Research

EFFICACY OF LASER IRRADIATION ON THE AREA NEAR THE STELLATE GANGLION IS DOSE-DEPENDENT: DOUBLE-BLIND CROSSOVER PLACEBO-CONTROLLED STUDY

Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan

In the present study we evaluate the effects of laser irradiation on the area near the stellate ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover and placebo-controlled study was designed to deny the placebo effect of laser irradiation. Eight inpatients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three session s of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS). Measurement were performed before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no changes in VAS were obtained by placebo treatment. These changes in the temperature and VAS were further dependent on the energy density, i.e the dose. Results demonstrate that laser irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Addressee for Correspondance:
Toshikazu Hashimoto MD,
Department of Anesthesia, I Hokkaido University I Hospital N15,
W7, Kita-ku Sapporo, Japan 060.
3/97 Rep US $ 8-10 12
©1997 by LT Publishers l. .K., Ltd.
LASER THERAPY 1997:9:7-- 12

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THE EFFECT OF INFRARED LASER IRRADIATION ON THE DURATION AND SEVERITY OF POSTOPERATIVE PAIN: A DOUBLE BLIND TRIAL

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank

Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K., General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of postoperative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6-8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand postoperative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups. Controls n = 5.5: LLLT n = 2.5. No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group. Controls n = 9: LLLT n = 4. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

Addressee for correspondence: Dr K. C. Moore, Department of Anaesthesia, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, U.K.

0898-5901/92/040145-05$07.50 @) 1992 by John Wiley & Sons, Ltd.

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Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality- application of low level laser

E. Wong G LEE J. Zu CHERMAN and D. P. MASON

Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract. Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury'' (RSI) or "carpal tunnel syndrome'' (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 - T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser ( 100 mW) was used and directed at the tips of the spinous processes C5 - Tl. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers. and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labeled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. cervical collars, and clavicle harnesses as well as improved work ergonomics.

Manuscript received: July, 1997
Accepted for publication: September, 1997
LASER THERAPY, 1997:9: 131- 136
09/97 Rep. US $ 10-12-14
© 1997 by LT Publishers, U.K., Ltd

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PHYSIOLOGICAL RESPONSES IN CHRONIC PAIN PATIENTS LLLT PROTOCOL

Scott D. Fender and David Diffee

Pain Research Group, Arvada, Colorado, U.S.A.

Use of Low Reactive Level Laser Therapy (LLLT) utilising helium-neon lasers has increased lately especially in pain control. New protocols are being developed aimed at a complex of primary and secondary symptomologies. One of these protocols Stellate Ganglion Stimulation has shown in our research a unique set of developments. Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with preexisting psychological symptomology have exacerbated during the initial stages of utilization of this protocol. Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment. Overall, response to this form of therapy seems to be positive but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

Addressee for correspondence: Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A.

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MECHANISMS OF THE ANALGESIC EFFECT OF THERAPEUTIC LASERS IN VIVO

L Navratil1 and I Dylevsky2

1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and 2: Department of Functional Anatomy, Second Medical Faculty and Faculty of Physical Education Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based reports have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy which, however, do not study the mechanism of the laser action. There are several different possible responses induced by non-invasive low level laser therapy (LLLT). The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Addressee for Correspondence: Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic.

03/97 Rep. US 5 10 12 14 © 1997 by LT Publishers U.K, Ltd.
LASER THERAPY 1997:9::'): 33-40
Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

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CAN LOW REACTIVE-LEVEL LASER THERAPY BE USED IN THE TREATMENT OF NEUROGENIC FACIAL PAIN? A DOUBLE-BLIND, PLACEBO CONTROLLED INVESTIGATION OF PATIENTS WITH TRIGEMINAL NEURALGIA

ArneEckerdal and and Lehmann Bastian

Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a double-blind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks. The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year only one patient was still completely free from pain. The use of analgesics was recorded and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Addressee for Correspondence: Arne Eckerdal DDS DOS Consultant, Department of Oral and Maxillofacial Surgery & Oral Medicine, Odense University Hospital, DK-5000 Odense' Denmark.

12/96 Rep. US X 8-10-12

LASER THERAPY, 1996:: 8: 247-252

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DOUBLE BLIND CROSSOVER TRIAL OF LOW LEVEL LASER THERAPY IN THE TREATMENT OF POST HERPETIC NEURALGIA

Kevin C Moore Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar and Toshio Ohshiro

Post herpetic. neuralgia can he an extremely painful condition which in many cases proves resistant lo all the accepted forms of treatment. II is frequently most severe in the elderly and may persist for years with no predictable course.

This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with . established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received tour consecutive laser treatments. The results ides demonstrate a significant reduction in troth pain intensity and distribution following a course of low level laser therapy.

by John Wiley & Sons. Ltd.

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EFFICACY OF LOW REACTIVE-LEVEL LASER THERAPY FOR PAIN ATTENUATION OF POSTHERPETIC NEURALGIA

Osamu Kemmotsu, Kenichi Sato,Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan.

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males. 38 females with an average age of 69 years) managed at our pain clinic over the past four years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). Pain scores (PS) were obtained using a linear analog scale (i) to 10))) before and after LLLT. The immediate effect after the initial LLLT was very good (PS: (}3) in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 + 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a noninvasive, painless and safe method of therapy, it is well acceptable by patients.

Addressee for correspondence: Osamu Kemmotsu, Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan.

0898-5901/91/020071-05$05.00 Ì 1991 by John Wiley & Sons, Ltd.

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MECHANISTIC APPROACH TO GaAIAs DIODE LASER EFFECTS ON PRODUCTION OF REACTIVE OXYGEN SPECIES FROM HUMAN NEUTROPHILS AS A MODEL FOR THERAPEUTIC MODALITY AT CELLULAR LEVEL

Makoto Yamaya*, Chiyuki Shiroto', Hiroki Kobayashi*, Shinji Naganuma*, Jyuichi Sakamoto*, Koh-Jun Suzuki*, Shigeyuki Nakaji*, Kazuo Sugawara* and Takashi Kumae *Department of' Hygiene, Hirosaki University School of Medicine. Hirosaki; .-Shiroto Clinic Coshogawara, Aomori: Department of Industrial Health. The Institute of Public Health, Tokyo. Japan

There have been many reports on the applications of low reactive level laser (LLL) therapy for pain attenuation or pain removal. Our group has reported previously on the effects of in vitro irradiation of LLLT particularly on the phagocytic activity of human Neutrophils. using luminol-dependent chemiluminescence (LmCL) for measurement of reactive oxygen species (ROS) production from human Neutrophils. But the mechanisms of the attenuation of phagocytic activity of NEUTROPHILS by LLL irradiation is not yet full understood,

In this study. we used luminol-dependent and lucigenin-dependent chemiluminescence (LgCL) for detection of affected ROS producing process of human Neutrophils by LLL irradiation. Two soluble action stimuli. N-formyl-Met-Leu-Phc (fMLP) and phorbol myristate acetate (PMA) were used to avoid the possible influence of lag-time from recognition to uptake of particles at the ROS production.

In case of using fMLP as a stimulus, the maximum luminescence intensity of LULL was increased hut LgCL luminescence was decreased by LLL irradiation. When PMA was used as a stimulus, the times to reach the maximum luminescence intensity of LmCL and LgCL were shortened by LLL irradiation but there was no effect on the maximum luminescence intensity of both.

These results suggest that LLL irradiation enhances the ROS production activity of human Neutrophils by the activation of the superoxide converting system, the active clement in which is mainly myeloperoxidase. LLL irradiation enabled a more rapid activation of the superoxide production system, NADPH -oxidase.

LASER THERAPY 1993: 5: 111-116

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Laser Therapy in Post Herpetic Neuralgia,

Dr KC Moore

The clinical application of low incident power density laser radiation for the treatment of acute and chronic pain is now a well established procedure. This paper reviews the currently available English speaking literature and summarises a selection of serious scientific papers which report a beneficial effect following the treatment of a wide variety of acute and chronic syndromes whose main presenting symptom is pain. Read Full Abstract

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Low Intensity Laser Therapy (LILT) for Head, Neck and Facial Pain,

Prof P.F. Bradley

Head and Neck Clinical Applications of LILT
LILT is proving useful in a wide variety of painful conditions in the Head and Neck but the following are particular applications:

1. TM Joint Pain Dysfunction
2. Post Herpetic Neuralgia
3. Trigeminal Neuralgia
4. Painful Ulcerative Conditions
5. Pain of Advanced Oro Facial Cancer
Read Full Abstract

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The Ability of Low Level Laser Therapy (LLLT) to Mitigate Fibromyalgic Pain
The CFIDS Chronicle Physicians' Forum Fall 1993

Douglas Ashendorf, MD, FAAPMR Newark, New Jersey

Results have suggested that the pain relieving properties of LLLT have been the most consistent benefit. The duration of benefit has varied from one hour to one week, and seems to increase as treatment progresses. In no case has pain relief been permanent. Other areas of improvement were not as clear. Improvement in sleep was observed with some regularity although this was undoubtedly due in part to decreased pain. The "non-restorative" sleep complaints were less regularly improved. Improvement with regard to abnormal sensations in the limbs (paresthesia and subjective swelling) appears to be fairly consistent. Improvements in fatigue, mood and headache.

Although the pilot study is incomplete, I believe that these early findings warrant the further investigation of laser therapy for patients with fibromyalgia. This is further supported by the relatively few and harmless side effects of this therapy, the fact that equipment and operating costs are reasonable, and the reality that there are few effective alternative treatments for fibromyalgia patients. Read Full Article

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Carpal Tunnel Study Results Released
Laser Focus World

A physician at UMDNJ-Robert Wood Johnson Medical School is evaluating a "cold" laser to treat patients with carpal tunnel syndrome, a debilitating nerve condition that causes severe pain and numbness in the hand.

Clinical results of a double-blind study of 11 patients afflicted with carpal tunnel syndrome who were treated with a diode-laser device manufactured by Lasermedics (Missouri City, TX) showed that after six to 15 treatments, nine of the 11 patients experienced relief of pain and other associated symptoms as well as normalization of abnormal latencies. The study was conducted by Michael L. Weintraub, a neurologist from Briarcliff, NY, and reported in the February 1996 issue of Neurology. The patients all used a 30mW 830nm, a hand-held, battery-operated, nonsurgical laser device that employs the process of photo-biostimulation. Dr. Weintraub concluded that the results of his study support the efficacy and safety of laser-light treatment in carpal tunnel syndrome.

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Physiotherapist Shows Lasers Relieve Pain

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person's primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats. In the study, Laakso applied different doses and wavelengths of a laser diode to "trigger points" on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief--most likely a placebo effect--but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

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Laser therapy takes pain, discomfort out of post-cancer condition

LOW-LEVEL laser therapy promises to be a valuable weapon in the fight against lymphoedema, the painful and permanent swelling of an arm which frequently follows breast cancer operations. Doctors at Adelaide's Flinders University (FU) have conducted trials which have produced the first clinical evidence that infra-red laser can improve tissue conditions rapidly in the affected area. Associate professor Neil Piller told the university magazine, Flinders Journal, that loosening the tissue encouraged the regrowth of lymph vessels. The results are very exciting," Dr Piller said. "This is the first time anyone specifically has set out to trial lasers in this way. Previously, information about the possible efficacy of lasers has come as a by-product of research into such areas as wound treatment and arthritic conditions, and even then there has been very little work done." Lymphoedema results from deliberate or accidental removal of lymph nodes or vessels. It affects about 15 per cent of women sometime after a breast cancer operation. In the FU trials, 15 women with prolonged or severe lymphoedema were given 16 half-hour laser treatments over 10 weeks. ". All had arms swollen to between 140 and 180 per cent of normal volume. A scanning laser, focusing 2-4 joules of power to each square centimeter, was applied to the entire arm. In all cases, the treatment reduced the amount of oedema, the volume of fluid and the circumference of the arm above the elbow. Tissues in the upper and lower arm were softened and patients reported less pain, tightness and heaviness, and far greater mobility. "Giving them 16 treatments actually was overkill," Dr Piller said. "Since the trial ended, we have achieved significant results from just three or four treatments, or in some cases one or two."

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Diode Laser Treats Peyronie's Disease

A study conducted at St. Joseph Hospital (Houston, TX) using a diode-laser

device from Lasermedics Inc. (Missouri City, TX) to treat Peyronie's disease showed improvement in 63% of the men involved in the test. Peyronie's disease is a focal inflammatory reaction accompanied by progressive fibrosis, resulting in painful erections and curvature of the penis. The disease most often occurs in men between the ages of 40 and 60.