LASER THERAPY IS SUPPORTED BY NUMEROUS CLINICAL STUDIES

In 1995 the editor of Archives of Physical Medicine and Rehabilitation, Dr. Jeffrey Bashford stated that Laser Therapy was still not an established tool.  He pointed out that promising results in the laboratory failed to translate into positive clinical results. Today 23 years later there has has been a large increase in the number of controlled scientific studies in the field of Laser Therapy.

In Pubmed, there are now more than 6000 scientific articles about Low Level Laser Therapy (LLLT) and Photobiomodulation (PBM). In the last two years, the amount of scientific evidence for laser therapy in clinical conditions has reached a level similar or above that of painkilling pills used to treat musculoskeletal disorders. In dentistry, nerve pathologies and wound healing you also see great advances in the amount of studies.

The applications of PBM are broad. Four clinical targets, however, are the most common: shining laser light on injured sites to promote healing, remodelling and/or to reduce inflammation; on nerves to induce analgesia; on lymph nodes in order to reduce oedema and inflammation; and on trigger points (a single one of as many as 15 points) to promote muscle relaxation and to reduce tenderness. Since it is non- invasive, PBM is very useful for patients who are needle phobic or for those who cannot tolerate therapies with non-steroidal anti-inflammatory drugs.

The positive outcomes depend on the parameters used on the treatment. The anti-inflammatory effect of light in low intensity was reported on patients with arthritis, acrodermatitis continua, sensitive and erythematous skin, for instance. With the same basic mechanism of action, which is the light absorption by mitochondrial chromophores, mainly Cox, the consequences of PBM are various, depending on the parameters used, on the signalling pathways that are activated and on the treated tissue. In order to apply PBM in clinical procedures, the clinicians should be aware of the correct parameters and the consequences for each tissue to be treated. More studies have to be performed in order to fill the gaps that still linger in the basic mechanisms underlying PBM.

• All

• Acupuncture

• Arthritis

• Cancer

• Cardiovascular

• Ear, Nose and Throat

• Female Disease

• Lichen Sclerosus

• Musculoskeletal

• Neurology

• Osteoarthritis

• Skin

• Sport Medicine

• Stem Cell

• Tinnitus

• Wounds

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

by Ozdemir F1, Birtane M, Kokino S. Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey. Clin Rheumatol. 2001;20(3):181-4

Abstract Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) 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.

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THE EFFECT OF LOW-LEVEL LASER IN KNEE OSTEOARTHRITIS: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

by Hegedus B1, Viharos L, Gervain M, Gálfi M. Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. arthrodent@freemail.hu. Photomed Laser Surg. 2009 Aug;27(4):577-84. doi: 10.1089/pho.2008.2297

INTRODUCTION: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).

MATERIALS AND METHODS: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.

RESULTS: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature–and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.

CONCLUSION: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

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PATIENTS WITH MODERATE CHEMOTHERAPY-INDUCED MUCOSITIS: PAIN THERAPY USING LOW INTENSITY LASERS

by Nes AG, Posso MB. Buskerud University, Drammen, Norway. s-oddmun@online.no. Int Nurs Rev. 2005 Mar;52(1):68-72

BACKGROUND: Intensive cancer therapy normally affects malignant and normal cells with high replication rates. Cells in the gastrointestinal tract are therefore commonly affected by cytotoxins. This often results in the development of chemotherapy-induced oral mucositis (COM). COM is the inflammatory response of the oral mucous membrane to the chemotherapy drugs. Low level laser therapy (LLLT) has proved to be effective in treating and repairing biologically damaged tissue and to reduce pain. LLLT has also proven to be an efficient method for the prevention of oral mucositis.

OBJECTIVE: To investigate the effect of LLLT on pain relief among patients who have developed COM.

METHOD: The study was performed as a clinical test with a sample consisting of 13 adult patients receiving oncology treatment. The patients were treated during a 5-day period, and the pain was measured before and after each laser application. The laser used was an AsGaAl, with a wavelength of 830 nm and a potency of 250 mW. The energy given was 35 J cm(-2).

ANALYSIS: The results were analysed using the Wilcoxon test.

RESULTS: There was a significant (P = 0.007) 67% decrease in the daily average experience of pain felt before and after each treatment, confirming that LLLT can relieve pain among patients who have developed COM.

STUDY LIMITATIONS: The low number of COM patients at the hospital did not allow a control group to be included in the study, and therefore the results contain a potential placebo effect.

IMPLICATIONS FOR NURSING CARE: The most important benefit the authors consider to be the value for the patients of better and quicker treatment with a drastic reduction in painful mucositis.

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PHOTOBIOMODULATION WITH SINGLE AND COMBINATION LASER WAVELENGTHS ON BONE MARROW MESENCHYMAL STEM CELLS: PROLIFERATION AND DIFFERENTIATION TO BONE OR CARTILAGE

by Fekrazad R1,2, Asefi S3, Eslaminejad MB4, Taghiar L4, Bordbar S4, Hamblin MR5,6,7. Lasers Med Sci. 2018 Sep 27. doi: 10.1007/s10103-018-2620-8 [Epub ahead of print]

Tissue engineering aims to take advantage of the ability of undifferentiated stem cells to differentiate into multiple cell types to repair damaged tissue. Photobiomodulation uses either lasers or light-emitting diodes to promote stem cell proliferation and differentiation. The present study aimed to investigate single and dual combinations of laser wavelengths on mesenchymal stem cells (MSCs). MSCs were derived from rabbit iliac bone marrow. One control and eight laser irradiated groups were designated as Infrared (IR, 810 nm), Red (R, 660 nm), Green (G, 532 nm), Blue (B, 485 nm), IR-R, IR-B, R-G, and B-G. Irradiation was repeated daily for 21 days and cell proliferation, osseous, or cartilaginous differentiation was then measured. RT-PCR biomarkers were SOX9, aggrecan, COL 2, and COL 10 expression for cartilage and ALP, COL 1, and osteocalcin expression for bone. Cellular proliferation was increased in all irradiated groups except G. All cartilage markers were significantly increased by IR and IR-B except COL 10 which was suppressed by IR-B combination. ALP expression was highest in R and IR groups during osseous differentiation. ALP was decreased by combinations of IR with B and with R, and also by G alone. R and B-G groups showed stimulated COL 1 expression; however, COL 1 was suppressed in IR-B, IR-R, and G groups. IR significantly increased osteocalcin expression, but in B, B-G, and G groups it was reduced. Cartilage differentiation was stimulated by IR and IR-B laser irradiation. The effects of single or combined laser irradiation were not clear-cut on osseous differentiation. Stimulatory effects on osteogenesis were seen for R and IR lasers, while G laser had inhibitory effects.

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LOW-LEVEL LASER THERAPY ACCELERATES COLLATERAL CIRCULATION AND ENHANCES MICROCIRCULATION

by Ihsan FR. Department of Anatomy, AL-Kindy College of Medicine, University of Baghdad, Iraq. PMID: 15954817 [PubMed – indexed for MEDLINE]

OBJECTIVE: To evaluate the efficacy of low-level laser therapy (LLLT) on collateral circulation and microcirculation if a blood vessel is occluded.

BACKGROUND DATA: Investigators have attempted prostaglandin and ultrasound therapy to promote improvements in the vascular bed of deprived tissue after an injury, which may lead to occlusion of the blood vessels.

MATERIALS AND METHODS: Thirty-four adult rabbits were used in this study, two of them considered 0-h reading group, while the rest were divided into two equal groups, with 16 rabbits each: control and those treated with LLLT. Each rabbit underwent two surgical operations; the medial aspect of each thigh was slit, the skin incised and the femoral artery exposed and ligated. The site of the operation in the treated group was irradiated directly following the operation and for 3 d after, one session daily for 10 min/session. The laser system used was a gallium-aluminum-arsenide (Ga-Al-As) diode laser with a wavelength of 904 nm and power of 10 mW. Blood samples collected from the femoral artery above the site of the ligation were sent for examination with high-performance liquid chromatography (HPLC) to determine the levels of adenosine, growth hormone (GH) and fibroblast growth factor (FGF). Tissue specimens collected from the site of the operation, consisting of the artery and its surrounding muscle fibers, were sent for histopathological examination to determine the fiber/capillary (F/C) ratio and capillary diameter. Blood samples and tissue specimens were collected at 4, 8, 12, 16, 20, 24, 48 and 72 h postoperatively from the animals of both groups, control and treated.

RESULTS: Rapid increases in the level of adenosine, GH, and FGF occurred. The F/C ratio and capillary diameter peaked at 12-16 h; their levels declined gradually, reaching normal values 72 h after irradiation in the treated group. Numerous collateral blood vessels proliferated the area, with marked increases in the diameters of the original blood vessels.

CONCLUSIONS: The results indicated that LLLT accelerated collateral circulation and enhanced microcirculation and seemed to be unique in the normalization of the functional features of the injured area, which could lead to occlusion of the regional blood vessels.

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LOW LEVEL LASER THERAPY IN THE TREATMENT OF ARTERIOSCLEROSIS OF THE LOWER LIMBS

by Attia M.A., EI-Kashef H. Laser center, Alhikmah Hospital, EI-Mansoura, Egypt Physics Department, Faculty of Science, Tanta Egypt

Twenty patients with arteriosclerosis in the lower limbs were treated by low level laser therapy with lumbar paravertebral application a 20mW continuous wave He-Ne laser(632nm> and simultaneously a 250mW continuous diode laser (830 nm> was applied transcutaneously to the lumbar region by the scanner for 30 minutes 6 days per week for 2 months. The mean value of percentage of success was 87.2%. The results of the study indicate that low level laser therapy can influence beneficially arteriosclerosis in the lower limbs which is generally difficult to treat.

Introduction 
Arteriosclerosis is a chronic obliterative disease affecting the lower portion of the aorta, its main branches and the arteries supplying the extremities. The condition occurs predominantly in patients between the ages of 45 and 70 years. It is present much more frequently in males than in females. It may be caused by an error in the metabolism of lipids (Oliver, 1955). Buck (1959) believed that the abnormal vascularization of the arterial wall has also been proposed as a significant factor in the development of the disease. Also, the Question of heredity as a factor in the pathogenesis of the disease must be raised (McKusick, 1958). The patient complains of pain in the extremities typical of intermittent calculation and difficulty in walking, finally rest pain is experienced particularly at night, characterized by a sensation of coldness or burning, hyperesthesia and tingling (Abramson, 1974). The purpose of the study was to evaluate the efficacy of low power laser in the treatment of arteriosclerosis. Materials and methods Twenty patients with arteriosclerosis of the lower limbs from the out-patient clinic of the General medicine Department of both Tanta University Hospital and Alhikmah Hospital, Mansoura were included in the study. The male to female ratio was 4:1. The ages ranged from 45 to 69 years. The duration of symptoms ranged from one to 8 months (table 1). The patients were experiencing pain in both calf muscles after walking distances (claudication distance) ranging from 200 to 500 meters. Three patients experienced rest pain at night. Clinical examinations revealed palpable walls of superficial arteries, particularly the dorsalis pedis. In the study, the claudication distance was determined for every patient in meters prior to treatment. Control normal individuals within the patients’ age group walked an average of 1500 meters without experiencing calf pain.

Results
Pain was relieved in 16 patients who received 3 to 7 courses of treatment. Eight patients were able to walk 1500 meters without experiencing any pain in the calf muscles, hence their rate of success was 100%. The remaining patients showed improvement from 73% to 95 (table 2). Three patients discontinued treatment for reasons not related to the treatment. One patient, age 69, with 4 months duration and claudication distance of 240 meters showed no improvement after receiving 7 courses of treatment. The mean rate of success was 87.2%.

Discussion
It was not easy to discuss the treatment of arteriosclerosis and only in the last 20 years have advancements been made. Although physical therapy is only part of the total management of arteriosclerosis of the lower limbs, it could play an important role in the management. No references were found in literature concentrating the use of low level laser therapy in the management of arteriosclerosis. This work has shown that low level laser therapy is capable of increasing the circulation in muscles and, with prolonged treatment, a considerable significant improvement in circulation can be achieved in cases of arteriosclerosis. Low level laser therapy not only influences the superficial circulation but also deep circulation. The mechanism of this action is probably due to the sympathetic effect, but it could also be used on the action of normal skin excitation. It can be assumed that apart from the increase in the pain threshold (Nikolova, 1968) and muscular excitation threshold, there is also an increase in the threshold for sympathicus stimulation (Pabst, 1960). By this paravertebral application, we must concede more importance to the sympathicus action, than to the direct action on the vasometer assumed by some authors (Monode, 1951; Zinn, 1956). The results obtained in the treatment of arteriosclerosis by means of low level laser therapy are certainly based on a number of different effects. First, there is sympathetic action. Also, the analgesic action of this type of current deserves special attention, since it is the cause of the subjective improvement which frequently precedes the objective improvement in cases of sever arteriosclerosis when pain is felt while resting. Also, rest pain did not mean the presence of irreversible pathologic change as the three patients with rest pain showed a good degree of improvement. The patient who showed no improvement after 7 courses of treatment may have an irreversible pathologic change and, this age of 69 years may have also contributed to the failure of treatment.

Conclusion
Low level laser therapy may be considered in the treatment of peripheral arteriosclerosis.

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LOW-INTENSITY LASER THERAPY IS AN EFFECTIVE TREATMENT FOR RECURRENT HERPES SIMPLEX INFECTION. RESULTS FROM A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED STUDY

by Schindl A1, Neumann R. J Invest Dermatol. 1999 Aug;113(2):221-3

Recurrent infection with herpes simplex virus is a common disease. Recently, alternative therapies have been introduced. Among those, low-intensity laser therapy mainly used for the acceleration of wound healing and in pain therapy has previously been shown to be of benefit in herpes zoster infections. In this study we evaluated the influence of low-intensity laser therapy (wavelength 690 nm, intensity: 80 mW per cm2, dose: 48 J per cm2) in 50 patients with recurrent perioral herpes simplex infection (at least once per month for more than 6 mo) in a randomized, double-blind placebo-controlled trial design. Patients in the laser group received daily irradiations for 2 wk, whereas patients in the placebo group were sham-irradiated. After completion of the laser/sham treatment, patients were asked to return to the Department of Dermatology, University of Vienna Medical School at the time of recurrence. All except two patients completed the study and were monitored for 52 wk. The median recurrence-free interval in the laser-treated group was 37.5 wk (range: 2-52 wk) and in the placebo group 3 wk (range: 1-20 wk). This difference was found to be statistically significant (p < 0.0001; Wilcoxon’s Rank Sum Test). In conclusion, we demonstrated that a total of 10 irradiations with low-intensity laser therapy significantly lowers the incidence of local recurrence of herpes simplex infection. Since this athermic phototherapeutic modality represents a safe, noninvasive treatment, it might be considered as an alternative to established therapeutic regimens in this indication.

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THE EFFECT OF 300 MW, 830 NM LASER ON CHRONIC NECK PAIN: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED STUDY

by Chow RT1, Heller GZ, Barnsley L. Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27

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 300 mW, 830 nm 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 change in a 10 cm 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 PainQuestionnaire (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.

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THE EFFECTIVENESS OF CONSERVATIVE TREATMENTS OF CARPAL TUNNEL SYNDROME: SPLINTING, ULTRASOUND, AND LOW-LEVEL LASER THERAPIES

by Dincer U1, Cakar E, Kiralp MZ, Kilac H, Dursun H. Photomed Laser Surg. 2009 Feb;27(1):119-25. doi: 10.1089/pho.2008.2211

OBJECTIVE: The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS).

BACKGROUND DATA: CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS.

MATERIALS AND METHODS: In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography.

RESULTS AND CONCLUSION: The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. 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.

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HISTOLOGICAL AND CLINICAL RESPONSES OF ARTICULAR CARTILAGE TO LOW-LEVEL LASER THERAPY: EXPERIMENTAL STUDY

by I. Ruiz Calatrava, J. M. Santisteban Valenzuela, R. J. Gómez-Villamandos, J. I. Redondo, J. C. Gómez-Villamandos, I. Avila Jurado. June 1997, Volume 12, Issue 2, pp 117–121

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 hindlimbs 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. Onc group was treated with He-Ne laser (8 J cm-2, 632.8 nm wavelength) and the other with infra-red (IR) 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 histopathologi-cal 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 He-Ne 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.