Clinical Data and Laser Research

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Clinical and Case studies on
Low-Level Laser

Efficacy of Low-Level Laser Therapy for Body Contouring and Spot Fat Reduction.

Caruso-Davis MK, Guillot TS, Podichetty VK, Mashtalir N, Dhurandhar NV, Dubuisson O, Yu Y, Greenway FL. School of Human Ecology, Louisiana State University, Baton Rouge, LA, 70803, USA.

Obes Surg. 2010 Apr 15. [Epub ahead of print]
PMID: 20393809 [PubMed - as supplied by publisher]

BACKGROUND: Low-level laser therapy (LLLT) is commonly used in medical applications, but scientific studies of its efficacy and the mechanism by which it causes loss of fat from fat cells for body contouring are lacking. This study examined the effectiveness and mechanism by which 635-680 nm LLLT acts as a non-invasive body contouring intervention method.
METHODS: Forty healthy men and women ages 18-65 years with a BMI < 30 kg/m(2) were randomized 1:1 to laser or control treatment. Subject's waistlines were treated 30 min twice a week for 4 weeks. Standardized waist circumference measurements and photographs were taken before and after treatments 1, 3, and 8. Subjects were asked not to change their diet or exercise habits. In vitro assays were conducted to determine cell lysis, glycerol, and triglyceride release.
RESULTS: Data were analyzed for those with body weight fluctuations within 1.5 kg during 4 weeks of the study. Each treatment gave a 0.4-0.5 cm loss in waist girth. Cumulative girth loss after 4 weeks was -2.15 cm (-0.78 +/- 2.82 vs. 1.35 +/- 2.64 cm for the control group, p < 0.05). A blinded evaluation of standardized pictures showed statistically significant cosmetic improvement after 4 weeks of laser treatment. In vitro studies suggested that laser treatment increases fat loss from adipocytes by release of triglycerides, without inducing lipolysis or cell lysis.
CONCLUSIONS: LLLT achieved safe and significant girth loss sustained over repeated treatments and cumulative over 4 weeks of eight treatments. The girth loss from the waist gave clinically and statistically significant cosmetic improvement.

1. Clinical study on the efficacy of the Terraquant device in the treatment of patients with shoulder problems.
Dr.Gabi Zeilig, M.D., Chaim Sheba Medical Center, Neurologic Rehabilitation Department, Tel Hashomer, Israel.
It's reported that the treatment by the Terraquant device proved to be significantly more efficient than placebo in patients with reduced shoulder range of motion and more efficient than placebo in patients with shoulder pain. The positive outcome of the therapy as well as the lack of side-effects suggests that the Terraquant therapy may be an effective and economical tool in the treatment of pain and reduced range of motion in people with shoulder problems.

2. 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.
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.

3. Effectiveness of quantum therapy on chemo- and radiation-related complications in children with oncology diseases.
S.A.Balakirev, Dr..Med.Sci., Chief of the Department of quantum methods in treatment, Reasearch Institute of Children's Oncology and Hematology, Blokhin Russian Oncology Centre, Russian Academy of Medical Sciences.
The subjects of the present research were chemotherapy-related complications: aphthous stomatitis, gingivitis, vulvovaginitis and radioepithelitis, radiation therapy-related complication.

In the treatment of aphthous ulcers the effect was noted in 3—5 days from the beginning of the treatment (7—10 days if only medication therapy was applied). The pain relief in newborns was confirmed already in some hours later after the first session.

4. Efficacy of quantum therapy in prophylaxis of nasopharynx disorders for frequently-ailing children as well as for increase of immunity.
V.P.Vavilova, M.D., Polyclinical Paediatrics Chair, Kemerovo State Medical Academy, N.K.Perevoschikova, Dr.Med.Sci., Head of Polyclinical Paediatrics Chair, Kemerovo State Medical Academy, Kemerovo, Russia.
The chronic epipharyngeal infection was the aim of the present study. Such results, as a disappearance of the clinical signs of adenoiditis (p < 0,01); reduction of number of aggravations of chronic adenoiditis and frequency of respiratory diseases in 2,8 times after quantum therapy, indicated that quantum therapy is a safe and effective way of treatment in the cases with frequently-ailing children. Also, patients who were exposed to quantum therapy observed an increase of the common immunity.

5. Effect of quantum irradiation in the treatment of children with serious burns.
Evgeny Gatkin, M.D., Moscow Research Institute of Paediatrics and Paediatric surgery.
The main advantage of the quantum therapy for children with serious burns is that the pathogenic treatment is provided instead of symptomatic one, as such a treatment exerted influence on all the links of pathogenic chain including so-called "Selye-stress reaction", non-specific reaction, which includes all protective mechanisms developed during a long evolution process in mammals and human beings. more (Russian, German)

6. Quantum therapy in children with intestinal motility at the background of appendical peritonitis.
Evgeny Gatkin, M.D., Moscow Research Institute of Paediatrics and Paediatric surgery, RF Ministry of Health; A.K.Konovalov, Dr..Med.Sci., Head of Purulent surgery department, Municipal Children's Clinic No.9, RF.
The aim of this clinical study was to assess the efficacy of quantum therapy in children after appendical peritonitis operation. The basic indication to application of the quantum therapeutic RIKTA device was the dynamic ileus at the background of appendical peritonitis. The evaluation was performed through the clinical results: appearance of intestinal murmur, going out of gases and stool etc.. These results confirm that quantum therapy may carry out non-invasive influence on intestinal motility. more (German)

7. Quantum therapy for cystitis: clinical study on children suffering from surgical pathology of urination tracts.
Evgeny Gatkin, M.D., Moscow Research Institute of Paediatrics and Paediatric surgery, RF Ministry of Health.
The aim of this clinical study was to assess the efficacy of quantum therapy for children with cystitis. The study was conducted at the Neuro-Urology Department of Municipal Children's clinical hospital No.9 (surgery base of Moscow Research Institute of Paediatrics and Paediatric surgery). The states of children suffering from cystitis at the background of defects of development and inflammatory diseases, were examined after therapy. None of the patients reported any side effects. The study suggests that this method allows to refuse invasive and traumatic method as an instillation of urinary bladder with daily catheterization is. more (Russian, German)

8. Efficacy of magnetic-infrared laser therapy on the breast reconstruction after mastectomy to treat breast cancer.
Leonid Gusev, Dr..Med.Sci, Leading specialist of Rehabilitation Surgery Department, Institute of clinical oncology, Russian Oncology Center, Moscow, Russia.
The beneficial results of the present study were based on major clinical abilities of electromagnetic irradiation in the RIKTA device: vasodilatation and acceleration of microvessel formation evoked by quantum stimulation. Quantum stimulation of skin blood flow was recognized as a highly effective, safe and economy method which may be applied in various plastic operations. more (Russian, German)

9. Laser therapy for myofacial painful syndromes in patients with deforming osteoarthrose.
Prof. G.M.Kapustina, Dr.Med.Sci., Republic Center "ARMENIA", Yerevan, Republique of Armenia.
The author reports on the effects of laser therapy for myofacial painful syndromes in patients with deforming osteoarthrose. 54 patients (55%) received one course of quantum therapy by RIKTA device exhibited a reduction of edema and pain syndrome as well as an increase of range of motion in the affected joints and improvement of general state of health. 92 patients (94%) noted the positive effect after second course of quantum therapy in a month, 6 patients (6%) exhibited only a reduction of edema and a reduction in the intensity of pain. more (Russian, German)

10.Clinical evaluation of laser therapy in peripheral nervous system disorders.
Prof. G.N.Ponomarenko, Dr.Med.Sci., Leading physiotherapeutist, RF Ministry of Defense, Chief of Physiotherapy training course, Military-Medical Academy, Saint-Petersburg.
The study focused on vertebral osteochondrosis cases with radicular syndrome and neurocirculatory dystonia of hypertonic type. The assessment of treatment efficacy was conducted according to the author's methods based on Trink's (1984) modality.

Patients with vertebral osteochondrosis in the experimental group exhibited a statistically significant reduction in the intensity of pain in the lumbar spine and increase range of motion against the patient of the control group who received only pharmaceutical(medication) treatment. more (Russian, German)

11.Quantum therapy in Paediatrics.
Prof. S.V.Buliarsky, Dr.of Sc.; Rector on Science; Prof. V.I.Ruzov, Dr..Med.Sci., Prof. A.I.Kuselman, Doc.Med.Sci., Head of Paediatrics chair, Ulyanovsk State University, Ulyanovsk, Russia.
The beneficial results on quantum therapy in the treatment of respiratory diseases, children enuresis, diabetes mellitus, alopecia were presented in the study. The positive effect after quantum therapy was marked in children suffering from different pathologies - from acute inflammatory processes (bronchitis, pneumonia) to allergic diseases (bronchial asthma), chronic auto-immune diseases (alopecia, diabetes mellitus) etc. The results confirm that quantum therapy is an effective tool and is beneficial for the treatment of many disorders. more (German)

12.Quantum therapy in children and adults with complications after surgical correction for congenital heart disease.
Prof. V.P.Podzolkov, Dr.Med.Sci, Academician of RAMS, Deputy Director on scientific researches, Scientific Center of cardiovascular surgery, RAMS, Moscow, Russia.
The quantum therapy of such complications as: a suppuration of post-operation wounds, pressure sores, hydrothorax, chylothorax, purulent mediastinitis, serous-hemorrhagic pericarditis was the main goal of the present study. This clinical study has demonstrated that the best results are obtained using combination/complex treatment. more (Russian)

13.Study on the efficacy of quantum therapy in the treatment and prophylaxis of certain dental disorders with the help of TerraQuant device.
V.V.Lutchenkova, M.D., Stomatologist, physiotherapeutist, VOSTOK-MED Company, M.R.Genkin, M.D., Stomatology Company, Moscow, Russia.
The paper reports the results on the treatment and prophylaxis of several dental disorders: caries, pulpitis, apical periodontitis, diseases of parodontium and mucous shell of oral cavity, stomato-neurology diseases, arthrosis-arthritis temporal and mandibular joints, treatment of decubitus, ulcers, and erosion of oral cavity, pain syndrome after root filling, inflammatory diseases of maxillo-facial area, pericoronitis etc. 2991 dental patients were evaluated. In most cases the patients in the experimental group experienced positive effect after 1—2 procedures of quantum laser therapy by TerraQuant device. Control subjects received conventional pharmaceutical (medication) therapy and the effect was noted by 3—5 days later than in the experimental group.

14. Osteoarthritis
FDA Cleared for Osteoarthritis of the Hand. The Effects of Low Level Laser Therapy on Osteoarthritis (OA) of the Hand. A Clinical Study
Dr Larry Lytle, DDS, Ph.D. and Dr. Serafettin Ozdogan, MD

Objective: The objective of this placebo controlled, randomized, double blind, parallel group designed clinical study was to determine the effectiveness and feasibility of over-the-counter (OTC) use of the Q Laser System, made up of the Q1000 low level laser, a multiple diode device and the 660 nm enhancer laser probe, in providing temporary relief of pain and stiffness arising from osteoarthritis of the hand, when the treatment is administered by an individual in his or her own home.
Background: Studies have shown that low level laser therapy is beneficial for treating the pain and stiffness associated with osteoarthritis when treated in medical offices 6,7,8,9,10,but there are few studies demonstrating the relief of osteoarthritis symptoms using low level laser therapy when the individual treats themselves at home.
Methods and Materials To qualify for the study subjects had to be diagnosed with osteoarthritis of one hand by criteria set by the American College of Rheumatology. Ninety one subjects, forty six in a placebo group and forty five in an active laser group treated themselves five times every other day for 10 days for one minute each on selected proprioceptive points using the multiple diode instrument and for 30 seconds on selected acupoints and direct on the affected joints using a single diode instrument. The laser system utilized (Q Laser System manufactured by 2035 Inc) was composed of two instruments, one, a hand held DC powered laser containing eight LEDs and twelve 5 mW laser diodes arranged to form 6 direct soliton waves and 32 indirect soliton waves, emitting 2.5 J/cm² of energy to an area 1.0322 cm2 covering an area of 45.7 mm in diameter. The other instrument used was a single diode 50 mW continuous beam enhancer probe operated at 35 mW emitting 2.16 J/cm² to an area 0.2826 cm2 covering an area of 6 mm in diameter.
Results: ROM evaluations demonstrated 87% improvement in range of motion over the placebo group and 87% of the subjects reported at least a 30% improvement in pain as measured by the VAS scale by the end of active treatment at day 10 with continuing latent benefits of reduction of pain and improvement of range of motion at days 21 and 32. The placebo group used twice as much Tylenol, the rescue pain medication designated for this study, as did the laser treated group and 81% of the treated group were satisfied with the laser system and 95% of all subjects stated the operations and instruction manual was easy to follow and they were very confident they followed the treatment protocol.
Conclusion: Based on the results of this study it can be concluded that the protocol used with this combination of low level lasers provided substantial relief of osteoarthritis symptoms when used by the patient in their own home and the instruments were easy to use.

The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial
Béla Hegedűs, M.D.,1
László Viharos, Ph.D.,2
Mihály Gervain, Ph.D.,3 and
Márta Gálfi, Ph.D.4
1 Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary.
2 Bolyai Institute, University of Szeged, Szeged, Hungary.
3 County Hospital, Laboratory for Thermography, Orosháza, Hungary.
4 Department of Biology, Juhász Gyula Teacher Training College, University of Szeged, Szeged, Hungary.
Address correspondence to:
Béla Hegedűs, M.D.
Physio- and Balneotherapy Center
Fasor Str. 3
Orosháza-Gyopáros
Hungary

Béla Hegedűs, László Viharos, Mihály Gervain, Márta Gálfi. Photomedicine and Laser Surgery. August 2009, 27(4): 577-584. doi:10.1089/pho.2008.2297.
Published in Volume: 27 Issue 4: August 20, 2009 Online Ahead of Print: June 16, 2009

Introduction: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).
Materials and Methods: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4wk with a diode laser (wavelength 830nm, continuous wave, power 50mW) in skin contact at a dose of 6J/point. The placebo control group was treated with an ineffective probe (power 0.5mW) of the same appearance. Before examinations and immediately, 2wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.
Results: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5°C increase in temperature—and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.
Conclusion: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

Laser Acupuncture in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Study
M. Yurtkuran, A. Alp, S. Konur, S. Özçakir, U. Bingol. Photomedicine and Laser Surgery. February 2007, 25(1): 14-20. doi:10.1089/pho.2006.1093.

Objective: The purpose of this study was to investigate the effects and minimum effective dose of laser acupuncture in knee osteoarthritis (KOA), and to determine if it is superior to placebo treatment (sham) in the evaluation of clinical-functional outcome and quality of life.
Methods: In this randomized, placebo-controlled study, patients with grade 2 and 3 primary KOA were selected. Group I (n = 27) received 904-nm low-level laser irradiation with 10 mW/cm2 power density, 4 mW output power, 0.4 cm2 spot size, 0.48 J dose per session, and 120-sec treatment time on the medial side of the knee to the acupuncture point Sp9. Group II (n = 25) received placebo-laser therapy at the same place on the same point. Patients in both of the groups had treatment 5 days per week (total duration of therapy was 10 days) and 20 min per day. The study was comprised of a 2-week (10-session) intervention. Participants were evaluated before treatment (baseline), after treatment (2nd week), and at the 12th week. In this double-blind study, a blind examiner carried out all outcome assesments. The main outcome measures were as follows: pain on movement (pVAS), 50-foot walking time (50 foot w), knee circumference (KC), medial tenderness score (MTS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and Nottingham Health Profile (NHP).
Results: Statistically significant improvement was observed in PVAS, 50 foot w, and KC in group 1. In Group II, statistically significant improvement was observed in PVAS, 50 foot w, and WOMAC. When groups were compared with each other, the improvement observed in KC was superior in Group I at the 2nd week (p = 0.005). Conclusion: Laser acupuncture was found to be effective only in reducing periarticular swelling when compared with placebo laser.

Infrared Diode Laser in Low Reactive-Level Laser therapy (LLLT) for Knee Osteoarthrosis
M. A. Trelles, J. Rigau, P. Sala, G. Calderhead, T. Ohshiro

Degenerative joint disease (DJD), in particular in the knee, is difficult to cure successfully at present, often requiring surgical intervention. In addition, the chronic DJD patient often exhibits symptoms of both a physiological and psychological nature. A study is presented using low reactive-laser therapy (LLLT) with an 830 nm infrared continuous wave gallium aluminium arsenide (GaAIAs) diode laser, with an output power of 60 mW, in light contact laser therapy for a population of 40 patients (power density of 18 J/cm2 per session) two sessions per week for eight weeks. Radiological pain score and joint mobility assessments were made before the first session, immediately after, and at 4 months after the final LLLT session. All other medication and physical therapy was discontinued at least 15 days prior to the first treatment session. Thirty-three patients (82%) reported significant removal of pain and recovery of articular joint mobility. The remaining seven patients felt there was no significant effect following LLLT, and returned to their original pretherapy medication. The side effects were minimal. LLLT is concluded to be a safe effective and noninvasive alternative to conventional surgical and medical treatment modalities for DJD patients.

Key words Degenerative joint disease (DJD) Llaser therapy Adjunctive photochemotherapy

Efficacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee: A double-blind and randomized-controlled trial
Ali Gur, MD 1 *, Abdulkadir Cosut 2, Aysegul Jale Sarac 3, Remzi Cevik 4, Kemal Nas 4, Asur Uyar 5

Keywords
exercise • low-power laser therapy • knee osteoarthritis

Abstract

Background and Objectives
A prospective, double-blind, randomized, and controlled trial was conducted in patients with knee osteoarthritis (OA) to evaluate the efficacy of infrared low-power Gallium-Arsenide (Ga-As) laser therapy (LPLT) and compared two different laser therapy regimes.
Study Design/Materials and Methods
Ninety patients were randomly assigned to three treatment groups by one of the nontreating authors by drawing 1 of 90 envelopes labeled A (Group I: actual LPLT consisted of 5 minutes, 3 J total dose + exercise; 30 patients), B (Group II: actual LPLT consisted of 3 minutes, 2 J total dose + exercise; 30 patients), and C (Group III: placebo laser group + exercise; 30 patients). All patients received a total of 10 treatments, and exercise therapy program was continued during study (14 weeks). Subjects, physician, and data analysts were unaware of the code for active or placebo laser until the data analysis was complete. All patients were evaluated with respect to pain, degree of active knee flexion, duration of morning stiffness, painless walking distance and duration, and the Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC) at week 0, 6, 10, and 14.
Results
Statistically significant improvements were indicated in respect to all parameters such as pain, function, and quality of life (QoL) measures in the post-therapy period compared to pre-therapy in both active laser groups (P < 0.01). Improvements in all parameters of the Group I and in parameters, such as pain and WOMAC of the Group II, were more statistically significant when compared with placebo laser group P < 0.05).
Conclusions
Our study demonstrated that applications of LPLT in different dose and duration have not affected results and both therapy regimes were a safe and effective method in treatment of knee OA.

Lasers Surg. Med. 33:330-338, 2003. © 2003 Wiley-Liss, Inc.

ACTION OF 904 NM DIODE LASER IN ORTHOPAEDICS AND TRAUMATOLOGY
Giuseppe Tam, M. D. Specialist in Legal/Insurance Medicine, Laser Center Tolmezzo - Italy

Objective: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in painreduction therapy.
Summary Background Data: Low power density laser acts on the Prostaglandins synthesis, increasing the change of PGG2 and PGH2 Periossidos into PGI2 (also called Prostaciclyn or Endoprostol). The last one is the main product of the Arachidonic acid into the endothelial cells and into the smooth muscular cells of the vessel walls having a vasodilating and anti-inflammatory action.
Methods: Treatment was carried out on 447 cases and 435 patients (250 women and 185 men) in the period between 20.05.1987 and 31.12.1999. The patients, whose age ranged from 25 to 70, with a mean age of 45 years, were suffering from rheumatic, degenerative and traumatic pathologies as well as cutaneous ulcers. The majority of the patients had been seen by orthopaedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy, with poor results. Two thirds were experiencing acute symptomatic pain, while the others presented a chronic pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength. Frequency of treatment: 1 application per day for 5 consecutive days, followed by a 2-day interval. In the evaluation of the results the following parameters have been considered: disappearance of spontaneous and induced pain, anatomic and functional evaluation of the joints, muscular growth, verbal rating scales, hand dinamometer, patient's pain diary.
Results: Very good results were achieved especially with cases of symptomatic osteoarthritis of the cervical vertebrae, with sport-related injuries, with epicondylitis, and with cutaneous ulcers; also, last but not of least importance, with cases of osteoarthritis of the coxa.
Conclusions: Treatment with 904 nm diode laser has substantially reduced the symptoms as well as improved the quality of life of the patient, thus postponing the need for surgery.

Laser therapy is effective for degenerative osteoarthritis
Stelian J, Gil I, Habot B et al. Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy. J Am Geriatr Soc. 1992; 40: 23-26.

In an Israeli study the effect of laser therapy in degenerative osteoarthritis (DOA) of the knee was investigated in a double blind study among 50 patients. One group received infrared (GaAlAs) and one red (HeNe) laser. Only the first group could be blinded, while the latter was open. Patients were treated twice daily, 15 minutes each time, for 10 days. The patients treated themselves after instruction. Total dose for each session was 10.3 J for red and 11.1 for infrared. Continuous mode was used for 7.5 minutes, pulsed for 7.5 minutes, rationale not stated. There was a significant pain reduction in the laser groups as compared to the placebo groups. There was no significant difference between the red and the infrared group. The Disability Index Questionnaire also revealed an improvement in the laser groups. All patients in the placebo group required analgesics within two months after laser therapy while the patients in the laser group were pain free ranging from 2 months to 1 year.

Clinical efficacy of low power laser therapy in osteoarthritis.
Review article: Marks R, de Palma F.

Of the various physical interventions used to relieve the symptoms of osteoarthritis, a common degenerative joint disease causing considerable pain and disability, low power laser therapy has been reported to be extremely successful in Russia and Eastern Europe. Although the overall number of studies was small, this literature review and analysis highlights the relevant controlled clinical trials and related basic research in English-language publications. This review indicates that, despite their shortcomings, the six studies analysed did report post-treatment improvements in a variety of osteoarthritic problems, including pain, mobility, tenderness and function, with few adverse effects. Possible mechanisms documented for the observed results included peripheral nerve stimulation, resolution of inflammation, enhanced chondrocyte proliferation and increased matrix synthesis. Not all studies were affirmative and few detailed how reliable their measurements were. Clearly, much more work is needed in this area.

THE EFFECT OF LOW POWER LASER THERAPY ON OSTEOARTHRITIS OF THE KNEE
Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.

Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval .The total number of applications was 12 sessions. Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. We achieved significant improvement in pain relief and quality of life in 70% of patients, comparing to their previous status (p < 0.05). There was no significant change in range of motion of the knee

Low-level laser therapy in osteoarticular diseases in geriatric patients
Giavelli S, Fava G, Castronuovo G, Spinoglio L, Galanti A. Dipartimento di Radiologia e Laserterapia, Istituto Gerontologico Pio Albergo Trivulzio, Milano.

INTRODUCTION: Laser light absorption through the skin causes tissue changes, targeting the nervous, the lymphatic, the circulatory and the immune systems with an antalgic, anti-inflammatory, anti-edemic effect and stimulating tissue repair. Therefore low level laser therapy is now commonly used in numerous rehabilitation centers, including the "Istituto Gerontologico Pio Albergo Trivulzio", Milan, Italy. However, to activate the treatment program, the basic medical research results must always be considered to choose the best optical wavelength spectrum, technique and dose, for rehabilitative laser therapy. We analyzed the therapeutic effects of different wavelengths and powers in various treatment schedules. In particular, a protocol was designed to test such physical parameters as laser type, doses and individual schedule in different pathologic conditions. We report the results obtained with low level laser therapy in the rehabilitation of geriatric patients, considering the various physical and technical parameters used in our protocol.
MATERIAL AND METHODS: We used the following laser equipment: an HeNe laser with 632.8 nm wavelength (Mectronic), a GaAs Laser with 904 nm wavelength (Mectronic) and a CO2 Laser with 10,600 nm wavelength (Etoile). To evaluate the patient clinical status, we use a different form for each involved joint; the laser beam is targeted on the region of interest and irradiation is carried out with the sweeping method or the points technique. Irradiation technique, doses and physical parameters (laser type, wavelength, session dose and number) are indicated on the form. The complete treatment cycle consists of 5 sessions per week--20 sessions in all. At the end of the treatment cycle, the results were scored on a 5- grade semiquantitative scale--excellent, good, fair, poor and no results. We examined 3 groups of patients affected with gonarthrosis (149 patients), lumbar arthrosis (117 patients), and algodystrophy (140 patients) respectively.
RESULTS: In gonarthrosis patients, the statistical analysis of the results showed no significant differences between CO2 laser and GaAs laser treatments (p = .975), but significant differences between CO2 laser and HeNe laser treatments (p = .02) and between GaAs laser and HeNe laser treatments (p = .003). In lumbar arthrosis patients treated with GaAs or HeNe laser, significant differences were found between the two laser treatments and the combined sweeping-points techniques appeared to have a positive trend relative to the sweeping method alone, especially in sciatic suffering. In the algodystrophy syndrome, in hemiplegic patients, significant differences were found between CO2 and HeNe laser treatments (p = .026), between high and low CO2 laser doses (p = .024), and between low CO2 laser dose and high HeNe laser dose (p = .006).
CONCLUSIONS: Low level laser therapy can be used to treat osteoarticular pain in geriatric patients. To optimize the results, the diagnostic picture must be correct and a treatment program defining the physical parameters used (wavelength, dose and irradiation technique) must also be designed.

Low level laser therapy (classes I, II and III) for the treatment of osteoarthritis.
Brosseau L, Welch V, Wells G, deBie R, Gam A, Harman K, Morin M, Shea B, Tugwell P. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H-8M5.

BACKGROUND: Osteoarthritis (OA) affects a large proportion of the population. Low Level Laser Therapy (LLLT) is a light source that generates extremely pure light, of a single wavelength. The effect is not thermal, but rather related to photochemical reactions in the cells. LLLT was introduced as an alternative non-invasive treatment for OA about 10 years ago, but its effectiveness is still controversial.
OBJECTIVES: To assess the effectiveness of LLLT in the treatment of OA.
SEARCH STRATEGY: We searched MEDLINE, EMBASE, the Cochrane Musculoskeletal registry, the registry of the Rehabilitation and Related Thereapies field and the Cochrane Controlled Trials Register up to January 30, 2000.
SELECTION CRITERIA: Following an a priori protocol, only controlled clinical trials of LLLT for the treatment of patients with a clinical diagnosis of OA were eligible. Abstracts were excluded unless further data could be obtained from the authors.
DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials and abstracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results were analyzed as weighted mean differences (WMD) with 95% confidence intervals (CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept (e.g. pain). Dichotomous outcomes were analyzed with odds ratios.
MAIN RESULTS: Five trials were included, with 112 patients randomized to laser, 85 patients to placebo laser. Treatment duration ranged from 4 to 10 weeks. Pain was assessed by four trials. The pooled estimate (random effects) of three trials showed no effect on pain measured using a scale (SMD: -0.2, 95% CI: -1.0, +0.6), but there was statistically significant heterogeneity (p>0,05). Two of the trials showed no effect and one demonstrated very beneficial effects with laser. In another trial, with no scale-based pain outcome, significantly more patients reported pain relief (yes/no) with laser with an odds ratio of 0.05, (95% CI: 0.0 to 1.56). Other outcomes of joint tenderness, joint mobility and strength were not significant.
REVIEWER'S CONCLUSIONS: For OA, the results are conflicting in different studies and may depend on the method of application and other features of the LLLT application. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques used. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this meta-analysis lacked data on how LLLT effectiveness is affected by four important factors: wavelength, treatment duration of LLLT, dosage and site of application over nerves instead of joints. There is clearly a need to investigate the effects of these factors on LLLT effectiveness for OA in randomized controlled clinical trials.

Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy.
Stelian J, Gil I, Habot B et al. J Am Geriatr Soc. 1992; 40: 23-26.

In an Israeli study the effect of laser therapy in degenerative osteoarthritis (DOA) of the knee was investigated in a double blind study among 50 patients. One group received infrared (GaAlAs) and one red (HeNe) laser. Only the first group could be blinded, while the latter was open. Patients were treated twice daily, 15 minutes each time, for 10 days. The patients treated themselves after instruction. Total dose for each session was 10.3 J for red and 11.1 for infrared. Continuous mode was used for 7.5 minutes, pulsed for 7.5 minutes, rationale not stated. There was a significant pain reduction in the laser groups as compared to the placebo groups. There was no significant difference between the red and the infrared group. The Disability Index Questionnaire also revealed an improvement in the laser groups. All patients in the placebo group required analgesics within two months after laser therapy while the patients in the laser group were pain free ranging from 2 months to 1 year

15. Lower Back
Acute Low Back Pain with Radiculopathy: A Double-Blind, Randomized, Placebo-Controlled Study.
Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND.

Clinic for Rehabilitation, Medical School , Belgrade, Serbia.

Objective: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.
Background Data: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.
Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.
Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005).
Conclusions: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.

In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial.
Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G.

Source: Australian Journal of Physiotherapy 2007 Vol. 53

It has been suggested that laser therapy may act by stimulating ligament repair (Reddy et al 1998), by anti-inflammatory effects (Sakurai et al 2000, Bjordal and Baxter 2006), and/or by reducing interstitial swelling by stimulating the motoricity of lymphatics (Carati et al 2003, Kaviani et al 2006). There is also in vivo and in vitro evidence that 830 nm laser inhibits Aä and C fibre transmission (Tsuchiya et al 1993, Tsuchiya et al 1994). It is possible that laser-induced neural blockade may then lead to long-term altered nociception, analogous to the prolonged analgesia seen in some patients with local anaesthetics (Arner et al 1990). The repeated application of laser may reduce tonic peripheral nociceptive afferent input to the dorsal horn and facilitate reorganisation of synaptic connections in the central nervous system producing pain modulation (Coderre et al 1993, Mense 1993).

Low level laser therapy may also be an effective adjunctive or alternative treatment for chronic low back pain with avoidance of systemic drug use (Basford et al 1999, Gur et al 2003). Because of the significant placebo response rate in clinical trials, non pharmacologic treatments require careful investigation to ascertain effectiveness. However, even though laser therapy is available in many clinics, it has not yet received FDA approval and the efficacy of laser therapy is controversial. Limitations of previous human studies and the application of an inadequate dose in our own previous studies lead us to choose a higher dose. In addition, we were interested in laser therapy as an adjuvant therapy to a conventional modality. The specific research questions for this study were:

1. In chronic low back pain, is low level laser therapy more effective than placebo-laser therapy plus exercise at decreasing pain, increasing lumbar range of motion, and reducing disability? 2. In chronic low back pain, is low level laser therapy plus exercise more effective than placebo-laser therapy plus exercise at decreasing pain, increasing lumbar range of motion, and reducing disability?

Numerous double-blind, randomized studies have shown that Laser Therapy is an effective treatment modality for a wide range of indications. Below are a few examples:

Achilles tendinitis: Bjordal, J.M., et al. (2006). A randomized, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. British Journal of Sports Medicine 40, pp. 75-80.

Acute pain (meta-analysis): Bjordal, J.M., et al. (2006). Low-Level Laser Therapy in Acute Pain: A Systematic Review of Possible Mechanisms of Action and Clinical Effets in Randomized Placebo-Controlled Trials. Photomedicine and Laser Surgery 24(2), pp. 158-168.

Carpal tunnel syndrome: Ekim, A., et al. (2007). Effect of low level laser therapy in rheumatoid arthritis patients with carpal tunnel syndrome. Swiss Medical Weekly 23-24, pp. 347-352.

Chronic neck pain: Chow, R.T., et al. (2006). The effect of 300 mW, 830 nm laser on chronic neck pain: A double-blind, randomized, placebo-controlled study. Pain 124(1-2), pp. 201-210.

Herpes simplex: Schindl, A., and Neumann, R. (1999). Low-Intensity Laser Therapy is an Effective Treatment for Recurrent Herpes Simplex Infection. Results from a Randomized Double-Blind Placebo-Controlled Study. Investigative Dermatology 113, pp. 221-223.

Myofascial Pain Syndrome: Gur, A., et al. (2004). Efficacy of 904 nm Gallium Arsenide Low Level Laser Therapy in the Management of Chronic Myofascial Pain in the Neck: A Double-Blind and Randomize-Controlled Trial. Lasers in Surgery and Medicine 35, pp. 229-235.

Oral mucositis: Bensadoun, R.J., et al. (1999). Low-energy He/Ne laser in the prevention of radiation-induced mucositis – A multicenter phase III randomized study in patients with head and neck cancer. Support Care Cancer 7(4), pp. 217-218.

Osteoarthritic knee pain (meta-analysis): Bjordal, J.M., et al. (2007). Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BNC Musculoskeletal Disorders 8, pp. 51-65.

Postmastectomy lymphedema: Carati, C.J., et al. (2003). Treatment of Postmastectomy Lymphedema with Low-Level Laser Therapy. American Cancer Society 98(6), pp. 1114-1122.

Stroke: Lampl, Y., et al. (2007). Infrared Laser Therapy for Ischemic Stroke: A new Treatment Strategy. Results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1). Stroke 38(6), pp.1843-1849.

Tendinitis and Myofascial Pain Syndrome (includes Epicondylitis, trochanteritis, etc): Lögdberg-Andersson, M., et al. (1997). Low Level Laser Therapy (LLLT) of Tendinitis and Myofascial Pains – A Randomized, Double-Blind, Controlled Study. LLLT 9, pp. 79-86.

Tinnitus: Gungor, A., et al. (2007). Effectiveness of transmeatal low power laser irradiation for chronic tinnitus. The Journal of Laryngology & Otology 122(5), pp. 447-451

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