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Low level laser therapy for osteoarthritis and rheumatoid arthritis: A metaanalysis
Abstract
Osteoarthritis (OA) and rheumatoid arthritis (RA) affect a large proportion of the population. Low level laser therapy (LLLT) was introduced as an alternative noninvasive treatment for RA and OA about 10 years ago, but its effectiveness is still controversial. We assessed the effectiveness of LLLT in the treatment of RA and OA.
A systematic review was conducted, following an a priori protocol, according to the methods recommended by the Cochrane Collaboration. Trials were identified by a literature search of Medline, Embase, and the Cochrane Controlled Trials Register. Only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA or OA were eligible. Thirteen trials were included, with 212 patients randomized to laser and 174 patients to placebo laser, and 68 patients received active laser on one hand and placebo on the opposite hand. Treatment duration ranged from 4 to 10 weeks. Followup was reported by only 2 trials for up to 3 months.
In patients with RA, relative to a separate control group, LLLT reduced pain by 70% relative to placebo and reduced morning stiffness by 27.5 min (95% CI -52.0 to -2.9), and increased tip to palm flexibility by 1.3 cm (95% CI -1.7 to -0.8). Other outcomes such as functional assessment, range of motion, and local swelling were not different between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application, or treatment length. In RA, relative to a control group using the opposite hand, there was no difference between control and treatment hand, but all hands were improved in terms of pain relief and disease activity. For OA, a total of 197 patients were randomized. Pain was assessed by 3 trials. The pooled estimate (random effects) showed no effect on pain (standardized mean difference -0.2, 95% CI -1.0 to +0.6), but there was statistically significant heterogeneity (p > 0.05). Other outcomes of joint tenderness, joint mobility, and strength were not significant.
LLLT should be considered for short term relief of pain and morning stiffness in RA, particularly since it has few side effects. For OA, the results are conflicting in different studies and may depend on the method of application and other features of the LLLT. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this metaanalysis lacked data on how effectiveness of LLLT is affected by 4 factors: wavelength, treatment duration of LLLT, dosage, and site of application over nerves instead of joints. There is a need to investigate the effects of these factors on effectiveness of LLLT for RA and OA in randomized controlled clinical trials.
... The mechanism of action of LLLT is photochemical (photobiomodulation) [26]. Light induces biochemical changes within cells, including cellular oxygenation, release of neurotransmitters associated with pain modulation (e.g., serotonin), and release of anti-inflammatory mediators [26][27][28][29][30][31]. Accordingly, LLLT may help control inflammation of the synovial membrane (synovitis) in KOA, thereby reducing the severity of symptoms [29]. ...
... Recent systematic/metaanalysis/reviews [21,[34][35][36] advocate LLLT as a safe and effective treatment modality to reduce pain as well as to improve physical function of patients with KOA. However, critics of LLLT cite discrepancies between various studies regarding its effectiveness, with some studies reporting no beneficial effects from LLLT [28,29,37]. Additionally, there is a lack of information regarding the optimal treatment parameters and the dose-response relationship in patients with KOA [29,35], which may be attributed to the heterogeneity of factors related to LLLT, such as the applied dose in terms of energy density, frequency, wavelength, treatment duration, number of treatment sessions, irradiation area, standalone vs. adjunctive therapy, or even factors related to the treated condition such as KOA severity [35]. ...
... The great variability in the parameters of LLLT and PEMFT used in previous studies is a significant issue that has been consistently raised in the literature, causing difficulties in generalizing conclusions and inability to recommend the optimal parameters of either treatments [22,24,28,29,33,35,36,47]. This issue is also reflected in the present study wherein the parameters used for PEMFT and LLLT were based on the manufacturer's recommendations. ...
Background
This randomized controlled trial aimed to compare the effects of pulsed electromagnetic field therapy (PEMFT) and low-level laser therapy (LLLT) on pain and physical function of participants with knee osteoarthritis (KOA).
Methods
According to the Kellgren–Lawrence classification, participants with grade 2–3 KOA were randomized to receive PEMFT or LLLT for six sessions lasting 15 min/session over a 3-week period. Pain at rest and when walking, standing from a sitting position, and climbing the stairs was assessed using the visual analog scale. Functional level was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up-and-go test (TUG), and 10-m walk (10 MW) test. Measurements were obtained before and after the interventions. Significance was determined at p ≤ 0.05.
Results
Forty participants were included in the study. Pain and physical function improved significantly (p < 0.0001) in both groups. PEMFT was significantly more effective in reducing pain at rest, when standing from a sitting position, and when climbing the stairs, and in improving both WOMAC scores and TUG results (p ≤ 0.0003). The improvements in pain during the activities and the WOMAC scores reached the minimal clinically important difference. No adverse events occurred.
Conclusion
Six sessions of PEMFT and LLLT had immediate positive effects on pain and physical function in individuals with low-grade KOA, with PEMFT resulting in significantly better results.
Trial registration
ISRCTN registry trial ID: ISRCTN17001174
... LLLT precipitates a complex series of cellular-level physiological interactions that reduce acute inflammation, reduce pain and speed up tissue healing (11) and effectiveness in treating chronic and acute pain associated many inflammatory diseases has been reported (12) . The role of LLLT in RA has been investigated, however, results are contradicting (13)(14)(15) . This study aimed to investigate the effectiveness and safety of LLLT in the management of early onset RA in a sample of Iraqi patients, applying different ways to alleviate disease activity and improve pain including acupuncture points, trigger points, nerve supply and referring pain points. ...
... A metanalysis conducted by Brosseau et al. pooled data form five placebo-controlled trials with a total of 222 patients, with 130 randomized to laser therapy concluded that LLLT reduced pain by 1.10 points (95% CI: 1.82, 0.39) on VAS relative to placebo, reduced morning stiffness for duration by 27.5 minutes (95%CI: 2.9 to 52 minutes) and increased tip to palm flexibility by 1.3 cm (95% CI: 0.8 to 1.7). Other outcomes such as functional assessment, range of motion and local swelling in aforementioned metanalysis were not different between groups (14) . Further, studies used other limbs, as control depicted no significant difference in stiffness duration, or pain RR 13.00 (95% CI: 0.79 to 214.06). ...
... LLLT is non pharmacological medical technique works through generating extremely pure light with no evident side effects. The effect of LLLT is related to photochemical reactions in the cells rather thermal (14) . Light can simultaneously target many cascades of immune system activation in comparison with drugs, so photo-biomodulation can modulate cellular dysfunctions by initiating selforganization phenomena and finally and subsequent healing (12) . ...
Background: Rheumatoid arthritis (RA) is a systemic chronic, inflammatory disease that may affect many tissues and organs. Objective: To investigate effectiveness and safety of Low-level-laser-therapy (LLLT) in management of early onset RA compared to symptomatic non-steroidal anti-inflammatory drugs (NSAIDS) therapy. Methods: A convenient selection 3 arms single blinded trial conducted in Al-Saraj Center for Rheumatoid Diseases in Baghdad during period between January-May 2017. Thirty-four patients with RA onset below one year were recruited. Disease activity score (DAS28) formula with American College of Rheumatology criteria (ACR20), erythrocyte sedimentation rate (ESR), visual analogue scale (VAS), complete blood count (CBC), C-reactive protein (CRP), rheumatoid factor (RF) were measured. Patients were divided into three groups: group 1 (n=12) received LLLT, group 2 (n=12) received placebo laser and naproxen and group 3 (n=10) received only naproxen. Primary outcomes measured were disease activity using DAS28 score, clinical improvement using ACR20 and pain assessment using VAS. Secondary outcomes measured were remission ACR50 and 70 and inflammatory indicators. Results: LLLT group has shown significant decrease of DAS28 (P=0.02), morning stiffness duration (p=0.05), number of tender joints (p=0.03), number of swelling joints (p=0.04), and VAS (p=0.01) compared to baseline whereas placebo laser group with naproxen and naproxen only group showed only significant reduction in duration of morning stiffness(P=0.04) and (p=0.048) respectively. There was marginal lowering of ESR (P=0.06) in LLLT group but no changes in CRP, RF. There were no reported side effects of LLLT use. Conclusion: Laser therapy is better than NSAIDS in controlling RA symptoms with no associated side effects. Therefore, it is recommended as first-line therapy in early onset RA. Keywords: laser, Low level laser therapy, rheumatoid arthritis, NSAIDS, ESR, Nerve root Citation: Al-Saraj MJA, Al-Ethary ZY, Al-Attar ZI. the effect of low level laser therapy on early onset rheumatoid arthritis patients. Iraq Iraqi JMS. 2021; 19(1): 126-133. doi: 10.22578/IJMS.19.1.16
... Several progressive and degenerative diseases have been effectively treated by means of LLLT (12,38,39) , but there is controversy regarding the results from studies analyzing pain and function among patients with knee OA, mainly because of the variations in the methods used. In the present clinical trial, care was taken to follow the WALT recommendations (40) regarding how to conduct a clinical trial with LLLT, and care was taken to report all the parameters used in the study. ...
... In the present clinical trial, care was taken to follow the WALT recommendations (40) regarding how to conduct a clinical trial with LLLT, and care was taken to report all the parameters used in the study. Because some important data was not reported in some studies, such as wavelength, treatment duration, final energy, application method, mean power, duration of application and beam area, meta-analyses have been unable to reach conclusions regarding the ideal parameters for LLLT (38) . ...
... Some explanations can be found in different experimental studies, which suggest that LLLT has an anti-inflammatory, analgesic and reparative effect. In a meta-analysis, Brosseau et al (38) stated that the reduction in pain through using LLLT might be due to mechanisms such as physiological effects mediated by photochemical actions at cellular level in animal or human tissue, and through increased levels of the neurotransmitters implicated in pain modulation, such as serotonin. Some researchers have also concluded that LLLT has an effect on joint cartilage regeneration, achieved through proliferation of chondrocytes and synthesis and secretion of extracellular matrix (32,34) . ...
Objective: This study was designed to evaluate the short-term efficacy of low-level laser therapy (LLLT) for improving pain and function in patients with knee osteoarthritis. Methods: Forty-seven patients with knee osteoarthritis (79 knees), of both genders, participated in this randomized controlled double-blind clinical trial. They were randomly allocated to two groups: laser group with 25 patients (41 knees) and placebo group with 22 patients (38 knees). LLLT was performed three times a week, totaling nine sessions, using a AsGa 904 nm laser with mean power of 60 mW and beam area of 0.5 cm². Nine points were irradiated on the knee, with energy of 3.0 J/point. The placebo group was treated with the same laser device, but with a sealed probe. Evaluations using Lequesne, visual numerical scale (VNS), Timed Up and Go (TUG), goniometry and dynamometry were conducted before the treatment started and after the nine sessions of LLLT. Results: A significant improvement in pain and function was found in all the assessments applied to the laser group. On comparing the laser group with the placebo group, significant differences were found in the VNS-resting and Lequesne evaluations. Conclusion: Treatment with LLLT improves pain and function over the short term in patients with knee osteoarthritis.
... These limitations lead to different dosimetry parameters. Therefore, there is not a conclusion of a therapeutic dosage of laser therapy protocol in different diseases [10,51,52]. This is due to the different mechanism of photon reaction with the skin until the photons reach the target area include reflection, refraction, transmission, absorption, differences in oily or dry skin, differences in skin color, and differences in target tissue distance, andtarget tissue, pathway tissue, contact or noncontact irradiation, and all of these do not trigger inference information for a conclusive PBM in medicine [10,51,52]. ...
... Therefore, there is not a conclusion of a therapeutic dosage of laser therapy protocol in different diseases [10,51,52]. This is due to the different mechanism of photon reaction with the skin until the photons reach the target area include reflection, refraction, transmission, absorption, differences in oily or dry skin, differences in skin color, and differences in target tissue distance, andtarget tissue, pathway tissue, contact or noncontact irradiation, and all of these do not trigger inference information for a conclusive PBM in medicine [10,51,52]. We resolved these limitations using interstitial laser irradiation. ...
One of the most important diabetic complications is diabetic neuropathy, which results in impaired wound healing, leading to numerous difficulties and morbidity and mortality, and is the ultimate consequence of micro-and macrovascular disease. It seems. There are several advanced techniques that reverse many degenerative processes and help heal chronic wounds in diabetics. Laser therapy has shown in many studies to improve wound healing in all phases: inflammatory, (2) proliferative, and (3) tissue remodeling. All of the sixteenth subjects were diagnosed with amputation. They all suffer from chronic severe wounds, and they are all diagnosed with diabetic neuropathy. This study used an advanced laser therapy called multi-wavelength interstitial laser therapy. We used 400nm, 450nm, 530nm, 630nm and 808nm. We applied transdermal laser irradiation on a wound area, and beside the wound, we applied interstitial laser irradiation. In interstitial irradiation, the output power at the end of the fiber is 50 mW. In transdermal irradiation the output power was 100mw. The laser was applied continuously with a total energy density of 1 J/cm² at the wound surface and 2 J/cm² in the area adjacent to the wound. All of the laser wavelengths were applied on each point, in both transdermal and interstitial laser irradiation. Patients are treated twice weekly for 6 weeks. Results show a rapid and conclusive effect on wound healing. All of them begin to feel and feel pain. The inflamed sore area is much better. More investigations can be done by regenerative methods combination.
... В исследованиях, посвященных изучению влияния НИЛИ на иммунную систему [42,43], было выявлено, что у 80 % пациентов с РА в 3 раза чаще удавалось снизить дозы нестероидных противовоспалительных средств и глюкокортикоидов и при этом достичь более длительной ремиссии. Согласно данным метаанализа 2000 г. и других исследований [44,45] наиболее эффективным является вариант импульсного НИЛИ в инфракрасном спектре для комплексного лечения РА. Проведенный систематизированный обзор показал, что лазерная терапия дает наиболее выраженный результат по сравнения с другими методами физиотерапевтического лечения в комплексном лечении больных с РА [46]. ...
... В результате проведенных исследований было выявлено, что включение лазеротерапии в комплексное лечение ОА у 80 % больных приводит к значительному снижению (в 3-4 раза) вводимых внутрисуставно доз нестероидных противовоспалительных препаратов, глюкокортикоидов и препаратов гиалуроновой кислоты. Также было выявлено удлинение периода ремиссии по сравнению с контрольной группой [42][43][44][45][46][47][48][49][50][51][52]. ...
... Morning stiffness is another useful evaluation indicator in assessing the therapeutic effects of PBM in arthritis patients [19]. It is a common symptom experienced by arthritis patients and can be assessed subjectively to gauge treatment outcomes and improvements in joint function. ...
Rheumatoid arthritis (RA) and osteoarthritis (OA) have a significant impact on the quality of life of patients around the world, causing significant pain and disability. Furthermore, the drugs used to treat these conditions frequently have side effects that add to the patient's burden. Photobiomodulation (PBM) has emerged as a promising treatment approach in recent years. PBM effectively reduces inflammation by utilizing near-infrared light emitted by lasers or LEDs. In contrast to photothermal effects, PBM causes a photobiological response in cells, which regulates their functional response to light and reduces inflammation. PBM's anti-inflammatory properties and beneficial effects in arthritis treatment have been reported in numerous studies, including animal experiments and clinical trials. PBM's effectiveness in arthritis treatment has been extensively researched in arthritis-specific cells. Despite the positive results of PBM treatment, questions about specific parameters such as wavelength, dose, power density, irradiation time, and treatment site remain. The goal of this comprehensive review is to systematically summarize the mechanisms of PBM in arthritis treatment, the development of animal arthritis models, and the anti-inflammatory and joint function recovery effects seen in these models. The review also goes over the evaluation methods used in clinical trials. Overall, this review provides valuable insights for researchers investigating PBM treatment for arthritis, providing important references for parameters, model techniques, and evaluation methods in future studies.
... Low-intensity laser irradiation is an approved phototherapy stimulation leading to biological effects with no thermal effects. However, photochemical reactions at the cellular or tissue level are still under investigation [49]. Four main mechanisms may explain the therapeutic effects of low-intensity lasers: (a) releasing opioid peptides, (b) inhibiting the secretion of toxic mediators such as bradykinin, (c) reducing the transmission of pain signals through the autonomic nervous system, and (d) regulating the release of serotonin and norepinephrine [50,51]. ...
Introduction: Neck pain is the fourth leading cause of disability worldwide. This study aims to investigate the effects of Electro Acupuncture (EA) versus Laser Acupuncture (LA) on symptoms of women with chronic cervical myofascial pain syndrome.
Materials and Methods: This is a single-blind randomized controlled clinical trial. Thirty women with chronic cervical myofascial pain syndrome were randomly divided into three groups: EA, LA, and sham. The EA group received electrical stimulation through needles at standard acupuncture points, while the LA group received low-intensity laser irradiation at the same points. The passive laser probe was applied for the sham group. The outcome measures were neck pain pressure threshold, neck pain severity, neck disability, and cervical range of motion
Results: The pain severity and disability were significantly lower in the EA group than in the other two groups. The neck range of motion (cervical lateral flexion and rotation) and pain pressure threshold increased significantly in the EA group immediately and one week after the intervention.
Conclusion: Both EA and LA interventions may be effective in alleviating the symptoms of cervical myofascial pain syndrome, but the EA can be more effective in reducing neck pain and disability in women with cervical myofascial pain syndrome.
... At the same time, Laser-therapy promotes an increase in local microcirculation, favoring the drainage of catabolic resulting from the maintained muscle contraction metabolism. One of the theories proposed for pain control with the use of laser therapy suggests a systemic effect causing a decrease in the perception of pain in the treated area, by altering the sensory input to the central nervous system [37]. Another theory proposes that the increased circulation induced by the irradiation of Laser Therapy leads to a greater blood supply to cells in hypoxia, that is, an increase in the oxygen supply, which may be responsible for breaking the pain-spasm-pain cycle [38]. ...
... Its initial application in the late 1960s concentrated on wound healing, as well as relief of pain and inflammation in a wide range of orthopaedic conditions. Since then, numerous laboratory studies on LLLT have been conducted to manage several conditions, such as osteoarthritis and rheumatoid arthritis [12], back pain [13], wounds [14,15], and neck pain [16,17]. ...
Breast cancer is responsible for one of the top leading causes of cancer deaths among women. Radiotherapy (RT) uses high energy radiation to kill cancer cells, but this method has been reportedly linked to risks of toxicity. Post-therapeutic relapse from RT believed to be caused by its toxicity is one of the challenges encountered during tumour therapy. Therefore, further attention should be devoted to developing novel anti-tumour therapeutic approaches. The role of low-level laser therapy (LLLT) in breast cancer management is to alleviate the side effects arising from RT, instead of acting against the tumour cells directly. This study investigated the effects of low-level laser (532 nm), as well as single and fractionated irradiation, on breast cancer MCF 7 cell line. Additionally, this study assessed the most effective laser parameter for fractionated irradiation. The MCF 7 cells were irradiated with green laser power at 1.5, 45.0, and 100.0 mW with a spot size diameter of 0.7 mm for 1, 5, 10, and 15 min. The irradiation was carried out in single, double, and triple fractionation separated by 5- and 10-min intervals in between the fractional regimes. The laser output of 100 mW showed a promising potential in killing cells with single fractionation. However, as the irradiation was fractionated into two, power of 1.5 mW appeared to be more effective in cell death, which contributed to the lowest percentage cells viable of 31.4% recorded in the study. It was proven that fractionated regime was more successful in tumour cell death.
... transcutaneous electrical nerve stimulation, physiotherapist-guided manual therapy or assistive devices) can reduce pain. Another noninvasive alternative treatment option is laser therapy and low intensity pulsed ultrasound, as they promise pain relief, while patients experience few side effects [2,9,31,44]. Furthermore in vivo OA-model studies indicate favourable effects by the application of ultrasound treatment, concerning cartilage repair, extracellular matrix destruction and vascularisation [15,16,46]. ...
Purpose
Apart from other risk factors, mechanical stress on joints can promote the development of osteoarthritis (OA), which can also affect the temporomandibular joint (TMJ), resulting in cartilage degeneration and synovitis. Synovial fibroblasts (SF) play an important role in upkeeping joint homeostasis and OA pathogenesis, but mechanical stress as a risk factor might act differently depending on the type of joint. We thus investigated the relative impact of mechanical stress on the gene expression pattern of SF from TMJs and knee joints to provide new insights into OA pathogenesis.
Methods
Primary SF isolated from TMJs and knee joints of mice were exposed to mechanical strain of varying magnitudes. Thereafter, the expression of marker genes of the extracellular matrix (ECM), inflammation and bone remodelling were analysed by quantitative real-time polymerase chain reaction (RT-qPCR).
Results
SF from the knee joints showed increased expression of genes associated with ECM remodelling, inflammation and bone remodelling after mechanical loading, whereas TMJ-derived SF showed reduced expression of genes associated with inflammation and bone remodelling. SF from the TMJ differed from knee-derived SF with regard to expression of ECM, inflammatory and osteoclastogenesis-promoting marker genes during mechanical strain.
Conclusions
Osteoarthritis-related ECM remodelling markers experience almost no changes in strain-induced gene expression, whereas inflammation and bone remodelling processes seem to differ depending on synovial fibroblast origin. Our data indicate that risk factors for the development and progression of osteoarthritis such as mechanical overuse have a different pathological impact in the TMJ compared to the knee joint.
... Beneficial effects of Laser Therapy on tissues and cells includes accelerated tissue repair, reduced fibrous tissue formation, improve blood circulation, improve cell metabolism, faster wound healing, relieve acute and chronic pain, anti-inflammatory and anti-edematous effects 15 . Laser therapy helps to reduce pain and inflammation and enhance tissue healing 16 . Ultrasound is a deep heating modality which has been shown to enhance collagen synthesis by Fibroblast 12 . ...
Aim: To find the effectiveness of laser therapy and ultrasound therapy along with muscle energy technique in treatment of Trapezitis. Materials and Methods: Non-equivalent quasi experimental study design was used in this study. Total of 30 subjects with trapezitis were selected using non probability convenient sampling technique.30 Subjects was divided into two groups by lot system. Group A received laser therapy and Group B received ultrasound therapy and for both the group muscle energy technique was given. The outcome measures are Neck Disability Index (NDI) for measuring Functional Disability. Data collected and tabulated was statistically analyzed. Result: Statistical analysis of post-test, Neck Disability Index (NDI) revealed that there is statistically significant difference seen between Group A and Group B. Conclusion: From the result, it has been concluded that Laser therapy with muscle energy technique (Group A) was more effective than Ultrasound therapy with muscle energy technique (Group B) on improving functional ability in subjects with Trapezitis.
... These findings are consistent with the result of our present study. Researchers have suggested mechanisms for pain relief using laser, which includes the secretion of endogenous opioids, such as in 6 acupuncture and transcutaneous electrical nerve stimulation, leading to clearance of the analgesic substances via stimulation of the microcirculatory system 10,11 . ...
Background: This study was designed to determine and compare the effect of low level laser therapy and strong surge faradic current on trapezius spasm. Material And Methods: Group A consisted of 15 subjects who received Low Level Laser Therapy and Group B consisted of 15 subjects who received Strong Surge Faradic current. On the 1st and 5th day Numerical pain rating scale (NPRS) was taken to measure pain intensity, Hubbard’s “Tenderness grading scale” was used for assessment of soft tissue tenderness and Cervical side flexion and rotation range of motion was measured using universal goniometer. Result: The t-value for NPRS, tenderness, cervical side flexion and rotation were 12.52, 11.05, -7.28 and -8.76 respectively. So, there was significant difference in all the outcome measures between Group A and Group B at level of significance p=0.00. Conclusion: The results of this study demonstrated that LLLT and SSF current both the interventions are effective for treatment of trapezius spasm. But SSF current is more effective than LLLT in improving cervical rotation range of motion
... Ultrasound was applied to the left scapulohumeral joint, followed by manual stretching to maximize range of motion. Photobiomodulation therapy was also employed for its analgesic and antiinflammatory properties, and to increase joint mobility and function (Brosseau et al., 2000) benefits of the buoyancy and resistance of water to minimize pain and maximize functional shoulder movement (Speer et al., 1993). The owner was directed to perform targeted athome exercises prescribed to promote weight-bearing and maintenance of range of motion. ...
Background:
Cranial luxation of the scapulohumeral has been rarely reported in dogs and there is limited information available regarding surgical management of this condition, particularly with respect to long-term functional outcomes.
Case description:
This report describes the successful resolution of a chronic traumatic cranial scapulohumeral joint luxation in a dog that was stabilized by cranial transposition of the biceps brachii tendon of origin. At surgery, an osteotomy of the greater tubercle was performed and a trough was made in the exposed bed of the osteotomy. The transverse humeral ligament was incised, and the bicipital tendon was levered into the trough and secured in that location by reattachment of the greater tubercle using multiple Kirschner wires and a figure-of-eight tension band wire. Postoperatively, the dog was maintained in a Spica splint for 2 weeks. Although surgical reduction was performed 4 months after the original injury, the luxation did not recur and the dog did not have appreciable lameness 14 months following the surgery.
Conclusion:
Although cranial transposition of the bicipital tendon is an invasive procedure, this dog's scapulohumeral luxation did not recur and the procedure yielded an excellent long-term functional outcome.
... Some explanations can be found in different experimental studies, which suggest that LLLT has an antiinflammatory, analgesic and reparative effect. In a meta-analysis, Brosseau et al [18] stated that the reduction in pain through using LLLT might be due to mechanisms such as physiological effects mediated by photochemical actions at cellular level in animal or human tissue, and through increased levels of the neurotransmitters implicated in pain modulation, such as serotonin. Some researchers have also concluded that LLLT has an effect on joint cartilage regeneration, achieved through proliferation of chondrocytes and synthesis and secretion of extracellular matrix. ...
... One of these methods is laser therapy. Low power laser is recently tried in different rheumatologic, neurologic and musculoskeletal disorders such as osteoarthritis, [3][4] rheumatoid arthritis, 5,6 fibromyalgia, 7,8 carpal tunnel syndrome, 9 rotator cuff tendinitis, [10][11][12] and chronic back pain syndromes. [13][14][15] It has resulted in considerable achievements in most of the studied conditions. ...
Introduction : Low back pain (LBP) is a very common musculoskeletal disorder. The big burden of disease necessitates investigating a more effective modality of treatments with more persistence and also fewer side effects. Low power laser has been proved as a pain reducing modality, but there is a lack of studies comparing it with other treatments and also among the Iranian race and society. The purpose of this study was to evaluate the effect of low-level laser on patients with LBP. Methods : Our study was a single-blind, randomized controlled trial. Forty subjects, aged between 20 to 70 with LBP participated in the study. Their pain severity scale was 3-10 according to the visual analogue scale of pain (VAS). They were randomly assigned to two groups, a case group (true laser) and a control group (sham laser). Naproxen was prescribed with a free dose (250-1000 mg/ daily) to both groups. We evaluated patients’ subjective pain, functional status (using the Roland Morris disability questionnaire), spinal range of motion (ROM) and spinal tenderness at the basic time, one month and 3 months after treatment. The true laser group received 12 sessions of laser (160 mW) and the control group took 12 sessions of sham laser (the same laser instrument in off status). An infrared laser GaAlAs, wavelength 808 nm, power 160 mw and spot size 1 cm2 and power density 0.16 J/cm2 in continuous mode was used in treatment. We applied the laser to articular spaces of vertebral column, adjacent paravertebral points, pain radiating areas, tender points and also pain-controlling acupuncture points. Results : Of the 40 participants in the study, 6 persons were excluded and thus the data obtained from 34 participants were statistically analyzed. There was significant improvement in pain (P<0.001 for both groups), functional status (Case group: P <0.001; control group: P=0.004) and spinal ROM (Case group: P <0.001; control group: P =0.007) in both groups at the end of the first month, but these gains persisted for 3 months only in the case group ( P <0.001). Regarding spinal tenderness, it was disappeared in 89.47% of the patients in the true laser group at the end of one month but remained unchanged in 73.33% of the subjects of the sham laser group. Conclusion : We concluded that laser therapy (in combination with NSAIDs) is an effective and long-lasting therapeutic strategy in bringing relief from LBP without any significant side effect.
... This suggests that LLLT could have disease-modifying effects as well as symptomatic benefits, although the results of early clinical trials have been mixed thus far [33]. Recent studies have tended to be more positive with those treated with laser therapy and exercise faring better than those treated with exercise alone in terms of pain measurements as well as function [34,35]. ...
Osteoarthritis (OA) is the most common joint condition worldwide. It can lead to chronic debilitating symptoms that can be definitively managed with surgical techniques at times. More frequently however, either due to age, extent of disease or patient choice, non-surgical approaches are preferred. They include topical therapies such as thermotherapy, ultrasound, laser treatment, non-steroidal anti-inflammatory drugs (NSAIDs) and capsaicin cream. Injections are another technique often implemented. These consist of intra-articular (IA) corticosteroid or hyaluronan injections, trigger point injections and subcutaneous sodium salicylate. Acupuncture and various types of external support are also widely used. This chapter examines the latest evidence and summarises the role of the various regional treatments available for use in the management of OA.
... The PBMT effects for OA treatment remain to be fully determined; however, PBMT potentially acts through mechanisms of photostimulation at the cellular level. 40 A leading hypothesis on the PBMT's mechanism of action involves mitochondrial mechanisms related to cytochrome activity, such as cytochrome-c-oxidase, which absorbs light into the near-infrared region. 41,42 Several signaling pathways are activated, leading to increased activity of transcription factors related to genes expression, which, in turn, are associated to protein synthesis, cell migration and proliferation, anti-inflammatory signaling, 42 and chondrogenesis. ...
Objective
Chronic pain associated with osteoarthritis (OA) often leads to reduced function and engagement in activities of daily living. Current pharmacological treatments remain relatively ineffective. This study investigated the efficacy of photobiomodulation therapy (PBMT) on cartilage integrity and central pain biomarkers in adult male Wistar rats.
Design
We evaluated the cartilage degradation and spinal cord sensitization using the monoiodoacetate (MIA) model of OA following 2 weeks of delayed PBMT treatment (i.e., 15 days post-MIA). Multiple behavioral tests and knee joint histology were used to assess deficits related to OA. Immunohistochemistry was performed to assess chronic pain sensitization in spinal cord dorsal horn regions. Furthermore, we analyzed the principal components related to pain-like behavior and cartilage integrity.
Results
MIA induced chronic pain-like behavior with respective cartilage degradation. PBMT had no effects on overall locomotor activity, but positive effects on weight support ( P = 0.001; effect size [ES] = 1.01) and mechanical allodynia ( P = 0.032; ES = 0.51). Greater optical densitometry of PBMT-treated cartilage was evident in superficial layers ( P = 0.020; ES = 1.34), likely reflecting the increase of proteoglycan and chondrocyte contents. In addition, PBMT effects were associated to decreased contribution of spinal glial cells to pain-like behavior ( P = 0.001; ES = 0.38).
Conclusion
PBMT during the chronic phase of MIA-induced OA promoted cartilage recovery and reduced the progression or maintenance of spinal cord sensitization. Our data suggest a potential role of PBMT in reducing cartilage degradation and long-term central sensitization associated with chronic OA.
... LILI, which involves the application of red or near infrared lasers irradiating between 600-1100 nm, was introduced as an alternative, non-invasive, therapeutic approach for various medical conditions such as osteoarthritis, rheumatoid arthritis, post-mastectomy lymphedema and chronic diabetic wound. The effectiveness of this phototherapy has been proven by the positive outcomes of findings and is no longer doubted [13,14]. Despite these positive findings, LILI remains a controversial treatment modality for some. ...
... The epidemiological studies available indicate that OA affects 10-15% of the world's population, presenting an incidence of more than 60% of men and 70% of women over 65 years of age (10). Regarding the prevalence, OA increases with age and is unusual in individuals under 40 but more frequent after the age of 60 (11). Our data match the worldwide findings. ...
Objectives:
This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists.
Methods:
The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated.
Results:
The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA.
Conclusion:
The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.
... Some explanations can be found in different experimental studies, which suggest that LLLT has an antiinflammatory, analgesic and reparative effect. In a meta-analysis, Brosseau et al [18] stated that the reduction in pain through using LLLT might be due to mechanisms such as physiological effects mediated by photochemical actions at cellular level in animal or human tissue, and through increased levels of the neurotransmitters implicated in pain modulation, such as serotonin. Some researchers have also concluded that LLLT has an effect on joint cartilage regeneration, achieved through proliferation of chondrocytes and synthesis and secretion of extracellular matrix. ...
Background/Purpose: Osteoarthritis (OA) of the knee is the most common joint disease in the elderly and is associated with significant physical disability. Low level laser therapy has been used previously as a therapeutic modality to control the pain in different musculoskeletal pathologies associated with joint disease. The aim of this investigation is to evaluate the effectiveness of low level laser therapy in combination with exercise in the long term to reduce pain, improve range of motion (ROM) and functionality in an osteoarthritis population. Methodology: 220 subjects with chronic osteoarthritis of the knee are recruited, aged-matched and divided into 2 groups. Intervention: one group receives laser therapy and exercise and the second group receives placebo laser therapy and exercise. Laser therapy was performed twice a week for 6 weeks. Measurements of pain, knee range of motion, WOMAC and Lequesne Questionnaire were taken at the baseline, after 6 weeks of intervention and another 6 weeks of no interventions. Result: The result of the study concluded that Low level laser therapy combined with exercise is more beneficial than placebo laser therapy with exercise in the long term. Hence Low level Laser therapy is used as an effective adjuvant treatment for patients with knee osteoarthritis.
... Brosseau et al. [52] reportou em seu metanálise que o tratamento com laser de baixa intensidade em artrite reumatóide é benéfico no alívio da dor e na redução da rigidez matinal com melhores resultados utilizando doses baixas (ex: 3 J/cm 2 ) e comprimento de onda de 632,8 nm comparado ao 820 nm, porém os resultados são conflitantes, pois não há um efeito à longo prazo desta terapia nos trabalhos analisados. ...
O objetivo desta revisão é complementar os dados revisados na parte 1 onde foram discutidos princípios e generalidades, disponibilizar ao leitor referencial teórico para conhecer a interação do laser de baixa intensidade com os diferentes tipos de tecidos e analisar as distintas respostas. Este material constitui um acervo atualizado onde se especificam os diversos parâmetros aplicados e a técnica utilizados em cada trabalho, o qual vai servir para que os profissionais interessadas nesta área direcionem melhor suas pesquisas e determinem com maior precisão as doses para o tratamento de seus pacientes ao contar com diferentes alternativas.Palavras-chave: laser de baixa intensidade, bioefeitos, fotoreatividade tecidual.
... Uma das teorias propostas para o alívio da dor proporcionado pelo laser de baixa intensidade sugere um efeito sistêmico que pode alterar o input sensorial para o sistema nervoso central e diminuir a percepção da dor na área tratada [41]. Outra teoria propõe que o aumento da circulação induzido pela luz acarreta em maior aporte sanguíneo para as células em hipóxia, ou seja, elevação da oferta de oxigênio. ...
Introdução: A síndrome dolorosa miofascial designa a dor muscular regional causada por trigger points. Esses são caracterizados como pontos de hiperirritabilidade presentes na musculatura, cuja palpação induz à reprodução de sintomas. Os dispositivos luminosos (LASER’s e LED’s) são citados na literatura como uma nova modalidade para o tratamento dessa síndrome. Objetivo: Avaliar os efeitos do laser de baixa intensidade na modulação da dor de indivíduos portadores de síndrome dolorosa miofascial. Métodos: Dois indivíduos foram aleatoriamente alocados em dois grupos – laser de baixa intensidade (LBI) e compressão isquêmica (CI). O sinal eletromiográfico dos músculos trapézio superior e médio e a intensidade da dor foram coletados diariamente antes e após as intervenções. Resultados: A intensidade da dor pré e pós-intervenção apresentaram diferenças significativas, em repouso e em movimento, apenas para o grupo LBI. Diferenças significativas não foram observadas na intensidade da dor ao longo das 8 sessões nos grupos avaliados. Não foram encontradas diferenças entre a atividade muscular de nenhum dos músculos em ambos os grupos, a curto e a longo prazo. Conclusão: Ambas as intervenções acarretaram efeitos benéficos distintos sob a síndrome dolorosa miofascial. A combinação das duas técnicas pode ser uma alternativa interessante para o tratamento desta síndrome.Palavras-chave: síndrome dor miofascial, terapia a laser de baixa intensidade, eletromiografia.
... Laser has also been admitted as a noninvasive therapy that was added to medicine and physiotherapy. It is suggested that the bio-effect of LLLT on animal and human tissues is through photochemical cellular reactions that mediated by photochemical actions at the cellular level [14]. It is used also for the improvement of tissue hypoxia/ischemia and inflammation in nerve entrapment neuropathy, as well as for the promotion of nerve regeneration [15]. ...
Diabetic neuropathy (DN) is the highly occurred complication of diabetes mellitus; it has been defined as an event of peripheral nerve dysfunction characterized by pain, allodynia, hyperalgesia, and paraesthesia. The current study was conducted to evaluate the efficacy of low-level laser therapy (LLLT) in the management of neuropathy in diabetic rats. The used animals were divided into the following groups: negative control, streptozotocin-induced diabetic rats, and diabetic rats with peripheral neuropathy (DNP) and DNP treated with gabapentin or with LLLT. Behavioral tests were carried out through hotplate test for the determination of pain sensations and the Morris water maze test for spatial reference memory evaluation. Blood samples were collected at the end of treatment for biochemical determinations. In the current study, the latency of hind-paw lick decreased significantly when DNP are treated with gabapentin or LLLT. The Morris water maze test showed that LLLT treatment improved memory that deteriorated in DNP more than gabapentin do. The results of the biochemical study revealed that LLLT could not affect the level of beta-endorphin that decreased in DNP but significantly decreased S100B that rose in DNP. PGE2 and cytokines IL-1β, IL-10, and TNF-α showed significant increase in DNP compared with control group. The gabapentin administration or LLLT application significantly reversed the levels of the mentioned markers towards the normal values of the controls. Levels of serum MDA and nitric oxide increased significantly in the DNP but rGSH showed significant decrease. These markers were improved significantly when the DNP were treated with gabapentin or LLLT. The treatment with gabapentin or LLLT significantly decreased the raised level in total cholesterol in DNP but could not decrease the elevated level of triglycerides, while LDL cholesterol decreased significantly in DNP treated with gabapentin but not affected by LLLT. Values of serum alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), urea, and creatinine increased significantly in the DPN and diabetic rats without peripheral neuropathy (PN) compared with control group. The treatment of DNP with gabapentin induced significant increases in ALAT and ASAT activities but LLLT treatment induced significant decreases in ALAT and ASAT activities as compared with DNP group. Neither gabapentin nor LLLT could improve the elevated levels of serum urea and creatinine in the DNP. It could be concluded that LLLT is more safe and effective than gabapentin in the management of neuropathy in diabetic rats.
... Although both US and LLLT were fairly good treatment of knee OA as evidenced by histopathology, US was more effective in returning the knee joint to its normal architecture.However, both treatment produced significantly lower score compared to Lev. group. In line with us, Brosseau et al reported that although LLLT was recommended for relief of pain and stiffness in rheumatoid arthritis (RA), it gives contradictory results in OA pending on wavelength, dosage, duration and site of application [32]. They recommend further studies to detect the previously mentioned parameters for both RA and OA. ...
... Although current literature showing positive effects in favor laser therapy for treatment of several kinds of joint inflammation, few authors have studied the use of laser in treatment of RA [11][12][13][14]. ...
The purposes of this study are to determine and compare efficacy of laser acupuncture versus reflexology in elderly with rheumatoid arthritis. Thirty elderly patients with rheumatoid arthritis aged between 60 and 70 years were classified into two groups, 15 patients each. Group A received laser acupuncture therapy (904 nm, beam area of 1cm², power 100 mW, power density 100 mW/cm², energy dosage 4 J, energy density 4 J/cm², irradiation time 40 s, and frequency 100,000 Hz). The acupuncture points that were exposed to laser radiation are LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, and HT7. While group B received reflexology therapy, both offered 12 sessions over 4 weeks. The changes in RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints were measured at the beginning and end of treatment. There was significant decrease in RAQoL, HAQ, IL-6, and MDA pre/posttreatment for both groups (p < 0.05); significant increase in ATP pre/posttreatment for both groups (p < 0.05); significant increase in ankle dorsi-flexion, plantar-flexion, wrist flexion, extension, and ulnar deviation ROM pre/posttreatment in group A (p < 0.05); and significant increase in ankle dorsi-flexion and ankle plantar-flexion ROM pre/posttreatment in group B (p < 0.05). Comparison between both groups showed a statistical significant decrease in MDA and a statistical significant increase in ATP in group A than group B. Percent of changes in MDA was 41.82%↓ in group A versus 21.68%↓ in group B; changes in ATP was 226.97%↑ in group A versus 67.02%↑ in group B. Moreover, there was a statistical significant increase in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation in group A than group B. Laser therapy is associated with significant improvement in MDA and ATP greater than reflexology. In addition, it is associated with significant improvement in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation greater than reflexology in elderly patients with rheumatoid arthritis.
... 17,18,20,21 Even when adding LLLT to exercise training in the treatment of OA, there are still questions on their efficacy. 21,22 The purpose of this study was to evaluate the effectiveness of adding LLLT with two common used intensities (6 J/ cm 2 ) 12,18 and (3 J/cm 2 ) 23 to exercise training program in reducing pain intensity, improving range of motion, muscle strength and quality of life in older patients with chronic knee OA. ...
Abstract
Introduction: Osteoarthritis (OA) is a common degenerative joint disease particularly in older subjects. It is usually associated with pain, restricted range of motion, muscle weakness, difficulties in daily living activities and impaired quality of life. To determine the effects of adding two different intensities of low-level laser therapy (LLLT) to exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, range of motion of the knee, and quality of life in older subjects with knee OA.
Methods: Patients were randomly assigned into three groups. They received 16 sessions, 2 sessions/week for 8 weeks. Group-I: 18 patients were treated with a laser dose of 6 J/cm2 with a total dose of 48 J. Group-II: 18 patients were treated with a laser dose of 3 J/cm2 with a total dose of 27 J. Group-III: 15 patients were treated with laser without emission as a placebo. All patients received same exercise training program including stretching and strengthening exercises. Patients were evaluated before and after intervention by visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index for quality of life, handheld dynamometer and universal goniometer.
Results: T test revealed that there was a significant reduction in VAS and pain intensity, an increase in isometric muscle strength and range of motion of the knee as well as increase in physical functional ability in three treatment groups. Also analysis of variance (ANOVA) proved significant differences among them and the post hoc tests (LSD) test showed the best improvements for patients of the first group.
Conclusion: It can be concluded that addition of LLLT to exercise training program is more effective than exercise training alone in the treatment of older patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm2 or 3 J/cm2.
Keywords: Laser therapy; Osteoarthritis; Life Quality.
... Researchers investigated the clinical effect of laser in the treatment of knee OA. Some authors reported a positive effect on pain relief [13], whereas the other authors disagreed with this result [14,15]. These controversial results may be because of the differences in parameters (wavelength, dose, time, area, technique) used in treatments by different studies [16]. ...
Objectives: the objective of this study was to investigate the effect of class IV diode laser on knee pain and functions in knee osteoarthritis (OA) patients. Methods: Fifty patients with mean (SD) 55.68 (8.88) years, 173.84 (4.946) cm, 83.86 (5.28) Kg and BMI 27.78 (1.89) Kg/cm2 were randomized into two groups. Group one received a multi-locked system laser plus exercise (MLS+EX) and group two received placebo laser plus exercise (PL+ Ex). Pain was evaluated using a visual analogue scale (VAS) and knee function by using the Western Ontario and Mc Master Universities index of Osteoarthritis (WOMAC). Patients received MLS laser three times weekly for four weeks. Exercise program was applied for all patients in the 2 treatment groups. The exercises included range of motion, stretching, isometric and isotonic resisted exercise to the quadriceps and hamstring muscles. Statistical analyses were performed to compare differences between baseline and after 4 weeks of treatment. Results: VAS and WOMAC were significantly decreased in both groups after 4 weeks, with a more significant decrease in VAS and WOMAC subscales on (MLS+EX) than (PL+ Ex). Conclusion: Class IV diode laser combined with exercises was more effective than exercises alone in treatment of patients with KOA. MLS laser combined with exercises effectively decreased pain and WOMAC subscales as compared to the PL+EX groups. Recommendation: MLS laser is an effective physical therapy modality that may provide better outcomes for patients with KOA especially when used in combination with exercise.
... In treatment small and medium power doses are used, which cause a thermal effect raising the tissue temperature by 0.1-0.5°C [14]. In treatment of pain ailments in hip osteoarthritis also other physical therapy treatments are applied. ...
... The effect of use of LLLT on mast cells in cutaneous wound and it's effect on wound healing was performed by many clinicians and investigators to investigate the most beneficial use of specific therapeutic modality.These studies have been done on different types of wounds and correlate the results with different types of laser,laser devices and frequenciesconcluded that many errors in the methods among studies made using LLLT did not allowsufficient conclusions to be tired relative to the value of the modality. [27][28][29][30][31] These studies didn't explain and quantify the actual differences between laser and non-laser-treated wounds and many of them often employ a variety of approachesin the same study; which makes it difficult to evaluate the effects of a single parameter. The cellular level of investigation forseveral intrinsic and extrinsic factors relatedto the inflammatory response and healing make well-designed studyis more reliable. ...
... Назначение ЛТ при РА определяется активностью процесса, выраженностью суставного синдрома и состоянием пациента, как и при ОА. Лечение с использованием ЛТ особенно показано в острую фазу воспаления при синовите сустава [13,14]. ...
Aim:
To enhance the efficiency of treatment in patients with secondary osteoarthritis (ОА) in the presence of comorbid condition, by using an interleukin-1 inhibitor (IL-1i) and laser therapy (LT).
Subjects and methods:
A total of 248 patients aged 38 to 65 years with RA and secondary OA who had predominantly Stage II in accordance with the Disease Activity Score 28 (DAS28) were examined. According to the received therapy, the patients were divided into 4 groups: 1) IL-1i + LT + mrthotrexate (MT); 2) IL-1i + MT; 3) LT + MT; 4) MT. The efficiency of treatment was evaluated from changes in the KOOS (Knee injury and Osteoarthritis Outcome Score), DAS 28, IL-1, and cartilage oligomeric matrix protein (COMP) 6 months later.
Results:
There were statistically significant functional improvements in KOOS and DAS28 in Groups 1 and 2 patients with secondary OA in RA. Clinical efficacy was confirmed by positive changes in serum IL-1 and COMP levels.
Conclusion:
Incorporation of an IL-1i into a therapy regimen for secondary OA in RA patients during basic therapy could not only improve the functional status of patients, but also decrease activity of the underlying disease according to the DAS 28.
Objective:
To assess whether photobiomodulation therapy (PBMT) enhances the benefits of exercise in older adults.
Data sources:
PubMed, Scopus, Medline and Web of Science, dated to February 2023.
Study selection:
All included studies were randomized controlled trials of PBMT combined with exercise co-intervention in persons 60 years and older.
Outcome measures:
Western Ontario and McMaster University Osteoarthritis Index (WOMAC-total, pain, stiffness and function), perceived pain intensity, Timed Up and Go (TUG) Test, 6-min walk test (6MWT), muscle strength and knee range of motion were included.
Data extraction:
Two researchers independently performed data extraction. Article data were extracted in Excel and summarized by a third researcher.
Data synthesis:
The meta-analysis included 14 of the 1864 studies searched in the database. No statistical differences were found between the treatment and control groups in terms of WOMAC-stiffness (MD = -0.31, 95%CI -0.64 to 0.03), TUG (MD = -0.17, 95%CI -0.71 to 0.38), 6MWT (MD = 32.2, 95%CI -44.62 to 109.01), or muscle strength (SMD = 0.24, 95%CI -0.02 to 0.50). However, statistically significant differences were found for WOMAC-total (MD = -6.83, 95%CI -12.3 to -1.37), WOMAC-pain (MD = -2.03, 95%CI -4.06 to -0.01), WOMAC-function (MD = -5.03, 95%CI -9.11 to -0.96), VAS/NPRS (MD = -1.24, 95%CI -2.43 to -0.06), knee range of motion (MD = 1.47, 95%CI 0.07 to 2.88).
Conclusions:
In older adults who exercise regularly, PBMT can potentially provide additional pain relief, improve knee joint function, and increase knee joint range of motion.
Widespread in nature ability of biological objects to emit photons (biophotons) made it possible to create devices for non-invasive and continuous monitoring of the metabolism of organs and tissues, used as a powerful clinical diagnostic tool, as well as for visualisation and spatio-temporal analysis of functioning organs and, in particular, the brain. Numerous experimental data indicating the participation of biophotons in the processes of inter- and intracellular communication served as a theoretical basis for the medical use of low-intensity light therapy for the effective treatment of a wide range of diseases, including delayed wound healing, pain in arthritis, and acute stroke.
The intent of this chapter is to provide the readers a focused clinical review assessing the current literature on a variety of complementary and alternative medicine treatments for musculoskeletal conditions. This chapter will assess acupuncture techniques, moxibustion, low-level laser therapy (LLLT), prolotherapy, and ozone injections. These treatment methods are growing in popularity by the public and are being utilized with much greater regularity. It is incumbent that providers become aware of the existing literature regarding the efficacy of these alternative methods for the treatment of a variety of musculoskeletal (MSK) conditions to adequately counsel and respond to the inquiries of our patients.
Safe, noninvasive, and effective treatments for brain conditions are everyone's dream. Low-level light therapy (LLLT) based on the photobiomodulation (PBM) phenomenon has recently been adopted in practice, with solid scientific evidence. Optogenetics provides high spatiotemporal resolution to precisely switch on and off a particular circuitry in the brain. However, there are currently no human trials of optogenetics on the human brain. These two approaches-PBM and optogenetics-are promising photonic treatments that target the brain using completely different technologies. PBM is based on the mitochondrial reaction to the photons for up- or downregulation on the cytochrome c oxidase synthase in cellular respiration. It is safe, noninvasive, and good for long-term treatments, with wide applications using light wavelengths ranging from 650 nm to ≈1,100 nm, the red to near-infrared range. Optogenetics is based on the expression of engineered opsins on targeted tissues through viral vectors. The opsins are engineered to be sensors, actuators, or switches and could be precisely controlled by light wavelength ranging from 450 nm to ≈650 nm, the visible light range. The penetration of visible light is limited, and thus the photons cannot be applied directly outside the head without surgical means to create a physical window. PBM using near-infrared light could reach deeper tissues for light directly applied outside the head. Detailed scientific foundations and the state of the art for both technologies are reviewed. Ongoing developments are discussed to provide insight for future research and applications.
The important sources of air pollution can be identified with the installation of ambient air quality monitoring station. The sampling with monitoring station can provide current status of air quality of that particular area. This chapter describes the different measuring and analytical technique for monitoring of air quality. The different method for the collection of pollutant is also explained. The types of the gaseous monitoring techniques were described in Sects. 2.3 and its subsections. The different measurement techniques of particulate pollutants were explained in Sects. 2.4. The Section 2.5 explained some of the important concepts of data quality assurance and quality control (QA/QC) with reference to the analysis of vapour-phase chemical composition in air.
Background
The combined effects of low-level laser therapy and neuromuscular electrical stimulation on knee osteoarthritis have yet to be analysed. This study aimed to determine the individual and combined effects of laser therapy and electrical stimulation on muscle activation and pain in older people with knee osteoarthritis.
Methods
A total of 45 women aged 60–75 years with knee osteoarthritis were randomised into three groups to receive stimulation, laser or stimulation plus laser therapy. All three groups underwent a 4-week control period (without intervention) followed by an 8-week intervention period. The effects of the interventions on muscle inhibition, electrical activity and pain were analysed.
Findings
There was a decrease in muscle inhibition (effect size ≥0.6) and a reduction in pain (effect size >1.2) in all three groups. All therapies generated an increase in electrical activity (effect size 0.1–0.5).
Conclusions
Laser alone or in combination with electrical stimulation promoted similar increases in muscle activation and pain relief.
Background: Work-related neck and shoulder pain are frequently reported in the workplace. Forward head posture (FHP) is associated with neck and shoulder pain. FHP is believed to alter the scapular kinematics and muscle activity which increases stress on the shoulder, leading to shoulder pain and dysfunction.
Aim and Objectives: To compare the electromyography (EMG) activity of scapular upward rotators during isometric shoulder flexion with forward head posture versus neutral head posture in normal healthy individuals.
Method: 40 normal healthy individuals with age of 18-24 years who have no history of pathology will participate in the study and instructed to perform isometric shoulder flexion with the upper extremity in both the forward head posture (FHP) and neutral head posture (NHP). Surface electromyography (EMG) will be recorded from the upper and lower trapezius, and serratus anterior muscles.
Result: Collected data are analyzed statistically by Paired t-test test.
Conclusion: There is increase in EMG activity of upper trapezius and lower trapezius and decrease in EMG activity of serratus anterior while forward head compare to neutral head posture.
Keywords: Forward head posture, Neutral head posture, Scapular upward rotators, EMG activity and Isometrics shoulder flexion
Introduction: One of the major complains after surgery is pain. Recent advances in the prevention and reduction of postoperative pain have provided several modalities. One of them is the use of laser irradiation on the surgical area. Objectives: To evaluate the effects of low level laser therapy (LLLT) on pain and side effects after surgery. Methods: In this research, databases such as: PubMed, Science Direct, Google Scholar, Springer and Cochrane were used and the words of laser therapy, photobiomodulation, therapeutic laser, low level laser therapy, surgery and pain were searched. Articles, including systematic reviews, original articles, case series, and clinical intervention studies related to these words, were studied. The language of all articles was English and consists of papers from 2009 until 2017. Results: A total of 370 papers were studied and 10 articles that met inclusion criteria were selected for this review. Few of these articles were followed up. Surgery included a wide range of surgeries including mastectomy, breast augment post-fracture, episiotomy, tonsillectomy and hernia. The methodological quality score on the PEDro scale was between 5 and 11. 8 trials reported positive effects and 2 trials reported negative effects. In order to study clinical effect size of laser therapy after surgery, only 4 papers met entry criteria and the mean effect sizes were 0.13 to 2.77. Accordingly, the best treatment protocol included a red laser dose of 4 J/cm ² for the post-operative pain of tonsillectomy, which was irradiated through the infra mandibular angle on the tonsils. Conclusion: LLLT may be an appropriate modality for reducing pain after surgery, nevertheless the effect size of this modality is variable. Therefore, further research based on proper protocols for these patients and follow-up of therapeutic course should be designed and implemented.
Abstract
Introduction: One of the major complains after surgery is pain. Recent advances in the prevention and reduction of postoperative pain have provided several modalities. One of them is the use of laser irradiation on the surgical area.
Objectives: To evaluate the effects of low level laser therapy (LLLT) on pain and side effects after surgery.
Methods: In this research, databases such as: PubMed, Science Direct, Google Scholar, Springer and Cochrane were used and the words of laser therapy, photobiomodulation, therapeutic laser, low level laser therapy, surgery and pain were searched. Articles, including systematic reviews, original articles, case series, and clinical intervention studies related to these words, were studied. The language of all articles was English and consists of papers from 2009 until 2017.
Results: A total of 370 papers were studied and 10 articles that met inclusion criteria were selected for this review. Few of these articles were followed up. Surgery included a wide range of surgeries including mastectomy, breast augment post-fracture, episiotomy, tonsillectomy and hernia. The methodological quality score on the PEDro scale was between 5 and 11. 8 trials reported positive effects and 2 trials reported negative effects. In order to study clinical effect size of laser therapy after surgery, only 4 papers met entry criteria and the mean effect sizes were 0.13 to 2.77. Accordingly, the best treatment protocol included a red laser dose of 4 J/cm2 for the post-operative pain of tonsillectomy, which was irradiated through the infra mandibular angle on the tonsils.
Conclusion: LLLT may be an appropriate modality for reducing pain after surgery, nevertheless the effect size of this modality is variable. Therefore, further research based on proper protocols for these patients and follow-up of therapeutic course should be designed and implemented.
Keywords: Photobiomodulation; Low level laser therapy; Surgery; Pain.
Elektrophysikalische Maßnahmen (im englischen Sprachgebrauch »electrophysical agents«, kurz EPAs) stellen in der Handtherapie einen wichtigen Teil der Behandlung dar. Physio- und Ergotherapeutinnen wenden thermische, elektrische, mechanische und zum Teil auch chemische Modalitäten an. Elektrophysikalische Maßnahmen sind eine gezielt eingesetzte Ergänzung zu weiteren therapeutischen Maßnahmen. Sie werden auch »passive« Maßnahmen genannt. Seit den Anfängen der Physiotherapie sind diese Anwendungen ein fester Bestandteil des Berufstandes (Watson 2016). Elektrophysikalische Maßnahmen sind weltweit ein Thema: 2009 wurde die International Society for Electrophysical Agents in Physiotherapy³, eine Untergruppe der World Confederation for Physical Therapy (WCPT) gegründet. Elektrophysikalische Modalitäten wirken primär auf der Ebene der Köperfunktionen, um in der Folge dem Patienten eine verbesserte Aktivität zu ermöglichen und seine Partizipation, seine Rollenerfüllung zu stärken. Zu den Körperfunktionen gehören u. a. Schmerzen, Gelenksbeweglichkeit, die Funktionen der Haut (Vernarbung), Muskelaktivität oder die Durchblutung. Jede Therapeutin wendet physikalische Mittel an und hat damit mehr oder weniger positive Erfahrungen sammeln können. Auch die Anwendung von elektrophysikalischen Maßnahmen sollte auf den Prinzipen der evidenzbasierten Medizin gründen: Es handelt sich um die Integration von Evidenz aus der Literatur, den Erfahrungen der Therapeutin und den Werten und Erwartungen des Patienten (Sackett 2000).
Background: Haemophilia is a common hereditary hemorrhagic disorder, however little is known about the oral
microflora of hemophilic patients.
The purpose of this research is to compare between the viable count of Streptococcus mutans, oral Lactobacilli and
Candida albicans from saliva of children suffering from haemophilia A aged (6-12) years and theviable count of the
samemicroorganisms isolated from saliva of healthy subject (healthy supject group) aged (6-12) years.
Materials and methods: - Saliva samples were collected from 30 children with severe Haemophilia A (patients group
and 30 healthy children (healthy subject group). Microbial counts of Streptococcus mutans, oral Lactobacilli and
Candida albicans were recorded for each group by using colony counter and expressed as colony forming unit
multiplied by thedilution factorper millimeter saliva (CFU/ml).
Results:- The present study observed that the viable count of Streptococcus mutans and oral Lactobacilli in patient
group was higher than the count of the healthy subject group while no significant differences were observed
between the viablecount of Candida albicans in patients group and healthy subject group.
Conclusion:- education,preventionand effort amongparentsand dentalprofessionalscan aid in improving the oral
health of Haemophilia children.
Key words: Haemophilia,Streptococcus mutans, Lactobacilli, Candida albicans. (J Bagh Coll Dentistry
2012;24(3):149-153).
The book includes the best-known techniques developed on the basis of the analysis of Russian and international clinical experience that were proven effective by international criteria and were approved by the Russian professional community (Low level laser therapy in treatment and rehabilitation and prevention programs: clinical recommendations. Moscow, 2015).
These techniques have been adapted for the Matrix and LASMIK laser physiotherapeutic devices, enabling to implement virtually all methods of laser intervention with maximum efficiency, aside from those presented in this publication.
For more information on the methodology of modern low level laser therapy refer to a special series "Effective Laser Therapy" (read more on our website http://lazmik.ru).
The book is intended for physical therapists, specialists in the field of medical rehabilitation and balneology, and doctors of other clinical specialties.
Photobiomodulation therapy is a valuable tool for the treatment of conditions in reptiles that benefit from reduced pain, reduced inflammation, and acceleration in the healing process. Numerous reptile clinical disorders are presented as indications for photobiomodulation therapy, alongside recommendations for target dosing and treatment intervals. Published information pertaining to laser therapy in reptiles is reviewed where available, as are clinical experience and extrapolation from other species. These clinical indications are presented in the categories of integumentary, musculoskeletal and coelomic disorders. A general review of precautions and contraindications is also presented.
Laser therapy, or photobiomodulation therapy (PBMT), is fast becoming a standard-of-care modality in veterinary medicine, as an adjunct to traditional medical treatment plans, for a variety of disorders that cause pain or inflammation, or that require healing. This chapter will discuss the physiological mechanisms behind photobiomodulation that are helpful in treating musculoskeletal conditions, including osteoarthritis. It will also examine the scientific literature supporting the use of PBMT, the recommended techniques and dosimetry, and common reasons for perceived treatment failure or inconsistent results in clinical practice.
Lasers/LEDs demonstrate therapeutic effects for a range of biomedical applications. However, a consensus on effective light irradiation parameters and efficient and reliable measurement techniques remain limited. The objective here is to develop, characterise and demonstrate the application of LED arrays in order to progress and improve the effectiveness and accuracy of in vitro photobiomodulation studies.
96‐well plate format LED arrays (400–850 nm) were developed and characterised to accurately assess irradiance delivery to cell cultures. Human dental pulp cells (DPCs) were irradiated (3.5–142 mW/cm²: 15–120 s) and the biological responses were assessed using MTT assays.
Array calibration was confirmed using a range of optical and analytical techniques. Multivariate analysis of variance revealed biological responses were dependent on wavelength, exposure time and the post‐exposure assay time (P < 0.05). Increased MTT asbsorbance was measured 24 h post‐irradiation for 30 s exposures of 3.5 mW/cm² at 470, 527, 631, 655, 680, 777, 798 and 826 nm with distinct peaks at 631 nm and 798 nm (P < 0.05). Similar wavelengths were also effective at higher irradiances (48–142 mW/cm²).
LED arrays and high throughput assays provide a robust and reliable platform to rapidly identify irradiation parameters which is both time‐ and cost‐effective. These arrrays are applicable in photobiomodulation, photodynamic therapy and other photobiomedical research.
Human immunodeficiency virus (HIV-1) infection remains a major health problem despite the use of highly active antiretroviral therapy (HAART), which has greatly reduced mortality rates. Due to the unavailability of an effective vaccine and treatment that would completely eradicate the virus in infected individuals, the quest for new therapies continues. Low level laser therapy (LLLT) involves the exposure of cells to low levels of red or infrared light. LLLT has been widely used in different medical conditions, but not in HIV-1 infection. This study aimed to determine the effects of LLLT on HIV-1 infected and uninfected TZM-bl cells. Both infected and uninfected cells were irradiated at a wavelength of 660 nm with different fluences from 2 J/cm(2) to 10 J/cm(2) . Changes in cellular responses were assessed using cell morphology, viability, proliferation, cytotoxicity and luciferase activity assays. Upon data analysis, uninfected irradiated cells showed no changes in cell morphology, viability, proliferation and cytotoxicity, while the infected irradiated cells did. In addition, laser irradiation reduced luciferase activity in infected cells. Finally, laser irradiation had no inhibitory effect in uninfected cells, whereas it induced cell damage in a dose dependent manner in infected cells.
ABSTRACT
Background: Nonspecific persistent chronic low back pain is arguably one of the most dreadful disabling medical conditions associated with huge financial implication, loss of work and deterioration of quality of life. Physical therapies are often the mainstay of treatment.
Objectives: To examine the effects of electrotherapies (Interferential Therapy, Laser therapy, Ultrasound therapy, Shortwave Diathermy, TENS), Thermotherapy, Lumbar Supports, Traction, and Acupuncture in the treatment of nonspecific persistent chronic low back pain: A comparison between European guidelines (2006) and NICE guideline (2009).
Search Strategy: Concerned topics and their respective studies from both guidelines were selected, compared and analysed. Further databases were searched until July 2011 in CENTRAL, MEDLINE, EMBASE, PEDro and Cochrane database using appropriate and relevant key words (eg. TENS nonspecific persistent / chronic low back pain).
Main Results: Interferential Therapy: insufficient evidence; Laser Therapy: weak, conflicting, insufficient evidence; Ultrasound Therapy: poor, insufficient evidence; Shortwave Diathermy: poor, insufficient evidence; TENS: conflicting, inconclusive evidence; Thermotherapy: no evidence; Lumbar Supports: weak, insufficient evidence; Traction: limited, insufficient evidence; Acupuncture: moderate, inconclusive evidence.
Author's Conclusion: The short-term use of acupuncture is desirable as recommended by the NICE guideline. Among other physical therapies and given their relatively „side-effects free profile;‟ TENS, laser therapy, traction can be a useful adjunct in the overall management.
Introduction:
Osteoarthritis (OA) is a common degenerative joint disease particularly in older subjects. It is usually associated with pain, restricted range of motion, muscle weakness, difficulties in daily living activities and impaired quality of life. To determine the effects of adding two different intensities of low-level laser therapy (LLLT) to exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, range of motion of the knee, and quality of life in older subjects with knee OA.
Methods:
Patients were randomly assigned into three groups. They received 16 sessions, 2 sessions/week for 8 weeks. Group-I: 18 patients were treated with a laser dose of 6 J/cm(2) with a total dose of 48 J. Group-II: 18 patients were treated with a laser dose of 3 J/cm(2) with a total dose of 27 J. Group-III: 15 patients were treated with laser without emission as a placebo. All patients received same exercise training program including stretching and strengthening exercises. Patients were evaluated before and after intervention by visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index for quality of life, handheld dynamometer and universal goniometer.
Results:
T test revealed that there was a significant reduction in VAS and pain intensity, an increase in isometric muscle strength and range of motion of the knee as well as increase in physical functional ability in three treatment groups. Also analysis of variance (ANOVA) proved significant differences among them and the post hoc tests (LSD) test showed the best improvements for patients of the first group.
Conclusion:
It can be concluded that addition of LLLT to exercise training program is more effective than exercise training alone in the treatment of older patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm(2) or 3 J/cm(2).
To define the value of low power laser treatment in small joint rheumatoid arthritis.
Twenty five women with active disease were recruited. The metacarpophalangeal and proximal interphalangeal joints of one hand were treated with 12 J/cm2 for 30 s with a gallium-aluminium-arsenate laser. The other hand received a sham laser treatment designed so that neither therapist nor patient could distinguish the active laser from the sham laser. Each patient received 12 treatments over four weeks. The following parameters were measured: pain as assessed by visual analogue scale; range of joint movements; grip strength; duration of early morning stiffness, joint circumference, Jebsen's hand assessment; drug usage; total swollen joint counts; Arthritis Impact Measurement Scales; three phase bone scans; haematological and serological tests.
A total of 72% of patients reported pain relief but this reduction was reported equally in both hands. No significant changes were seen in other clinical, functional, scintigraphic, or laboratory features. Neither patients nor staff were able to detect which hand was treated with the active laser.
When this specific laser and dose regimen was used, low power laser treatment had no objective effect on patients with rheumatoid arthritis. It did appear to produce analgesia through a powerful placebo effect.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
Quantitative studies of the action of low-power visible monochromatic light on various cells (E. coli, yeasts, HeLa) were performed to find irradiation conditions (wavelength, dose, intensity) conducive to vital activity stimulation. The action spectra of visible light on DNA and RNA synthesis in HeLa cells have maxima near 404, 620, 680, 760, and 830 nm. Growth simulation of E. coli is at a maximum when irradiated at 404, 454, 570, 620, and 750 nm, and biomass accumulation stimulation in yeasts has a maxima at 404, 570, 620, 680, and 760 nm. Absorption of quanta is only a trigger for the rearrangement of cellular metabolism, with photosignal transduction being effected by standard cellular means such as changes in the cAMP level. Respiratory chain components are discussed as primary photoacceptors. It is concluded that "laser biostimulation" is of a photobiological nature, and low-power laser effects can be related to well-known photobiological phenomena.
This paper reviews arthritis-related literature on the effectiveness of a number of physical interventions to reduce pain. Original research reports as well as information from principle texts and review articles of thermal agents, topical applications, phoresis, transcutaneous electrical nerve stimulation, cold laser, and exercise are included. Although the biophysical actions of many physical interventions are partially understood, their effects on pain and function have not been defined clearly. The results of studies of one or a combination of physical interventions were generally inconsistent and reflected a wide variety of research designs and methods. Most physical agents, used alone, had minimal effects on pain. Interventions that combined physical agents and exercise were more successful in attenuating pain and also decreasing impairment. Research and clinical experience have provided insights into appropriate selection of physical intervention and their effectiveness in achieving treatment goals in arthritis care. However, considerable investigation into the mechanisms of action, differential effects of dose, staging and treatment combinations, and the relation of pain, impairment, and function remains to be undertaken.
In order to investigate the safety and efficacy of low energy laser irradiation to the arthritis of the patients with rheumatoid arthritis, a multi-center double blind comparative study was conducted. Sixty eight patients with rheumatoid arthritis were randomly allocated into two groups of laser and sham irradiation. The each inflamed knee joint received 3 minut's irradiation of Ga-AI-As laser at 20mw with wave length of 830nm or 3 minut's sham irradiation, twice a week during 5 weeks. Evaluation items included pain and swelling of the knee joint, 15m walking time, ESR and morning stiffness. Routine laboratory tests including CBC, blood chemistry such as GOT, GPT, and LDH were also examined at the entry of the study and the completion of 10 times irradiation. Among various evaluation items, 15m walking time showed significant decrease in the laser group comparing with that in the sham group (P < 0.01). The remaining items showed no significant differences between two groups. Laboratory data showed no remarkable changes during the study and no apparent adverse effect with irradiation was observed. These results show some beneficial effect of low energy laser therapy to the patient with rheumatoid arthritis and also safety of irradiation.
The clinical symptoms and signs of RA-affected joints were improved by low-power He-Ne laser irradiation. The medial site of the knee was irradiated with this type of laser. The synovial membrane of the irradiated medial site was histologically compared with that of the non-irradiated lateral site. Irradiation was performed on 20 knees of 18 patients who had suffered from RA for durations of 4-30 years. The specifications of the laser used in this study are: medium, He-Ne gas; wavelength, 632.8 nm; power, 8.5 mW; spot size, 0.2 mm; duration of irradiation, 15 min per day; frequency, every other day; total, from 12 to 46 times; laser assemblage, Model PDT, Senko Medical Instrument Co., Tokyo. The synovial membrane in the irradiated medical site became smooth and thin. Villi underwent necrosis and significantly decreased in number or disappeared. The proliferation of synovial lining cells and blood vessels, as well as lymph follicles, was also decreased. Inflammatory cellular infiltration was weakened. In the non-irradiated lateral site, numerous villi and marked cellular infiltration were seen on the synovial membrane as is found in non-treated rheumatoid arthritis. Irradiation was very effective in nine joints and effective in seven joints. There was no definite effect in four joints.
Rat saphenous nerve was irradiated in vivo with an 830 nm, 60 mW continuous wave beam of a gallium aluminium arsenide (GaAlAs) diode laser for 6 s, 30 s, 60 s, and 120 s. An unirradiated group of animals served as control. Demonstrable sodium-potassium-adenosine trophosphatase (Na-K-ATPase) activity noticeably increased over the normal control level following 6 s irradiation, peaked at 15 s, increased following 30 s, and was inhibited to below normal level after 60 s and 120 s irradiation. Inorganic phophate release was measured as a biochemical indication of Na-K-ATPase activity: these results were echoed by histochemical analysis. Increased Na-K-ATPase activity in nerve tissue following low reactive level laser therapy (LLLT) may be associated with the pain attenuation process.
The tongue of the Swiss mouse is rich in mast cells (MC). Tongues of animals in the experimental group were irradiated using a He-Ne laser (2.4 J/cm2, 632 nm), and a second set of unirradiated animals served as the control. Two output powers were used, with the irradiation time adjusted to produce the same energy density. The possible nonselective degranulation of LLLT-irradiated mast cells was examined quantitatively and morphometrically using optic and electron microscopy. By means of radioimmunoassay, the histamine content of pulverized tongue was evaluated, comparing the levels of both experimental and control tissue. The irradiated tongue tissue showed a significantly higher histamine level compared with the control. In addition, the level of histamine in the interstitial cellular medium and the degree of other histological changes such as vasodilation was significantly higher following a single irradiation with the He-Ne laser at the above settings. The observations from this study may serve as a further indication of a bioactivative effect of low reactive level laser therapy, a therapeutic process still not fully understood.
The relationship between pain attenuation and serotonergic mechanism by low powered laser have been studied. The subjects of 63 cases, having chronic pain and good pain relief were investigated and the change ratio of plasma serotonin was analysed. On first time laser therapy, the change ratio of plasma serotonin had a stable tendency to give a statistically positive ratio (P < 0.001), by the tenth time the ratio had decreased and tended to give a negative ratio (P < 0.05) as a result of every other day irradiation. Furthermore, by every day repeated irradiation, the change ratio in plasma serotonin had altered to a negative ratio. In this respect, the change ratio of plasma serotonin may be a good clinical indication for LLLT in the assessment of pain attenuation.
With the increase in acceptance of low reactive-level laser therapy. or LLLT, as a valid medicoscientific subset, there is a corresponding increase in the number of papers appearlng in the literature. Unfortunately, the majority of these papers are marred by inaccurate and inconsistent reporting of parameters, and incorrect use of inappropriate terminology. The correct and accepted scientific units and their use in describing an experiment or clinical application are next discussed: the orthodox reporting of the incident laser power in watts or milliwatts; the spot size or irradiated area in square centimetres; the exposure time in seconds: and the incident energy, measured in joules; and their derivative terms, power density: energy; and energy density are examined, The importance of correct and accurate reporting of experimental parameters to enable repetition by another worker in the field is stressed. The author suggests that the disparity in parameter reporting can probably account for the different results from different groups working on the ‘same’ experiment. Ideas on a scientifically-based terminology are presented, including the pedigree of the term LLLT itself for the clinical therapy, and the general term of bioactivation to cover the study of the effects of LLLT at an in vitro level. The author concludes that correct and accurate reporting of well-designed LLLT studies in an acceptable and consistent terminology will help to solidify the acceptance of LLLT in the medicoscientific community.
colon; Human subjects received transcutaneous irradiation on the skin overlying peripheral nerves with a low-power helium-neon laser (1 MW, 632.5 nm, 20 Hz) for 20 s to each site. This treatment was accompanied by irradiation of the skin overlying painful joints for 4-8 min according to a predetermined protocol. Control group (n = 34) received treatment by an apparatus that looked identical to the laser apparatus but emitted no radiation. Laser or placebo therapy was repeated 3 times a week for 10 weeks. Subjects in the experimental group exhibited a highly significant reduction in pain intensity. Low-power laser may represent an adjunct in the management of the pain of rheumatoid arthritis.
(C) Lippincott-Raven Publishers.
This paper reviews arthritis-related literature on the effectiveness of a number of physical interventions to reduce pain. Original research reports as well as information from principle texts and review articles of thermal agents, topical applications, phoresis, transcu-taneous electrical nerve stimulation, cold laser, and exercise are included. Although the biophysical actions of many physical interventions are partially understood, their effects on pain and function have not been defined clearly. The results of studies of one or a combination of physical interventions were generally inconsistent and reflected a wide variety of research designs and methods. Most physical agents, used alone, had minimal effects on pain. Interventions that combined physical agents and exercise were more successful in attenuating pain and also decreasing impairment. Research and clinical experience have provided insights into appropriate selection of physical intervention and their effectiveness in achieving treatment goals in arthritis care. However, considerable investigation into the mechanismsof action, differential effects of dose, staging and treatment combinations, and the relation of pain, impairment, and function remains to be undertaken.
Thirty-five patients suffering from rheumatoid arthritis were allocated at random to treatment with either a low-power laser (3.58 J cm–2, continuous wave 820 nm) or a placebo in a 4-week, double-blind study. Eight finger joints (2nd–5th metacarpo- and proximal interphalangeal joints) of the most affected hand were treated. In the laser group the grip strength and finger flexibility improved, the swelling of the joints declined, the morning stiffness and pain decreased. The sedimentation rate and the number of leukocytes showed a fall with a significant trend. In the placebo group there were no changes in these parameters except for the registration of pain, where a significant, less than with the laser, effect was observed. Thus, low-power laser therapy, at the chosen wavelength and energy dose, appears to be effective against the classical complaints from rheumatoid arthritis.
This double-blind randomised and placebo-controlled trial evaluated the effect of low intensity laser light combined with phototherapy on the articular, systemic and functional manifestations of rheumatoid arthritis. Either an active or placebo low intensity laser/phototherapy was given to 35 subjects twice-weekly for four weeks. Only the knee and metatarsophalangeal joints were irradiated and all treated joints showed an active synovitis. The laser/phototherapy device emitted light at six wavelengths in the range 660–950 nm. Each application lasted 240 seconds and delivered an energy density of 8.1 joules/cm2. Each subject was assessed at one, three and six months after the initial treatment. Measures of outcome included range of joint movement, articular index, suprapatellar swelling, morning stiffness, walking speed, joint pain, HAQ Disability Index and several haematological and serological indicators. There were no significant differences observed between the active or placebo cohorts although range of movement at the knee improved slightly in the active treatment group. Combined low intensity laser and phototherapy, used under these conditions, does not appear useful for altering the course of rheumatoid arthritis.
This study was conducted to examine the effects of helium-neon laser auriculotherapy on experimental pain threshold. Eighty healthy female and male subjects, aged 18 to 39 years, were assigned randomly to one of two treatment groups. Subjects in the Experimental Group (n = 41) received laser stimulation, and subjects in the Control Group (n = 39) received sham stimulation to appropriate acupuncture points on the left ear. Experimental pain threshold at the ipsilateral wrist was determined with an electrical stimulus immediately before and after treatment. The mean change (posttreatment minus pretreatment) for the Experimental Group was greater than the mean change for the Control Group (p less than .05). The Experimental Group demonstrated a statistically significant (p less than .05) increase in mean pain threshold after treatment, but the Control Group did not. Results indicate that helium-neon laser auriculotherapy can increase experimental pain threshold and suggest a possible alternative for patients intolerant of transcutaneous electrical nerve stimulation.
The effect of soft-laser therapy on rheumatoid arthritis was evaluated in 17 patients with symmetrical involvement of the metacarpophalangeal joint of the index. Nine treatments with a He-Ne laser, 6 J/cm2, were given on the one hand with a sham irradiation of the other. The study was double-blind. The laser therapy gave some pain relief, but no difference in morning stiffness or joint performance was obtained. It is concluded that the laser therapy is of limited value in rheumatoid arthritis. © 1987 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
The effects of laser energy on articular cartilage were studied utilizing the neodymium YAG laser. Partial-thickness cartilage defects were surgically attempted in the femoral condyles of knee joints in guinea pigs. The defects were exposed to laser energy of varying intensities [group I, 25 J (5 W X 5 sec); group II, 75 J (15 W X 5 sec); group III, 125 J (25 W X 5 sec)]. A fourth group was studied, in which the defect was not lased. Animals were killed at weekly intervals from 1 to 6 weeks and the knee joints were subjected to histological analysis. At 5 weeks, the knees exposed to 25 and 75 J demonstrated a reparative process with chondral proliferation. The knees exposed to 125 J demonstrated fibrotic tissue and tissue necrosis that resulted in fibrosis. In the knees not exposed to laser energy, numerous foci of granulation tissue were present at all stages with the end point of healing being one of fibrosis with disorganized patchy cartilage islands.
Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased. The patient, physician, and occupational therapy evaluators did not know which hand was being lased. Twenty-one patients noted improvement of both their MCP and PIP joints of both hands during laser therapy. Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy. Heat, erythema, pain, swelling, and tenderness all improved with time in both hands, but the lased hand had more significant improvement in erythema and pain. There was also significant improvement in grasp and tip pressure on the lased side. The level of circulating immune complexes as measured by platelet aggregation decreased during lasing. The improvement may be related to laser exposure. The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain to be elucidated.
Peripheral tissue damage or nerve injury often leads to pathological pain processes, such as spontaneous pain, hyperalgesia and allodynia, that persist for years or decades after all possible tissue healing has occurred. Although peripheral neural mechanisms, such as nociceptor sensitization and neuroma formation, contribute to these pathological pain processes, recent evidence indicates that changes in central neural function may also play a significant role. In this review, we examine the clinical and experimental evidence which points to a contribution of central neural plasticity to the development of pathological pain. We also assess the physiological, biochemical, cellular and molecular mechanisms that underlie plasticity induced in the central nervous system (CNS) in response to noxious peripheral stimulation. Finally, we examine theories which have been proposed to explain how injury or noxious stimulation lead to alterations in CNS function which influence subsequent pain experience.
Assessing the quality of randomized controlled trials (RCTs) is important and relatively new. Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth. We present an annotated bibliography of scales and checklists developed to assess quality. Twenty-five scales and nine checklists have been developed to assess quality. The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs. The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias. There are several shortcomings with these scales. Future scale development is likely to be most beneficial if questions common to all trials are assessed, if the scale is easy to use, and if it is developed with sufficient rigor.
The effect of a 940-980 nm length wave laser radiation in rheumatic degenerative diseases was studied in 136 patients unresponsive to or with contraindications for antiinflammatory non-steroid therapy. The evolution was clinically estimated using four parameters; pain, muscular contracture, local edema and the impairment of the articular mobility. All patients presented a beneficial evolution appearing gradually during the treatment. The osteoarthritis of the knee, ankle and shoulder evolved worse than the painful back. The painful back presented an improved evolution when it was located at the thoracal level. No adverse reaction was observed during this study.
A meta-analysis was undertaken of low-level laser therapy (LLLT) on musculoskeletal pain. A literature search revealed 23 LLLT trials and of these 17 were controlled trials. Ten were double blind and 7 were insufficiently blinded. Within the studies identified pain was assessed by visual analogue scale or by "some other indices of pain". Nine double-blind trials and 4 controlled trials presented results in a form which allowed pooling of data. In the double-blind trials, the mean difference in pain between LLLT and placebo was 0.3% (S.E.(d) 4.6%, confidence limits -10.3-10.9%). In the insufficiently blinded trials the mean difference in pain was 9.5% (S.E.(d) 4.5%, confidence limits -2.9-21.8%). We conclude that LLLT has no effect on pain in musculoskeletal syndromes.