Research Abstracts

Low Level Laser Therapy For Tendinopathy. Evidence Of A Dose-Response Pattern.

Bjordal J M, Couppé C, Ljunggren E.

To investigate whether low level laser therapy can reduce pain from tendinopathy, the authors performed a review of randomised placebo-controlled trials with laser therapy for tendinopathy. Validity assessment of each trial was done acc. to predefined criteria for location-specific dosage and irradiation of the skin directly overlying the affected tendon. The literature search identified 78 randomised control trials of which 20 included tendinopathy. Seven trials were excluded for not meeting the validity criteria on treatment procedure and trial design. 12 of the remaining 13 trials investigated the effect of laser therapy for patients with subacute and chronic tendinopathy and provided a pooled mean effect of 21%. If results from only the nine trials adhering to assumed optimal treatment parameters were included, the mean effect over placebo increased to 32%. Low Level Laser Therapy can reduce pain in subacute and chronic tendinopathy if a valid treatment procedure and location-specific dose is used.

Physical Therapy Reviews. 2001; 6: 91-99.

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Low Level Laser Therapy ( LLLT) Of Tendinitis And Myofascial Pains A Randomized, Double-Blind, Controlled Study

Mimmi Logdberg-Anderssont1, Sture Mutzell2, and Ake Hazel3
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. Low Level 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.

Laser Therapy, 1997:9: 79-86

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Treatment Of Medial And Lateral Epicondylitis--Tennis And Golfer's Elbow--With Low Level Laser Therapy: A Multicenter Double Blind, Placebo-Controlled Clinical Study On 324 Patients.

Simunovic Z, Trobonjaca T, Trobonjaca Z Laser Center, Locarno, Switzerland. tzlatko@mamed.medri.hr

Background And Objective: Among the other treatment modalities of medial and lateral epicondylitis, low level laser therapy (LLLT) has been promoted as a highly successful method. The aim of this clinical study was to assess the efficacy of LLLT using trigger points (TPs) and scanner application techniques under placebo-controlled conditions. STUDY DESIGN/MATERIAL AND METHODS: The current clinical study was completed at two Laser Centers (Locarno, Switzerland and Opatija, Croatia) as a double-blind, placebo controlled, crossover clinical study. The patient population (n = 324), with either medial epicondylitis (Golfer's elbow; n = 50) or lateral epicondylitis (Tennis elbow; n = 274), was recruited. Unilateral cases of either type of epicondylitis (n = 283) were randomly allocated to one of three treatment groups according to the LLLT technique applied: (1) Trigger points; (2) Scanner; (3) Combination Treatment (i.e., TPs and scanner technique). Bilateral cases of either type of epicondylitis (n = 41) were subject to crossover, placebo-controlled conditions. Laser devices used to perform these treatments were infrared (IR) diode laser (GaAlAs) 830 nm continuous wave for treatment of TPs and HeNe 632.8 nm combined with IR diode laser 904 nm, pulsed wave for scanner technique. Energy doses were equally controlled and measured in Joules/cm2 either during TPs or scanner technique sessions in all groups of patients. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: (1) short form of McGill's Pain Questionnaire (SF-MPQ); (2) visual analogue scales (VAS); (3) verbal rating scales (VRS); (4) patient's pain diary; and (5) hand dynamometer. RESULTS: Total relief of the pain with consequently improved functional ability was achieved in 82% of acute and 66% of chronic cases, all of which were treated by combination of TPs and scanner technique. CONCLUSIONS: This clinical study has demonstrated that the best results are obtained using combination treatment (i.e., TPs and scanner technique). Good results are obtained from adequate treatment technique correctly applied, individual energy doses, adequate medical education, clinical experience, and correct approach of laser therapists. We observed that under- and over irradiation dosage can result in the absence of positive therapy effects or even opposite, negative (e.g., inhibitory) effects. The current clinical study provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis.

J Clin Laser Med Surg 1998 Jun;16(3):145-51

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Pain Scores And Side Effects In Response To Low Level Laser Therapy (LLLT) For Myofascial Trigger Points.

E Liisa Laakso, Carolyn Richardson, and Tess Cramond
1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane;
2: Physiotherapy Department, University of Queensland, Brisbane; and
3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

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 (IR) 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 experienced side effects. Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependent on power output, dose and/or wavelength.

Laser Therapy , 9:67-72.

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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 non operational. Pain was monitored using the Italian version of the McGill pain questionnaire and the Scott- Huskisson 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 followup examination.

The Clinical Journal of Pain 5:301-304

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A Systematic Review Of Low Level Laser Therapy With Location-Specific Doses For Pain From Chronic Joint Disorders.

Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. jmb@hib.no

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

Aust J Physiother 2003;49(2):107-16

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The Clinical Efficacy Of Low-Power Laser Therapy On Pain And Function In Cervical Osteoarthritis.

Ozdemir F, Birtane M, Kokino S. Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.

Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

Clin Rheumatol 2001;20(3):181-4

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Improvement Of Pain And Disability In Elderly Patients With Degenerative Osteoarthritis Of The Knee Treated With Narrow-Band Light Therapy.

Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD, Michal Rosenthal, MD, Iulian Abramovici, MD, Nathalia Kutok, MD, and Auni Khahil, MD

Objective: To evaluate the effects of low-power light therapy on pain and disability in elderly patients with degenerative osteoarthritis in the knee.

Design: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters.

Patients: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients) and placebo (17 patients). Infrared and placebo emitters were double-blinded.

Interventions: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.

Main Outcome Measures: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient's request to be retreated was summed up 1 year after the trial.

Results: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red and infrared treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo respectively)

Conclusions: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee. J Am Geriatr Soc 40:23-26, 1992. Degenerative osteoarthritis (DOA) is the most common rheumatic disorder of man and causes pain and disability especially in elderly people.1 Autopsy surveys show that degenerative changes in joints begin as early as the second decade of life. 2 Roentgenographic studies conducted in the United States showed osteoarthritic changes in 4 percent of persons under 24 years of age in 85 percent at 75 to 79 years of age. Symptomatic manifestations of osteoarthritis increase with ageing, reflecting disease changes that begin in early life and progress slowly over a period of many decades. 3-4

J Am Geriatr Soc. 1992; 40: 23-26

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Infared Diode Laser In Low Reactive-Level Laser Therapy (LLLT) For Knee Osteoarthrosis

M. A. Trelles, J. Rigau, P. Sala, G. Calderhead and 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 high reactive-level laser therapy (LLLT) with an 830 nm infra red continuous wave gallium aluminium (or aluminium) arsenide (GaAlAs) diode laser with an output power of 60 mW. in light contact Laser therapy for a population of 40 patients (power density of approximately 3 W/cm²). Four points around the patella were irradiated for 60 s each (energy density of 18 J/cm² per point. total of 72 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 at 4 months after the final LLT 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 safe, effective and non-invasive alternative to conventional surgical and medical treatment modalities for DJD patients.

Laser Therapy 1991, 3:149-153

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Clinical Application Of Gaalas 830 Nm Diode Laser In Treatment Of Rheumatoid Arthritis

Kanji Aoada, Yasutaka Ytani, Akira Sakawa and Akira Shimazu 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 recognised 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 GaAIAs diode laser system (830 nm, 60 mW CIW). 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 - 59.6%; good - 30.4%; unchanged - 10%. For ROM improvement the scores were: excellent - 12.6%; good - 43.7%; unchanged - 43.7 Yo. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

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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 HI. 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 labelled 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.

Laser Therapy, 1997:9: 131- 136 09/97

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LLLT Using A Diode Laser In Successful Treatment Of A Herniated Lumbar/Sacral Disc, With Magnetic Resonance Imaging (MRI) Assessment: A Case Report

Tatsuhide Abe Abe Orthopaedic Clinic Futuoka City Fukuoka Prefecture Japan X12'

A 40-year-old woman presented at the Abe Orthopaedic 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/1st sacral vertebrae. The condition had failed to respond to conventional treatment methods including pelvic traction, nonsteroid anti-inflammatory drugs and aural block anaesthetic injections. MRI scans were made of the affected disc, showing it protruding on the left side through the aural membrane. The gallium aluminium 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/S1 disc.

O898-5901/89/020093-03 $05.00 © 1989 by John Wiley & Sons. Ltd.

Clinical Research

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