Article

The anti-inflammatory mechanism of low level laser therapy and its relevance for clinical use in physiotherapy

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Abstract

Background: Low level laser therapy (LLLT) is a modality that has been used by physiotherapists for more than two decades. Clinical use has largely relied on empirical data, but new evidence suggests that LLLT can trigger specific photobiological mechanisms. Objective: To review possible therapeutic windows for LLLT in inflammatory reactions. Methods: Systematic review of LLLT in studies with cell cultures and animals where inflammation is induced. Skin wound studies were excluded unless they measured the influence of drugs on LLLT effects, or made a direct comparison of LLLT and drugs in inflammation. Results: We identified 1 review, 34 cell studies, 54 animal studies and 106 skin incision studies potentially eligible for analysis. Eleven cell studies and 27 animals studies met all our inclusion criteria, and another six animal studies met our inclusion criteria for drug comparisons and LLLT interactions. There is strong evidence of an anti-inflammatory effect from LLLT, which is consistent across all 12 tested laboratory models and phases of inflammation and wavelengths between 633 and 904 nm. The magnitude of the antiinflammatory effect is not significantly different from that of non-steroidal anti-inflammatory drugs (NSAIDs), but it is slightly less than glucocorticoid steroids. There is moderate evidence that concomitant use of glucocorticoid steroid has a negative effect on LLLT mechanisms and should be avoided. Conclusion: Red and near infrared LLLT administered with mean laser output of 2.5–100 mW, irradiation times of 16–600 s and doses of 0.6–9.6 J reduces inflammation significantly, and is equally effective as NSAIDs in animal laboratory studies. Scattered evidence from human studies have found similar antiinflammatory effects of LLLT, suggesting that this mechanism may be responsible for many of the significant effects reported in clinical LLLT studies.

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... Low-level laser therapy (LLLT) is one of the electrophysical agents used in physiotherapy to treat a wide range of pathologies (Bjordal, Lopes-Martins, Joensen, and Iversen, 2010;Hashmi et al, 2010). Three properties of a laser light in comparison with other forms of light are: 1) monochromacity; 2) collimation; and 3) coherence. ...
... These events can lead to modulation of cell metabolism, normalization of cell function, inflammation reduction, pain relief, and tissue repair (Bjordal et al, 2006;Ferreira et al, 2005;Karu, 1999). There is strong evidence that LLLT used by physiotherapists has anti-inflammatory effects (Bjordal, Lopes-Martins, Joensen, and Iversen, 2010). In a recent in vitro study, researchers demonstrated that laser has bacterial biofilm treatment potential; a significant bacterial count reduction was achieved in an animal model of acute bacterial rhinosinusitis (Krespi, Kizhner, and Kara, 2009;. ...
... Moustsen, Vinter, Aas-Andersen, and Kragstrup (1991) used the same wavelength but only irradiation of a single point in each sinus (irradiation time on each sinus 90 sec) and only three treatment sessions with one to three days interval. More current authors emphasize the need to irradiate most of the pathology, irradiate large affected tissues at several points, and have more repeated sessions to observe positive clinical outcomes (Bjordal, Lopes-Martins, Joensen, and Iversen, 2010). Recent optimal dose-finding reviews of LLLT in the head and neck region suggest that the optimal treatment parameters (e.g., dose per point, irradiation times, treatment frequency, and interval between sessions) are important to achieve meaningful results (Bjordal et al, 2011;Chow, Johnson, Lopes-Martins, and Bjordal, 2009). ...
... Low-level laser therapy (LLLT) is one of the electrophysical agents used in physiotherapy to treat a wide range of pathologies (Bjordal, Lopes-Martins, Joensen, and Iversen, 2010;Hashmi et al, 2010). Three properties of a laser light in comparison with other forms of light are: 1) monochromacity; 2) collimation; and 3) coherence. ...
... These events can lead to modulation of cell metabolism, normalization of cell function, inflammation reduction, pain relief, and tissue repair (Bjordal et al, 2006;Ferreira et al, 2005;Karu, 1999). There is strong evidence that LLLT used by physiotherapists has anti-inflammatory effects (Bjordal, Lopes-Martins, Joensen, and Iversen, 2010). In a recent in vitro study, researchers demonstrated that laser has bacterial biofilm treatment potential; a significant bacterial count reduction was achieved in an animal model of acute bacterial rhinosinusitis (Krespi, Kizhner, and Kara, 2009;. ...
... Moustsen, Vinter, Aas-Andersen, and Kragstrup (1991) used the same wavelength but only irradiation of a single point in each sinus (irradiation time on each sinus 90 sec) and only three treatment sessions with one to three days interval. More current authors emphasize the need to irradiate most of the pathology, irradiate large affected tissues at several points, and have more repeated sessions to observe positive clinical outcomes (Bjordal, Lopes-Martins, Joensen, and Iversen, 2010). Recent optimal dose-finding reviews of LLLT in the head and neck region suggest that the optimal treatment parameters (e.g., dose per point, irradiation times, treatment frequency, and interval between sessions) are important to achieve meaningful results (Bjordal et al, 2011;Chow, Johnson, Lopes-Martins, and Bjordal, 2009). ...
Article
Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients' quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest-posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0-3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (ηp(2) ηp(2) = 0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.
... The MeSH database in PubMed contains more than 7000 articles on LLLT. The effects of LLLT have been confirmed through several metaanalysis studies and include anti-inflammatory [3] and analgesic effects [4], tissue healing [5], treating tendinopathy [6], and improving lymphedema [7]. Recent lab and animal studies suggest LLLT is ready for clinical trials over myocardial infarction [5]. ...
... Recent lab and animal studies suggest LLLT is ready for clinical trials over myocardial infarction [5]. In 2010, a meta-analysis concluded that there was strong evidence of an anti-inflammatory effect of LLLT [3]. ...
... Eleven cell studies, 27 animal studies, and another six animal studies for drug comparisons and LLLT interactions verified that there is strong evidence of an anti-inflammatory effect of LLLT. The scale of the anti-inflammatory effect is not significantly different than non-steroidal anti-inflammatory drugs, but it is slightly less than glucocorticoid steroids [3]. • It has diverse applications and effects confirmed through several meta-analysis studies include analgesia [4], tissue healing [5], treating tendinopathy [6], and improved lymphedema [7]. ...
Article
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The global pandemic COVID-19 is a contagious disease and its mortality rates ranging from 1% to 5% are likely due to acute respiratory distress syndrome (ARDS), and cytokine storm. A significant proportion of patients who require intubation succumb to the disease, despite the availability of ventilators and the best treatment practices. Researchers worldwide are in search of anti-inflammatory medicines in the hope of finding a cure for COVID-19. Low-level laser therapy (LLLT) has strong, anti-inflammatory effects confirmed by meta-analyses, and it may be therapeutic to ARDS. LLLT has been used for pain management, wound healing, and other health conditions by physicians, physiotherapists, and nurses worldwide for decades. In addition, it has been used in veterinary medicine for respiratory tract disease such as pneumonia. Laser light with low-power intensity is applied to the surface of the skin to produce local and systemic effects. Based on the clinical experience, peer-reviewed studies, and solid laboratory data in experimental animal models, LLLT attenuates cytokine storm at multiple levels and reduces the major inflammatory metabolites. LLLT is a safe, effective, low-cost modality without any side-effects that may be combined with conventional treatment of ARDS. We summarize the effects of LLLT on pulmonary inflammation and we provide a protocol for augmenting medical treatment in COVID-19 patients. LLLT combined with conventional medical therapy has the potential to prevent the progression of COVID-19, minimize the length of time needed on a ventilator, enhance the healing process, and shorten recovery time. Key Words: COVID-19; ARDS; cytokine storm; low level laser therapy; anti-inflammatory; ventilator; photobiomodulation
... LLLT is an athermic photochemical modality, where red or near-infrared light is used to stimulate tissue healing and reduce pain and inflammation. [22][23][24] The working mechanisms of LLLT are partly established. There is evidence that LLLT increases adenosine triphosphate production, 25 modulates the reactive oxygen species, and the induction of transcription factors. ...
... Impossible to isolate effect, combined treatments compared with other treatment Aigner et al. 1996 2 No control group Ashok et al. 2018 3 Lacks randomisation Atik et al. 2018 4 Commentary only Bjordal et al. 2006 5 Outcomes of interest not reported Chang et al. 2015 6 Outcomes of interest not reported Cinar et al. 2013 7 Conference paper only (author contacted) Cinar et al. 2012 8 Solely abstract available Costantino et al. 2005 9 Not LLLT, high intensity laser therapy Coughlin et al. 2014 10 Solely abstract available Fernandes et al. 1991 11 Mixed population with unclear inclusion of diagnosis Foley et al. 2016 12 Not LLLT, light emitting diode therapy Jastifer et al. 2014 13 No control group Lögdberg-Andersson et al. 1994 14 Only pooled data on lower and upper extremity available Mardh et al. 2016 15 Not LLLT, high intensity laser therapy Meier et al. 1988 16 Outcomes of interest not reported Morimoto et al. 2013 17 No control group Mulcahy et al. 1995 18 Lacks credible control group, includes only 3 patients with tendinopathy Notarnicola et al. 2014 19 Not LLLT, high intensity laser therapy Olivera et al. 2009 20 Animal study Orellana-Molina et al. 2010 21 Outcomes of interest not reported Saxena et al. 2015 22 Not LLLT Scott et al. 2011 23 Review Siebert et al. 1987 24 Mixed population/diagnoses Simunovic 1996 25 Narrative review Suleymanoglu et al. 2014 26 Conference abstract Takla et al. 2019 27 Used a combination of LLLT and light emitting diode therapy Tumilty et al. 2015 28 Conference abstract Tumilty et al. 2016 29 Not LLLT, high intensity laser therapy ...
Article
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OBJECTIVES: We investigated the effectiveness of low-level laser therapy (LLLT) in lower extremity tendinopathy and plantar fasciitis on patient-reported pain and disability. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eligible articles in any language were identified through PubMed, Embase and Physiotherapy Evidence Database (PEDro) on the 20 August 2020, references, citations and experts. ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES: Only randomised controlled trials involving participants with lower extremity tendinopathy or plantar fasciitis treated with LLLT were included. DATA EXTRACTION AND SYNTHESIS: Random effects meta-analyses with dose subgroups based on the World Association for Laser Therapy treatment recommendations were conducted. Risk of bias was assessed with the PEDro scale. RESULTS: LLLT was compared with placebo (10 trials), other interventions (5 trials) and as an add-on intervention (3 trials). The study quality was moderate to high. Overall, pain was significantly reduced by LLLT at completed therapy (13.15 mm Visual Analogue Scale (VAS; 95% CI 7.82 to 18.48)) and 4–12 weeks later (12.56 mm VAS (95% CI 5.69 to 19.42)). Overall, disability was significantly reduced by LLLT at completed therapy (Standardised Mean Difference (SMD)=0.39 (95% CI 0.09 to 0.7) and 4–9 weeks later (SMD=0.32 (95% CI 0.05 to 0.59)). Compared with placebo control, the recommended doses significantly reduced pain at completed therapy (14.98 mm VAS (95% CI 3.74 to 26.22)) and 4–8 weeks later (14.00 mm VAS (95% CI 2.81 to 25.19)). The recommended doses significantly reduced pain as an add-on to exercise therapy versus exercise therapy alone at completed therapy (18.15 mm VAS (95% CI 10.55 to 25.76)) and 4–9 weeks later (15.90 mm VAS (95% CI 2.3 to 29.51)). No adverse events were reported. CONCLUSION LLLT significantly reduces pain and disability in lower extremity tendinopathy and plantar fasciitis in the short and medium term. Long-term data were not available. Some uncertainty about the effect size remains due to wide CIs and lack of large trials. PROSPERO REGISTRATION NUMBER: CRD42017077511.
... According to Chung et al [17] the therapeutic use of LLLT in the red and near infrared wavelengths can be divided in three main areas: 1) reducing inflammation and edema; 2) wound healing and tissue repair and 3) pain relief and treatment from neurological disorders. Some examples from murine models include edema, inflammatory infiltrate and proinflammatory cytokines expression reduction in joint disorders [18, 19, 20, 21]; renal function improvement, decreased blood pressure and lowered expression of cytokines in renal disease [22, 23]; decreased fibrosis in diabetic rats with muscle injury [24]; and pain reduction after induced neuropathic pain [25]. In vitro assays have shown LLLT's immunomodulatory potential as demonstrated by lower expression and synthesis of inflammatory cytokines by murine monocytes/macrophages stimulated by proinflammatory agents like lipopolysaccharides or interferon-γ [26, 27]. ...
... As mentioned before, to our knowledge there are no studies using phototherapy to treat the inflammatory component of MetS. That being said, our irradiation parameters were based on LLLT application on chronic inflammatory conditions, which usually adopts lower energy density and power density [19, 21, 22, 24, 42]. We recognize opportunities for improvement and other irradiation protocols should be evaluated. ...
Article
Metabolic syndrome comprises a constellation of morbidities such as insulin resistance, hyperinsulinemia, atherogenic dyslipidemia, dysglycemia and obesity (especially abdominal). Metabolic alterations are observed in major insulin target organs, increasing the risk of cardiovascular diseases, type-2 diabetes and therefore mortality. Tissue alterations are characterized by immune cells infiltrates (especially activated macrophages). Released inflammatory mediators such as TNF-α induce chronic inflammation in subjects with metabolic syndrome, since inflammatory pathways are activated in the neighboring cells. The intra-abdominal adipose tissue appears to be of particular importance in the onset of the inflammatory state, and strategies contributing to modulate the inflammatory process within this adipose tissue can mitigate the metabolic syndrome consequences. Considering the low level light therapy (LLLT) recognized benefits in inflammatory conditions, we hypothesized this therapeutic approach could promote positive effects in modulating the inflammatory state of metabolic syndrome. That being the scope of this study, male C57BL/6 mice were submitted to a high-fat/high-fructose diet among 8 weeks to induce metabolic syndrome. Animals were then irradiated on the abdominal region during 21 days using an 850 nm LED (6 sessions, 300 seconds per session, 60 mW output power, ~6 J/cm2 fluence, ~19 mW/cm2 fluence rate). Before and during treatment, blood was sampled either from the retroorbital plexus or from tail puncture for glucose, total cholesterol and triglycerides analysis. So far our results indicate no alterations on these metabolic parameters after LLLT. For further investigations, blood was collected for plasma inflammatory cytokine quantification and fresh ex vivo samples of liver and intra-abdominal adipose tissue were harvested for immunohistochemistry purposes.
... Both tracks have been extensively investigated by reviews of nearly 200 experimental LLLT studies (Gao and Xing 2009;Bjordal et al. 2006Bjordal et al. , 2010. For both tracks, the vast majority of experimental studies show consistently positive results for one or more LLLT doses and fairly systematic dose-response patterns. ...
... The investigated wavelengths between 632-680, 810-830, and 904 nm induced significant anti-inflammatory effects in cell and animal trials. We have previously estimated that the median value for laser mean optical output was 25 mW in the animal studies where anti-inflammatory LLLT effects have been demonstrated (Bjordal et al. 2010). Likewise, the lower limits for achieving anti-inflammatory effects were found to be 0.6 J/cm 2 in animal studies, and the lower limit for irradiation time was 16 s. ...
Chapter
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Musculoskeletal disorders are burdens to modern society, and they account for a considerable amount of sick-listing and permanent work disability. Disorders of the spinal column are common, while arthritis and tendinitis are more common in the extremities. Arthritis may have a systemic rheumatic inflammatory origin and cause inflammation in several joints across the life span. Both rheumatoid arthritis and osteoarthri-tis exhibit inflammatory and degenerative signs. Rheumatoid arthritis may be aggressive and result in severe inflammation and eventually joint erosions, but the development of pharmaceutical agents like tumor necrosis factor-alpha (TNF-α) inhibitors (infliximab, etanercept, etc.) has brought new possibilities for inhibiting inflammatory processes, pain, and disability. In this chapter, we will focus more on osteoarthritis and tendinitis, which seem to exhibit more similarities than differences. 52.2 Osteoarthritis Pathology Osteoarthritis has a strong relation to older age and degenera-tion of tissue cartilage and other joint structures. Progression of cartilage degeneration is predominantly slow and almost never seen in uninjured joints before the fourth decade of the human life span. Inflammatory signs like synovitis, subchondral bone marrow lesions, and edema seem to be associated with cartilage degeneration and a poorer prognosis in the clinical setting (Dore et al. 2010; Hunter et al. 2011). Sustained inflammation in experimental animal models has been shown to induce infiltration of mononuclear cells and considerable degenerative changes in cartilage , joint fluid, and synovia. Moderate to severe osteoarthritis has limited, if any, possibility for cartilage repair. In particular, moderate to severe osteoarthritis usually involves irreparable destruction of the osteochondral endplate, resulting in exposure of subchondral bone to inflammatory cytokines from the syno-vial fluid, altered biomechanical conditions, and impaired sub-chondral vascular architecture (Suri and Walsh 2012). For tendinitis, on the other hand, inflammation is prevalent at the onset and early stages of this diagnosis and tendinitis may be seen across the whole life span. It is often seen as a result of repetitive overload, and while sports-induced tendinitis occurs in all age groups, it is often seen in sporting adolescents (Cook et al. 2000). The wider term tendinopathy has been introduced because the inflammatory component (-nitis) seems less dominant than degeneration in long-term tendon symptoms (Khan et al. 2002). Broadly under the tendinopathy term, tendinitis is characterized 52
... Odontológicos Ltda., Taubaté, SP, Brazil) with wavelength of 795 nm, energy density of 8 J/ cm 2 , average power density of 63.6 mW/cm 2 , beam area of 5.3 cm 2 and power level of 120 mW. Continuous emission was done for 66 seconds per point of application [31]. Following the biosafety rules for laser application, the equipment was protected by a plastic film, and the volunteer and the professional used safety glasses during the phototherapy. ...
... Some mechanisms of laser action are cited in the literature, as increase on the endogenous opiates liberation, decrease on the permeability of the nerve cell membrane and increase on the ATP production [14]. The reduction on the levels of creatine kinase activity, a cytokine involved in the early phase of muscle damage, and C-reactive protein, a marker of systemic inflammation, is also reported in the literature [31]. ...
Article
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Objective: To report two cases of low level laser therapy used in the treatment of muscle pain caused by temporomandibular disorders (TMDs). Methods: Two patients of the Sao Jose dos Campos Dental School (UNESP) were selected and subjected to eight applications of low level laser therapy (diode). Laser was punctually applied on masseter and temporalis muscles bilaterally. Three methods were used to evaluate the effectiveness of treatment: pressure algometer, visual analog scale (VAS) and maximal mouth opening. Each measure was performed before and after the laser therapy session. The results were subjected to statistical analysis (ANOVA two factors and Tukey's test, α = 0.05). Results: For both patients, no significant difference was found between the results obtained by algometer before and after laser application within each session. Nonetheless, VAS showed a tendency to lower values after laser application. The highest values obtained by the pressure algometer were found between days 9 (fourth application) and 16 (sixth application), in both cases. Both patients had an improvement in mouth opening. Conclusions: The assessment methods used were quite practical to register the pain before and after treatment. Therapy with low level laser seems to have a beneficial effect for muscle pain of temporomandibular joint (TMJ).
... However, PBM effects on the defence mechanisms against excessive ROS production are not well understood, since there is a great divergence between doses, exposure times, and intensities applied in the studies [41]. Besides, the use of PBM is already well established for clinical purposes to reduce inflammatory process [46]. The expression and secretion of inflammatory cytokines, prostaglandin E2 (PGE2), tumor-necrosis factor (TNF)-α, cyclooxygenase-2 (COX-2), and interleukin 1 beta (IL-1β) can be inhibited by PBM exposure [46,47]. ...
... Besides, the use of PBM is already well established for clinical purposes to reduce inflammatory process [46]. The expression and secretion of inflammatory cytokines, prostaglandin E2 (PGE2), tumor-necrosis factor (TNF)-α, cyclooxygenase-2 (COX-2), and interleukin 1 beta (IL-1β) can be inhibited by PBM exposure [46,47]. ...
Article
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High-fat diets lead to accumulation of body fat that is associated with the onset of insulin resistance and type II diabetes mellitus. On the other hand, photobiomodulation (PBM) is an electrophysical resource that interacts with cells, stimulating mitochondrial respiration, increasing ATP production, reducing key inflammatory mediators, inhibiting apoptosis, and stimulating angiogenesis. However, little is known about its therapeutic effectiveness on the development of diabetes in diet-induced obese mice. Thus, our aim was to evaluate the effect of PBM applied single point over the pancreas area on glucose homeostasis, insulin expression, and pancreatic morphometric parameters of mice submitted to high-fat diet for 12 weeks. Male mice C57BL6/J were divided into three groups: control group (C), diabetic group (D), and diabetic + PBM (D + PBM). The treatment with PBM started at 9th week and ended in the 12th week, applied 3 × /week. Body mass, fast blood glucose, and glucose and insulin tolerance were evaluated. Immunohistochemistry to detect insulin expression and pancreatic morphometry were also performed. At the end of 12th week, both groups submitted to high-fat diet showed an increase in body mass, adiposity, disturbances on glucose homeostasis, and high insulin expression when compared to the control group. However, mice treated with PBM had more discrete impairments on glucose homeostasis during the glucose tolerance test when compared to untreated D animals. Despite modest, the results were positive and encourage future investigations to explore different doses and duration of PBM to better elucidate its role in obesity-associated type 2 diabetes development.
... Experimental studies have shown that laser reduces the presence of pro-inflammatory substances associated with pain, such as agents interleukin-1β (IL-1β), cyclooxygenase-2 (COX-2), and prostaglandin E2 (PGE2) [21,22]. ...
Article
Full-text available
Variables studied: pain intensity assessed by visual analog scale (VAS), degree of flexion of the affected hip measured by the universal goniometer and functional capacity assessed by the Oswestry Disability Index. The three groups had statistically significant improvement in lumbar and radicular pain, in hip mobility, and in the functional disability index (p ≤ 0.001). There was a statistically significant difference (p = 0.024) in radicular pain between the groups, gait claudication and Oswestry Disability Index. We can conclude that in the treatment of L4-L5 and L5-S1 LDH with radiculopathy, LED, associated with lateral decubitus position and flexion exercises of the lower limbs, showed better therapeutic performance for radicular pain, gait claudication, and functional disability.
... Human studies have shown similar anti-inflammatory effects with LLLT, which may account for many of the associated positive clinical effects. 13 ...
Article
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Background: Laser acupuncture (LA)-the use of nonthermal, low-intensity laser irradiation to stimulate acupuncture points-has become more common among acupuncture practitioners in recent years. LA is promoted as a safer pain-free alternative to traditional acupuncture, with minimal adverse effects and greater versatility. However, little is known about the mechanism of action of LA, laser characteristics, and effectiveness of LA therapy. Objective: This concise review of LA describes basic parameters and procedures, potential mechanisms of action, and the current evidence for its clinical efficacy. The article also highlights the need for more robust research on LA that can be translated into evidence-based clinical practices. Conclusions: LA has many features that make it an attractive option as a treatment modality, including minimal sensation; short duration of treatment; and minimal risks of infection, trauma, and bleeding complications. Future studies with high-quality methodologies, ample sample sizes, and consistent and reproducible laser parameters are critically needed to increase understanding and establish potential future clinical applications.
... In addition, Bjordal et al reported that the magnitude of suppression of peripheral inflammation by low level lasers is not significantly different from non-steroidal antiinflammatory drugs [29]. ...
Article
We evaluate the efficacy of laser acupuncture on the elbow range of motion in rheumatoid arthritis patients. Rheumatoid arthritis is the most common autoimmune inflammatory joint disease seen in clinical practice. Interventions for treating patients with rheumatoid arthritis are under investigation. Forty subjects in the age range of 50-60 years old were divided into two groups; each group consisted of twenty subjects. The first group had undergone laser acupuncture treatment. The other group consisted of healthy subjects, forming the control group. A computer vision system was used for elbow range of motion (ROM) measurement before and after 12 sessions of treatment. The results showed that the pre-A nd post-treatment mean values ±SD of elbow flexion ROM were 143.75 ± 2.68 and 144.89 ± 3.12°, respectively. The differences between pre and post treatment mean values ±SD of elbow flexion ROM was non-significant (P > 0.05). The pre and post treatment mean values ±SD of elbow extension ROM were 1.01° ± 4.01° and 3.07° ± 1.25°, respectively. The differences between pre-A nd post-treatment mean values ±SD of elbow extension ROM was significant (P < 0.05). It was concluded that laser acupuncture significantly increased elbow extension ROM in patients with rheumatoid arthritis.
... In experimental wound healing studies, photobiomodulation has been reported to improve rates of healing (less time for wound closure), collagen formation, wound tensile strength, and flap survival. 12 It was also shown to resolve inflammation, 13 reduce the pain associated with chronic neuropathic lesions and chronic joint disorders, 12,[14][15][16][17] and reduce acute soft tissue injury edema after second-degree ankle sprain, 18 compared with standard care (rest, ice compress application, and elevation). Positive outcomes (ie, reduction of pain, improved function, faster recovery, and circulating concentrations of markers for inflammation and muscle damage) have been associated with photobiomodulation therapy for diseases such as osteoarthritis, tendinopathies, wounds, muscle fatigue, and various neurologic dysfunctions 19,20 in human clinical trials. ...
Article
OBJECTIVE: To evaluate the effects of postoperative photobiomodulation therapy and physical rehabilitation on early recovery variables for dogs after hemilaminectomy for treatment of intervertebral disk disease. ANIMALS: 32 nonambulatory client-owned dogs. PROCEDURES: Dogs received standard postoperative care with photobiomodulation therapy (n = 11), physical rehabilitation with sham photobiomodulation treatment (11), or sham photobiomodulation treatment only (10) after surgery. Neurologic status at admission, diagnostic and surgical variables, duration of postoperative IV analgesic administration, and recovery grades (over 10 days after surgery) were assessed. Time to reach recovery grades B (able to support weight with some help), C (initial limb movements present), and D (ambulatory [≥ 3 steps unassisted]) was compared among groups. Factors associated with ability to ambulate on day 10 or at last follow-up were assessed. RESULTS: Time to reach recovery grades B, C, and D and duration of postoperative IV opioid administration did not differ among groups. Neurologic score at admission and surgeon experience were negatively associated with the dogs' ability to ambulate on day 10. The number of disk herniations identified by diagnostic imaging before surgery was negatively associated with ambulatory status at last follow-up. No other significant associations and no adverse treatment-related events were identified. CONCLUSIONS AND CLINICAL RELEVANCE: This study found no difference in recovery-related variables among dogs that received photobiomodulation therapy, physical rehabilitation with sham photobiomodulation treatment, or sham photobiomodulation treatment only. Larger studies are needed to better evaluate effects of these postoperative treatments on dogs treated surgically for intervertebral disk disease.
... There is increasing interest in the application of near-infrared (NIR) light for the treatment of various musculoskeletal disorders, where the NIR light is used to reduce pain and inflammation and to stimulate tissue healing [1][2][3][4][5]. A number of studies showed that high power laser therapy alone can effectively be applied to treat various musculoskeletal disorders (for examples and references, see [6]). ...
Preprint
There is increasing interest in the application of near-infrared (NIR) laser light for the treatment of various musculoskeletal disorders. The present study thoroughly examined the physical characteristics of laser beams from two different laser therapy devices that are commercially available for the treatment of musculoskeletal disorders. Then, these laser beams were used to measure the penetration depth in various biological tissues from different animal species. The key result of the present study was the finding that for all investigated tissues, most of the initial light energy was lost in the first one to two millimeters, more than 90% of the light energy was absorbed within the first ten millimeters, and there was hardly any light energy left after 15 – 20 mm of tissue. Furthermore, the investigated laser therapy devices fundamentally differed in several laser beam parameters that can have an influence on how light is transmitted through tissue. Overall, the present study showed that a laser therapy device that is supposed to reach deep layers of tissue for treatments of musculoskeletal disorders should operate with a wavelength between 800 nm and 905 nm, a top-hat beam profile, and it should emit very short pulses with a large peak power.
... W praktyce klinicznej optyczne promieniowanie elektromagnetyczne z zakresu widmowego (600-1000) nm jest stosowane w leczeniu lub wspomaganiu leczenia urazów tkanek miękkich [4,[10][11][12][13][14][15][16], ran [17][18][19][20][21][22], przewlekłego bólu [23][24][25][26][27][28] i wielu innych jednostek chorobowych [29][30][31][32][33][34][35][36][37][38][39][40][41]. Zakres widmowy (600-1000) nm obejmuje okno transmisji tkanek, co pozwala na efektywne naświetlanie stosunkowo grubych (nawet do 50 mm) warstw tkanek. ...
Chapter
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Light emitting diodes are used for research and treatments of a wide variety of medical indications. Selected problems of interaction of LEDs radiation from the UV-VIS-NIR spectral range with basic structures of organism (cells, tissues) and these emitters’ applications in medical and treatment procedures were considered in the work. Also, the impact of physical parameters of LEDs light on obtained biological effects in in vitro tests and therapeutic effects in in vivo research was discussed. The developed optoelectronic diagnostic set for objectification of light irradiation and for studies the effect of low-energy optical radiation to cell lines as well as for measurements spectral parameters of patients’ skin and thin biological centers was presented too. Praca poświęcona jest wybranym problemom oddziaływania promieniowania diod elektroluminescencyjnych z zakresu UV-VIS-NIR na podstawowe struktury organizmu (komórki, tkanki) oraz ich zastosowaniu w procedurach medycznych i terapeutycznych. Przedstawione zostały półprzewodnikowe źródła LED wykorzystywane do badań i terapii bardzo różnych wskazań medycznych, a także wpływ ich fizycznych parametrów na uzyskiwany efekt biologiczny w przypadku badań in vitro i leczniczy w przypadku badań in vivo. Przedstawiono też opracowany optoelektroniczny układ diagnostyczny do obiektywizacji naświetlań i badań wpływu niskoenergetycznego promieniowania optycznego na linie komórkowe oraz pomiaru parametrów spektralnych skóry pacjentów i cienkich ośrodków biologicznych.
... trudno gojące się rany [84,95,170] i owrzodzenia [109], odleżyny [110], obrzęk limfatyczny [111], przewlekłe stany zapalne [112], utrudniony zrost kości [99], choroby stawów [94,96] i ścięgien [93], trądzik pospolity [113], choroby skóry [114], ostry i przewlekły ból różnego pochodzenia [91, 92,171,172], nadwrażliwość zębów [98], a także inne [50,67,70,97,[151][152][153]. Część spośród nich nie jest do tej pory dobrze udokumentowana naukowo i w związku z tym nie daje podstaw do powszechnego stosowania [47,62]. ...
Thesis
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Rozprawa doktorska METODA l URZĄDZENIE DO WYZNACZANIA WYBRANYCH PARAMETRÓW OPTYCZNYCH TKANEK PODDANYCH ZABIEGOWI BIOSTYMULACJI LASEROWEJ poświęcona jest problematyce niskoenergetycznego oddziaływania promieniowania optycznego z zakresu spektralnego okna optycznego transmisji tkanek (600-1000) nm na ośrodki biologiczne, czyli procedurom Low Level Light Therapy. Motywacją podjęcia badań były zauważone w dostępnej literaturze przedmiotu niejednoznaczności dotyczące wyników badań odpowiedzi biologicznych komórek, tkanek i narządów powodowanych przez przeprowadzone naświetlania promieniowaniem laserowym o niskiej mocy. Występuje wiele nawzajem wykluczających się konkluzji odnośnie skuteczności danego źródła i parametrów promieniowania bądź metody realizacji zabiegu terapeutycznego. W związku z brakiem narzędzi do standaryzacji badań wpływu parametrów spektralnych i energetycznych promieniowania optycznego na wybrane procesy fizjologiczne komórek przyjęto podstawowe cele dysertacji: Zaprojektowanie, wykonanie i przetestowanie układu do obiektywnej weryfikacji parametrów spektralnych i energetycznych wiązki promieniowania istotnych dla realizowanego zabiegu, odpowiadających za efekty biostymulacyjne. Opracowanie metody i układu pomiarowego realizującego pomiar widma absorpcji ośrodka biologicznego, a także widma odbicia ośrodka w trakcie trwania zabiegu biostymulacji światłem. W wyniku realizacji rozprawy powstał optoelektroniczny układ diagnostyczny pozwalający na naświetlanie ośrodka promieniowaniem elektromagnetycznym (laserowym lub diod LED) z zakresu okna transmisji tkanek (600-1000) nm o w pełni weryfikowalnych parametrach radiometrycznych (w tym widmowych): długość fali promieniowania, moc optyczna promieniowania źródła, irradiancja i jej rozkład na próbce, irradiancja spektralna i jej rozkład na próbce, obszar oddziaływania, powierzchniowa doza energii. Układ umożliwia również pomiar parametrów optycznych próbki (widma absorpcji lub odbicia) w trakcie zabiegu w celu selekcji odpowiedniego emitera dla danej aplikacji. Pochłonięta energia fotonów umożliwia indukowanie zmian w tkankach oraz może pełnić rolę katalizatora reakcji biochemicznych. Do najważniejszych i oryginalnych osiągnięć niniejszej rozprawy doktorskiej należy zaliczyć: Opracowanie i zestawienie układu oświetlacza laserowego z wyselekcjonowanego zestawu laserów półprzewodnikowych średniej mocy zapewniającego możliwość dostrojenia długości fali źródła do pasm absorpcyjnych chromoforów istotnych dla procedur LLLT. Układ zapewnia możliwość strojenia długości fali w całym zakresie spektralnym (625-990) nm - oknie optycznym tkanek. Opracowanie i zestawienie układu szerokopasmowego oświetlacza LED-owego emitującego w zakresie spektralnym (620-980) nm jednorodny rozkład spektralnej gęstości mocy - będącego źródłem dla pomiarów parametrów widmowych ośrodka biologicznego. Do układu wyselekcjonowano zestaw diod LED dużej mocy. Opracowanie i zestawienie układu aplikatora zapewniającego obiektywizację naświetlań LLLT: równomierny rozkład irradiancji i irradiancji spektralnej w polu oddziaływania z ośrodkiem poddanym oddziaływaniu oraz zwiększającego skuteczność dozowania energii promieniowania eksponowanym liniom komórkowym. Opracowanie i zestawienie układów sprzęgaczy optycznych dla promieniowania oświetlaczy: laserowego (zwiększającego kąt rozbieżności wiązki) i LED-owego, celem wprowadzenia promieniowania do komory pomiarowej. Opracowanie i weryfikacja metod analizy spektralnej promieniowania zaabsorbowanego bądź odbitego od biologicznego ośrodka. Weryfikacja opracowanych układów do obiektywizacji procedur biostymulacyjnych na liniach komórkowych - przeprowadzono szereg badań doświadczalnych na liniach komórek śródbłonka naczyniowego pobranych z krwi pępowinowej - HUVEC. Eksperymentalna weryfikacja wpływu parametrów energetycznych i spektralnych wiązki promieniowania stosowanej w procedurach biostymulacyjnych na odpowiedź biologiczną linii komórkowych HUVEC. Uzyskano mierzalne zmiany parametrów komórkowych wiążące odpowiedź biologiczną komórek (proliferację komórek oraz ekspresję genów czynnika wzrostu) z parametrami fizycznymi zabiegu. Wyniki pracy stanowić mogą punkt wyjścia do dalszych prac badawczych konfrontujących wpływ parametrów promieniowania na odpowiedź biologiczną komórek i być może rozwiązania zagadnienia jak przebiegają szlaki sygnalizacyjne w komórkach i wybór najistotniejszego z nich oraz dobór najefektywniejszego źródła promieniowania optycznego dla danej aplikacji biostymulacyjnej. Opracowany układ może też posłużyć do weryfikacji problemu wpływu stanu polaryzacji wiązki promieniowania, stosowanej w procedurach biostymulacyjnych na skuteczność zabiegów. PhD thesis METHOD AND DEVICE FOR DETERMINING SELECTED OPTICAL PARAMETERS OF TISSUES IN LASER BIOSTIMULATION THERAPY is devoted to the problems of Low Level Light Therapy procedures. Low Level Light Therapy uses low-power optical radiation correlated with tissue optical window spectral range (600-1000) nm to effect on biological media. The ambiguities of biological responses results of cells, tissues and organs as consequence of low-power irradiation found in available literature were the motivation to take the study. There are many other conflicting conclusions on the effectiveness of the radiation source, radiation parameters or realization methods of therapeutic treatment. Due to the lack of tools to standardize the investigations the effect of spectral and energy parameters of optical radiation to the selected physiological processes in cells were adopted the basic aims of the dissertation: - to design, implement and test the set for objective verification of spectral and energy parameters of radiation beam relevant for the realized procedure – responsible for biostimulation effects. - to develop the method and the measurement system realizing measurement of the absorption spectrum of the biological medium, as well as reflection spectrum of the biological center during light biostimulation procedure. As a result of the thesis realization optoelectronic diagnostic set was made. It allows to irradiate medium with electromagnetic radiation (laser or LED) in the range of tissue transmission window (600-1000) nm with fully verifiable radiometric and spectral parameters: radiation wavelength, optical power of the radiation source, irradiance and its distribution on the sample surface, spectral irradiance and its distribution on the sample surface, area of irradiation, surface energy dose. The set also enables the measurement of optical parameters of the sample (absorption or reflection spectra) during procedure in order to select the appropriate emitter for the application. Absorbed photon energy enables to induce changes in the biological tissues and can act as a catalyst for biochemical reactions. The most important and original achievements of the present PhD thesis are: - Developing and building the laser illuminator from selected set of medium-power semiconductor lasers providing the ability to tune the wavelength of the source to the chromospheres absorption bands relevant to the LLLT procedures. The set provides the ability to tune wavelength in the entire spectral range (625-990) nm – tissue optical window. - Developing and building the broadband LED illuminator emitting homogeneous distribution of spectral power density in the spectral range (620-980) nm – it is the source for the measurement of spectral parameters of the biological medium. High power LEDs were selected to the set. - Developing and building the applicator providing the objectification of LLLT irradiation: uniform distribution of irradiance and spectral irradiance in the irradiation area with the medium subjected to irradiation and increasing the effectiveness of application of radiation energy to exposed cell lines. - Developing and building optical couplers systems for illuminators radiation: laser illuminator (which increasing beam divergence angle) and LED illuminator in order to introduce radiation into the measuring chamber. - Developing and verifying methods of spectral analysis of absorbed and reflected radiation from the biological medium. - Verifying the system developed for objective biostimulation procedures on cell lines – a series of experiments were carried out on the series of vascular endothelial cells lines taken from umbilical cord blood – HUVEC. - Analyzing the problem of the effect of energy and spectral parameters of the radiation beam used in the biostimulation procedures on the biological response of HUVEC cell lines. Measurable cellular effects binding a biological response of cells (cell proliferation and growth factor gene expression) with procedure parameters were obtained. The results of the thesis can be the starting point for further research confronting the effect of different parameters of radiation on the biological cells response. Perhaps it resolves issues as signaling pathways run in the cells and choice the most important of them. Then could be selection the most efficient source of optical radiation for a given application of biostimulation. The developed set can also be used to verify the problem of the effect of polarization state of the radiation beam used in the biostimulation procedures on the effectiveness of treatments. Results and solutions of semispherical applicator may also be used for other (non-biological) studies. For example, to measurements of luminescence, there the important problem is the optical excitation efficiency of the tested elements and systems.
... 175 Current known mechanisms of LLLT action have been well reviewed 4,195,196 and include roles for cytochrome-c-oxidase and mitochondrial energy production, 196 retrograde mitochondrial signaling, 197 NOS modulation, 173,181,196,198,199 electron transfer via a redox reaction 200 resulting in antioxidant enzyme activity, 201,202 restoration of balance between pro-and antioxidant mediators by increasing peroxisome proliferator-activated receptor expression and glutathione concentration, 203 modulation of hypoxia-inducible factor 1a (HIF-1a), 204 reduction in TNF-a, 205 modulation of inflammatory cytokines and ILs, NF-kB, 206,207 IL-6, and IL-1b, 208 modulation of growth factors IGF-1, and transforming growth factor beta-1 (TGF-b1), 201 modulation of opioid and its precursor molecule proopiomelanocortin (the melanocortin signaling system), 209 and cytokine abscopal effects. 155 LLLT is known to downregulate the inflammatory process 210 by increasing antioxidants and decreasing oxidative stress, 211 via the mechanisms described earlier and by increasing superoxide dismutase. 201,203 PBM also directly affects the cell signaling molecule MAPK. ...
Article
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Postoperative cognitive dysfunction (POCD) is a decline in memory following anaesthesia and surgery in elderly patients. While often reversible, it consumes medical resources, compromises patient well-being, and possibly accelerates progression into Alzheimer's disease. Anesthetics have been implicated in POCD, as has neuroinflammation, as indicated by cytokine inflammatory markers. Photobiomodulation (PBM) is an effective treatment for a number of conditions, including inflammation. PBM also has a direct effect on microtubule disassembly in neurons with the formation of small, reversible varicosities, which cause neural blockade and alleviation of pain symptoms. This mimics endogenously formed varicosities that are neuroprotective against damage, toxins, and the formation of larger, destructive varicosities and focal swellings. It is proposed that PBM may be effective as a preconditioning treatment against POCD; similar to the PBM treatment, protective and abscopal effects that have been demonstrated in experimental models of macular degeneration, neurological, and cardiac conditions.
... Many studies indicate that LLLT could inhibit the expression and secretion of inflammatory cytokines, such as IL-1β, TNF-α, prostaglandin E2 (PGE 2 ) and cyclooxygenase-2 (COX-2), in the initial stage of inflammation [5]. LLLT involves a complexity of biophysical, photobiological, pathological and clinical aspects, and treatment success may be compromised by a lack of understanding of the mechanisms. ...
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The aim of this study was to investigate the effects of low-level laser therapy (LLLT) on a rat model of lipopolysaccharide (LPS)-induced mastitis and its underlying molecular mechanisms. The rat model of mastitis was induced by inoculation of LPS through the canals of the mammary gland. The results showed that LPS-induced secretion of IL-1β and IL-8 significantly decreased after LLLT (650 nm, 2.5 mW, 30 mW/cm(2)). LLLT also inhibited intercellular adhesion molecule-1 (ICAM-1) expression and attenuated the LPS-induced decrease the expression of CD62L and increase the expression of CD11b. Moreover, LLLT also suppressed LPS-induced polymorphonuclear neutrophils (PMNs) entering the alveoli of the mammary gland. The number of PMNs in the mammary alveolus and the myeloperoxidase (MPO) activity were decreased after LLLT. These results suggested that LLLT therapy is beneficial in decreasing the somatic cell count and improving milk nutritional quality in cows with an intramammary infection.
... LLLT, however, decreased NF-kB gene expression, suggesting that this effect could be responsible for the reduced amount of pro-inflammatory mediators in this model. As discussed above, LLLT mediated anti-inflammatory effects could be a consequence of NF-kB reduction or inactivation [40][41][42][43]. ...
... Presently, cytochrome c oxidase, opsins and their associated calcium channels, and water molecules have been identified as the main mediators The Medical Subject Heading (MeSH) database in PubMed contains more than 7000 articles on LLLT. The effects of LLLT have been confirmed through several meta-analysis studies and include anti-inflammatory 3 and analgesic effects 4 , tissue healing 5 , treating tendinopathy 6 , improving lymphedema 7 . Recent lab and animal studies suggest LLLT is ready for clinical trials over myocardial infarction 5 . ...
Article
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S Mokmeli MD, M Vetrici MD. Low level laser therapy as a modality to attenuate cytokine storm at multiple levels, enhance recovery, and reduce the use of ventilators in COVID-19. Can J Respir Ther 2020;56:1-7. doi: 10.29390/cjrt-2019-015. The global pandemic COVID-19 is a contagious disease and its mortality rates ranging from 1% to 5% are likely due to acute respiratory distress syndrome (ARDS), and cytokine storm. A significant proportion of patients who require intubation succumb to the disease, despite the availability of ventilators and the best treatment practices. Researchers worldwide are in search of anti-inflammatory medicines in the hope of finding a cure for COVID-19. Low-level laser therapy (LLLT) has strong, anti-inflammatory effects confirmed by meta-analyses, and it may be therapeutic to ARDS. LLLT has been used for pain management, wound healing, and other health conditions by physicians, physiotherapists, and nurses worldwide for decades. In addition, it has been used in veterinary medicine for respiratory tract disease such as pneumonia. Laser light with low-power intensity is applied to the surface of the skin to produce local and systemic effects. Based on the clinical experience, peer-reviewed studies, and solid laboratory data in experimental animal models, LLLT attenuates cytokine storm at multiple levels and reduces the major inflammatory metabolites. LLLT is a safe, effective, low-cost modality without any side-effects that may be combined with conventional treatment of ARDS. We summarize the effects of LLLT on pulmonary inflammation and we provide a protocol for augmenting medical treatment in COVID-19 patients. LLLT combined with conventional medical therapy has the potential to prevent the progression of COVID-19, minimize the length of time needed on a ventilator, enhance the healing process, and shorten recovery time.
... 11 The anti-inflammatory mechanism of PBM and its clinical use in physiotherapy. 12 To reduce pain and swelling after implantation and accelerates bone formation around it. 13 E) To reduce pain during orthodontic treatment and accelerate tooth movement, to accelerate bone destruction and bone formation together. ...
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Results: The results of this study showed that the necessity for supplemental injection was lower in the group receiving laser than in the group without laser (P = 0.033). The mean pain intensity during dentin cutting was lower in the group receiving laser than in the group without laser (P = 0.031). Also, the mean pain intensity during pulp dropping was lower in the group receiving laser, than the group without laser (P = 0.021). Conclusion: Based on the results of this study, it seems that the application of PBM before anesthesia is effective on increasing depth of anesthesia.
... Low level laser therapy (LLLT), also known as photobiomodulation therapy (PBMT) is a noninvasive, safe modality with significant anti-inflammatory effects confirmed by meta-analyses [8]. It is approved for pain management, tissue healing, and lymphedema reduction. ...
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Introduction: COVID-19 poses a higher risk of complications in obese patients due to low respiratory system compliance, increased inflammatory cytokines, and an activated immune system secondary to excess adiposity. Low level laser therapy (LLLT) has significant anti-inflammatory effects and reduces inflammatory cytokines. It is noninvasive and approved for pain management and musculoskeletal injuries. Data from human and experimental animal models of respiratory tract disease suggests that LLLT reduces inflammation and promotes lung healing. Case and outcomes: A morbidly obese 32-year-old Asian female with severe COVID-19 received four consecutive once-daily LLLT sessions via a laser scanner. Pulsed 808 nm and 905 nm laser beams were delivered over the posterior chest for 28 min. The patient was evaluated before and after LLLT by radiological assessment of lung edema (RALE) on chest X-ray, oxygen requirements and saturation, pneumonia severity indices (SMART-COP and Brescia-COVID), blood inflammatory markers (interleukin-6, ferritin, and C-Reactive protein (CRP)). Prior to treatment, oxygen saturation (SpO2) via pulse oximetry was 88%-93% on 5-6 L oxygen. Following LLLT, SpO2 increased to 97%-99% on 1-3 L oxygen. Reductions in RALE score from 8 to 3, Brescia-COVID from 4 to 0, and SMART-COP from 5 to 0 were observed. Interleukin-6 decreased from 45.89 to 11.7 pg/mL, ferritin from 359 to 175 ng/mL, and CRP from 3.04 to 1.43 mg/dL. Post-treatment, the patient noted appreciable improvement in respiratory symptoms. Conclusion: Following LLLT our patient showed improvement over a few days in respiratory indices, radiological findings, inflammatory markers, and patient outcomes. This report suggests that adjunct LLLT can be safely combined with conventional treatment in patients with severe COVID-19 and morbid obesity.
... Normally the bones and the tendon connection area have low absorption capacity, so the frequency will depend on the injury [32,33]. Laser therapy accelerates energy metabolism and tissue synthesis as reported by several studies, [34][35][36]. Lowlevel laser stimulates the cells and modulates inflammatory processes [37][38][39], produces an increment of collagen production in the tendons structure [30,[40][41][42] and reduces the levels of inflammation [43,44]. Electrostimulation for neuromuscular-skeletal mild to moderate pain is based on transcutaneous electrical nerve stimulation (TENS) and ...
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Nowadays, after suffering a fracture in an upper or lower limb, a plaster cast is placed on the affected limb. It is a very old and efficient technique for recovery from an injury that has not had significant changes since its origin. This project aims to develop a new low-cost smart 3D printed splint concept by using new sensing techniques. Two rapidly evolving Advanced Manufacturing (AM) technologies will be used: 3D scanning and 3D printing, thus combining engineering, medicine and materials evolution. The splint will include new small and lightweight sensors to detect any problem during the treatment process. Previous studies have already incorporated this kind of sensor for medical purposes. However, in this study it is implemented with a new concept: the possibility of applying treatments during the immobilization process and obtaining information from the sensors to modify the treatment. Due to this, rehabilitation treatments like infrared, ultrasounds or electroshock may be applied during the treatment, and the sensors (as it is showed in the study) will be able to detect changes during the rehabilitation process. Data of the pressure, temperature, humidity and colour of the skin will be collected in real time and sent to a mobile device so that they can be consulted remotely by a specialist. Moreover, it would be possible to include these data into the Internet of Things movement. This way, all the collected data might be compared and studied in order to find the best treatment for each kind of injury. It will be necessary to use a biocompatible material, submersible and suitable for contact with skin. These materials make it necessary to control the conditions in which the splint is produced, to assure that the properties are maintained. This development, makes it possible to design a new methodology that will help to provide faster and easier treatment.
... PBMT was applied in human medicine in the case of various chronic and degenerative diseases, in the temporary reduction of pain, lymphedema, cellulite therapy, rejuvenation, and hair recovery. PBMT is also successfully used in veterinary medicine for multiple conditions, including lower respiratory tract disorders [89][90][91][92][93][94]. ...
Article
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Light and lasers, as high-tech devices whose medical potential has yet to be fully discovered, have made important contributions to medicine, even in the current pandemic. The main aim of this review was to investigate how light was applied as a therapeutic tool during a crisis triggered by COVID-19. Another goal was to encourage scientists and industry to quickly design new at-home photobiomodulation therapy (PBMT) and/or antimicrobial photodynamic therapy (aPDT) easy to use systems to end this pandemic, especially for those who believe in high-tech but would never get vaccinated. This review revealed that PBMT has been successfully applied as adjunct therapy, in combination with conventional medical treatment, and as a pioneering action in SARS-CoV-2 infection, demonstrating significant improvements in airway inflammation and general clinical condition of patients, a faster recovery, avoiding intensive care unit (ICU) hospitalization, mechanical ventilation, mortality, and overcoming long-term sequelae. Application in only a limited number of cases strongly suggests the need for future randomized, placebo-controlled clinical trials to objectively determine the action and effects of PBMT in COVID-19. Implementation of unparalleled theragnostics methods and light-based techniques for disinfection of spaces, air, skin, mucosae, and textures to decrease the load of SARS-CoV-2 virus would save lives, time, and money. In this ongoing and challenging search for the seemingly intangible end of this pandemic, a non-invasive, easily accessible, safe, and side-effect-free adjuvant method appears to be PBMT, alone or in synergistic combination with aPDT, which has been shown to work in COVID-19 and opens unprecedented potential for use as home self-treatment to end the pandemic.
... 3 The clinical efficacy of low-level laser therapy in the treatment of osteoarthritis is questionable; while some authors have reported pain relief, 4 others have not. 5 These discrepancies may be associated with the variation in low-level laser therapy doses used by different studies. 6 Different dosimetric aspects must be considered in the therapeutic application of low-level laser therapy in patients with knee osteoarthritis. ...
Article
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Objectives To investigate the effect of prolonged low-level laser therapy application combined with exercise on pain and disability in patients with osteoarthritis of the knee. Design A randomized controlled trial. Setting Special rehabilitation services. Subjects Forty-three participants with knee osteoarthritis. Intervention Following initial assessment, participants were randomly allocated to the Laser group (n = 22, 44 knees) and received low-level laser therapy while the Placebo group (n = 21, 42 knees) received placebo therapy three times a week for 3 weeks. Both groups then received low-level laser therapy combined with exercise three times a week for the following 8 weeks. Main outcome measures The primary outcome was change in knee pain and disability (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscular strength (dynamometer), activity (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and medication intake and relief. Results Mean (SD) age of participants was 63.02 (9.9) years. Pain scores at baseline, 3 weeks, 11 weeks, and 6 months follow-up were 9.1 (1.3), 2.6 (2.3), 0.2 (0.9), and 0.2 (0.8) for the Laser group and 9.5 (8.0), 7.7 (5.3), 5.6 (2.4), and 7.4 (5.0) for the Placebo group, respectively. Disability scores at baseline, 3 weeks, 11 weeks, and 6 months follow-up were 14.9 (4.7), 7.6 (4.8), 3.9 (4.2), and 3.5 (4.1) for the Laser group and 17.8 (14.7), 15.2 (11.5), 11.6 (6.4), and 15.8 (11.9) for the Placebo Group, respectively. Conclusion In participants with osteoarthritis of the knee, the isolated application of low-level laser therapy in the initial 3 weeks and combined with exercises in the final 8 weeks reduced pain, disability, and intake of medication over a 6-month period.
... Therefore, the development of innovative and more efficient therapeutical intervention to treat OA symptoms is of extreme clinical importance (Comblain et al. 2017). In this context, photobiomodulation (PBM), also known as lowlevel laser therapy, has also been considered a very promising therapeutic intervention for cartilage tissue engineering, mainly due to its stimulatory effect on tissue metabolism and ability of modulating the inflammatory process after an injury (Bjordal et al. 2010;Hamblin 2016). Several studies have demonstrated, in experimental models of joint inflammation, that PBM can decrease the expression of chemotactic factors and inflammatory cytokines and increase antioxidant enzyme levels (Bublitz et al. 2014;Pallotta et al. 2012). ...
Article
Purpose The aim of the present study was to investigate the tissue performance of the association of photobiomodulation (PBM) and chitosan hydrogel (Ch), using in vitro and in vivo studies, in culture of chondrocytes and in an experimental model of osteoarthritis (OA) in the knee of rats. Methods The chitosan hydrogel was characterized by pH, gelation time, and degradation rate. For the in vitro study, chondrocyte cells were seeded in the Ch irradiated or not with PBM to assess cell viability and proliferation after 1, 3, and 5 days. For the in vivo study, sixty Wistar rats with OA were randomly distributed: control group (CG), Ch hydrogel injection (Ch), Ch hydrogel injection associated with PBM (Ch/PBM). Results The characterization results revealed that Ch hydrogels can be controlled precisely by variation of the urea and urease concentrations. The in vitro findings demonstrated that Ch and Ch/PBM are biocompatible and noncytotoxic. The in vivo findings showed that PBM associated with Ch prevented articular degeneration by stimulating anabolic factor (TGF-β) and reducing catabolic factor (TNF-α) and increasing the gene related to components of the cartilage extracellular matrix. Conclusion In conclusion, the PBM associated with Ch can be used as a cartilage repair application.
... A more detailed review, however, has compiled a number of side effects following laser treatments, including skin burns, dysesthesia, superficial thrombophlebitis, hematoma, nerve injury, and some rare incidences of pulmonary embolism [92] . A number of investigators make claims about the anti-inflammatory effects of low level laser therapy (LLLT) and present cases of pain analgesia, reduced oedema, and improvement of some pulmonary diseases [93][94][95][96][97][98][99] . A recent LLLT review proposes that this type of therapy should be used to counteract the cytokine storm of Covid-19, however they present no clinical studies involving Covid-19 patients (100). ...
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The imminent danger of the Covid-19 pandemic has accelerated research in pharmaceuticals that either target the viral Spike proteins fusion with ACE2 receptors, or the infectious RNA replication that often overwhelms immune defences. The scope of this review was to elucidate the main human vulnerabilities to Covid-19, including the accumulation of ACE2 receptors in testes, adipose tissue, thyroid, heart and kidneys that escalate viral affinity in males, the aged, and certain medical conditions, including diabetes, CVD, and pulmonary diseases. Pre-existing inflammation inherent in obesity may exacerbate the “cytokine storm,” a rampaging immune reaction during the course of Covid-19 that is deleterious to the host. We examined the molecular dynamics illustrating the action of new therapeutics necessary for Covid-19 patients; the estradiol advantage hypothesis;alternative therapies including hormone replacement procedures and mesenchymal stem cells; plus preventive and protective interventions.The current perspective also explored the primary components of dysregulated health predisposing individuals to Covid-19, including hormonal imbalance, increased lipids and lipoproteins, thyroid dysfunction, degraded fitness, and age-related testosterone decline accompanied by cortisol increase that provokes stress eating behaviours and weight accumulation.Obesity increases the probability of Covid-19 infection due to its abundance of ACE2 receptors; while physical activity may decrease Covid-19 vulnerability, by reducing fat and increasing muscle mass that manifests a relatively inhibited ACE2 expression. Several weight management solutions feature lasers and radiofrequency which diminish subcutaneous adiposity but do not enhance fitness. A data metanalysis of seven recently published clinical studies on 95 obese individuals, 73 males and 22 females with an average BMI of 30.9, demonstrated visceral fat reduction combined with increased skeletal muscle mass. It also revealed a statistically significant decrease in BMI, lipids, lipoproteins, inflammation and toxicity as measured by CRP, Creatinine and Bilirubin respectively, juxtaposed by optimally healthier levels of Cortisol, Testosterone, Free T3,IGF-1, Insulin, and the appetite controlling hormones Leptin and Ghrelin.
... 12 PBMT is applied to reduce pain, inflammation or edema and accelerate tissue repair. 13,14 Also, there are several published reports about the satisfactory results of PBMT in combination with other conventional therapies in pneumonia and other respiratory disorders, which have similar symptoms to COVID-19 in the moderate and severe stage of disease. [15][16][17][18][19][20] Therefore, in this review, we discussed the possible anti-inflammatory effect of PBMT on ARSD patients and presented the potential role of PBMT in the improvement of respiratory symptoms associated with SARS-COV2 by reviewing the published studies in this field. ...
Article
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Introduction: Currently, the COVID-19 pandemic is an important health challenge worldwide. Due to the cytokine storm, the mortality rate in acute respiratory distress syndrome (ARDS) is high, but until now no therapy for these patients was approved. The aim of this review was to discuss the possible anti-inflammatory effect of photobiomodulation therapy (PBMT) on ARSD patients and present the potential role of low-level laser therapy (LLLT) in the improvement of respiratory symptoms associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: Studies about PBMT in inflammation and ARSD patients were examined. A primary search with reviewing English-language citations between 2005 and 2020 using the keywords COVID-19, ADRS, cytokine storm, low-level laser therapy, anti-inflammatory, and photobiomodulation was performed. The initial search yielded 818 articles; however, 60 articles were selected and discussed in the present study. Results: The results of the selected studies showed the usefulness of PBMT in the treatment of inflammation and ARSD in patients with COVID-19 infection. This therapy is non-invasive and safe to modulate the immune responses in ARSD patients. Conclusion: PBMT can potentially reduce the viral load and bacterial super-infections in patients with COVID-19 infection and control the inflammatory response. Therefore, the use of PBMT could be an efficient strategy for preventing severe and critical illness in SARS-COV2 infection.
... These results might be ascribed to the analgesic and anti-inflammatory effect of LLT [36]. Previous studies on the effectiveness of LLT on musculoskeletal pain have shown that a significant reduction of the level of inflammatory cytokine prostaglandin E2 in the synovial membrane or the bloodstream after the treatment with LLT was significantly associated with the reduction of pain levels [37,38]. Besides, it may be explained by other therapeutic effects of LLT including microcirculation improvement, tissue ischemia remediation, oxidative stress mitigation, and bioenergetic activation [39]. ...
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Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P = .003, ηp2 = .014), fatigue perception (P = .004, ηp2 = .015), and functional status (P = .022, ηp2 = .09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P > .05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance.
... LLLT, however, decreased NF-κB gene expression, suggesting that this effect could be responsible for the reduced amount of pro-inflammatory mediators in this model. As discussed above, LLLT mediated antiinflammatory effects could be a consequence of NF-κB reduction or inactivation [41][42][43]. ...
Article
Muscle regeneration is a complex phenomenon, involving coordinated activation of several cellular responses. During this process, oxidative stress and consequent tissue damage occur with a severity that may depend on the intensity and duration of the inflammatory response. Among the therapeutic approaches to attenuate inflammation and increase tissue repair, low-level laser therapy (LLLT) may be a safe and effective clinical procedure. The aim of this study was to evaluate the effects of LLLT on oxidative/nitrative stress and inflammatory mediators produced during a cryolesion of the tibialis anterior (TA) muscle in rats. Sixty Wistar rats were randomly divided into three groups (n = 20): control (BC), injured TA muscle without LLLT (IC), injured TA muscle submitted to LLLT (IRI). The injured region was irradiated daily for 4 consecutive days, starting immediately after the lesion using a AlGaAs laser (continuous wave, 808 nm, tip area of 0.00785 cm2, power 30 mW, application time 47 seconds, fluence 180 J/cm2; 3.8 mW/cm2; and total energy 1.4 J). The animals were sacrificed on the fourth day after injury. LLLT reduced oxidative and nitrative stress in injured muscle, decreased lipid peroxidation, nitrotyrosine formation and NO production, probably due to reduction in iNOS protein expression. Moreover, LLLT increased SOD gene expression, and decreased the inflammatory response as measured by gene expression of NF-kβ and COX-2 and by TNF-α and IL-1β concentration. These results suggest that LLLT could be an effective therapeutic approach to modulate oxidative and nitrative stress and to reduce inflammation in injured muscle. Lasers Surg. Med. 44: 726–735, 2012.
... However, possible mechanisms of action of LLLT in the treatment of AR have been studied previously [10,[13][14][15][16][17][18]. The benefits of LLLT in AR may be primarily explained by anti-inflammatory mechanisms [21,22]. In animal models of acute pulmonary inflammation, LLLT relieved airway inflammation through the induction of IL−10 and reduction in the expression of macrophage inflammatory protein 2 and tumor necrosis factor (TNF) [23]. ...
Article
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Allergic rhinitis (AR) is a common disease that interferes with the daily activities and reduces the quality of life. Conventional treatments often do not provide complete resolution of the symptoms, and many new treatment modalities have been tried. This study aimed to evaluate the efficacy and safety of low-level laser therapy (LLLT) for AR in a randomized, double-blind, placebo-controlled trial. Patients diagnosed with AR were randomly allocated to receive LLLT or sham treatment. The primary outcome was a change in the reflective total nasal symptom score (TNSS). The secondary outcome was quality of life scores assessed using the Rhinoconjunctivitis Quality of Life Questionnaire. Incidences of adverse events were also recorded. Among 67 randomized subjects, 41 subjects (22 in LLLT group and 19 in sham treatment group) were included for efficacy analysis. The LLLT group showed a significantly improved TNSS score compared to the sham treatment group for decreasing AR symptom severity (p = 0.011) and improving quality of life regarding nasal symptoms (p = 0.036) at the end of treatment. Throughout the treatment period, no severe adverse events occurred. This clinical trial showed that LLLT is an effective and safe option for the management of AR regarding symptom relief and quality of life improvement.
... 6 PBMT is an adjunctive treatment option that has demonstrated significant anti-inflammatory effects in pain management, lymphedema, wound healing, and musculoskeletal injuries. [7][8][9][10] Other terms that fall under the category of PBMT include low-level laser therapy (LLLT), cold laser, and biostimulatory laser therapy. 11 PBMT differs from the lasers used in cosmetic and surgical procedures, which destroy or cut tissue. ...
Article
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Purpose: Evidence-based and effective treatments for COVID-19 are limited, and a new wave of infections and deaths calls for novel, easily implemented treatment strategies. Photobiomodulation therapy (PBMT) is a well-known adjunctive treatment for pain management, wound healing, lymphedema, and cellulitis. PBMT uses light to start a cascade of photochemical reactions that lead to local and systemic anti-inflammatory effects at multiple levels and that stimulate healing. Numerous empirical studies of PBMT for patients with pulmonary disease such as pneumonia, COPD and asthma suggest that PBMT is a safe and effective adjunctive treatment. Recent systematic reviews suggest that PBMT may be applied to target lung tissue in COVID-19 patients. In this preliminary study, we evaluated the effect of adjunctive PBMT on COVID-19 pneumonia and patient clinical status. Patients and methods: We present a small-scale clinical trial with 10 patients randomized to standard medical care or standard medical care plus adjunctive PBMT. The PBMT group received four daily sessions of near-infrared light treatment targeting the lung tissue via a Multiwave Locked System (MLS) laser. Patient outcomes were measured via blood work, chest x-rays, pulse oximetry and validated scoring tools for pneumonia. Results: PBMT patients showed improvement on pulmonary indices such as SMART-COP, BCRSS, RALE, and CAP (Community-Acquired Pneumonia questionnaire). PBMT-treated patients showed rapid recovery, did not require ICU admission or mechanical ventilation, and reported no long-term sequelae at 5 months after treatment. In the control group, 60% of patients were admitted to the ICU for mechanical ventilation. The control group had an overall mortality of 40%. At a 5-month follow-up, 40% of the control group experienced long-term sequelae. Conclusion: PBMT is a safe and effective potential treatment for COVID-19 pneumonia and improves clinical status in COVID-19 pneumonia.
... 12 PBMT is applied to reduce pain, inflammation or edema and accelerate tissue repair. 13,14 Also, there are several published reports about the satisfactory results of PBMT in combination with other conventional therapies in pneumonia and other respiratory disorders, which have similar symptoms to COVID-19 in the moderate and severe stage of disease. [15][16][17][18][19][20] Therefore, in this review, we discussed the possible anti-inflammatory effect of PBMT on ARSD patients and presented the potential role of PBMT in the improvement of respiratory symptoms associated with SARS-COV2 by reviewing the published studies in this field. ...
Article
Full-text available
Introduction: Currently, the COVID-19 pandemic is an important health challenge worldwide. Due to the cytokine storm, the mortality rate in acute respiratory distress syndrome (ARDS) is high, but until now no therapy for these patients was approved. The aim of this review was to discuss the possible anti-inflammatory effect of photobiomodulation therapy (PBMT) on ARSD patients and present the potential role of low-level laser therapy (LLLT) in the improvement of respiratory symptoms associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: Studies about PBMT in inflammation and ARSD patients were examined. A primary search with reviewing English-language citations between 2005 and 2020 using the keywords COVID-19, ADRS, cytokine storm, low-level laser therapy, anti-inflammatory, and photobiomodulation was performed. The initial search yielded 818 articles; however, 60 articles were selected and discussed in the present study. Results: The results of the selected studies showed the usefulness of PBMT in the treatment of inflammation and ARSD in patients with COVID-19 infection. This therapy is non-invasive and safe to modulate the immune responses in ARSD patients. Conclusion: PBMT can potentially reduce the viral load and bacterial super-infections in patients with COVID-19 infection and control the inflammatory response. Therefore, the use of PBMT could be an efficient strategy for preventing severe and critical illness in SARS-COV2 infection.
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ARTICLE INFO ABSTRACT The study aimed to evaluate the effectiveness of laser therapy for the evolution of immunomodulatory markers and physiological parameters in patients with COVID-19 with moderate to high risk of death. Twenty seriously diagnosed patients with COVID-19 were selected for the study, which were divided into two groups: control (who did not receive the treatment) and laser (who received the treatment), selected through non-blind randomization. The laser was administered in five areas: pulmonary area, face, tonsillar fossae, trachea, and bronchi. The treatment was monitored throughout its duration, six days. Laboratory tests were collected daily in both groups and several parameters were measured. We tested the difference between the days with paired tests and tested the correlation of the parameters with time using Pearson's correlation. In the laser group, patients showed a constant improvement in partial arterial oxygen pressure (PaO2) when compared to patients in the control group. Therefore, when thinking about intervening in the pathophysiology of the disease, one should take into account the use of techniques or drugs that can act both in restricting the most pernicious phase of the inflammatory cascade and in modulating all events related to the evolution of COVID-19.
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The Burning Mouth Syndrome (BMS) is a pathologic entity characterized by the presence of chronic symptoms of burning or pain in normal oral mucosa. It mainly affects women in the postmenopausal period, and its cause is unknown, but as there is an association with biological and psychological factors, it may assume a multifactorial etiology. Considering the unclear etiology of BMS, studies that contribute to its understanding are of great importance. In order to achieve a better understanding regarding microbial etiological factors of this disease, the aim of this review is to compile studies on possible involvement of micro-organisms of dental interest in the etiology of BMS. Studies have reported that patients with BMS harbor greater amount of intra-oral Candida and Enterobacteriaceae than patients without clinical manifestations of this disease. Different sources such as articles, books and journals, published in the world literature, were used in this research. These sources were accessed by databases like PubMed, SciELO, Scopus or search of full text. Studies in the literature have suggested that Candida and Enterococcus were correlated with BMS, although they might not necessarily be considered as an etiological factor but a predisposing factor. However, further studies that aim to elucidate relation between BMS and infectious factors are necessary. Keywords Candida ; Enterobacteriaceae ; Burning mouth syndrome.
Article
OBJECTIVE To assess the effect of low-level laser therapy (LLLT) on markers of synovial inflammation and signs of pain, function, bone healing, and osteoarthritis following tibial plateau leveling osteotomy (TPLO) in dogs with spontaneous cranial cruciate ligament rupture (CCLR). ANIMALS 12 client-owned dogs with unilateral CCLR. PROCEDURES All dogs were instrumented with an accelerometer for 2 weeks before and 8 weeks after TPLO. Dogs were randomly assigned to receive LLLT (radiant exposure, 1.5 to 2.25 J/cm ² ; n = 6) or a control (red light; 6) treatment immediately before and at predetermined times for 8 weeks after TPLO. Owners completed a Canine Brief Pain Inventory weekly for 8 weeks after surgery. Each dog underwent a recheck appointment, which included physical and orthopedic examinations, force plate analysis, radiography and synoviocentesis of the affected joint, and evaluation of lameness and signs of pain, at 2, 4, and 8 weeks after surgery. Select markers of inflammation were quantified in synovial fluid samples. Variables were compared between the 2 groups. RESULTS For the control group, mean ground reaction forces were greater at 2 and 4 weeks after TPLO and owner-assigned pain scores were lower during weeks 1 through 5 after TPLO, compared with corresponding values for the LLLT group. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the LLLT protocol used had no beneficial effects on signs of pain or pelvic limb function following TPLO. Further research is necessary to evaluate the effects of LLLT and to determine the optimum LLLT protocol for dogs with CCLR.
Chapter
After suffering a fracture in an upper or lower limb, a plaster cast is placed on the affected limb. It is a very old and efficient technique for recovery from an injury that has not had significant changes since its origin. This project aims to develop a new, low-cost smart 3D-printed splint concept by using new sensing techniques. Two rapidly evolving advanced manufacturing (AM) technologies will be used: 3D scanning and 3D printing. This is possible thanks to the application of engineering on additive manufacturing techniques and the use of biocompatible materials available in the market. This study proposes the use of these materials and techniques, including sensor integration inside the splints. The main parameters considered to be studied are pressure, humidity, skin colour, and temperature. These aspects are combined and analyzed to determine any kind of unexpected evolution of the treatment. The goal of this study is to generate a smart splint by using biomaterials and engineering techniques based on the advanced manufacturing and sensor system for clinical purposes.
Article
Background: Adhesive capsulitis (also termed frozen shoulder) is a common condition characterised by spontaneous onset of pain, progressive restriction of movement of the shoulder and disability that restricts activities of daily living, work and leisure. Electrotherapy modalities, which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, thermal) into the body, are often delivered as components of a physical therapy intervention. This review is one in a series of reviews which form an update of the Cochrane review 'Physiotherapy interventions for shoulder pain'. Objectives: To synthesise the available evidence regarding the benefits and harms of electrotherapy modalities, delivered alone or in combination with other interventions, for the treatment of adhesive capsulitis. Search methods: We searched CENTRAL, MEDLINE, EMBASE, CINAHL Plus and the ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) clinical trials registries up to May 2014, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials to identify any other potentially relevant trials. Selection criteria: We included randomised controlled trials (RCTs) and controlled clinical trials using a quasi-randomised method of allocation that included adults with adhesive capsulitis and compared any electrotherapy modality to placebo, no treatment, a different electrotherapy modality, or any other intervention. The two main questions of the review focused on whether electrotherapy modalities are effective compared to placebo or no treatment, or if they are an effective adjunct to manual therapy or exercise (or both). The main outcomes of interest were participant-reported pain relief of 30% or greater, overall pain, function, global assessment of treatment success, active shoulder abduction, quality of life, and the number of participants experiencing any adverse event. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment, and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. Main results: Nineteen trials (1249 participants) were included in the review. Four trials reported using an adequate method of allocation concealment and six trials blinded participants and personnel. Only two electrotherapy modalities (low-level laser therapy (LLLT) and pulsed electromagnetic field therapy (PEMF)) have been compared to placebo. No trial has compared an electrotherapy modality plus manual therapy and exercise to manual therapy and exercise alone. The two main questions of the review were investigated in nine trials.Low quality evidence from one trial (40 participants) indicated that LLLT for six days may result in improvement at six days. Eighty per cent (16/20) of participants reported treatment success with LLLT compared with 10% (2/20) of participants receiving placebo (risk ratio (RR) 8.00, 95% confidence interval (CI) 2.11 to 30.34; absolute risk difference 70%, 95% CI 48% to 92%). No participants in either group reported adverse events.We were uncertain whether PEMF for two weeks improved pain or function more than placebo at two weeks because of the very low quality evidence from one trial (32 participants). Seventy-five per cent (15/20) of participants reported pain relief of 30% or more with PEMF compared with 0% (0/12) of participants receiving placebo (RR 19.19, 95% CI 1.25 to 294.21; absolute risk difference 75%, 95% CI 53% to 97%). Fifty-five per cent (11/20) of participants reported total recovery of joint function with PEMF compared with 0% (0/12) of participants receiving placebo (RR 14.24, 95% CI 0.91 to 221.75; absolute risk difference 55%, 95% CI 31 to 79).Moderate quality evidence from one trial (63 participants) indicated that LLLT plus exercise for eight weeks probably results in greater improvement when measured at the fourth week of treatment, but a similar number of adverse events, compared with placebo plus exercise. The mean pain score at four weeks was 51 points with placebo plus exercise, while with LLLT plus exercise the mean pain score was 32 points on a 100 point scale (mean difference (MD) 19 points, 95% CI 15 to 23; absolute risk difference 19%, 95% CI 15% to 23%). The mean function impairment score was 48 points with placebo plus exercise, while with LLLT plus exercise the mean function impairment score was 36 points on a 100 point scale (MD 12 points, 95% CI 6 to 18; absolute risk difference 12%, 95% CI 6 to 18). Mean active abduction was 70 degrees with placebo plus exercise, while with LLLT plus exercise mean active abduction was 79 degrees (MD 9 degrees, 95% CI 2 to 16; absolute risk difference 5%, 95% CI 1% to 9%). No participants in either group reported adverse events. LLLT's benefits on function were maintained at four months.Based on very low quality evidence from six trials, we were uncertain whether therapeutic ultrasound, PEMF, continuous short wave diathermy, Iodex phonophoresis, a combination of Iodex iontophoresis with continuous short wave diathermy, or a combination of therapeutic ultrasound with transcutaneous electrical nerve stimulation (TENS) were effective adjuncts to exercise. Based on low or very low quality evidence from 12 trials, we were uncertain whether a diverse range of electrotherapy modalities (delivered alone or in combination with manual therapy, exercise, or other active interventions) were more or less effective than other active interventions (for example glucocorticoid injection). Authors' conclusions: Based upon low quality evidence from one trial, LLLT for six days may be more effective than placebo in terms of global treatment success at six days. Based upon moderate quality evidence from one trial, LLLT plus exercise for eight weeks may be more effective than exercise alone in terms of pain up to four weeks, and function up to four months. It is unclear whether PEMF is more or less effective than placebo, or whether other electrotherapy modalities are an effective adjunct to exercise. Further high quality randomised controlled trials are needed to establish the benefits and harms of physical therapy interventions (that comprise electrotherapy modalities, manual therapy and exercise, and are reflective of clinical practice) compared to interventions with evidence of benefit (for example glucocorticoid injection or arthrographic joint distension).
Article
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Eccentric training has been popularized for physical conditioning and prevention/rehabilitation of musculoskeletal disorders, especially due to the expressive responses in terms of muscular strength gain. In view of evidence that low-level laser therapy (LLLT) is able to increase exercise performance and accelerate post-exercise recovery, the aim of this study was to verify the effect of LLLT on hypertrophy and strengthening of knee extensor muscles submitted to eccentric training. Thirty healthy male subjects were randomized into three groups: Control Group (CG), Training Group (TG) and Training + LLLT Group (TLG). CG received no intervention, while TG and TLG were engaged on an 8-week knee extensor isokinetic eccentric training program. Only subjects from TLG were treated with LLLT (wavelength = 810 nm; power output = 200 mW; total dosage = 240 J) before each training session. Knee extensor muscle thickness and peak torque were assessed through ultrasonography and isokinetic dynamometry, respectively. CG presented no changes in any variable throughout the study, while eccentric training led to significant increases in muscle thickness and peak torque in TG and TLG. Subjects from TLG reached significantly higher percent changes compared to subjects from TG for sum of muscles' thicknesses (15.4 vs. 9.4 %), isometric peak torque (20.5 vs. 13.7 %), and eccentric peak torque (32.2 vs. 20.0 %). LLLT applied before eccentric training sessions seems to improve the hypertrophic response and muscular strength gain in healthy subjects.
Article
Objective: Many patients with distal radius fracture (DRF) experience pain and disability after removal of the cast. The aim of this study was to investigate if photobiomodulation therapy (PBMT) applied after cast removal provides an add-on effect to a home-based exercise program in rehabilitation after DRF. Methods: In this triple-blinded placebo-controlled trial, 50 patients with conservatively treated DRF were randomized to receive either active PBMT or placebo PBMT after cast removal in addition to a home-based exercise therapy program. The outcome measures were the Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaire, night pain (NP), and consumption of analgesic medication (AM) and were evaluated after cast removal at 4 (baseline), 8, 12, and 26 weeks after injury. NP and AM were also evaluated 7 weeks after injury (end of active/placebo PBMT). Results: There was a significant between-group difference in PRWHE scores in favor of active PBMT 8, 12, and 26 weeks after DRF. NP and consumption of AM were significantly lower in the active PBMT group from 7 to 26 weeks. There was a minimum clinically important improvement between the groups in favor of active PBMT in total score at 12 weeks, in pain subscore at 8, 12, and 26 weeks, and in disability subscore at 8 and 12 weeks. Conclusions: PBMT is safe and has long-term positive effect on pain and disability in DRF patients, when applied in combination with a home-based rehabilitation exercise program. Clinical Trial registration number: NCT03014024.
Chapter
Low level laser therapy (LLLT) was developed in Hungary in the 1960s by Mester. The inflammatory phase is characterized by five cardinal signs of inflammation: edema, pain, erythema, heat, and loss of function. LLLT has important anti-inflammatory effects in the initial healing processes: reduction of chemical mediators, cytokines, edema, and migration of inflammatory cells, and increased growth factors, which directly contribute to the tissue rehabilitation process, as well as indirectly through the resolution of the inflammation inherent in the process. The technique described in this chapter aims to activate the lymphatic drainage of a region where inflammation is established. This activation is achieved with LLLT by placing the tip of the laser equipment directly on the lymph nodes responsible for the drainage of the region affected. Digital palpation of the lymph node chains will detect any altered surface lymph nodes where irradiation should be applied.
Article
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BACKGROUND AND OBJECTIVES Photobiomodulation (PBM) is an important therapeutic tool for inflammatory process modulation. In this study, the anti-inflammatory and analgesic effect of two different energies and two different wavelengths (660 nm and 830 nm) were investigate and compared through the model of carrageenan-induced paw edema in mice. METHODS Male Swiss mice, 36 animals (n=6 animals/group) were divided into six groups: Group 1 (saline-control), Group 2 (carrageenan), Group 3 (carrageenan + laser 660 nm, 5.88 J), Group 4 (carrageenan + laser 660 nm, 2.94 J), Group 5 (carrageenan + laser 830 nm, 5.88 J), and Group 6 (carrageenan + laser 830 nm, 2.94 J). PBM was applied 1h after the carrageenan injection which induced paw edema and hyperalgesia, which were measured by means of a plethysmometer and by flicker test using a water bath at 38ºC (±0.5ºC), respectively. Left paws of mice injected with carrageenan exhibited local edema that persisted for up to 6h after its administration. All animals were evaluated before, 1, 2, 3, 4, and 6 h after the injection of carrageenan. RESULTS PBM, specially the 830 nm wavelength with 2.94 J of energy, reduced the paw edema induced by carrageenan. In addition, the 660 nm wavelengths (5.88 J / 2.94 J) and 830 nm (2.94 J) inhibited thermal hyperalgesia induced by carrageenan after 4 h of paw injection. CONCLUSION There was evidence that the PBM 830 nm (2.94 J) produced a more pronounced anti-inflammatory effect, while the 660 nm (5.88 J / 2.94 J) energy laser was more effective to inhibit the hyperalgesia response induced by the carrageenan injection. Keywords: Edema; Hyperalgesia; Inflammation; Low level laser therapy; Pain.
Book
The third edition of Therapeutic Electrophysical Agents: Evidence Behind Practice-revised and expanded, with new chapters and ancillary resources and tools on thePoint-is designed to give you the expertise with electrophysical agents you will need in your clinical practice. As with previous editions, the foundation of this book rests solidly and uniquely on evidence from experimental and clinical human trials. The goal of this textbook is to offer all the necessary knowledge, skills, and tools you need to master the practice of therapeutic electrophysical agents. The online resources include new unit conversion and dosimetric calculators, which allows students and practitioners to learn about prescribing treatment and what measurements to think about when dosing, without having to work through all the equations. Also included are new practice questions to help prepare for the Physical Therapy certification exam. These questions are similar to the ones students are likely to face on their board exams and will help build proficiency and competence.
Chapter
Low level laser therapy (LLLT) has been used for the treatment of musculoskeletal pain for more than two decades. During the last decade, interest in LLLT research has picked up and the effect of LLLT in conditions involving inflammatory processes has been under scrutiny. In acute or postoperative pain conditions, non-steroidal anti-inflammatory drugs (NSAIDs) have been the gold standard treatment in treatment guidelines and surveys of clinical practice. However, anti-inflammatory treatment with NSAIDs and steroids appears to provide short-term pain relief in acute and subacute tendinopathies. LLLT works mostly through non-thermal photobiological mechanisms where laser light is absorbed by chromophores and thereby modulates pathophysiological processes. There is strong evidence that red and infrared LLLT exhibits a dose-dependent anti-inflammatory effect in cell and animal studies. The practical use of LLLT is easy once the optimal dose and target points have been determined.
Article
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Periodontitis is a multifactorial inflammatory disease due to the host response to a microbial aggression. The current treatment of periodontitis aims to reduce subgingival biofilm in order to establish the equilibrium between bacteria and the host. Scaling and root planning (SRP) is the traditional treatment modality and it is performed with curettes and/or power-driven instruments (sonic or ultrasonic instruments), which allow us to remove the dental biofilm and calculus from the infected root, creating a clean, hard and smooth surface. The evidence demonstrates that it is a predictable treatment in terms of probing depth and bleeding on probing reduction. The use of lasers has been proposed as a tool to reach the objectives of SRP, although it is important to review the different types of laser that we have in dentistry to evaluate those that have the capacity to mechanically remove the biofilm. Among the lasers that achieve these conditions, the erbium-doped yttrium aluminium garnet laser (Er:YAG) is the one that has been more evaluated in the non-surgical treatment of chronic periodontitis or residual pockets, as an adjunctive treatment to conventional instrumentation or as unique treatment
Article
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of electrotherapy modalities compared with placebo, no treatment, or another treatment in adults with lateral elbow pain.
Article
Background and objective: The majority of studies investigating penetration of laser light are performed in vitro on skin flaps, with measures of immediate penetration depth and energy loss. The aim of this study was to investigate the penetration time profiles for two different lasers used in low-level laser therapy, during 150 sec of exposure both in stretched and relaxed human Achilles in situ. Materials and methods: Thirty-four Achilles tendons from 17 healthy volunteers were irradiated by an 810 nm, 200 mW, continuous- and a 904 nm, 60 mW, super-pulsed laser. Irradiation was performed with the Achilles tendons in relaxed and stretched condition. The energy penetrating skin-skin was measured every 30 sec using an optical power meter. Results: The 810 nm laser penetration ability did not differ significantly in relaxed and stretched condition with 0.17% [standard error of the mean (SEM) 0.02] of mean output power (MOP) and 0.02% (SEM 0.004) of MOP, respectively. The 904 nm laser demonstrated a statistical significant (p < 0.05) and almost linear increasing penetration ability both in relaxed and stretched Achilles from 0.25% (SEM 0.03) to 0.38% (SEM 0.04) of MOP and from 0.05% (SEM 0.01) to 0.13% (SEM 0.01) of MOP, respectively. The penetrated ability differed between lasers and tissue conditions at all measure points (p < 0.05). Conclusions: The 904 nm laser penetrates relatively more energy than the 810 nm laser in in situ human Achilles. Moreover, penetration from the super-pulsed 904 nm laser increased during exposure time, whereas penetration from the 810 nm laser was constant. In addition, stretching the Achilles causes a higher energy attenuation by the tissue.
Article
Background: Management of rotator cuff disease often includes manual therapy and exercise, usually delivered together as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. Objectives: To synthesise available evidence regarding the benefits and harms of manual therapy and exercise, alone or in combination, for the treatment of people with rotator cuff disease. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCO, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. Selection criteria: We included randomised and quasi-randomised trials, including adults with rotator cuff disease, and comparing any manual therapy or exercise intervention with placebo, no intervention, a different type of manual therapy or exercise or any other intervention (e.g. glucocorticoid injection). Interventions included mobilisation, manipulation and supervised or home exercises. Trials investigating the primary or add-on effect of manual therapy and exercise were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. Main results: We included 60 trials (3620 participants), although only 10 addressed the main comparisons of interest. Overall risk of bias was low in three, unclear in 14 and high in 43 trials. We were unable to perform any meta-analyses because of clinical heterogeneity or incomplete outcome reporting. One trial compared manual therapy and exercise with placebo (inactive ultrasound therapy) in 120 participants with chronic rotator cuff disease (high quality evidence). At 22 weeks, the mean change in overall pain with placebo was 17.3 points on a 100-point scale, and 24.8 points with manual therapy and exercise (adjusted mean difference (MD) 6.8 points, 95% confidence interval (CI) -0.70 to 14.30 points; absolute risk difference 7%, 1% fewer to 14% more). Mean change in function with placebo was 15.6 points on a 100-point scale, and 22.4 points with manual therapy and exercise (adjusted MD 7.1 points, 95% CI 0.30 to 13.90 points; absolute risk difference 7%, 1% to 14% more). Fifty-seven per cent (31/54) of participants reported treatment success with manual therapy and exercise compared with 41% (24/58) of participants receiving placebo (risk ratio (RR) 1.39, 95% CI 0.94 to 2.03; absolute risk difference 16% (2% fewer to 34% more). Thirty-one per cent (17/55) of participants reported adverse events with manual therapy and exercise compared with 8% (5/61) of participants receiving placebo (RR 3.77, 95% CI 1.49 to 9.54; absolute risk difference 23% (9% to 37% more). However adverse events were mild (short-term pain following treatment).Five trials (low quality evidence) found no important differences between manual therapy and exercise compared with glucocorticoid injection with respect to overall pain, function, active shoulder abduction and quality of life from four weeks up to 12 months. However, global treatment success was more common up to 11 weeks in people receiving glucocorticoid injection (low quality evidence). One trial (low quality evidence) showed no important differences between manual therapy and exercise and arthroscopic subacromial decompression with respect to overall pain, function, active range of motion and strength at six and 12 months, or global treatment success at four to eight years. One trial (low quality evidence) found that manual therapy and exercise may not be as effective as acupuncture plus dietary counselling and Phlogenzym supplement with respect to overall pain, function, active shoulder abduction and quality life at 12 weeks. We are uncertain whether manual therapy and exercise improves function more than oral non-steroidal anti-inflammatory drugs (NSAID), or whether combining manual therapy and exercise with glucocorticoid injection provides additional benefit in function over glucocorticoid injection alone, because of the very low quality evidence in these two trials.Fifty-two trials investigated effects of manual therapy alone or exercise alone, and the evidence was mostly very low quality. There was little or no difference in patient-important outcomes between manual therapy alone and placebo, no treatment, therapeutic ultrasound and kinesiotaping, although manual therapy alone was less effective than glucocorticoid injection. Exercise alone led to less improvement in overall pain, but not function, when compared with surgical repair for rotator cuff tear. There was little or no difference in patient-important outcomes between exercise alone and placebo, radial extracorporeal shockwave treatment, glucocorticoid injection, arthroscopic subacromial decompression and functional brace. Further, manual therapy or exercise provided few or no additional benefits when combined with other physical therapy interventions, and one type of manual therapy or exercise was rarely more effective than another. Authors' conclusions: Despite identifying 60 eligible trials, only one trial compared a combination of manual therapy and exercise reflective of common current practice to placebo. We judged it to be of high quality and found no clinically important differences between groups in any outcome. Effects of manual therapy and exercise may be similar to those of glucocorticoid injection and arthroscopic subacromial decompression, but this is based on low quality evidence. Adverse events associated with manual therapy and exercise are relatively more frequent than placebo but mild in nature. Novel combinations of manual therapy and exercise should be compared with a realistic placebo in future trials. Further trials of manual therapy alone or exercise alone for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.
Article
Background: Management of rotator cuff disease may include use of electrotherapy modalities (also known as electrophysical agents), which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, or thermal) into the body. Examples include therapeutic ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), and pulsed electromagnetic field therapy (PEMF). These modalities are usually delivered as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. Objectives: To synthesise available evidence regarding the benefits and harms of electrotherapy modalities for the treatment of people with rotator cuff disease. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCOhost, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. Selection criteria: We included randomised controlled trials (RCTs) and quasi-randomised trials, including adults with rotator cuff disease (e.g. subacromial impingement syndrome, rotator cuff tendinitis, calcific tendinitis), and comparing any electrotherapy modality with placebo, no intervention, a different electrotherapy modality or any other intervention (e.g. glucocorticoid injection). Trials investigating whether electrotherapy modalities were more effective than placebo or no treatment, or were an effective addition to another physical therapy intervention (e.g. manual therapy or exercise) were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. Main results: We included 47 trials (2388 participants). Most trials (n = 43) included participants with rotator cuff disease without calcification (four trials included people with calcific tendinitis). Sixteen (34%) trials investigated the effect of an electrotherapy modality delivered in isolation. Only 23% were rated at low risk of allocation bias, and 49% were rated at low risk of both performance and detection bias (for self-reported outcomes). The trials were heterogeneous in terms of population, intervention and comparator, so none of the data could be combined in a meta-analysis.In one trial (61 participants; low quality evidence), pulsed therapeutic ultrasound (three to five times a week for six weeks) was compared with placebo (inactive ultrasound therapy) for calcific tendinitis. At six weeks, the mean reduction in overall pain with placebo was -6.3 points on a 52-point scale, and -14.9 points with ultrasound (MD -8.60 points, 95% CI -13.48 to -3.72 points; absolute risk difference 17%, 7% to 26% more). Mean improvement in function with placebo was 3.7 points on a 100-point scale, and 17.8 points with ultrasound (mean difference (MD) 14.10 points, 95% confidence interval (CI) 5.39 to 22.81 points; absolute risk difference 14%, 5% to 23% more). Ninety-one per cent (29/32) of participants reported treatment success with ultrasound compared with 52% (15/29) of participants receiving placebo (risk ratio (RR) 1.75, 95% CI 1.21 to 2.53; absolute risk difference 39%, 18% to 60% more). Mean improvement in quality of life with placebo was 0.40 points on a 10-point scale, and 2.60 points with ultrasound (MD 2.20 points, 95% CI 0.91 points to 3.49 points; absolute risk difference 22%, 9% to 35% more). Between-group differences were not important at nine months. No participant reported adverse events.Therapeutic ultrasound produced no clinically important additional benefits when combined with other physical therapy interventions (eight clinically heterogeneous trials, low quality evidence). We are uncertain whether there are differences in patient-important outcomes between ultrasound and other active interventions (manual therapy, acupuncture, glucocorticoid injection, glucocorticoid injection plus oral tolmetin sodium, or exercise) because the quality of evidence is very low. Two placebo-controlled trials reported results favouring LLLT up to three weeks (low quality evidence), however combining LLLT with other physical therapy interventions produced few additional benefits (10 clinically heterogeneous trials, low quality evidence). We are uncertain whether transcutaneous electrical nerve stimulation (TENS) is more or less effective than glucocorticoid injection with respect to pain, function, global treatment success and active range of motion because of the very low quality evidence from a single trial. In other single, small trials, no clinically important benefits of pulsed electromagnetic field therapy (PEMF), microcurrent electrical stimulation (MENS), acetic acid iontophoresis and microwave diathermy were observed (low or very low quality evidence).No adverse events of therapeutic ultrasound, LLLT, TENS or microwave diathermy were reported by any participants. Adverse events were not measured in any trials investigating the effects of PEMF, MENS or acetic acid iontophoresis. Authors' conclusions: Based on low quality evidence, therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease. Further high quality placebo-controlled trials are needed to confirm these results. In contrast, based on low quality evidence, PEMF may not provide clinically relevant benefits over placebo, and therapeutic ultrasound, LLLT and PEMF may not provide additional benefits when combined with other physical therapy interventions. We are uncertain whether TENS is superior to placebo, and whether any electrotherapy modality provides benefits over other active interventions (e.g. glucocorticoid injection) because of the very low quality of the evidence. Practitioners should communicate the uncertainty of these effects and consider other approaches or combinations of treatment. Further trials of electrotherapy modalities for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.
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Our aim was to investigate the immediate effects of bilateral, 830nm, low-level laser therapy (LLLT) on high-intensity exercise and biochemical markers of skeletal muscle recovery, in a randomised, double-blind, placebo-controlled, crossover trial set in a sports physiotherapy clinic. Twenty male athletes (nine professional volleyball players and eleven adolescent soccer players) participated. Active LLLT (830nm wavelength, 100mW, spot size 0.0028cm2, 3–4 J per point) or an identical placebo LLLT was delivered to five points in the rectus femoris muscle (bilaterally). The main outcome measures were the work performed in the Wingate test: 30s of maximum cycling with a load of 7.5% of body weight, and the measurement of blood lactate (BL) and creatine kinase (CK) levels before and after exercise. There was no significant difference in the work performed during the Wingate test (P > 0.05) between subjects given active LLLT and those given placebo LLLT. For volleyball athletes, the change in CK levels from before to after the exercise test was significantly lower (P = 0.0133) for those given active LLLT (2.52Ul−1 ± 7.04Ul−1) than for those given placebo LLLT (28.49Ul−1 ± 22.62Ul−1). For the soccer athletes, the change in blood lactate levels from before exercise to 15min after exercise was significantly lower (P < 0.01) in the group subjected to active LLLT (8.55mmoll−1 ± 2.14mmoll−1) than in the group subjected to placebo LLLT (10.52mmoll−1 ± 1.82mmoll−1). LLLT irradiation before the Wingate test seemed to inhibit an expected post-exercise increase in CK level and to accelerate post-exercise lactate removal without affecting test performance. These findings suggest that LLLT may be of benefit in accelerating post-exercise recovery.
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There are some indications that low-level laser therapy (LLLT) may delay the development of skeletal muscle fatigue during high-intensity exercise. There have also been claims that LED cluster probes may be effective for this application however there are differences between LED and laser sources like spot size, spectral width, power output, etc. In this study we wanted to test if light emitting diode therapy (LEDT) can alter muscle performance, fatigue development and biochemical markers for skeletal muscle recovery in an experimental model of biceps humeri muscle contractions. Ten male professional volleyball players (23.6 [SD +/-5.6] years old) entered a randomized double-blinded placebo-controlled crossover trial. Active cluster LEDT (69 LEDs with wavelengths 660/850 nm, 10/30 mW, 30 seconds total irradiation time, 41.7 J of total energy irradiated) or an identical placebo LEDT was delivered under double-blinded conditions to the middle of biceps humeri muscle immediately before exercise. All subjects performed voluntary biceps humeri contractions with a workload of 75% of their maximal voluntary contraction force (MVC) until exhaustion. Active LEDT increased the number of biceps humeri contractions by 12.9% (38.60 [SD +/-9.03] vs. 34.20 [SD +/-8.68], P = 0.021) and extended the elapsed time to perform contractions by 11.6% (P = 0.036) versus placebo. In addition, post-exercise levels of biochemical markers decreased significantly with active LEDT: Blood Lactate (P = 0.042), Creatine Kinase (P = 0.035), and C-Reative Protein levels (P = 0.030), when compared to placebo LEDT. We conclude that this particular procedure and dose of LEDT immediately before exhaustive biceps humeri contractions, causes a slight delay in the development of skeletal muscle fatigue, decreases post-exercise blood lactate levels and inhibits the release of Creatine Kinase and C-Reative Protein. Lasers Surg. Med. 41:572-577, 2009. (c) 2009 Wiley-Liss, Inc.
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BACKGROUND DATA AND OBJECTIVE: There is anecdotal evidence that low-level laser therapy (LLLT) may affect the development of muscular fatigue, minor muscle damage, and recovery after heavy exercises. Although manufacturers claim that cluster probes (LEDT) maybe more effective than single-diode lasers in clinical settings, there is a lack of head-to-head comparisons in controlled trials. This study was designed to compare the effect of single-diode LLLT and cluster LEDT before heavy exercise. This was a randomized, placebo-controlled, double-blind cross-over study. Young male volleyball players (n = 8) were enrolled and asked to perform three Wingate cycle tests after 4 x 30 sec LLLT or LEDT pretreatment of the rectus femoris muscle with either (1) an active LEDT cluster-probe (660/850 nm, 10/30 mW), (2) a placebo cluster-probe with no output, and (3) a single-diode 810-nm 200-mW laser. The active LEDT group had significantly decreased post-exercise creatine kinase (CK) levels (-18.88 +/- 41.48 U/L), compared to the placebo cluster group (26.88 +/- 15.18 U/L) (p < 0.05) and the active single-diode laser group (43.38 +/- 32.90 U/L) (p < 0.01). None of the pre-exercise LLLT or LEDT protocols enhanced performance on the Wingate tests or reduced post-exercise blood lactate levels. However, a non-significant tendency toward lower post-exercise blood lactate levels in the treated groups should be explored further. In this experimental set-up, only the active LEDT probe decreased post-exercise CK levels after the Wingate cycle test. Neither performance nor blood lactate levels were significantly affected by this protocol of pre-exercise LEDT or LLLT.
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Low power laser irradiation (LPLI) promotes proliferation of multiple cells, which (especially red and near infrared light) is mainly through the activation of mitochondrial respiratory chain and the initiation of cellular signaling. Recently, the signaling proteins involved in LPLI-induced proliferation merit special attention, some of which are regulated by mitochondrial signaling. Hepatocyte growth factor receptor (c-Met), a member of tyrosine protein kinase receptors (TPKR), is phosphorylated during LPLI-induced proliferation, but tumor necrosis factor alpha (TNF-alpha) receptor has not been affected. Activated TPKR could activate its downstream signaling elements, like Ras/Raf/MEK/ERK, PI3K/Akt/eIF4E, PI3K/Akt/eNOS and PLC-gamma/PKC pathways. Other two pathways, DeltaPsim/ATP/cAMP/JNK/AP-1 and ROS/Src, are also involved in LPLI-induced proliferation. LPLI-induced cell cycle progression can be regulated by the activation or elevated expressions of cell cycle-specific proteins. Furthermore, LPLI induces the synthesis or release of many molecules, like growth factors, interleukins, inflammatory cytokines and others, which are related to promotive effects of LPLI.
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The aim of this study was to investigate the mechanisms whereby low-intensity laser therapy may affect the severity of oral mucositis. A hamster cheek pouch model of oral mucositis was used with all animals receiving intraperitoneal 5-fluorouracil followed by surface irritation. Animals were randomly allocated into three groups and treated with a 35 mW laser, 100 mW laser, or no laser. Clinical severity of mucositis was assessed at four time-points by a blinded examiner. Buccal pouch tissue was harvested from a subgroup of animals in each group at four time-points. This tissue was used for immunohistochemistry for cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), and factor VIII (marker of microvessel density) and the resulting staining was quantified. Peak severity of mucositis was reduced in the 35 mW laser group as compared to the 100 mW laser and control groups. This reduced peak clinical severity of mucositis in the 35 mW laser group was accompanied by a significantly lower level of COX-2 staining. The 100 mW laser did not have an effect on the severity of clinical mucositis, but was associated with a decrease in VEGF levels at the later time-points, as compared to the other groups. There was no clear relationship of VEGF levels or microvessel density to clinical mucositis severity. The tissue response to laser therapy appears to vary by dose. Low-intensity laser therapy appears to reduce the severity of mucositis, at least in part, by reducing COX-2 levels and associated inhibition of the inflammatory response.
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In the classic model of pleurisy there is little evidence about the anti-inflammatory effects of low-level laser therapy (LLLT) as well the dosage characteristics, such as wavelength, total energy, number and pattern of treatment. In this study we investigated the potential effects of LLLT on modulating the pro-inflammatory and anti-inflammatory mediators of acute inflammation in a rat pleurisy model. A sample of 48 female Wistar rats were divided into control and experiential groups. An inflammation was induced by carrageenan (0.2 ml) injected into the pleural cavity. At 1, 2, and 3 hours after induction a continuous wave (20 mW) diode laser of the InGaAlP (660 nm) type was used in the four laser groups with different doses and treatment patterns. One group received a single dose of 2.1 J and the other three groups received a total energy of 0.9, 2.1, and 4.2 J. Four hours later the exudate volume, total and differential leukocytes, protein concentration, NO, IL-6, IL-10, TNF-alpha, and MCP-1 were measured from the aspirated liquid. All the treatment patterns and quantity of energy studied show significant reduction of the exudate volume (P<0.05). Using energy of 0.9 J only NO, IL-6, MCP-1 and IL-10 are significantly reduced (P<0.05). On the other hand, higher energies (2.1 and 4.2 J) significantly reduce all variables independently of the treatment pattern. The neutrophil migration has a straight correlation with the TNF-alpha (r = 0.551) and NO (r = 0.549) concentration. LLLT-660 nm induced an anti-inflammatory effect characterized by inhibition of either total or differential leukocyte influx, exudation, total protein, NO, IL-6, MCP-1, IL-10, and TNF-alpha, in a dose-dependent manner. Under these conditions, laser treatment with 2.1 J was more effective than 0.9 and 4.2 J.
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In this study we investigated the role of extracellular matrix elements and cells during the wound healing phases following the use of low-level laser therapy (LLLT) and anti-inflammatory drugs. There are few scientific studies that characterize the possible interactions of LLLT and anti-inflammatory medications. Thirty-two rats submitted to a wound inflicted with a 6-mm-diameter punch. The animals were divided into four groups: sham treated, those treated with the GaAlAs laser (4 J/cm(2), 9 mW, lambda = 670 nm, spot size 28.27 x 10(2) cm(2)), those treated with dexamethasone (2 mg/kg), and those treated with both LLLT and dexamethasone. After 3 and 5 d, the cutaneous wounds were assessed by histopathology using polarized light and ultrastructural assessment using transmission electron microscopy. Changes seen in polymorphonuclear inflammatory cells, edema, mononuclear cells, and collagen fiber deposition were semi-quantitatively evaluated. The laser-treated group demonstrated increased collagen content and better arrangement of the extracellular matrix (p < 0.05). Fibroblasts in these tissues were increased in number and were more synthetically active. In the dexamethasone group, the collagen was shown to be non-homogenous and disorganized, with a scarcity of fibroblasts. In the group treated with both types of therapy, fibroblasts were more common and they exhibited vigorous rough endoplasmic reticulum, but they had less collagen production compared to those seen in the laser group. LLLT alone accelerates post-surgical tissue repair and reduces edema and the polymorphonuclear infiltrate even in the presence of dexamethasone.
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This study was carried out to explore the pain-alleviating effect of Ga-As + He-Ne laser (gallium-arsenide + helium-neon) in lateral epicondylalgia. A Space Mid Laser Mix 5-up laser was used. The probe consisted of five Ga-As emitters and one He-Ne emitter in the center. The parameters for Ga-As were wavelength, 904nm; average output power, 4mW, peak power, 10W; pulse frequency, 3800Hz; pulse duration, 180nsec; divergence, 70mrad. The He-Ne parameters were wavelength, 632.8nm; continuous; power output, 5mW, divergence 60mrad. A pen laser (Ga-As) was also included in the equipment. Two machines were available; one of them had no output in the Ga-As diodes, and the He-Ne emitter was replaced with a red light emitter. Fifty-eight patients were consecutively assigned to two groups for laser or placebo. The probe was applied perpendicularly over the painful area for eight minutes, and then the pen probe was applied to two acupuncture points, LI 11 and LI 12, for two minutes per point. The treatments were given three to four times weekly, ten treatments in all. Follow-ups were done after 3, 6, and 12 months. The treatment procedure was performed exactly according to the manufacturer's manual for this diagnosis. No other therapeutic measures were used, and medication use was proscribed during the treatments and the follow-up period. The statistical analysis showed no significant differences in subjective or objective outcome between the laser and placebo treatments after the treatment period. However, the objective outcome indicated a difference in favor of the placebo treatment (p less than .06).(ABSTRACT TRUNCATED AT 250 WORDS)
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To examine the United States Food and Drug Administration's (FDA) standards for reviews of the scientific basis for efficacy claims for newly approved oral analgesics. Comparison of the trial methodologies and results provided by the FDA's medical reviewer in the Summary Bases of Approval (SBA) for the 9 oral acute analgesics approved in the last 10 years: ketorolac, diclofenac potassium, bromfenac, tramadol, hydrocodone/ibuprofen fixed combination, celecoxib, rofecoxib, tramadol/acetaminophen, and valdecoxib. For all 9 new analgesics, studies were conducted in patients with postoperative dental pain and nondental surgical pain. The relief of gynecologic pain was examined for 5 of the new drugs. No studies in other pain models (such as infection, neuropathy, and nonsurgical trauma) supported claims of efficacy for any of the new drugs. The overall designs of the dental and nondental surgical studies, including timing of the single dose of trial drug, timing of evaluations, scales used for evaluations, and the use of both measured and derived outcome variables, were similar across the 8 development programs fully described in SBAs. Other characteristics of the trials, including choice of population for efficacy analyses, methods of carrying forward pain intensity and pain relief scores, and the length of time patients were encouraged to refrain from use of rescue medication differed across the development programs. The requirements for approval of new analgesics in the United States encourage the pharmaceutical industry to perform efficacy studies using stylized designs in dental and nondental surgical pain. Studies of the efficacy of new analgesics in other common clinical settings are rarely or never included in development programs.
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Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
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Low level laser therapy (LLLT) is a known anti-inflammatory therapy. Herein we studied the effect of LLLT on lung permeability and the IL-1beta level in LPS-induced pulmonary inflammation. STUDY DESIGN/METHODOLOGY: Rats were divided into 12 groups (n = 7 for each group). Lung permeability was measured by quantifying extravasated albumin concentration in lung homogenate, inflammatory cells influx was determined by myeloperoxidase activity, IL-1beta in BAL was determined by ELISA and IL-1beta mRNA expression in trachea was evaluated by RT-PCR. The rats were irradiated on the skin over the upper bronchus at the site of tracheotomy after LPS. LLLT attenuated lung permeability. In addition, there was reduced neutrophil influx, myeloperoxidase activity and both IL-1beta in BAL and IL-1beta mRNA expression in trachea obtained from animals subjected to LPS-induced inflammation. LLLT reduced the lung permeability by a mechanism in which the IL-1beta seems to have an important role.
Article
Certain crystals cause synovial tissue inflammation and variability of inflammatory indicators like plasmatic prostaglandin E2 (PGE2), fibrinogen (PF) and synovial tissue PGE2. We evaluated Helium-Neon Laser efficacy on PF, plasmatic PGE2 and synovial PGE2 and its ability to induce involution of anatomopathological (AP) lesions in induced granulomatose process, alone and combined with a meloxicam injection. Rats were assigned to five different treatment groups. 5 mW He-Ne Laser radiation (632.8 nm) and 8 J.cm2 energy density were used in the treated groups. PF and plasmatic PGE2 and synovial PGE2 levels decreased in granulomatose arthritis groups treated with low level laser therapy (LLLT) or with a meloxicam injection or a combination of both therapies; the differences being statistically significant (p<0.01), as compared with the non-treated control group. In the combination therapy group, involution of granulomatose inflammation was observed. We conclude that He-Ne laser treatment or meloxicam administration after experimentally induced inflammation, normalizes plasmatic PGE2 and fibrinogen levels, but produces similar histological lesions as non-treated controls.
Article
A number of clinical studies have reported the efficacy of the 820 nm Gallium Aluminum Arsenide (GaAlAs) laser for the management of musculoskeletal pain, but its mode of action is not clear. The aim of this study was to investigate the effect of 820 nm GaAlAs at energy densities of 4 J/cm2 and 19 J/cm2 on prostaglandin E2 (PGE2) production by myoblast cultures undergoing stimulation with interleukin I alpha (IL-1). The differentiated C2C12 cultures were allocated randomly into 6 groups (6 samples per group). Each group, except the control and the IL-1 supplement groups, was jrradiated with 820 nm GaAIAs at energy densities of 4J/cm2 or 19 J/cm2 on three occasions. The irradiation was undertaken initially and at one hour and two hours. The difference in mean PGE2 at 12 hours among the 6 groups was statistically significantly different as compared by Analysis of Variance, p=0.0001. The result from Scheffe multiple comparison (p = 0.05) showed that the PGE2 production of the culture with IL-1 and the culture with IL-1 irradiated by 820 nm at 4 J/cm2 were higher than the control group. There was no statistically significant difference in PGE2 production among the control group, the laser-irradiated groups without IL-1 supplement and the IL-1 stimulation group irradiated by 820 nm at 19 J/cm2. The results indicate that IL-1 can stimulate PGE2 synthesis in differentiated C2C12 skeletal muscle cells. 820 nm laser irradiation at 19 J/cm2 was found to inhibit that mechanism, while the lower energy density (4 J/cm2) failed to inhibit PGE2 production.
Article
Despite extensive research into the biology of tendon healing, predictably restoring normal function to a digit after a flexor tendon laceration remains one of the most difficult problems facing the hand surgeon. The challenge of simultaneously achieving tendon healing while minimizing the peritendinous scar formation, which limits tendon gliding, has captured the attention of investigators for many years. It has been said that low-power density helium-neon laser radiation had effects on anti-inflammation, detumescence, progressive wound healing, and reducing intestinal adhesions. This experimental study aims at whether helium-neon laser can reduce injured tendon adhesions and improve functional recovery of the injured tendon. Fifty white Leghorn hens were used. Ten were randomly assigned as a normal control group, the other forty were used in the operation. After anesthetizing them with Amytal, a half of the profundus tendons of the second and third foretoes on both sides of the feet were cut. Postoperatively, the hens moved freely in the cages. One side of the toes operated on were randomly chosen as a treatment group, the other side served as an untreated control group. The injured tendon toes in the treatment group were irradiated for twenty minutes daily with a fiber light needle of helium-neon laser therapeutic apparatus (wavelength, 6328 angstroms) at a constant power density of 12.74 mW/cm2, the first exposure taking place 24 hours after the operation. The longest course of treatment was 3 weeks. The control group was not irradiated. At 3 days, 1, 2, 3, and 5 weeks after surgery, 8 hens were sacrificed and their tendons were examined. The experimental results: (1) active, passive flexion and tendon gliding functional recovery were significantly better in the treatment group (p < 0.01); (2) width and thickness of the tendon at the cut site were significantly smaller in the treatment group (p < 0.01); (3) degrees of tendon adhesions were significantly lighter in the treatment group (p < 0.05). The experimental results demonstrate helium-neon laser radiation had significant effects on anti-inflammation, detumescence, progressive hematoma absorbing, inhibiting the tendon extrinsic healing, reducing tendon adhesions, improving the tendon intrinsic healing, i.e., stimulating epitenon and endotenon cells proliferation and migrating into the gap, stimulating collagen synthesis in the tendon gap, and enhancing the late remodeling of fibrous peritendonous adhesion.
Article
. Human gingival fibroblast (hGF) cells reside in gingival tissues which are challenged frequently by oral bacteria. Lipopolysaccharide (LPS) from periodontal pathogens can penetrate gingival tissues and stimulate the production of interleukin-1β (IL-1β), which has been implicated in inflammation and bone resorption. The anti-inflammatory effects of low-energy laser irradiation have been reported, but the mechanisms of this biostimulatory effect have not been fully elucidated. Primary cultured hGF cells were challenged with LPS isolated from Campylobacter rectus, a known periodontal disease-associated pathogen, and irradiated by a Ga-Al-As diode low-energy laser (830 nm, 3.95–7.90 J/cm2). The hGF cells cultured medium showed a marked elevation of IL-1β production by LPS, which was significantly inhibited by laser irradiation in a dose-dependent manner. By reverse transcription-polymerase chain reaction (RT-PCR) analysis, this inhibitory effect was involved in the reduction of IL-1β mRNA levels but not that of the IL-1β converting enzyme.
Article
Background and Objective The aim of the present study was to investigate the possibility that low-energy laser irradiation attenuates infarct size formation after induction of chronic myocardial infarction (MI) in small and large experimental animals.Study Design/Materials and Methods Laser irradiation was applied to the infarcted area of rats and dogs at various power densities (2.5 to 20 mW/cm2) after occlusion of the coronary artery.ResultsIn infarcted laser-irradiated rats that received laser irradiation immediately and 3 days after MI at energy densities of 2.5, 6, and 20 mW/cm2, there was a 14%, 62% (significant; P < 0.05), and 2.8% reduction of infarct size (14 days after MI) relative to non–laser-irradiated rats, respectively. In dogs, a 49% (significant; P < 0.01) reduction of infarct size was achieved.Conclusion The results of the present study indicate that delivery of low-energy laser irradiation to infarcted myocardium in rats and dogs has a profound effect on the infarct size after MI. Lasers Surg. Med. 28:204–211, 2001. © 2001 Wiley-Liss, Inc.