Diode Laser in Cervical Myofascial Pain: A Double-Blind
Study versus Placebo
* F. Ceccherelli, * L. Altafini, * G. Lo Castro,
* A. Avila, *F. Ambrosio, and * G. P. Giron
*Institute of Anesthesiology and Intensive Care,
University of Padua, and the Associazione Italiana per la Ricerca
e, l'Aggiornamento Scientif co, Padua, Italy
Summary: We present a double-blind trial in which
a pulsed infrared beam was compared with a placebo in the treatment
of myofascial pain in the cervical region. The patients were submitted
to 12 sessions on alternate days to a total energy dose of 5 J each.
At each session, the four most painful muscular trigger points and
five bilateral homometameric acupuncture points were irradiated. Those
in the placebo group submitted to the same number of sessions following
an identical procedure, the only difference being that the laser apparatus
was nonoperational. Pain was monitored using the Italian version of
the McGill pain questionnaire and the ScottHuskisson visual analogue
scale. The results show a pain attenuation in the treated group and
a statistically significant difference between the two groups of patients,
both at the end of therapy and at the 3-month follow-up examination.
Key Words: Laser&emdash;Infrared laser beam&emdash;Pain&emdash;Chronic
pain&emdash;Placebo&emdash;Double blind study.
Address correspondence and repent requests to
Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione,
via C. Battisti 267, 35121 Padova, Italia.
The Clinical journal of Pain 5:301-304 copyright
1989 Raven Press, Ltd., New York
Energy per point
5mW av (25Wpeak)
1KHz x 200nS
PAIN SCORES AND SIDE EFFECTS IN RESPONSE TO
LOW LEVEL LASER THERAPY (LLLT) FOR MYOFASCIAL TRIGGER POINTS
E Liisa Laakso Carolyn Richardson, and Tess
1: Physiotherapy Department, Royal Brisbane
Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland,
Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane,
Clinically, Low Level Laser Therapy - LLLT has
been used successfully in the treatment of chronic pain but many have
questioned the scientific basis for its use. Many studies have been
poorly designed or poorly controlled. A double-blind, placebo-controlled,
random allocation study was designed to analyse the effect of second
daily infrared (JR) laser (820 nm, 25 mW) and visible red laser (670
nm, 10 mW) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting
subjects with chronic pain conditions exhibiting myofascial trigger
points in the neck and upper trunk region underwent five treatment
sessions over a two week period. To assess progress, pain scores were
measured using visual analogue scales before and after each treatment.
The incidence of side effects was recorded. All groups demonstrated
significant reductions in pain over the duration of the study with
those groups which received infrared (820 nm) laser at I J/cm2 and
5 J/cm2. demonstrating the most significant effects (p < 0.001).
Only those subjects who had active laser treatment experi enced side
effects. Results indicated that responses to LLLT at the parameters
used in this study are subject to placebo and may be dependant on
power output, dose and/or wavelength.
Key words: chronic pain, Visual Analogue Scal,
LLLT, side effects, phototherapy.
Addressee for Correspondence: E Liisa Laakso BPhty
PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland,
6/97 Rep. US $8-10-12 copyright 1997 by LT Publishers,
, U.K.' Ltd. Manuscript received:January, 1997 Accepted for publication:
LASER THERAPY. 9: 67-72 67
Two wavelengths studied.
Best results with the higher powered infrared
laser compared with the lower powered red laser
LOW LEVEL LASER THERAPY ( LLLT) OF TENDINITIS
AND MYOFASCIAL PAINS A RANDOMIZED, DOUBLE-BLIND, CONTROLLED STUDY
Mimmi Logdberg-Anderssont1, Sture Mutzell2, and
1: Akersberga Health Care Centre, 2: Danderyd
University Hospital, Danderyd, and
3: Vaxholm Health Care Centre, Stockholm, Sweden.
The purpose of this randomised, double-blind study
was to examine the effect of GaAs laser therapy for tendinitis and
myofascial pain in a sample from the general population of Akersberga
in the northern part of Greater Stockholm. 176 patients (of an original
group of 200) completed the scheduled course of treatment. The patients
were assigned randomly to either a laser group (92 patients, of whom
74 had tendinitis, completed the study) or a placebo group (84 patients,
of whom 68 had tendinitis, completed the study). All 176 patients
received six treatments during a period of 3-4 weeks. Their pain was
estimated objectively using a pain threshold meter, and subjectively
with a visual analogue scale before, at the end of, and four weeks
after the end of treatment. Laser therapy had a significant, positive
effect compared with placebo measured from the first assessment to
the third assessment, four weeks after the end of treatment. Laser
treatment was most effective on acute tendinitis.
Addressee for Correpondance, Sture Mutzell, Danderyd
University Hospital 5-182 87 Danderyd, Sweden.
03/07 Rep US 10-12-14 , 1997 By LT Publishers, U.K.,
Ltd., LASER THERAPY, 1997:9: 79-86
Energy per point
8mW av (10Wpeak)
4KHz x 180nS
THE EFFICACY OF LASER THERAPY FOR MUSCULOSKELETAL
AND SKIN DISORDERS:
A CRITERIA-BASED META-ANALYSIS OF RANDOMIZED
Beckerman H, de Bie RA, Bouter LM, et al.
The efficacy of laser therapy for musculoskeletal
and skin disorders has been assessed on the basis of the results of
36 randomized clinical trials (RCTs) involving 1,704 patients. For
this purpose, a criteria-based meta-analysis that took into account
the methodological quality of the individual trials was used. The
studies with a positive outcome were generally of a better quality
than the studies with a negative outcome. No clear relationship could
be demonstrated between the laser dosage applied and the efficacy
of laser therapy, or between the dosage and the methodological score.
In general, the methodological quality of these studies appeared to
be rather low. Consequently, no definite conclusions can be drawn
about the efficacy of laser therapy for skin disorders. The efficacy
of laser therapy for musculoskeletal disorders seems, on average,
to be larger than the efficacy of a placebo treatment. More specifically,
for rheumatoid arthritis, post-traumatic joint disorders, and myofascial
pain, laser therapy seems to have a substantial specific therapeutic
effect. Further RCTs, avoiding the most prevalent methodological errors,
are needed in order to enable the benefits of laser therapy to be
more precisely and validly evaluated.
Physical Therapy. 72(7):483-91, 1992 Jul. (60
LLLT USING A DIODE LASER IN SUCCESSFUL TREATMENT
OF A HERNIATED LUMBAR/SACRAL DISC, WITH MAGNETIC RESONANCE IMAGING
(MRI) ASSESSMENT: A CASE REPORT
Abe Orthopaedic Clinic Futuoka City Fukuoka
Prefecture Japan X12'
A 40-year-old woman presented at the Abe Orthopedic
Clinic with a 2-year history of lower hack pain and pain in the left
hip and leg diagnosed as a ruptured disc between the 5th lumbar/lst
sacral vertebrae. The condition had failed to respond to conventional
treatment methods including pelvic traction, nonsteroid anti-inflammatory
drugs and aural block anesthetic injections. MRI scans were made of
the affected disc, showing it protruding on the left side through
the aural membrane. The gallium aluminum arsenide (GaAlAs) diode laser
(830 nm, 60 mW) was used in outpatient therapy. and after 7 months,
the patient's condition had dramatically improved. demonstrated by
motility exercises. This improvement was confirmed by further MRI
scans, which showed clearly the normal condition of the previously
herniated L5/SI disc.
O898-5901/89/020093-03 $05.00 © 1989 by John
Wiley & Sons. Ltd.
PHYSIOLOGICAL RESPONSES IN CHRONIC PAIN PATIENTS
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.
0898-5901/92/040169-05$07.50 © 1992 by John
Wiley & Sons, Ltd.
CLINICAL APPLICATION OF GaAIAs 830 NM DIODE
LASER IN TREATMENT OF RHEUMATOID ARTHRITIS
Kanji Asada, Yasutaka Yutani, Akira Sakawa and
Department of Orthopaedic Surgery, Osaka City
University Medical School, Japan
The authors have been involved in the treatment
of rheumatoid arthritis (RA), in particular chronic poly-arthritis
and the associated pain complaints. The biggest problem facing such
patients is joint contracture, leading to bony ankylosis. This in
turn severely restricts the range of motion (ROM) of the RA-affected
joints, thereby seriously restricting the patient's quality of life
(QOL). The authors have determined that in these cases, daily rehabilitation
practice is necessary to maintain the patient's QOL at a reasonable
level. The greatest problem in the rehabilitation practice is the
severe pain associated with RA-affected joints, which inhibits restoration
of mobility and improved ROM. LLLT or low reactive level laser therapy
has been recognized in the literature as having been effective in
pain removal and attenuation. The authors accordingly designed a clinical
trial to assess the effectiveness of LLLT in RA related pain (subjective
self-assessment) and ROM improvement (objective documented data).
From July 1988 to June 1990, 170 patients with a total of 411 affected
joints were treated using a GaAlAs diode laser system (830 nm, 60
mW C/W). Patients mean age was 61 years, with a ratio of males: females
of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories:
excellent (remarkable improvement), good (clearly apparent improvement),
and unchanged (little or no improvement). For pain attenuation, scores
were: excellent&emdash;59.6%; good&emdash;30.4%; unchanged&emdash;10%.
For ROM improvement the scores were: excellent&emdash;12.6%; good&emdash;43.7%;
unchanged&emdash;43.7%. This gave a total effective rating for pain
attenuation of 90%, and for ROM improvement of 56.3%.
0898-5901/91/020077-06$05.00 © 1991 by John
Wiley & Sons, Ltd.
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
Laser's Effect on Bone and Cartilage Change
Induced by Joint Immobilization An Experiment With Animal Model
Masami Akai, MD,1* Mariko Usuba, RPT,1 Toru
Maeshima, Yoshio Shirasaki,2 and Shozo Yasuaka, MD3 'Department
of Physical Therapy Tsukuba College of Technology, Tsukuba, Ibaraki,
Japan Mechanical Engineering Laboratory, Agency of Industrial Science
and Technology, TsuPuba, Ibaraki Japan. Yasuoka Orthopaedic Clinic,
Mitaka, Tokyo, Japan
Objective: Influence of low-level (810nm, Ga-Al-As
semiconductor) laser on bone and cartilage during joint immobilization
was examined with rats' knee model.
Materials and Methods: The hind limbs of 42 young
Wistar rats were operated on in order to immobilise the knee joint.
One week after operation they were assigned to three groups; irradiance
3.9W/cm2, 5.8W/cm2, and sham treatment. After 6 times of treatment
for another 2 weeks both hind legs were prepared for 1) indentation
of the articular surface of the knee (stiffness and loss tangent),
and for 2) dual energy X-ray absorptiometry (bone mineral density)
of the focused regions.
Results and Conclusions: The indentation test
revealed preservation of articular cartilage stiffness with 3.9 and
5.8W/cm2 therapy. Soft laser treatment has a possibility for prevention
of biomechanical changes by immobilisation. Lasers Surg. Med. 21:480-484,
1997. C) 1997 Wiley-Liss, Inc.
Correspondence to: Masami Akai, M.D., Department
of Central Rehabilitation Service University Hospital, Faculty of
Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.
- Accepted 20 May 1997
- Lasers in Surgery and Medicine 21:480-484 (1997)
- © 1997 Wiley-Liss, Inc.
Histological and Clinical Responses of Articular
Cartilage to Low-level Laser Therapy: Experimental Study
I. RUIZ CALATRAVA, J.M.SANTISTEBAN VALENZUELA,
R.J.G0MEZ-VILLAMANDOS J.I.REDONDO, J.C.G0MEZ-VILLAMANDOS, l.AVIGA
Department of Veterinary Clinical Pathology-Surgery,
Faculty of Veterinary Medicine, University of Cordoba, Spain. Correspondence
to 1. Ruiz Calatrava, Department of Veterinary Clinical Pathology-Surgery,
Faculty of Veterinary Medicine, University of Cordoba, Avda. Medina
Azahara, 9, 14005 Cordoba, Spain
Abstract. This study was carried out to evaluate
the effects of low-level laser irradiation on experimental lesions
of articular cartilage. A standard lesion was practised on the femoral
trochlea of both hind limbs of 20 clinically normal Californian rabbits.
These animals were divided into two groups of 10 individuals each,
depending on the laser equipment used for treatment. One group was
treated with HeNe laser (8 J cm - 2, 632.8 nm wavelength) and the
other with infra-red (JR) laser (8 J cm - 2, 904 nm wavelength). In
both groups, five points of irradiation to the right limb alone were
irradiated per session for a total of 13 sessions, applied with an
interval of 24 h between sessions. These points were the following:
left and right femoral epicondyles, left and right tibial condyles
and the centre of articulation. The distance between these points
was approximately 1 cm. The untreated left limb was left as a control.
During treatment, extension angle and periarticular thickness were
considered. At the end of the treatment, samples were collected for
histopathological study and stained with: Haematoxylin-Eosin, PAS
and Done. The results show a statistically higher anti-inflammatory
capacity of the IR laser ( p<0.0001). The functional recovery was
statistically similar for both treatments (p<0.176). Histological
study showed, at the end of the treatment, hyaline cartilage in the
IR group, fibrocartilage in the HeNe group and granulation tissue
in the control limbs. Clinical and histological results indicated
that this laser treatment had a clear anti-inflammatory effect that
provided a fast recuperation and regeneration of the articular cartilage.
- Lasers in Medical Science 1997, 12:117-121
- 0268 - 892 1/97/020117 +05 $1 2.00/0
- © 1997 W.B. Saunders Company Ltd
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
- 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
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.
0898-5901/93/03011 1-06$08.00 © 1993 by John
Wiley & Sons. Ltd.
LASER THERAPY 1993: 5: 111-116
LLLT_Clinical pain abstracts
clinical wound healing abstracts
lab wound study abstracts
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