Studies
            Pain - Wound Healing

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PAIN

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
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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
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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
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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
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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%.
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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.
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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.
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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
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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.
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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

Arne Eckerdal 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
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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

WOUND HEALING

THE USE OF LOW ENERGY PHOTON THERAPY (LEPT) IN VENOUS LEG ULCERS: A DOUBLE BLIND, PLACEBO-CONTROLLED 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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