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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
̀ 1991 by John Wiley & Sons, Ltd.
EFFICACY OF LASER IRRADIATION (LLLT) 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 (LLLT) 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. Laser Therapy
1997:9:7-- 12
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, 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
THE USE OF LOW ENERGY PHOTON THERAPY (LEPT) IN VENOUS LEG ULCERS: A DOUBLE BLIND, PLACEBOCONTROLLED STUDY Adltya K.
Gupta, MD, FRCP(C)), Natalia Filonenko, PhD, Norman Salansky, PhD, flms, Daniel
N. Sadder, MD, FRCP(C) BACKGROUND.
Venous ulcers are estimated to be present in 0.2 to 0.4% of the population.
Although new therapies have significant promise, nonhealing ulcers still
represent a significant problem. Objective. To evaluate the efficacy of low
energy photon therapy (LEPT) in the treatment of venous leg ulcers. METHODS. A
placebo-controlled, double-blind study using low energy photon therapy was
performed in nine patients with 12 venous ulcers. Treatment was given three
times a week for 10 weeks, using two monochromatic optical sources. One source
provided a wavelength (A) of 660 nm (red) while the second source delivered a
wavelength of 880 nm (infrared). Two optical probes were used, one consisted of
an array of 22 monochromatic sources, operating at a wavelength of 660 nm and
covering an area 6 x 10 cm2. The second probe had seven infrared sources,
operating at a wavelength of 880 nm and covering an area of 4 cm2 The above
configuration of optical probes was selected to cover the majority of the ulcer
area being treated. The patients who were randomized to placebo treatment
received sham therapy from an identical-appearing light source from the same
delivery system. RESULTS. Nine
patients with 12 venous ulcers were randomized to receive LEPT or placebo
therapy. At the conclusion of the study, the percentage of the initial ulcer
area remaining unhealed in the LEPT and placebo groups was 24.4% and 84.7%,
respectively (P = 0.0008). The decrease in ulcer area (compared to baseline)
observed in the LEPT and placebo groups was 193.0 mm2 and 14.7 222, respectively
(P = 0.0002). One patient dropped out of the study, complaining of lack of
treatment efficacy; he was found to be randomized to the placebo group. There
were no adverse effects. CONCLUSION.
In this placebo-controlled, double-blind study LEPT was an effective modality
for the treatment of venous leg ulcers. © 1998 by the American Society for
Dermatologic Surgery, Inc. Dermatol Surg 1998;24:1383-1386. From the Division of
Dermatology, Department of Medicine, University of Toronto; International
Medical Instruments Inc.; and Selye-Toffler University, Toronto, Ontario,
Canada. © 1998 by
the American Society for Dermatologic Surgery, Inc. - Published by Elsevier
Science Inc. 1076-0512/98/$19.00 - PII S1076-0512(98)00168-X
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