an increased number of large and medium diameter axons. IV. Clinical Pilot Studies The group of patients who were treated in the Department of Neurosurgery at Tel Aviv Sourasky Medical Center had been suffering from severe peripheral nerve and brachial plexus injuries for more than two years. Each of the 59 patients received laser treatment CW, 780nm, five hours daily for 21 consecutive days with the use of a laser system specially developed for our treatment method. The criterion for laser treatment in these cases was as follows: patients who suffered from partial motor and sensory disturbances and where surgery was not indicated. Fifty-six percent of the laser-treated patients showed good to excellent results in their motor function. V.
Clinical Double-Blind Placebo-Controlled, Randomized Study of Low Power Laser in the Treatment of Peripheral Nerve Injuries Since our previous pilot clinical results were positive, a final evaluation of the response to treatment was in order. Therefore, we performed a double-blind, placebo-controlled randomized study of patients who had been suffering from incomplete peripheral nerve and brachial plexus injuries from 6 months up to several years after injury. The protocol of this study was done with the permission of the Helsinki Committee of the Tel Aviv Sourasky Medical Center and with the approval of the Ministry of Health of Israel and by a grant from the Rehabilitation Department of the Ministry of Defence of Israel. The study evaluated the functional recovery of these patients after undergoing low power laser or placebo treatment. Recovery was classified by comparing each of the deficits present before and after surgery. The post-laser or post-placebo grade was determined by the change in strength compared to the pretreatment levels. In almost all cases, the level of motor function was minimal to poor pre-treatment. In the laser-treated group, statistically significant improvement was found in motor functional activity P=0.0001, compared to the placebo group). The electrophysiological findings also showed statistically significant improvement in the laser-treated group. Our twenty-five years of experience indicates that Laser Therapy is a low-cost, non-invasive method and will be recognized as a standard additional treatment for improving the functional recovery of patients with peripheral nerve and brachial plexus injuries. According to our clinical experience, the main advantages of Laser Therapy are the enhancement and acceleration of the recovery of injured nerve tissue. The therapeutic results show that an objective progressive improvement appears in nerve function, leading to a significant and earlier recovery.Stergioulas A. Faculty of Human Motion, University of Peloponnese, Attica, Greece. [email protected]
J Clin Laser Med Surg. 2004 Apr;22(2):125-8. PMID: 15165387 [PubMed – indexed for MEDLINE]
OBJECTIVE: Low-level laser therapy (LLLT) has been used for the last few years to treat sports injuries. The purpose of this study was to compare three therapeutic protocols in treating edema in second-degree ankle sprains that did not require immobilization with a splint, under placebo-controlled conditions.
MATERIALS AND METHODS: Forty-seven soccer players with second degree ankle sprains, selected at random, were divided into the following groups: The first group (n = 16) was treated with the conventional initial treatment (RICE, rest, ice, compression, elevation), the second group (n = 16) was treated with the RICE method plus placebo laser, and the third group (n = 15) was treated with the RICE method plus an 820-nm GaA1As diode laser with a radiant power output of 40 mW at 16 Hz. Before the treatment, and 24, 48, and 72 h later, the volume of the edema was measured.
RESULTS: A three by three repeated measures ANOVA with a follow up post hoc test revealed that the group treated with the RICE and an 820-nm GaA1As diode laser presented a statistically significant reduction in the volume of the edema after 24 h (40.3 ± 2.4 mL, p < 0.01), 48 h (56.4 ± 3.1 mL, p < 0.002), and 72 h (65.1 ± 4.4 mL, p < 0.001).
CONCLUSIONS: LLLT combined with RICE can reduce edema in second-degree ankle sprains.
Low-power laser treatment in patients with frozen shoulder: preliminary results
Stergioulas A., Laboratory of Health, Fitness, and Rehabilitation Management, Faculty of Human Movement and Quality of Life, Peloponnese University, Sparta, Greece. [email protected]
Photomed Laser Surg. 2008 Apr;26(2):99-105 PMID: 18341417 [PubMed – indexed for MEDLINE]
OBJECTIVE: In this study, I sought to test the efficacy of low-power laser therapy (LLLT) in patients with frozen shoulder.
Background Data: The use of low-level laser energy has been recommended for the management of a variety of musculoskeletal disorders.
MATERIALS AND METHODS: Sixty-three patients with frozen shoulder were randomly assigned to one of two groups. In the active laser group (n = 31), patients were treated with an 810-nm Ga-Al-As laser with a continuous output of 60 mW applied to eight points on the shoulder for 30 sec each, for a total dose of 1.8 J per point and 14.4 J per session. In the placebo group (n = 32), patients received placebo laser treatment. During 8 wk of treatment, the patients in each group received 12 sessions of laser or placebo, two sessions per week (for weeks 1-4), and one session per week (for weeks 5-8).
RESULTS: Relative to the placebo group, the active laser group had: (1) a significant decrease in overall, night, and activity pain scores at the end of 4 wk and 8 wk of treatment, and at the end of 8 wk additional follow-up (16 wk post-randomization); (2) a significant decrease in shoulder pain and disability index (SPADI) scores and Croft shoulder disability questionnaire scores at those same intervals; (3) a significant decrease in disability of arm, shoulder, and hand questionnaire (DASH) scores at the end of 8 wk of treatment, and at 16 wk posttreatment; and (4) a significant decrease in health assessment questionnaire (HAQ) scores at the end of 4 wk and 8 wk of treatment. There was some improvement in range of motion, but this did not reach statistical significance.
CONCLUSIONS: The results suggested that laser treatment was more effective in reducing pain and disability scores than placebo at the end of the treatment period, as well as at follow-up.Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E.
Lasers Med Sci. 2002;17(1):57-61
Low energy lasers are widely used to treat a variety of musculoskeletal conditions including fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomized, single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser therapy in 40 female patients with fibromyalgia. Patients with fibromyalgia were randomly allocated to active (Ga-As) laser or placebo laser treatment daily for two weeks except for weekends. Both the laser and placebo laser groups were evaluated for the improvement in pain, a number of tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm. In both groups, significant improvements were achieved in all parameters (p < 0.05) except sleep disturbance, fatigue and skinfold tenderness in the placebo laser group (p > 0.05). It was found that there was no significant difference between the two groups with respect to all parameters before therapy whereas a significant difference was observed in parameters as pain, muscle spasm, morning stiffness and tender point numbers in favor of laser group after therapy (p < 0.05). None of the participants reported any side effects. Our study suggests that laser therapy is effective on pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and suggests that this therapy method is a safe and effective way of treatment in the cases with fibromyalgia.
Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND, Clinic for Rehabilitation, Medical School, Belgrade, Serbia.
Objective: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.
Background Data: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.
Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.
Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005).
Conclusions: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.
In chronic low back pain, low-level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomized trial
Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G.
Australian Journal of Physiotherapy 2007 Vol. 53
It has been suggested that laser therapy may act by stimulating ligament repair (Reddy et al 1998), by anti-inflammatory effects (Sakurai et al 2000, Bjordal and Baxter 2006), and/or by reducing interstitial swelling by stimulating the motoricity of lymphatics (Carati et al 2003, Kaviani et al 2006). There is also in vivo and in vitro evidence that 830 nm laser inhibits AÃƒÂ¤ and C fiber transmission (Tsuchiya et al 1993, Tsuchiya et al 1994). It is possible that laser-induced neural blockade may then lead to long-term altered nociception, analogous to the prolonged analgesia seen in some patients with local anesthetics (Arner et al 1990). The repeated application of laser may reduce tonic peripheral nociceptive afferent input to the dorsal horn and facilitate the reorganization of synaptic connections in the central nervous system producing pain modulation (Coderre et al 1993, Mense 1993).
Low-level laser therapy may also be an effective adjunctive or alternative treatment for chronic low back pain with avoidance of systemic drug use (Basford et al 1999, Gur et al 2003). Because of the significant placebo response rate in clinical trials, non-pharmacologic treatments require careful investigation to ascertain effectiveness. However, even though laser therapy is available in many clinics, it has not yet received FDA approval and the efficacy of laser therapy is controversial. Limitations of previous human studies and the application of an inadequate dose in our own previous studies lead us to choose a higher dose. In addition, we were interested in laser therapy as an adjuvant therapy to a conventional modality. The specific research questions for this study were:
In chronic low back pain, is low-level laser therapy more effective than placebo-laser therapy plus exercise at decreasing pain, increasing lumbar range of motion, and reducing disability?
In chronic low back pain, is low-level laser therapy plus exercise more effective than placebo-laser therapy plus exercise at decreasing pain, increasing lumbar range of motion, and reducing disability?Saayman L, Hay C, Abrahamse H.
J Manipulative Physiol Ther 2011 Mar-Apr 34(3) 153-63
PURPOSE: The aim of this study was to determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction.
METHODS: Sixty ambulatory women between the ages of 18 and 40 years with cervical facet joint pain of more than 30-day duration and normal neurologic examination were randomized to receive 1 of 3 treatment options: (1) CMT of the cervical spine, (2) LLLT applied to the cervical facet joints, or (3) a combination of CMT and LLLT. Each participant received 6 treatments in 3 weeks. The main outcome measures were as follows: the Numerical Pain Rating Scale, Neck Disability Index, Cervical Range of Motion Instrument, and Baseline Digital Inclinometer. Measurements were taken during weeks 1 (baseline), 2, 3, and 4.
RESULTS: No differences existed between the 3 groups at baseline. A significant difference was seen between groups 1 (CMT) and 2 (LLLT) for cervical flexion, between groups 1 (CMT) and 3 (CMT + LLLT) for cervical flexion and rotation, and between groups 2 (LLLT) and 3 (CMT + LLLT) for pain disability in everyday life, lateral flexion, and rotation.
CONCLUSION: All 3 groups showed improvement in the primary and secondary outcomes. A combination of CMT and LLLT was more effective than either of the 2 on their own. Both therapies are indicated as potentially beneficial treatments for cervical facet dysfunction. Further studies are needed to explore optimal treatment procedures for CMT and LLLT and the possible mechanism of interaction between therapies.Chow RT, Heller GZ, Barnsley L. Castle Hill Medical Centre, 269-271 Old Northern Road, Castle Hill, NSW 2154, Australia.
Pain. 2006 Jun 23; [Epub ahead of print]
A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain was conducted with the aim of determining the efficacy of 300mW, 830nm laser in the management of chronic neck pain. Subjects were randomized to receive a course of 14 treatments over 7 weeks with either active or sham laser to tender areas in the neck. The primary outcome measure was changed in a 10cm Visual Analogue Scale (VAS) for pain. Secondary outcome measures included Short- Form 36 Quality-of-Life questionnaire (SF-36), Northwick Park Neck Pain Questionnaire (NPNQ), Neck Pain and Disability Scale (NPAD), the McGill Pain Questionnaire (MPQ) and Self-Assessed Improvement (SAI) in pain measured by VAS. Measurements were taken at baseline, at the end of 7 weeks’ treatment and 12 weeks from baseline. The mean VAS pain scores improved by 2.7 in the treated group and worsened by 0.3 in the control group (difference 3.0, 95% CI 3.8-2.1). Significant improvements were seen in the active group compared to placebo for SF-36-Physical Score (SF36 PCS), NPNQ, NPAD, MPQVAS and SAI. The results of the SF-36 – Mental Score (SF36 MCS) and other MPQ component scores (afferent and sensory) did not differ significantly between the two groups. Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.Rochkind S, Shahar A. Nevo Z.
J. KÄs. PNAS. 2002; 99: 16024-16028
An innovative approach to induce regeneration and the repair of spinal cord injury. An Israeli research group has investigated an innovative method of repairing injured spinal cords. In a rat model, the spinal cords were transected in 31 animals (between T7/T8). In vitro constructed composite implants were used in the transected area. These implants contained embryonal spinal cord neuronal cells dissociated from rat fetuses, cultured on biodegradable microcarriers. After being embedded in hyaluronic acid the implants were ready to be placed into the injured area. The whole lesion area was covered with a thin coagulated fibrin-based membrane. Control animals underwent the same laminectomy but did not receive an implant. In all animals, the wound was closed normally. Laser therapy was started immediately after surgery. It was continued daily for two weeks using 780 nm, 200 mW, 30 minutes daily. One group received the implant but no laser. During the 3-6 months follow up, 14 of the 15 animals that received laser (A) showed different degrees of active movements in one or both legs, compared to 4 of 9 animals in the group who had received implants but no laser (B). In the group receiving no implant and no laser (C), 1 out of 7 showed some motor movements in one leg. Somatosensory evoked potentials were elicited in 10 of the 15 rats in group A at three months, and on one side in one animal in group B. Axon sprouting was observed as soon as three days post surgery, in group A only.
Photomed Laser Surg. 2009 Oct;27(5):763-9
Twenty-one women suffering from unilateral PML received 12 sessions of LLLT in 4 weeks. They found a significant improvement in arm volume and tissue quality in the torso and forearm region. The laser group had a 28% reduction in the arm volume! That is a significant decrease in swelling. The laser group also demonstrated an excellent function of the arm and shoulder in the that showed progressive improvement over time. The concluded that LLLT was effective in the management of PML, and the effects were maintained even 4 weeks after the end of treatment.
Proof: Laser Effective for Neck Pain
Lancet. 2009 Nov 12
This study on lasers and neck pain was so well done that it was published in the prestigious medical journal Lancet. This research was done by performing a meta-analysis. A meta-analysis combines the results of several studies that address a set of related research hypotheses. The meta-analysis used 16 quality studies including a total of 820 patients. The results demonstrated a clear benefit with acute and chronic neck pain when using low-level laser therapy (LLLT). The researchers concluded that side-effects from LLLT were mild and not different from those of placebo. They found that LLLT reduced pain almost immediately and the results lasted up to 22 weeks after completion of treatment! Wow! This is another landmark study to prove that LLLT is a very safe and effective modality for treatment of all kinds of pain, especially acute and chronic neck pain.
Treatment of Medial and Lateral Epicondylitis – Tennis and Golfer’s Elbow – with Low-Level Laser Therapy: A Milticenter, Double-Blind, Placebo-Controlled Clinical Study on 324 Patients
Zlatko Simunovic, M.D. F.M.H., Tatjana Trobonjaca, M.D., Zlatko Trobonjaca, M.D.
Among the other treatment modalities of medial and lateral epicondylitis, Low-Level Laser Therapy (LLLT) has been promoted as a highly successful method. The aim of this clinical study was to determine the efficacy of LLLT on medial and lateral epicondylitis using Trigger Points (TPs) and scanning application technique under placebo-controlled conditions in two independent Laser Centers located at Locarno, Switzerland and Opatija, Croatia. Unilateral cases of either type of epicondylitis (n=283) were randomly allocated to one of three treatment groups according to the LLLT technique applied: (1) TPs; (2) scanning; (3) combination of TPs and scanning. Bilateral cases of either type of epicondylitis (n=41) were subject to crossover, placebo-controlled conditions. Laser devices used in all groups of patients were infrared diode laser (GaAlAs) 830 nm continuous wave for treatment of TPs and HeNe 632,8 nm combined with infrared diode laser 904 nm. Pulsed wave for scanning technique. Treatment outcome was observed and measured according to the following methods: (1) short form McGill’s Pain Questionnaire; (2) Visual Analogue Scales; (3) Verbal Rating Scales; (4) Patient’s pain diary; and (5) hand dynamometer. The result has demonstrated that total relief of pain with consequently improved functional ability was achieved in 82% of chronic cases all of which were treated by a combination of TPs and scanning technique. The current clinical study provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis.
Treatment of the acute Periarthritis humeroscapular with laserpuncture
Odalys GonzÃ¡les Álvarez, Main Educational Clinic of Urgencies “Antonio Maceo”, Cerro Municipality, Havana City
The periarthritis humeroscapular is a syndrome that contains very precise affections: bursitis, the calcified tendinitis of supraspinous, the bicipital tendinitis, among others. Pain and limitation of the joint movements of the shoulder characterize it. The treatment with the laser of low power can produce a resolution of the lesion, whenever it is made in the early phases of the disease. In this study, we propose the use of the laserpuncture, due to our accumulated experience in the treatment of this affection in the acute phase, with acupuncture. A prospective study was carried out during 2 years (1997 – 1999), where 62 patients were selected because they accomplished the Approaches of Inclusion for the study. The sample was divided by aleatory assignment in 2 Groups of Treatment. The study Group I was treated with laserpuncture, using Cuban laser equipment of HeNe of 632,8 nm and a dose of joule/cm2 was applied, and the Control Group II was treated with acupuncture needles. The conventional medical treatment was suspended. Daily sessions were given from Monday to Friday, for two weeks, until a total of 10. Both techniques demonstrated to be effective in the treatment of these affections, improving the clinical and radiological symptoms significantly when the treatment sessions were concluded. The patients accepted the laserpuncture better because of its painless character, less time of application, and the absence of bleeding and stress.
Vojnosanit Pregl. 2010 Sep;67(9):755-60
The aim of the study was to evaluate and compare the effects of low-level laser therapy (LLLT) with interferential current (IF) in the treatment of CRPS (sometimes called RSD). CRPS, Complex Regional Pain Syndrome, is a severe and chronic pain condition that has few successful medical interventions.
In this controlled study, 45 patients with unilateral CRPS were treated with LLLT. Group A was treated with LLLT and group B was treated with IF. There was a statistically significant improvement with both groups, but the decrease in pain was significantly higher in the laser group. This study shows three important findings:
- Laser is effective in treating serious chronic pain conditions;
- Laser and Interferential both have benefit;
- Laser is superior to Interferential with chronic pain.
This study supports the work of Dr. Basford from Mayo Clinic showing successful treatment of CRPS with a laser. It also supports prior studies showing that laser is generally superior to electrical stimulation, with the caveat that some studies show laser plus electrical stimulation has a synergistic effect.
Photomed Laser Surg 2009 Jan 26
There is a lot of research on laser and ultrasound, but there is very little information comparing laser to ultrasound. In this study (Photomed Laser Surg 2009 Jan 26), the researchers investigated the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS). This study is important because of the frequency of CTS and the fact that there is no consensus about the best way to manage CTS.
Patients were randomly allocated to three groups that receive either splinting only, splinting plus US, and splinting plus LLL therapy. The study was completed with a total of 100 hands of 50 women patients with bilateral CTS. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction.
This again supports prior research that documents that, although ultrasound has some healing effects, there is little doubt that laser is significantly more effective at stimulating healing, while increasing healthy tissue proliferation, than ultrasound.