Low Level Laser Therapy for Painful Joints

Low Level Laser Therapy (LLLT) uses a light source that generates extremely pure light, of a single wavelength1. 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 controversial2. A Cochrane review of LLLT in osteoarthritis included five trials, and concluded that despite some positive findings, the meta-analysis lacked data on how LLLT effectiveness was affected by the important factors of wavelength, treatment duration of LLLT, dosage, and site of application over nerves instead of joints1,3,4,5,6,7. A different review2 addresses some of these issues in a wider range of trials, and is broadly positive, if limited by numbers

Evaluation of the Effects of Intravenous and Percutaneous Low Level Laser Therapy in the Management of Shoulder Myofascial Pain Syndrome

Introduction: Myofascial pain syndrome (MPS) treatment is challenging with a high recurrence rate and still lacks a clear treatment frame. Therefore research on new, more efficient and long lasting effect treatment modalities is necessary. This study looked at the effects of intravenous laser therapy (IVL) and percutaneous low level laser (PLLL) in the management of shoulder MPS.Methods: In this randomized controlled trial, 30 patients fulfilling inclusion criteria were randomly equally allocated to 3 groups, control, IVL and PLLL. Control group received 12 sessions of placebo low level laser, IVL group received 12 sessions of IVL therapy, and PLLL group received 12 sessions of PLLL therapy. All patients were trained for better body posture, body mechanics, gentle massage of trigger points, stretching exercises of affected muscle (trapezius), and received 10 mg of oral nortriptyline regimen every night for 3 months. Outcomes included pain severity, functional disability, and quality of life. Patients were assessed using Numeric Rating Scale (NRS), Pain Disability Index (PDI), and Short Form Health Survey (SF-12). Data collected were analyzed using analysis of variance (ANOVA), Mann-Whitney and t tests.Results: The mean of PDI and maximum pain intensity during day and night significantly reduced in both PLLL and IVL groups compared to control group. Although pain severity and PDI reduction was more pronounced in IVL group compared to PLLL group, the differences were not statistically significant. Also, quality of life statistically significantly improved in both IVL and PLLL groups compared to control group was more, and although higher in IVL group, the difference was not statistically significant when compared to PLLL group. No side effects were observed in the intervention groups.Conclusion: Intravenous laser and PLLL therapy had a positive effect on pain severity and PDI reduction, and quality of life in this study. Also no adverse event was recorded. Thus, intravenous lasers and PLLL therapy seem to be effective complementary modalities in managing patients with shoulder MPS

Low Level Laser Therapy (LLLT) Combined with Physical Exercise, A More Effective Treatment in Low Back Pain

INTRODUCTION: Low back pain is one of the most common musculoskeletal disorders,which is prevalent among the public population. Depending on the severity of the patients’ pain, different treatments are selected for them. Few studies have addressed, so far, the therapeutic effects of laser in such pains and different results have been published in this regard. The aim of this study is to investigate the therapeutic effect of low intensity laser therapy (LILT) on these diseases.METHODS: Sixty patients are randomly divided into three groups, one received low intensity laser therapy (LILT), the second group the low intensity laser and physical exercises simultaneously and the other the laser placebo and physical exercises simultaneously. Laser therapy was performed for 6 weeks, two sessions per week.Pain and disability were measured and compared, at 0, 6 and 12 weeks after the treatment in the three groups.RESULTS: Patient’s disability in groups 1 and 2 at week 6 showed a significant improvement compared to the beginning of the study. (Group I, P=0.02, P=0.012, group II, P=0.031, P=0.042, respectively).The rate of pain and disability at the week 12 improved significantly compared to the week 6 of the study in each group of 1 and 2. (Group I, P=0.002, P=0.02, group II, P=0.043, P=0.02, respectively). In the comparison of the groups at week 12, the values of pain (P=0.02) and disability (P=0.03) had improved in group I (laser therapy accompanied with physical exercise).CONCLUSION: Our Results revealed that laser therapy accompanied with physical exercise can be the most effective way for improving the chronic back pains including pain relief and reduction of disability in the patients

Clinical Effectiveness of Ultrasound-Guided Biolaser Versus Ozone Therapy in Reducing Chronic Pain in Knee Osteoarthritis: A Three-Month Follow-Up Study

Background: Biolaser is an emerging technology, which has attracted the attention of many surgeons and specialists in different medical fields. Objectives: This study aimed to evaluate the clinical effectiveness of ultrasound-guided biolaser radiation versus ozone therapy in reducing chronic pain in patients with knee osteoarthritis during a three-month follow-up. Patients and Methods: Sixty patients referring to pain clinic of Shohadaye-Tajrish and Akhtar hospitals in 2017, were included in this randomized single-blind clinical trial study. According to a randomized table of numbers, in Biolaser group (n = 30): 10 mL of normal saline + 5 mL of lidocaine 1% + BioLaser + Physical Therapy and in the Ozone group (n = 30), received 10 mL Ozone (30 mic/mL) plus 5 mL lidocaine 1% + BioLaser placebo + Physical Therapy received. The patients were evaluated for pain using visual analog scale (VAS) and knee function with Knee injury and Osteoarthritis Outcome Score (KOOS) questioner. The patients were followed up 4 & 12 weeks and reviewed at weeks 12 after the injection by an observer who was unaware of the groups (IRCT20111121008146N15). Results: Comparison of the mean age (56.8 ± 8.5 years in the biolaser group vs. 51.5 ± 5.4 years in the ozone therapy group; P = 0.721) and body mass index (31.1 ± 3.4 kg/m2 in the biolaser group vs. 30.5 ± 2.6 kg/m2 in the ozone therapy group; P = 0.214) did not indicate any significant differences between the two groups. The pain severity decreased significantly at different times in the biolaser and ozone therapy groups (P = 0.018). The knee pressure sensitivity score was 1.3 ± 0.5 in the biolaser group and 1.6 ± 0.4 in the ozone therapy group at 12 weeks post-treatment (P = 0.037). The knee circumference was also 35.6 ± 3.0 cm in the biolaser group and 39.7 ± 3.9 cm in the ozone therapy group at 12 weeks post-treatment (P = 0.032). The KOOS performance score was 46.9 ± 9.4 in the biolaser group and 49.3 ± 7.9 in the ozone therapy group (P = 0.187). Besides, the KOOS quality of life score was 10 ± 1.3 in the biolaser group and 10.4 ± 1.5 in the ozone therapy group (P = 0.586). Conclusion: Biolaser therapy under ultrasound guidance was found to be a safe, non-invasive, and effective method, which could improve chronic pain in knee osteoarthritis during a three-month follow-up

The Intravenous Laser Blood Irradiation in Chronic Pain and Fibromyalgia

Intravenous laser blood irradiation was first introduced into therapy by the Soviet scientists EN.Meschalkin and VS.Sergiewski in 1981. Originally this method was developed for the treatment of cardiovascular diseases. Improvement of rheologic properties of the blood as well as improvement of microcirculation and reduction of the area of infarction has been proved. Further, reduction of dysrhythmia and sudden cardiac death was achieved. At first, only the Helium-Neon laser (632.8 nm) was used in this therapy. For that, a power of 1-3mW and a period of exposure of 20-60 minutes were applied. The treatments were carried out once or twice a day up to ten appointments in all1. In the years after, many, and for the most part Russian studies showed  that helium-neon laser had various effects on many organs and on the hematologic and immunologic system. The studies were published mainly in Russian which were little known in the West because of decades of political separation, and were regarded with disapproval. Besides clinical research and application for patients, the cell biological basis was developed by the Estonian cell biologist Tiina Karuat the same time. An abstract is to be found in her work “The Science of Low-Power Laser-Therapy

The Effect of Percutaneous Laser Disc Decompression on Reducing Pain and Disability in Patients With Lumbar Disc Herniation

Introduction: As low back pain incidence is increasing, noninvasive modalities are gaining attention for their ability to achieve the best possible outcome with the least complications. Percutaneous laser disc decompression (PLDD) is currently popular for this purpose. This study aims to evaluate the effect of PLDD on disability and pain reduction in patients with lumbar disc herniation.Methods: Thirty patients were enrolled in this study. Spinal nerve blocks were conducted by laser discectomy single stage injection of a needle into the disc space. The nucleus pulposus of herniated discs were irradiated with laser in order to vaporize a small part of the nucleus pulposus of the intervertebral discs and reduce the voluminosity of diseased discs. Patients were treated with 1000 J of 980 nm diode laser with 5 W energy. In order to measure the severity of pain, visual analog scale (VAS) and also ODI (Oswestry Disability Index) were used. Data were analyzed using SPSS version 12.Results: Thirty patients participated in this trial including 11 men and 19 women with a mean age (SD) of 40.8 (10.8) years. The mean patients VAS score and ODI level before and after discectomy showed statistically significant differences. The mean VAS and ODI scores showed no statistical difference between males and females (P < 0.05) and percutaneous laser discectomy decreased the VAS and ODI at both groups of patients similarly.Conclusion: We found the use of PLDD reduces pain and disability in patients as a noninvasive procedure

Efficacy of Low-Level Laser Therapy for the Treatment of Nonspecific Chronic Neck Pain: LowLevel Laser Therapy vs. Sham Laser: Low-Level Laser Therapy for Nonspecific Chronic Neck Pain

Introduction: The most common type of neck pain is chronic nonspecific pain. There are conflicting opinions about the beneficial effects of a low-level laser in reducing chronic nonspecific neck pain. The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) for the treatment of non-specific chronic neck pain.Methods: This study was conducted as a prospective randomized clinical trial. Forty-four patients were randomly divided into two groups: (1) Intervention group (n=22): LLLT in the red spectra range with a wavelength of 980 (nm) and a power of 16 (J/cm2) was irradiated in the affected areas of the neck, the muscles along the spine, and the upper trapezius; (2) sham group (n=22): A low-level laser was irradiated with a passive probe (non-laser red light) in the affected areas of the neck, the muscles along the spine, and the upper trapezius. The treatment protocol consisted of 12 sessions (15 minutes, three times a week, for four weeks). These patients were evaluated for pain using the visual analog scale (VAS) (0-10). The patients were followed up for four weeks.Results: This study showed a statistically significant reduction in chronic nonspecific neck pain in the LLLT group (P<0.05).Conclusion: It is concluded that LLLT was effective in reducing chronic nonspecific neck pain. LLLT is a non-invasive, safe, and effective method that can improve chronic nonspecific neck pain in patients in the short ter

Pain Management Perceptions of the Neonatal Nurses in NICUs and Neonatal Units in Ardebil, Iran

Background: This study aimed to determine neonatal nurses’ perceptions of knowledge and practice in pain management in NICUs & neonatal units. Methods: A cross-sectional descriptive study design was used. A total of 120 neonatal nurses who working in NICUs & neonatal units in Ardebil province, Iran were selected using the convenience sampling technique. A questionnaire of Nurses’ Perceptions of Neonatal Pain (Cong, 2013), including 36 questions with Likert scale and 2 open ended questions, was used. Data collected were analyzed with descriptive statistics of frequencies and percentages.Results: Nurses had Appropriate knowledge of neonatal pain management , but less than 50% felt that they received adequate training and continuing education on pain. Participants reported that they don’t use of pain assessment tools (65%). Less than half felt that the pain tool used in their unit was an accurate measure (44.2%). Fewer than half reported that pain was well managed (28.3%) , that their pain protocols were research evidence based (34.2%) and more than half reported that parents should be involve with the care and comfort of their infant during painful procedures (71.6%). Barriers to effective pain management emerged as high workload, shortage of personnel, lack of knowledge, absence of pain protocols, lack of time, and lack of trust in the pain assessment tools.Conclusions: proper pain management was significantly correlated with adequate training, use of proper and accurate pain tools, and clear and research-based protocols and parental involvement. It can be improved by developing guidelines and support of nurses, develop of clinically feasible pain tools, adequate training and proper supervision