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Laser Therapy Studies - Page 2

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Arthritis and Osteoarthritis

Low Level Laser Therapy and Its Effects on the Quality of Life for Patients Suffering from OsteoArthritis Knee Pain in the Medial Compartment: A Detailed Analysis by Questionnaire

Schnee A, Hanson R
DFW Spine & Joint Center, Irving, TX, United States

Introduction: The aim of this study was to assess the effects of low- level laser therapy for patients specifically diagnosed with moderate to severe (bone on bone) osteoarthritis knee pain in the medial compartment of the knee by using questionnaires.

Materials and Methods: We used the ML830 DC laser manufactured by MicroLight Corporation of America. Twenty treatments were delivered 4X a week over a 5 week period. The wavelength used was 830nm, continuous wave, with an output power of 90mw. The laser probe is made up of three laser diodes. The size of the area treated was 16.5 cm2. The laser was placed directly on the skin along the medial joint line of the knee, where the osteoarthritis was diagnosed, on two separate points, for a total of 20 minutes. The power density was .005 W/cm 2 and the energy density was 6.55 J/cm 2 . The total dose per treatment session was 108 J. Patients were treated at the DFW Spine & Joint Clinic from June 2010 thru April 2011. There were a total of 119 knees treated representing 86 patients. One hundred nineteen questionnaires were completed and collected after the patients' 20th treatment.

Results: There were a total of 86 patients diagnosed and treated for moderate to severe (bone on bone) osteoarthritis in the medial joint compartment with symptoms of knee pain. This diagnosis was a result of either an x-ray or an MRI. Out of those patients 33 had both knees treated and 53 patients had only one knee treated. There were a total of 34 males and a total of 52 females, with a mean age of 66.13 years.
Patients were asked to rate their overall change in activity, limitations, symptoms, emotions, and quality of life after completing 20 treatments using PGIC Scale (Patients' Global Impression of Change). Patients who had both knees treated were asked to fill out two different questionnaires, one for each knee treated. On the 20th treatment 2.5% of the patients rated no change/ almost the same in their knee, 17.6% rated their knee a little better/ somewhat better, 54.6% rated moderately better/better, and 25.2% rated the change in their knee a great deal better. Overall 79.8% rated the overall improvement of their knee either moderately better to a great deal better. None of the patients rated that the treatments had negative effects on their quality of life or that they experienced more knee pain on the completion of their 20th treatment.

Conclusion:Our results indicate that Low-level laser therapy significantly improves the overall quality of life and related factors for patients diagnosed with moderate to severe (bone on bone) osteoarthritis knee pain in the medial compartment of the knee making this therapy an ideal treatment for patients with chronic knee pain.

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Infrared Diode Laser in Low Reactive-Level Laser Therapy (LLLT) for Knee Osteoarthrosis

MA Trelles, J Rigau, P Sala, RG Calderhead, and T Ohshiro

Instituto Medico Vilafortuny, Cambrils (Tarragona) Spain,
International Medical Laser Information Service, Tochigi
Japann Medical Laser Laboratory Tokyo Japan

Abstract: 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-level laser therapy (LLLT) with an 830 nm infrared continuous wave gallium aluminium arsenide (GaAIAs) diode laser, with an output power of 60mW, in light contact laser therapy for a population of 40 patients (incident power density approximately 3W/cm2). Four points around the patella were irradiated for 60s each ( energy density of 180J/cm2 per point) two sessions per week for eight weeks. Radiological, pain score and joint mobility assessments were made before the first session, immeditaely after, and at 4 months after the final LLLT session. All the 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 noninvasive alternative to conventional surgical and medical treatment modalities for DJD patients

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Beneficial Effects of Laser Therapy in the Early Stages of Rheumatoid Arthritis Onset

Contantin Ailioaie and Laura Marinela Lupusoru-Ailioaie

Medical Office for Laser Therapy, 1 Bistrita, B 10-2, 6600 - Iassy, Romania
Al.I. Cuza University, Dept. of Medical Physics, Iassy, Romania

Abstract: The purpose of this study was to determine the effects of laser therapy in pain reduction and/or recovery of patients at the onset of Rheumatoid Arthritis (RA), comparatively with the traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Fifty-nine patients with RA of 6-12 months duration were included in the study. The patients were divided into 3 groups: Group 1 (21 patients) received laser therapy; Group 2 (18 patients) was submitted to placebo laser therapy and NSAIDs medication; Group 3 (20) patients was treated only with NSAIDs. Physical therapy was instituted in all three groups. GaAIAs diode laser of 830 nm wavelength and 200 mW maximum power output power was used. Group 1 received laser therapy once each day, eight days per month, for a total of 32 treatments during a four-month period. The parameters used were 2-4 J/cm2 energy density, and a frequency of 5Hz or 10Hz depending on the number and severity of pain in the affected joints. Placebo laser treatment was given to group 2. The functional activity score, the acute phase reactants (ESR and C - reactive protein), T-Lymphocytes and NK (natural killer) - cells were estimated. Synovial biopsies and Magnetic Resonance Imaging (MRI) of the synoviall membrance were perfomed as well. The analysis of the clinical and biological parameters at the end of treatment showed a statistically significant decrease of duration of morning stiffness, of pain at rest and during movements, and improved acute phase reactants. The overall efficacy rate in these studies was 86% in the first group, 50% in the laser placebo group and 40% in the NSAIDs-treated third group. After four months of treatment, our investigations showed that 830nm infrared laser therapy promoted the restoration of function, relieved pain and limited the complications of RA.

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Anti-Inflammatory Effect of Low-Level Laser and Light-Emitting Diode in Zymosan-Induced Arthritis

de Morais NC, Barbosa AM, Vale ML, Villaverde AB, de Lima CJ, Cogo JC, Zamuner SR.
Laboratory of Inflammation, Institute of Research and Development, University of Vale do Paraí ba , Sáo José dos Campos, Brazil.

Photomed Laser Surg. 2009 Sep 25. [PMID: 19780633]

Abstract Objective: The aim of this work was to investigate the effect of low-level laser therapy (LLLT) and light-emitting diode (LED) on formation of edema, increase in vascular permeability, and articular joint hyperalgesia in zymosan-induced arthritis.

Background Data: It has been suggested that low-level laser and LED irradiation can modulate inflammatory processes.

Material and Methods: Arthritis was induced in male Wistar rats (250-280 g) by intra-articular injection of zymosan (1 mg in 50 muL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1 h, and 2 h after zymosan administration with a semiconductor laser (685 nm and 830 nm) and an LED at 628 nm, with the same dose (2.5 J/cm(2)) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1 h prior to the zymosan administration. Edema was measured by the wet/dry weight difference of the articular tissue, the increase in vascular permeability was assessed by the extravasation of Evans blue dye, and joint hyperalgesia was measured using the rat knee-joint articular incapacitation test.

Results: Irradiation with 685 nm and 830 nm laser wavelengths significantly inhibited edema formation, vascular permeability, and hyperalgesia. Laser irradiation, averaged over the two wavelengths, reduced the vascular permeability by 24%, edema formation by 23%, and articular incapacitation by 59%. Treatment with LED (628 nm), with the same fluence as the laser, had no effect in zymosan-induced arthritis.

Conclusion: LLLT reduces inflammatory signs more effectively than LED irradiation with similar irradiation times (100 sec), average outputs (20 mW), and energy doses (2 J) in an animal model of zymosan-induced arthritis. The anti-inflammatory effects of LLLT appear to be a class effect, which is not wavelength specific in the red and infrared parts of the optical spectrum.

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Clinical Application of GaAIAs 830 NM Diode Laser in Treatment of Rheumatoid Arthritis

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu.
Department of Orthopedic 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).

Results: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%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%

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The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial

Hegedus B, Viharos L, Gervain M, Gálfi M.
Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. arthrodent@freemail.hu

Photomed Laser Surg. 2009 Aug;27(4):577-84. [PMID: 19530911]

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 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, 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 degrees 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.

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Reduction of CXCR4 expression in Rheumatoid Arthritis rat joints by Low Level Diode Laser Irradiation

Lin Zhang, Hiroki Kajiwara, Noboru Kuboyama and Yoshimitsu Abiko
Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry
Department of Oral Molecular Pharmacology, Nihon University School of Dentistry

(Received December 21, 2010)(Accepted February 18, 2011)

Abstract Background: Rheumatoid arthritis (RA) is an inflammatory joint disorder, whose progression leads to the destruction of cartilage and bone. Chemokines and their receptors are potential therapeutic targets in RA. Among these, it has been suggested that CXC chemokine 4 (CXCR4) and its ligand CXC ligand 12 (CXCL12) are involved in RA pathogenesis. Low-level laser irradiation (LLLI) is currently being evaluated for the treatment of RA; however, the molecular mechanisms underlying its effectiveness remain unclear.

Aim: To understand the anti-inflammatory effect of LLLI, we used the collagen-induced arthritis (CIA) rat as RA model and analyzed the gene expression profile in synovial membrane in the hindpaw joints of control, CIA and CIA + LLLI. Expression of CXCR4 and CXCL12 genes were also studied.

Materials and Methods: Total RNA was isolated from the synovial membrane tissue of CIA rat joints or CIA joints treated with LLLI (830 nm Ga-Al-As diode), and gene expression profiles were analyzed by DNA microarray (41,000 rat genes). The mRNA levels were confirmed by reverse transcription polymerase chain reaction (RT-PCR) and real-time PCR. Immunohistochemical examination to examine CXCR4 protein expression was also carried out.

Results: DNA microarray analysis showed that CXCR4 gene expression was increased in CIA tissue and LLLI treatment significantly decreased CIA-induced CXCR4 mRNA levels. In contrast, CXCL12 did not show any significant changes. The microarray data of CXCR4 mRNA levels were further validated using RT-PCR and real-time PCR. Increased CXCR4 mRNA levels by CIA and its reduction following LLLI was successfully confirmed. CXCR4 production was increased in CIA joints and its production was decreased by LLLI.

Conclusion: Decreased CXCR4 expression may be one of the mechanisms in LLLI-mediated reduction of RA inflammation.

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Low-level laser irradiation treatment reduces CCL2 expression in rat rheumatoid synovia via a chemokine signaling pathway.

Zhang L, Zhao J, Kuboyama N, Abiko Y.
Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry at Matsudo, 870-1, Sakaecho-Nishi 2, Matsudo, Chiba, 271-8587, Japan.

Lasers Med Sci. 2011 Sep;26(5):707-17. Epub 2011 May 4. PMID: 21541773

Rheumatoid arthritis (RA) is an inflammatory joint disorder whose progression leads to the destruction of cartilage and bone. Although low-level laser irradiation (LLLI) is currently being evaluated for the treatment of RA, the molecular mechanisms underlying its effectiveness remain unclear. To investigate possible LLLI-mediated antiinflammatory effects, we utilized a collagen-induced arthritis (CIA) rat model and analyzed gene expression profiles in the synovial membranes of the knee joint. Total RNA was isolated from the synovial membrane tissue of the joints of untreated CIA rats or CIA rats treated with LLLI (830 nm Ga-Al-As diode), and gene expression profiles were analyzed by DNA microarray (41,000 rat genes), coupled with Ingenuity pathways analysis (IPA). DNA microarray analysis showed that CCL2 gene expression was increased in CIA tissue, and that LLLI treatment significantly decreased CIA-induced CCL2 mRNA levels. IPA revealed that chemokine signal pathways were involved in the activation of CCL2 production. These microarray data were further validated using real-time PCR and reverse transcription PCR. Immunohistochemistry confirmed that CCL2 production was decreased in CIA rats treated with LLLI.
These findings suggest that decreased CCL2 expression may be one of the mechanisms involved in LLLI-mediated RA inflammation reduction.

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan. yoko@dentc.hal.kagoshima-u.ac.jp

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

PURPOSE: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

CLINICAL FEATURES: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

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Back pain

Low Level Laser Therapy (LLLT) for Patients with Sacroiliac Joint Pain

Ikuko Ohkuni, Nobuyuki Ushigome, Takashi Harada, Toshio Ohshiro, Kazuhiro Mizutani, Yoshiro Musya, Yukihiko Okada, Hiroshi Takahashi
Dept. of Rehabilitation Medicine, Toho University School of Medicine
Japan Medical Laser Laboratory
Dept. of Second Orthopaedic Surgery, Toho University School of Medicine
Okada Orthopaedic Clinic, Yokohama, Japan
Dept. of Orthopaedic Surgery Toho University School of Medicine

Background and Aims: Sacroiliac Joint pain not associated with a major etiological factor is a common problem seen in the orthopedic clinical setting, but diagnosis is difficult because of the anatomical area and thus it is sometimes difficult to effect a complete cure. Low Level Laser Therapy (LLLT) has been well-reported as having efficacy in difficult pain types, so the following preliminary study was designed to assess the efficacy of LLLT for sacroiliac pain.
Materials and Methods: Nine patients participated, 4 males and 5 females, average age of 50.4 yrs, who attended the outpatient department with sacroiliac pain. The usual major disorders were ruled out. Pain was assessed subjectively pre and post-LLLT on a visual analog scale, and trunk range of motion was examined with the flexion test to obtain the pre and post-treatment finger to floor distance (FFD). The LLLT system used was an 830nm CW diiode laser, 1000 mW, 30 sec/point (20 J/cm2) applied on the bilateral tender points twice/week for 5 weeks. Baseline and final assessment values (after the final treatment session) were compared with the Wilcoxon signed rank test (nonparametric score).
Results: All patients completed the study. Eight of the 9 patients showed significant pain improvement and 6 demonstrated significantly increased trunk mobility (P <0.05 for both).
Conclusions: LLLT was effective for sacroiliac pain, and this may be due to improvement of the blood circulation of the strong ligaments which support the sacroiliac joint, activation of the descending inhibitory pathway, and the additional removal of irregularities of the sacroiliac joint articular surfaces. Further larger-scale studies are warranted.

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Low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica.

Bertolini GR, Artifon EL, Silva TS, Cunha DM, Vigo PR.
Injury and Physiotherapeutic Resource Study Laboratory, Western Paraná State University, Cascavel, PR, Brazil. gladson_ricardo@yahoo.com.br

Arq Neuropsiquiatr. 2011;69(2B):356-9. [PMID: 21625765]

Abstract: Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.

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Retrospective study of adjunctive diode laser therapy for pain attenuation in 662 patients: detailed analysis by questionnaire.

Nakaji S, Shiroto C, Yodono M, Umeda T, Liu Q.
Department of Hygiene, Hirosaki University School of Medicine, Aomori, Japan

Photomed Laser Surg. 2005 Feb;23(1):60-5. [PMID: 15782035]

OBJECTIVE: The aim of this study was to assess the long-term effects of low-level laser therapy (LLLT) through a retrospective survey using questionnaires.

BACKGROUND DATA: The use of LLLT for chronic pain attenuation has been reported in the international literature for over 20 years.

METHODS: We used a series of diode laser systems in which the most effective wavelength was consistently found to be 830 nm with an output power in continuous-wave of 60 mW. Subjects were 1,087 patients treated by LLLT at the Shiroto Clinic from April 1992 to August 1995. Questionnaires were sent to subjects in September and October 1996.

RESULTS: The reply rate was 60.9%, comprising 662 questionnaires (265 males, 397 females, mean age of 53.4 years). The total efficacy rating (excellent plus good) immediately after LLLT was 46.8% in men and 47% in women. At the time of the survey, this rose to 73.3% in men and 76.8% in women, with positive effects also recorded on psychosomatic factors such as well-being, physical energy, general fatigue, mental vigor, and emotional stability. LLLT effects continued for 1-3 days. No statistically significant difference in efficacy was seen between males and females. LLLT as used in the study is therefore considered safe, effective, and side-effect-free, making it an ideal adjunctive therapeutic modality for intractable chronic and other pain.

CONCLUSION: Infrared diode LLLT is therefore considered safe, effective, and side-effect-free, making it an ideal adjunctive therapeutic modality for intractable chronic pain.

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Combination Therapy Comprising Low Level Laser Therapy (LLLT) and Brace Therapy for Chronic Lower Back Pain Patients

1) Ikuko Ohkuni, 1) Nobuyuki Ushigome, 1) Takashi Harada, 2) Toshio Oshiro, 3) Yoshiro Musya, 3) Kazuhiro Mizutani, 4) Hiroshi Takahashi, 4) Toru Suguro, 4) Kazuaki Tsuchiya
1) Dept. of Rehabilitation Medicine, Toho University 2) Japan Medical Laser Laboratory 3) Dept. of Orthopaedic Surgery, Toho University Ohashi Hospital 4) Dept. of Orthopaedic Surgery, Toho University

Summary: Low Level Laser Therapy (LLLT) in combination with a sacroiliac brace was used on 33 patients with chronic lower back pain to examin the effectiveness of this combination therapy. A semiconductor laser (1000mW, CW, 830nm) was used. Due to the short duration effect of LLLT previously reported, we tested the effect of combination therapy using LLLT and a sacroliliac brace. Our results showed that the number of patients who had lower back pain in their activities of daily living (ADL) or work decreased, and this combination therapy improved both their ADL and quality of life (QOL). Chronic lower back pain patients who had just started visiting our hospital obtained satisfactory results with LLLT but the latency period was short. In order to maintain the effects of LLLT, we controlled the patients' posture with a sacroiliac brace, which was able to prevent chronic pain for a longer period. The combination treatment was well-tolerated, side-effect free and offered good efficacy in improving pain and range of motion of the lumbar spine.

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Retroactive study 524 patients function 830 nm GaAlAs diode laser reactive-level laser therapy lumbago

T. Ohshiro and Y. Shirono
Japan Medical Laser Laboratory and Ohshiro Clinic, Kojimachi, Tokyo, Japan

Summary: From 1983, out of 4500 pain patients treated at the Ohshiro clinic, 1500 had lumbago-related disease entities. From 1987 until the present, a period of 61 months, 524 patients with a variety of lumbar diseases received low reactive-level laser therapy, LLLT, using the GaAlAs diode laser (830 nm, 60 mW, continuous wave). There were 364 males and 160 females (M:F-2.3:1), with an average age of 53.7 years (M: 5.37, F: 47.5). The laser was applied in the pressure contact technique at a variety of treatment times, using Ohshiro's proximal priority method. The patients graded the effectiveness of their therapy into four grades, from excellent to poor; the sum of the first two grades was used to assess the overall efficacy rate. Patients were interviewed immediately before and after the first therapy session, to give the immediate effect, and at one week after the final session, to elucidate the delayed LLLT effect. Some of the patients (81.6%) reported excellent or good immediate results, and 82% gave the same assessment for the delayed effect. No side-effects at all were reported, and patients have maintained the effective results during the follow-up period. The authors conclude that LLLT with the GaAlAs diode laser at the parameters as reported affords an easily applied, noninvasive, effective and safe therapeutic method for the treatment of pain entities in the lumbago group. Further controlled studies are needed to research in detail the possible mechanisms and pathways, although some are already known.

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Bone Repair

Effect of low-level laser therapy (GaAlAs) on bone regeneration in midpalatal anterior suture after surgically assisted rapid maxillary expansion.

Angeletti P, Pereira MD, Gomes HC, Hino CT, Ferreira LM.

Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Mar;109(3):e38-46. [PMID: 20219584]

OBJECTIVE: The aim of this study was to evaluate the effects of laser therapy on bone regeneration in the midpalatal anterior suture (MPAS) after surgically assisted rapid maxillary expansion (SARME).

METHODS: Thirteen patients aged between 18 and 33 years old with maxillary transverse deficiency (> or =7.0 mm) were evaluated. All patients underwent subtotal Le Fort I osteotomy with separation of the pterygomaxillary suture with the use of Hyrax expander, and were divided into 2 groups: control group (n = 6) and laser group (n = 7). A GaAlAs laser (P = 100 mW, lambda = 830 nm, Ø = 0.06 cm(2)) was used. The laser was applied in 8 treatment sessions with intervals of 48 hours. Each treatment session consisted of laser applications, per point (E = 8.4J, ED = 140J/cm(2)), at 3 points on the MPAS, and total dose of E = 25.2 J, ED = 420 J/cm(2). Digital radiographs were taken before the surgical procedure and at 1-, 2-, 3-, 4-, and 7-month follow-up visits. Optical density analysis of the regenerated bone was performed using Adobe Photoshop 8.0 software.

RESULTS: Bone regeneration associated with the use of laser after SARME showed a statistically significant difference. A higher mineralization rate was found in the laser group (26.3%, P < .001) than the control group.

CONCLUSIONS: Low-level laser irradiation (GaAlAs) accelerates bone regeneration in MPAS after SARME. However, the optical density measurements after 7 months of follow-up were lower in comparison with the preoperative measurements.

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Effects of Continuous and Pulsed Infrared Laser Application on Bone Repair Using Different Energy Doses. Study in Rats

L. Almeida-Lopes1, H. Pretel2, V. Moraes3, P. Jurgens3, L. Ramalho2 and R. Sader3
1 NUPEN, Research and Education Center for Photo Therapy in Health Sciences, São Carlos, Brazil
2 Morphology Department, UNESP, Araraquara, Brazil
3 Hightech Forschungs Zentrum, Munich, Germany

Summary: The Laser Therapy effects on the cellular proliferation are extensively searched and widely known. However, there are controversies on the best out put power used in the applications, the ideal fluency and irradiance, better emission mode and the adequate number of sessions in order to obtain the best results. The aim of this paper was to search for the best application fluency and emission mode, using an infrared laser in the repair of bone defects in the rat tibia. Thus, the histological quality of the neo-formed bone was evaluated by analysis using common optic microscopy and polarized light. Application Parameters: 100 mW, 830 nm, spot diameter = 0,06 nm, CW and 10 Hz, 3 sessions with 72 h of interval, energies and respective fluencies: 2 J =70 J/cm2, 4 J =140 J/cm2, 6 J =210 J/cm2, 8 J =160 J/cm2, 10 J =200 J/cm2. Conclusions: Laser Therapy has increased and accelerated the time bone repairing process (in the initial period of 10 days). This laser effect showed to be dose-dependent with the presence of an effective therapeutic window presenting biostimulation of the bone tissue between 4J and 8 J of total energy for both emission mode. The use of the laser with 10 J of energy generated, characterized by the bioinhibition of the tissues (in the initial period of 10 days). This inhibition took place at the exact irradiation spot).

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Low-level laser therapy enhances the stability of orthodontic mini-implants via bone formation related to BMP-2 expression in a rat model.

Omasa S, Motoyoshi M, Arai Y, Ejima K, Shimizu N.
Department of Orthodontics, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan

Photomed Laser Surg. 2012 May;30(5):255-61. Epub 2012 Mar 9. [PMID: 22404559]

OBJECTIVES:: The aim of this study was to investigate the stimulatory effects of low-level laser therapy (LLLT) on the stability of mini-implants in rat tibiae.

BACKGROUND DATA: In adolescent patients, loosening is a notable complication of mini-implants used to provide anchorage in orthodontic treatments. Previously, the stimulatory effects of LLLT on bone formation were reported; here, it was examined whether LLLT enhanced the stability of mini-implants via peri-implant bone formation.

MATERIALS AND METHODS: Seventy-eight titanium mini-implants were placed into both tibiae of 6-week-old male rats. The mini-implants in the right tibia were subjected to LLLT of gallium-aluminium-arsenide laser (830 nm) once a day during 7 days, and the mini-implants in the left tibia served as nonirradiated controls. At 7 and 35 days after implantation, the stability of the mini-implants was investigated using the diagnostic tool (Periotest). New bone volume around the mini-implants was measured on days 3, 5, and 7 by in vivo microfocus CT. The gene expression of bone m2orphogenetic protein (BMP)-2 in bone around the mini-implants was also analyzed using real-time reverse-transcription polymerase chain reaction assays. The data were statistically analyzed using Student's t test.

RESULTS: Periotest values were significantly lower (0.79- to 0.65-fold) and the volume of newly formed bone was significantly higher (1.53-fold) in the LLLT group. LLLT also stimulated significant BMP-2 gene expression in peri-implant bone (1.92-fold).

CONCLUSIONS: LLLT enhanced the stability of mini-implants placed in rat tibiae and accelerated peri-implant bone formation by increasing the gene expression of BMP-2 in surrounding cells.

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Infrared laser photobiomodulation (lambda 830 nm) on bone tissue around dental implants: a Raman spectroscopy and scanning electronic microscopy study in rabbits.

Lopes CB, Pinheiro AL, Sathaiah S, Da Silva NS, Salgado MA.
Instituto de Pesquisa & Desenvolvimento [Institute for Research & Development] (IP&D), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, Brazil., Department of Dentistry, UNIVAP, São José dos Campos, Brazil.

Photomed Laser Surg. 2007 Apr;25(2):96-101. [PMID: 17508844]

OBJECTIVES: The aim of this study was to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA; approximately 960 cm(1)), and scanning electron microscopy (SEM), the bone quality on the healing bone around dental implants after laser photobiomodulation (lambda830 nm).

BACKGROUND DATA:Laser photobiomodulation has been successfully used to improve bone quality around dental implants, allowing early wearing of prostheses.

METHODS: Fourteen rabbits received a titanium implant on the tibia; eight of them were irradiated with lambda830 nm laser (seven sessions at 48-h intervals, 21.5 J/cm(2) per point, 10 mW, phi approximately 0.0028 cm(2), 86 J per session), and six acted as control. The animals were sacrificed 15, 30, and 45 days after surgery. Specimens were routinely prepared for Raman spectroscopy and SEM. Eight readings were taken on the bone around the implant.

RESULTS: The results showed significant differences on the concentration of CHA on irradiated and control specimens at both 30 and 45 days after surgery (p < 0.001).

CONCLUSION: It is concluded that infrared laser photobiomodulation does improve bone healing, and this may be safely assessed by Raman spectroscopy or SEM.

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Low-level laser therapy induces differential expression of osteogenic genes during bone repair in rats.

Fávaro-Pípi E, Ribeiro DA, Ribeiro JU, Bossini P, Oliveira P, Parizotto NA, Tim C, de Araújo HS, Renno AC.
Department of Physiotherapy, Federal University of São Carlos, Brazil.

Photomed Laser Surg. 2011 May;29(5):311-7. doi: 10.1089/pho.2010.2841. Epub 2011 Feb 9. [PMID: 21306231]

OBJECTIVES: The aim of this study was to measure the temporal pattern of the expression of osteogenic genes after low-level laser therapy during the process of bone healing. We used quantitative real-time polymerase chain reaction (qPCR) along with histology to assess gene expression following laser irradiation on created bone defects in tibias of rats.

MATERIALS AND METHODS: The animals were randomly distributed into two groups: control or laser-irradiated group. Noncritical size bone defects were surgically created at the upper third of the tibia. Laser irradiation started 24 h post-surgery and was performed for 3, 6, and 12 sessions, with an interval of 48 h. A 830 nm laser, 50 J/cm(2), 30 mW, was used. On days 7, 13, and 25 post-injury, rats were sacrificed individually by carbon dioxide asphyxia. The tibias were removed for analysis.

RESULTS: The histological results revealed intense new bone formation surrounded by highly vascularized connective tissue presenting slight osteogenic activity, with primary bone deposition in the group exposed to laser in the intermediary (13 days) and late stages of repair (25 days). The quantitative real-time PCR showed that laser irradiation produced an upregulation of BMP-4 at day 13 post-surgery and an upregulation of BMP4, ALP, and Runx 2 at day 25 after surgery.

CONCLUSION: Our results indicate that laser therapy improves bone repair in rats as depicted by differential histopathological and osteogenic genes expression, mainly at the late stages of recovery.

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Effect of lower-level laser therapy on rabbit tibial fracture.

Liu X, Lyon R, Meier HT, Thometz J, Haworth ST.
Musculoskeletal Functional Assessment Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53201, USA. xcliu@mcw.edu

Photomed Laser Surg. 2007 Dec;25(6):487-94. [PMID: 18158750]

OBJECTIVES: The purpose of the study was to demonstrate the biological effects of low-level laser therapy (LLLT) on tibial fractures using radiographic, histological, and bone density examinations.

MATERIALS AND METHODS: Fourteen New Zealand white rabbits with surgically induced mid-tibial osteotomies were included in the study. Seven were assigned to a group receiving LLLT (LLLT-A) and the remaining seven served as a sham-treated control group (LLLT-C). A low-energy laser apparatus with a wavelength of 830 nm, and a sham laser (a similar design without laser diodes) were used for the study. Continuous outflow irradiation with a total energy density of 40 J/cm(2) and a power level of 200 mW/cm(2) was directly delivered to the skin for 50 seconds at four points along the tibial fracture site. Treatment commenced immediately postsurgery and continued once daily for 4 weeks.

RESULTS: Radiographic findings revealed no statistically significant fracture callus thickness difference between the LLLT-A and LLLT-C groups (p > 0.05). However, the fractures in the LLLT-A group showed less callus thickness than those in LLLT-C group 3 weeks after treatment. The average tibial volume was 14.5 mL in the LLLT-A group, and 11.25 mL in the LLLT-C group. The average contralateral normal tibial volume was 7.1 mL. Microscopic changes at 4 weeks revealed an average grade of 5.5 and 5.0 for the LLLT-A group and the LLLT-C group, respectively. The bone mineral density (BMD) as ascertained using a grey scale (graded from 0 to 256) showed darker coloration in the LLLT-A group (138) than in the LLLT-C group (125).

CONCLUSION: The study suggests that LLLT may accelerate the process of fracture repair or cause increases in callus volume and BMD, especially in the early stages of absorbing the hematoma and bone remodeling. Further study is necessary to quantify these findings.

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BIOMODULATORY EFFECTS OF LLLT ON BONE REGENERATION

Antonio L.B. Pinheiro1), Marilia G. Oliveira2), Pedro Paulo M. Martins3), Luciana Maria Pedreira Ramalho4), Marcos A. Matos de Oliveira5), Aurelicio Novaes Júnior, Renata Amadei Nicolau
1) School of Dentistry, Department of Diagnostic and Therapeutics, Universidade Federal da Bahia 2) School of Dentistry, Post-Graduate Program on Oral and Maxillofacial Surgery, Pontificia Universidade Católica do Rio Grande do Sul 3) School of Dentistry, University of Pernambuco 4) School of Dentistry, Laser Center, Universidade Federal da Bahia 5) Lecture, Institute of Research and Development (IP&D) Universidade Vale do Paraíba (UNIVAP)

ABSTRACT SUMMARY: Tissue healing is a complex process that involves local and systemic responses. The use of Low Level Laser Therapy (LLLT) for wound healing has been shown to be effective in modulating both local and systemic response. Usually the healing process of bone is slower than that of soft tissues. The effects of LLLT on bone are still controversial as previous reports show different results. This paper reports recent observations on the effect of LLLT on bone healing. The amount of newly formed bone after 830nm laser irradiation of surgical wounds created in the femur of rats was evaluated morphometricaly. Forty Wistar rats were divided into four groups: group A (12 sessions, 4.8J/cm2 per session, 28 days); group C (three sessions, 4.8J/cm2 per session, seven days). Groups B and D acted as non-irradiated controls. Forty eight hours after the surgery, the defects of the laser groups were irradiated transcutaneously with a CW 40mW 830nm diode laser, (f∼1mm) with a total dose of 4.8J/cm2. Irradiation was performed three times a week. Computerized morphometry showed a statistically significant difference between the areas of mineralized bone in groups C and D (p=0.017). There was no significant difference between groups A and B (28 days) (p=0.383). In a second investigation, we determined the effects of LLLT on bone healing after the insertion of implants. It is known that dental implants need four and six months period for fixation on the maxillae and on the mandible before receiving loading. Ten male and female dogs were divided into two groups of five animals that received the implant. Two animals of each group acted as controls. The animals were sacrificed 45 and 60 days after surgery. The animals were irradiated three times a week for two weeks in a contact mode with a CW 40mW 830nm diode laser, (f ∼1mm) with a total dose per session of 4.8J/cm2 and a dose per point of 1.2J/cm2. The results of the SEM study showed better bone healing after irradiation with the 830nm diode laser. These findings suggest that, under the experimental conditions of the investigation, the use of LLLT at 830nm significantly improves bone healing at early stages. It is concluded that LLLT may increase bone repair at early stages of healing.

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Carpal Tunnel Syndrome (CTS)

ML830 Laser in the Treatment of Carpal Tunnel Syndrome

GM Double Blind Studies (1.2 Megabytes)

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Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament

Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT.
Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, Taiwan.

Photomed Laser Surg. 2008 Dec;26(6):551-7. [PMID: 19025407]

OBJECTIVE: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome (CTS).

BACKGROUND DATA: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT.

MATERIALS AND METHODS: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm(2), at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up.

RESULTS: Before treatment, there were no significant differences between the two groups for all assessments (p > 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p < 0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p > 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p < 0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2-wk follow-up.

CONCLUSIONS: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.

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Ultrasound and laser therapy in the treatment of carpal tunnel syndrome

Bakhtiary AH, Rashidy-Pour A.
Rehabilitation Faculty, Semnan Medical Sciences University, Senman, Iran. amir822@yahoo.com.

Aust J Physiother. 2004;50(3):147-51. [PMID: 15482245]

This study was designed to compare the efficacy of ultrasound and laser treatment for mild to moderate idiopathic carpal tunnel syndrome. Ninety hands in 50 consecutive patients with carpal tunnel syndrome confirmed by electromyography were allocated randomly in two experimental groups. One group received ultrasound therapy and the other group received low level laser therapy. Ultrasound treatment (1 MHz, 1.0 W/cm(2), pulse 1:4, 15 min/session) and low level laser therapy (9 joules, 830 nm infrared laser at five points) were applied to the carpal tunnel for 15 daily treatment sessions (5 sessions/week). Measurements were performed before and after treatment and at follow up four weeks later, and included pain assessment by visual analogue scale; electroneurographic measurement (motor and sensory latency, motor and sensory action potential amplitude); and pinch and grip strength. Improvement was significantly more pronounced in the ultrasound group than in low level laser therapy group for motor latency (mean difference 0.8 m/s, 95% CI 0.6 to 1.0), motor action potential amplitude (2.0 mV, 95% CI 0.9 to 3.1), finger pinch strength (6.7 N, 95% CI 5.0 to 8.2), and pain relief (3.1 points on a 10-point scale, 95% CI 2.5 to 3.7). Effects were sustained in the follow-up period. Ultrasound treatment was more effective than laser therapy for treatment of carpal tunnel syndrome. Further study is needed to investigate the combination therapy effects of these treatments in carpal tunnel syndrome patients.

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Noninvasive laser neurolysis in carpal tunnel syndrome

Weintraub MI, MD, FACP

Muscle Nerve (1997) 20:1029-1031.

The peripheral nervous system is photosensitive, the scientific rationale for this study which determines the efficacy and safety to laser light exposure in 30 cases with CTS. Nine joules of energy over 5 points (7-15 treatments) reversed CTS in 77% of cases with three-fold normalization of CMAP. A photobiologic response was seen in 80%. This unique and novel approach is cost-effective and has a role in future management of CTS.

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Treatment of repetitive use carpal tunnel syndrome

Smith CF, Vangsness CT, Anderson T & Good W (1995)

Proceedings SPIE (1995) 2395; 658-661.

A randomized, double-blind study was initiated in 1990 to evaluate an eight-point conservative treatment program in carpal tunnel syndrome. 160 patients were delineated with symptoms of carpal tunnel syndrome and these patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit LLLT unit was used in Group A, while an actual LLLT unit was used in Group B. Groups A and B were statistically significantly different in terms of return to work, conduction study improvement, and certain range of motion.

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Cerebral Palsy

Low Level Laser Therapy (LLLT) For Cerebral Palsy

Kazuaki Tsuchiya MD, Takashi Harada MD, Nobuyuki Ushigome MD, Ikuko Ohkuni MD, Toshio Ohshiro MD PhD, Yoshiro Musya MD, Kazuhiro Mizutani MD, Yu Maruyama MD, Toru Suguro MD
Rehabilitation Medicine and Orthopaedic Surgery Toho University, Tokyo
Japan Medical Laser laboratory, Shinanomachi, Tokyo, Japan
Departments of Orthopedic Surgery, Ohhashi Hospital and Plastic Surgery, Toho University, Tokyo Japan

Abstract: Spasticity in cerebral palsy (CP) patients is a critical factor preventing voluntary movement, and can also be associated with involuntary clonus. Low reactive-level laser therapy (LLLT) has been reported as having good overall efficacy in CP patients and also in controlling clonus. The present study was designed to evaluate LLLT in the clinical setting to attenuate spasticity in severely handicapped CP patients. We treated 20 CP patients with near infrared (830 nm) LLLT (16.2 J/cm2/point, once/week over 10 weeks) as a clinical study at our university hospital and a hospital connected with our university. For spasticity of the hip adductor muscle, the obturator nerve was the target for LLLT, and the tibial nerve was irradiated in the case of triceps surae muscle spasticity. LLLT was indicated for the 10 sessions and the degree of attenuation of spasticity was assessed after the final session. Some degree of efficacy and treatment latency was seen in 14 (70%) of the 20 patients, 5 evaluated as excellent, 6 as very good and 3 as fair. Little or no change was seen in the remaining 6 patients, and in no patient did the symptoms worsen. We concluded that LLLT was an efficacious treatment option in the conservative treatment of CP patients, that it was easily-applied, non-invasive and pain-free, and that it did not have any adverse side effects.

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Application of Low Reactive-Level Laser Therapy (LLLT) in Patients with Cerebral Palsy of the Adult Tension Athetosis Type

Yoshimi Asagai, Ryuichi Ueno, Yukio Miura, Toshio Ohshiro MD PhD
Shinano Handicapped Children's Hospital, Shimosuwa, Nagano
Department of Orthopaedic Surgery, Tokyo Medical College, Shinjuku, Tokyo
Japan Medical Laser Laboratory, Shinanomachi, Tokyo Japan

Abstract: In patients with cerebral palsy of the tension athetosis type, a number of symptoms may be observed, including not only the fairly constant involuntary athetotic movements but also myotonic disorders of the motor function of all four limbs and trunk, vocalization and motions associated with eating such as mastication and swallowing. Aggravation of involuntary movements and pain in the neck and back are also seen in many cases. Existing conservative treatment methodologies have proved to be more or less ineffective, and limitations in functional training in adults have made treatment extremely difficult. We first employed low reactive-level laser therapy (LLLT) in a case of spastic cerebral palsy in 1994 with good results. Inn the present study, we applied laser irradiation (830 nm. 60 mW continuous wave) to all myotonic sites around the face and neck region where myotonia was severe in 20 patients with cerebral palsy of the adult tension type for which there was no effective treatment for their neck and back pain. Improvement of myotonia was seen in 19 patients who had pain in these regions. Suppression of myotonia reduced tonic vocalization making words easily heard; more-over, suppression of myotonia and involuntary movements improved working efficiency enabling the patient to perform fairly complex tasks such as word processing. Insomnia and dysuria also improved. Even in the most severe cases, assisting the patient became easier and breathing improved. LLLT with the 830 nm diode laser provides a new and effective treatment modality in this extremely problematic condition, has no serious side effects, and has the potential to improve these patients' quality of life.

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Suppression of Myotonia in Cerebral Palsy and Adjuctive Effect of Low Level Laser Therapy on Intensive Functional Training

Yoshimi Asagai, Yasutaka Watanabe, Toshio Ohshiro, Kengo Yamamoto
Shinano Handicapped Children's Hospital, Shimosuwa, Nagano
Department of Orthopaedic Surgery, Tokyo Medical College, Shinjuku, Tokyo
Japan Medical Laser Laboratory, Shinanomachi, Tokyo Japan

Abstract: This study assesses successively the changes in gross movement by hospital treatment with intensive functional training for 1-2 months according to the objective assessment criteria, the gross motor function measure (GMFM), which is commonly accepted as the global standard. Intensive functional training was carried out on its own in institutions other than the principal author's, or together with low reactive-level IR diode laser therapy (LLLT) in the Shinano Handicapped Children's Hospital, and the efficacy of the two approaches was compared. The severity of the disease was classified according to the gross motor function classification system (GMFCS). Whenn the development of motor function was compared separately by disease severity with the cross-sectional motor growth curve, in the cases of the GMFCS level III a significant improvement was observed in patients of up to around age 8. A significant improvement was observed in patients of up to around 8 years old, especially up to 3 years old, when compared with the cross-sectional motor growth curve even when the GMFCS level was IV. When compared with patients at other rehabilitation and training sites, where only functional training therapy was applied without LLLT, the efficacy of intensive functional training was clearly enhanced in combination with LLLT.

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Degenerative disc disease

Effect of low power laser treatment on a traumatized disc in a rat model.

Adah F, Benghuzzi H, Tucci M, Ragab A, Greenwald N.
University of Mississippi Medical Center, Jackson, MississippI, USA.

Biomed Sci Instrum. 2008;44:34-40. PMID: 19141889]

Abstract: This study investigated the effects of low power laser on the healing process of a traumatized disc in an animal model. The experimental design consisted of 14 rats divided into the following three groups: Animals in group I (n = 5) served as controls with no surgery. Animals in group II (n = 5), the sham group, received a surgically created defect in the disc at L4/L5 level and received no other treatment. Animals in the third group (n = 4) received a similar defect to L4/L5 in similar fashion as described for animals in the sham group (group II) with the exception that they received laser of 830 nm wavelength treatment or irradiation for a period of 4 weeks. The animals were euthanized at 30 days post-implantation using overdose of isoflurane. The discs were then harvested in addition to the vital organs, the reproductive organs, and sample of the adjacent skeletal muscles. The hard and soft tissues were evaluated histopathologically by following laboratory standard techniques. The results of this study indicated that the discs of the laser treated animals healed in a greater magnitude than the sham group. Image analysis revealed that there was more disc formation in the laser irradiated animals than the sham.

Conclusion: In conclusion, data obtained from this study demonstrated that laser irradiation delivered on traumatized discs resulted in a remarkable increase in discs regeneration and healing following trauma.

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Dental

Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis.

Makhlouf M, Dahaba MM, Tunér J, Eissa SA, Harhash TA.

Laser Institute, Cairo, Egypt. mona_makhlouf05@yahoo.com

Photomed Laser Surg. 2012 Mar;30(3):160-6. Epub 2012 Jan 10. [PMID: 22233558]

OBJECTIVE: The aim of this split-mouth, double blinded, short-term, controlled clinical trial was to study the effect of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) for treatment of chronic periodontitis.

BACKGROUND DATA: LLLT is reported to improve the outcome of traditional SRP, but the evidence is still weak.

MATERIALS & METHODS: Sixteen patients with a probing pocket depth (PPD) of 4-6 mm involving at least three teeth in each quadrant were recruited for the study. Afterwards, SRP quadrants were randomly assigned for 10 sessions of LLLT.

RESULTS: Results showed that when compared to sites treated with SRP alone, those treated with SRP+LLLT (10 sessions, 830 nm, 100 mW, 3 J per point, 3 J/cm(2)) exhibited greater reductions in PPD at 5 weeks and 3 months but not at 6 months. Further, SRP+LLLT-treated sites had a statistically significant increase in mean radiographic bone density when comparing 6- and 12-month data and overall from baseline to 12 months. There was a trend to reduce interleukin (IL)-1β but the difference between control and laser sites was not statistically significant.

CONCLUSIONS: SRP combined with LLLT improved radiographic bone density and short-term PPD reduction in patients with chronic periodontitis, but did not significantly affect either the gingival crevicular fluid of IL-1β or the gingival or plaque index.

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Effect of low-level laser therapy (GaAlAs) on bone regeneration in midpalatal anterior suture after surgically assisted rapid maxillary expansion.

Angeletti P, Pereira MD, Gomes HC, Hino CT, Ferreira LM.

Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Mar;109(3):e38-46. [PMID: 20219584]

OBJECTIVE: The aim of this study was to evaluate the effects of laser therapy on bone regeneration in the midpalatal anterior suture (MPAS) after surgically assisted rapid maxillary expansion (SARME).

METHODS: Thirteen patients aged between 18 and 33 years old with maxillary transverse deficiency (> or =7.0 mm) were evaluated. All patients underwent subtotal Le Fort I osteotomy with separation of the pterygomaxillary suture with the use of Hyrax expander, and were divided into 2 groups: control group (n = 6) and laser group (n = 7). A GaAlAs laser (P = 100 mW, lambda = 830 nm, Ø = 0.06 cm(2)) was used. The laser was applied in 8 treatment sessions with intervals of 48 hours. Each treatment session consisted of laser applications, per point (E = 8.4J, ED = 140J/cm(2)), at 3 points on the MPAS, and total dose of E = 25.2 J, ED = 420 J/cm(2). Digital radiographs were taken before the surgical procedure and at 1-, 2-, 3-, 4-, and 7-month follow-up visits. Optical density analysis of the regenerated bone was performed using Adobe Photoshop 8.0 software.

RESULTS: Bone regeneration associated with the use of laser after SARME showed a statistically significant difference. A higher mineralization rate was found in the laser group (26.3%, P < .001) than the control group.

CONCLUSIONS: Low-level laser irradiation (GaAlAs) accelerates bone regeneration in MPAS after SARME. However, the optical density measurements after 7 months of follow-up were lower in comparison with the preoperative measurements.

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Low reactive-level 830 nm GaAlAs diode laser therapy successfully accelerates regeneration of peripheral nerves in human

Ezekiel Dangwa Midamba and Hans Reidar Haanaes
Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark
Laser Therapy 5; 125-129, 1993 © John Wiley & Sons, Ltd.

Abstract:Forty patients with short and long-term neurosensory impairment following perioral nerve injuries are presented in this study. Assessment of their sensory level was undertaken using a variety of nerve tests, one of them was a visual analog scale for registration of sensitivity level prior to and after 10 treatment sessions and additionally for 21 of the 40 patients after 20 treatment sessions. Low level laser therapy was applied using GaAlAs 830 nm, 70 mW continuous wave. Dose of 6.0 J/cm2 was standardized for all patients. Improvement of the eight patients with clinical symptoms of less than 1 year after 10 treatments, was between 40-90% and after 20 treatments between 60-80% for the three patients who continued with the treatment. In 32 of the 40 patients with clinical symptoms of more than 1 year in duration, their improvement was estimated at between 40 and 80%, 21 patients completed 20 treatment sessions and the end results were between 60-90%. This was an uncontrolled clinical study of LLLT on perioral nerve injuries and demonstrated the effectiveness of GaAlAs laser on the nerve involved when applied to the nerve trunk and terminal endings. Although controlled research into actual mechanisms and pathways is needed, the preliminary findings are very promising

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Adjunctive Infrared Diode Laser Therapy Accelerates Healing in Apical Granulomas: A Case Report Study

Rozana Dana Vieru and Agafita Lefter
Center for Dentistry, Periodontology and Laser, Bucharest, Romania

Abstract: The final stage of severe infection round the apex of a tooth is granuloma formation, the treatment of which can be a major problem in clinical dentistry. Although granulomas in the early stages can respond to conservative conventional therapy, such as the application of calcium hydroxide, many in the later stage require surgical intervention with the risk of postoperative sequelae and patient downtime. Low Reactive-Level Laser Therapy (LLLT) has been shown to reduce inflammation and accelerate wound healing. The present study was designed to assess the role of 830nm diode laser therapy in conjuction with conservative conventional therapy in the treatment of severe apical granulomas. Thirty-three young male patients with severe apical granulomas participated in the study, 19 of whom were treated with conventional treatments, and 14 with calcium hydroxide combined with 0.5 J/cm2 - 2 J/cm2 intra- and extraoral diode laser therapy. Significant improvements were seen in the LLLT combination group compared with the control group in the time taken for the resolution of acute postoperative pain (100 vs 500 min) and inflammation (1.6 vs 5.6 days), and long-term tooth remineralization and alveolar bone regeneration (15 vs 33 months). LLLT with the 830 nm diode laser was shown to be safe and effective in combination with conservative conventional therapy in the treatment of severe apical granulomas and was superior to the conventional approach on its own for granulomas of similar severity.

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Low-level laser therapy influences mouse odontoblast-like cell response in vitro.

Pereira LB, Chimello DT, Ferreira MR, Bachmann L, Rosa AL, Bombonato-Prado KF.

Department of Orthodontics, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.

Photomed Laser Surg. 2012 Apr;30(4):206-13. Epub 2012 Feb 29. [PMID: 22375953]

OBJECTIVE: The purpose of this study was to analyze the influence of two different irradiation times with 85 mW/cm(2) 830 nm laser on the behavior of mouse odontoblast-like cells.

BACKGROUND DATA: The use of low-level laser therapy (LLLT) to stimulate pulp tissue is a reality, but few reports relate odontoblastic responses to irradiation in in vitro models.

METHODS: Odontoblast-like cells (MDPC-23) were cultivated and divided into three groups: control/nonirradiated (group 1); or irradiated with 85 mW/cm(2), 830 nm laser for 10 sec (0.8 J/cm(2)) (group 2); or for 50 sec (4.2 J/cm(2)) (group 3) with a wavelength of 830 nm. After 3, 7, and 10 days, it was analyzed: growth curve and cell viability, total protein content, alkaline phosphatase (ALP) activity, calcified nodules detection and quantification, collagen immunolocalization, vascular endothelial growth factor (VEGF) expression, and real-time polymerase chain reaction (PCR) for DMP1 gene. Data were analyzed by Kruskall-Wallis test (α=0.05).

RESULTS: Cell growth was smaller in group 2 (p<0.01), whereas viability was similar in all groups and at all periods. Total protein content and ALP activity increased on the 10th day with 0.8 J/cm(2) (p<0.01), as well as the detection and quantification of mineralization nodules (p<0.05), collagen, and VEGF expression (p<0.01). The expression of DMP1 increased in all groups (p<0.05) compared with control at 3 days, except for 0.8 J/cm(2) at 3 days and control at 10 days.

CONCLUSIONS: LLLT influenced the behavior of odontoblast-like cells; the shorter time/smallest energy density promoted the expression of odontoblastic phenotype in a more significant way.

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Low-level laser therapy enhances the stability of orthodontic mini-implants via bone formation related to BMP-2 expression in a rat model.

Omasa S, Motoyoshi M, Arai Y, Ejima K, Shimizu N.

Department of Orthodontics, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.

Photomed Laser Surg. 2012 May;30(5):255-61. Epub 2012 Mar 9. [PMID: 22404559]

OBJECTIVE: The aim of this study was to investigate the stimulatory effects of low-level laser therapy (LLLT) on the stability of mini-implants in rat tibiae.

BACKGROUND DATA: In adolescent patients, loosening is a notable complication of mini-implants used to provide anchorage in orthodontic treatments. Previously, the stimulatory effects of LLLT on bone formation were reported; here, it was examined whether LLLT enhanced the stability of mini-implants via peri-implant bone formation.

MATERIALS AND METHODS: Seventy-eight titanium mini-implants were placed into both tibiae of 6-week-old male rats. The mini-implants in the right tibia were subjected to LLLT of gallium-aluminium-arsenide laser (830 nm) once a day during 7 days, and the mini-implants in the left tibia served as nonirradiated controls. At 7 and 35 days after implantation, the stability of the mini-implants was investigated using the diagnostic tool (Periotest). New bone volume around the mini-implants was measured on days 3, 5, and 7 by in vivo microfocus CT. The gene expression of bone morphogenetic protein (BMP)-2 in bone around the mini-implants was also analyzed using real-time reverse-transcription polymerase chain reaction assays. The data were statistically analyzed using Student's t test.

RESULTS: Periotest values were significantly lower (0.79- to 0.65-fold) and the volume of newly formed bone was significantly higher (1.53-fold) in the LLLT group. LLLT also stimulated significant BMP-2 gene expression in peri-implant bone (1.92-fold).

CONCLUSIONS: LLLT enhanced the stability of mini-implants placed in rat tibiae and accelerated peri-implant bone formation by increasing the gene expression of BMP-2 in surrounding cells.

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Analgesic effect of a low-level laser therapy (830 nm) in early orthodontic treatment.

Artés-Ribas M, Arnabat-Dominguez J, Puigdollers A.

Dental School, International University of Catalunya, Campus Sant Cugat, Josep Trueta s/n, 08195-St. Cugat del Vallès, Barcelona, Spain.

Lasers Med Sci. 2012 Jul 21. [Epub ahead of print] [PMID: 22814893]

Abstract: The aim of this study was to evaluate the pain sensation that orthodontic patients experience when elastic separators are placed between molars and premolars and to determine the degree of analgesic efficacy of low-level laser therapy (LLLT) compared to a placebo treatment. The study was conducted with 20 volunteers who were fitted with elastic separators between the maxillary molars and premolars. One quadrant was randomly chosen to be irradiated with an 830-nm laser, 100 mW, beam diameter of 7 mm, 250 mW/cm(2) applied for 20 s per point (5 J/cm(2)). Three points were irradiated in the buccal face and three were irradiated in the palate. The same procedure was applied in the contralateral quadrant with a placebo light. A visual analogue scale was used to assess pain 5 min, 6 h, 24 h, 48 h, and 72 h after placement of the separators. Maximum pain occurred 6-24 h after placement of the elastic separators. Pain intensity was significantly lower in the laser-treated quadrant (mean, 7.7 mm) than in the placebo-treated quadrant (mean, 14.14 mm; p = 0.0001). LLLT at these parameters can reduce pain in patients following placement of orthodontic rubber separators.

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Effects of low-level laser therapy and orthodontic tooth movement on dental pulps in rats

Abi-Ramia LB, Sasso Stuani A, Sasso Stuani A, Sasso Stuani MB, de Moraes Mendes A.

Angle Orthod. 2010 Jan;80(1):116-22. [PMID: 19852650]

Abstract Objectives: To describe the microscopic pulpal reactions resulting from orthodontically induced tooth movement associated with low-level laser therapy (LLLT) in rats.

Materials and Methods: Forty-five young male Wistar rats were randomly assigned to three groups. In group I (n = 20), the maxillary right first molars were submitted to orthodontic movement with placement of a coil spring. In group II (n = 20), the teeth were submitted to orthodontic movement plus LLLT at 4 seconds per point (buccal, palatal, and mesial) with a GaAlAs diode laser source (830 nm, 100 mW, 18 J/cm(2)). Group III (n = 5) served as a control (no orthodontic movement or LLLT). Groups I and II were divided into four subgroups according to the time elapsed between the start of tooth movement and sacrifice (12 hours, 24 hours, 3 days, and 7 days).

Results: Up until the 3-day period, the specimens in group I presented a thicker odontoblastic layer, no cell-free zone of Weil, pulp core with differentiated mesenchymal and defense cells, and a high concentration of blood vessels. In group II, at the 12- and 24-hour time points, the odontoblastic layer was disorganized and the cell-free zone of Weil was absent, presenting undifferentiated cells, intensive vascularization with congested capillaries, and scarce defense cells in the cell-rich zone. In groups I and II, pulpal responses to the stimuli were more intense in the area underneath the region of application of the force or force/laser.

Conclusions: The orthodontic-induced tooth movement and LLLT association showed reversible hyperemia as a tissue response to the stimulus. LLLT leads to a faster repair of the pulpal tissue due to orthodontic movement.

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The Short-term Effects of Low Level Lasers as Adjunct Therapy in the Treatment of Periodontal Inflammation

Qadri T, Miranda L, Tuné r J, Gustafsson A.
Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. talat.qadri@mbox.lidnet.se

J Clin Periodontol. 2005 Jul;32(7):714-9. [PMID: 15966876]

OBJECTIVES: The aim of this split-mouth, double-blind controlled clinical trial was to study the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue.

MATERIALS AND METHODS: Seventeen patients with moderate periodontitis were included. After clinical examination, all teeth were scaled and root planed (SRP). One week after SRP, we took samples of gingival crevicular fluid (GCF) and subgingival plaque. The laser therapy was started 1 week later and continued once a week for 6 weeks. One side of the upper jaw was treated with active laser and the other with a placebo. The test side was treated with two low-level lasers having wavelengths of 635 and 830 nm. The patients then underwent another clinical examination with sampling of GCF and plaque. The GCF samples were analysed for elastase activity, interleukin-1beta (IL-1beta) and metalloproteinase-8 (MMP-8). We examined the subgingival plaque for 12 bacteria using DNA probes.

RESULTS: The clinical variables i.e. probing pocket depth, plaque and gingival indices were reduced more on the laser side than on the placebo one (p<0.01). The decrease in GCF volume was also greater on the laser side, 0, 12 microl, than on the placebo side, 0.05 microl (p=0.01). The total amount of MMP-8 increased on the placebo side but was slightly lower on the laser side (p=0.052). Elastase activity, IL-1beta concentration and the microbiological analyses showed no significant differences between the laser and placebo sides.

CONCLUSION: Additional treatment with low-level lasers reduced periodontal gingival inflammation.

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Infrared laser photobiomodulation (lambda 830 nm) on bone tissue around dental implants: a Raman spectroscopy and scanning electronic microscopy study in rabbits.

Lopes CB, Pinheiro AL, Sathaiah S, Da Silva NS, Salgado MA.
Instituto de Pesquisa & Desenvolvimento [Institute for Research & Development] (IP&D), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, Brazil., Department of Dentistry, UNIVAP, São José dos Campos, Brazil.

Photomed Laser Surg. 2007 Apr;25(2):96-101. [PMID: 17508844]

OBJECTIVES: The aim of this study was to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA; approximately 960 cm(1)), and scanning electron microscopy (SEM), the bone quality on the healing bone around dental implants after laser photobiomodulation (lambda830 nm).

BACKGROUND DATA:Laser photobiomodulation has been successfully used to improve bone quality around dental implants, allowing early wearing of prostheses.

METHODS: Fourteen rabbits received a titanium implant on the tibia; eight of them were irradiated with lambda830 nm laser (seven sessions at 48-h intervals, 21.5 J/cm(2) per point, 10 mW, phi approximately 0.0028 cm(2), 86 J per session), and six acted as control. The animals were sacrificed 15, 30, and 45 days after surgery. Specimens were routinely prepared for Raman spectroscopy and SEM. Eight readings were taken on the bone around the implant.

RESULTS: The results showed significant differences on the concentration of CHA on irradiated and control specimens at both 30 and 45 days after surgery (p < 0.001).

CONCLUSION: It is concluded that infrared laser photobiomodulation does improve bone healing, and this may be safely assessed by Raman spectroscopy or SEM.

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Effect of low-level laser therapy on Candida albicans growth in patients with denture stomatitis.

Maver-Biscanin M, Mravak-Stipetic M, Jerolimov V.
Department of Prosthodontics, Clinical Hospital Centre, Zagreb, Croatia. mirela.maver@zg.htnet.hr

Photomed Laser Surg. 2005 Jun;23(3):328-32. [PMID: 15954824]

OBJECTIVE: The purpose of our report is to present the effect of low-level laser therapy on Candida albicans growth and palatal inflammation in two patients with denture stomatitis.

BACKGROUND DATA: The most common oral mucosal disorder in denture wearers is denture stomatitis, a condition that is usually associated with the presence of the yeast Candida albicans. Different treatment methods have been suggested to treat this symptom, none of which is proven to be absolutely effective.

METHODS: Two denture-wearing patients, both with palatal inflammation diagnosed as Newton type II denture stomatitis were treated with low-power semiconductor diode laser (BTL-2000, Prague, Czech Republic) at different wavelengths (685 and 830 nm) for 5 d consecutively. In both patients, palatal mucosa and acrylic denture base were irradiated in noncontact mode (probe distance of 0.5 cm from irradiated area) with different exposure times-5 min (830 nm, 3.0 J/cm2, 60 mW) and 10 min (685 nm, 3.0 J/cm2, 30 mW). The effect of laser light on fungal growth in vivo was evaluated after the final treatment using the swab method and semiquantitative estimation of Candida albicans colonies growth on agar plates. The severity of inflammation was evaluated using clinical criteria.

RESULTS: After lowlevel laser treatment, the reduction of yeast colonies on the agar plates was observed and palatal inflammation was diminished.

CONCLUSION: LLLT is effective in the treatment of denture stomatitis. Further placebo controlled studies are in progress.

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ML830 Laser Therapy for the Treatment of TMJ & TMD

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

There are a variety of treatment modalities, which can be divided into Phase I and Phase II. The purpose of Phase I is to eliminate muscle spasms, TMJ swelling, bruxism (grinding of the teeth) and any dislocation, and generally reduce any type of pain. This treatment usually includes the use of the TMJ appliance (mouth splint), exercises, medication, different therapy, and natural muscles relaxants, and Micro-light Cold Laser Treatments (ML830) to relieve TMJ pain. The ML830 ia a non-invasive, non-thermal laser, capable of penetrating deep into tissue. It is one of the most fascinatingnew healing advances, and is FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief.
The purpose of Phase I therapy is to definitively correct any discrepancies, if necessary, between the upper and lower jaws. Phase 1 therapy may include adjustments of the TMJ joint, orthodontics, surgery or a combination of treatments. It is important to note that Phase II therapy should not be attempted without successful Phase 1 treatment.
Phase I Therapy is usually composed of three types of treatment, all aimed at reducing or eliminating muscle and joint pain.
Therapy No.1
The use of an intra-oral splint (The TMJ Appliance). The TMJ appliance is a computer designed intra oral device that fits most adult mouths without adjusting. It is specifically designed to assist in the treatments of TMJ disorders. The TMJ appliance has been designed by Australian Dentist Dr. Chris Farrell, in response to the need for a low cost intra-oral splint that could be implemented by health care providers, as well as dentists, for the many patients who present with symptoms of TMJ disorders. It is specifically designed to assist in treatments of TMJ disorder. No molding, adjusting or custom fitting is required.
Therapy No. 2
The use of different modes of treatment to reduce muscle and nerve pain. This is a special natural pain relief supplement called (SERENITOL). Proven effective in reducing the reversing the effect if Sleep Apnea, Bruxism, nightly TMJ dysfunction, insomnia, Anxiety Neurosis, Chronic Fatigue and other sleep related disorders. Use of Serenitol, used properly and conservatively is very benefical.
Therapy No.3
The use of MicroLight ML830 Cold Laser Therapy. The ML830 Laser is a non-thermal laser capable of penetrating deep into tissue. FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief, the ML830 Laser is also used to treat carpal tunnel syndrome at our office.
One of the most fascinating and used healing advances is the ML830 low level laser. We are pleased to announce that the ML830 laser has received clearance for the treatment of TMJD and Carpal Tunnel Syndrome.
Laser therapy has been successfully used around the world for over 25 years, with no reported long-term or irreversible side effect. TMJD sufferers are now free to seek relief from TMJ jaw pain through a new non-invasive form of therapy before resorting to surgery. We have had excellent results using the non-thermal laser to relieve pain and promote healing of the painful tissue.
Phase I therapy is considered reversible. In other words, if treatment of phase 1 therapy is discontinued, no detrimental changes will have occurred. If the patient sees no improvement, then they are no worse off than before they began treatment.

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

Click Here to Read the Full Article on ML830 Laser for TMJ

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Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders.

Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME.

Dental School, University of Pernambuco, Pernambuco, Brazil, janainasalmos@hotmail.com.

Lasers Med Sci. 2012 Feb 25. [Epub ahead of print] [PMID: 22367394]

Abstract: The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

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Effectiveness of physiotherapy and GaAlAs laser in the management of temporomandibular joint disorders.

Dostalová T, Hlinakova P, Kasparova M, Rehacek A, Vavrickova L, Navrátil L.

Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic. tatjana.dostalova@fnmotol.cz

Photomed Laser Surg. 2012 May;30(5):275-80. [PMID: 22551049]

OBJECTIVE: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.

BACKGROUND DATA: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives.

MATERIALS AND METHODS: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of ~0.2 cm(2).

RESULTS: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm.

CONCLUSIONS: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan. yoko@dentc.hal.kagoshima-u.ac.jp

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

PURPOSE: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

CLINICAL FEATURES: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

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Measurements of Jaw Movements and TMJ Pain Intensity in Patients Treated with GaAlAs Laser

Marcelo Oliveira MAZZETTO 1; Takami Hirono HOTTA 1,2; Renata Campi de Andrade PIZZO 1
1) Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil; 2) Dental School, University of Franca, Franca, SP, Brazil

Braz Dent J (2010) 21(4): 356-360 [PMID: 20976388]

Abstract: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser λ 830 nm, 40 mW, 5J/cm²) and Group 2 received the placebo application (0 J/cm²), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

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Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders.

BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD.

METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire.

RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain.

CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

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Arthralgia of the temporomandibular joint and low-level laser therapy

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic. hfikackova@hotmail.com

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

OBJECTIVE: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

BACKGROUND DATA: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system’s natural healing ability.

METHODS: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

RESULTS: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

CONCLUSION: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

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Fibromyalgia

Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial

Gü r A, Karakoç M, Nas K, Cevik R, Saraç J, Demir E.
Physical Medicine and Rehabilitation, School of Medicine, Dicle University, Diyarbakir, Turkey. alig@dicle.edu.tr

Lasers Med Sci. 2002;17(1):57-61. [PMID: 11845369]

Low energy lasers are widely used to treat a variety of musculoskeletal conditions including fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomised, single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser therapy in 40 female patients with fibromyalgia.
Patients with fibromyalgia were randomly allocated to active (Ga-As) laser or placebo laser treatment daily for two weeks except weekends. Both the laser and placebo laser groups were evaluated for the improvement in pain, number of tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm.
In both groups, significant improvements were achieved in all parameters (p<0.05) except sleep disturbance, fatigue and skinfold tenderness in the placebo laser group (p>0.05).
It was found that there was no significant difference between the two groups with respect to all parameters before therapy whereas a significant difference was observed in parameters as pain, muscle spasm, morning stiffness and tender point numbers in favour of laser group after therapy (p<0.05). None of the participants reported any side effects. Our study suggests that laser therapy is effective on pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and suggests that this therapy method is a safe and effective way of treatment in the cases with fibromyalgia.

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Herniated discs

coming soon

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Inflammation

Effects of Laser on the Synovial Fluid in the Inflammatory Process of the Knee Joint of the Rabbit

Sandoval MC, Mattiello-Rosa SM, Soares EG, Parizotto NA.
School of Physical Therapy, Industrial University of Santander, Bucaramanga, Columbia.

Photomed Laser Surg. 2009 Feb 2 [PMID: 19187016]

Abstract Objective: The purpose of this study was to evaluate the effects of low-level laser (LLL) energy on the clinical signs of inflammation and the cellular composition of synovial fluid (SF) in the inflamed knee of the rabbit.

Background Data: There are few findings related to the effects of LLL on SF in inflammatory processes and there is little knowledge about the optimal parameters for reducing joint inflammation.

Materials and Methods: Inflammation in the right knee of 36 rabbits was induced by intracapsular injection (0.2 mL) of Terebinthina commun (Tc). The animals were randomly assigned to three groups: acute experimental group (AEG), chronic experimental group (CEG), and control group (CG), which only received Tc. Each group was divided in two subgroups of six animals each. The AEG and CEG groups began to receive laser treatment 2 and 5 d after the induction of inflammation, respectively. Laser irradiation at a wavelength of 830 nm, power output of 77 mW, and power density of 27.5 W/cm(2) was applied daily for 7 d for either 0.12 sec or 0.32 sec, resulting in doses of 3.4 J/cm(2) and 8 J/cm(2), respectively. Body mass, joint perimeter, joint temperature, and the morphology of the SF were analyzed.

Results: There was no statistically significant differences between groups in the body mass, joint perimeter, and SF morphology.

Conclusion: Laser irradiation with the selected parameters produced only a few subtle differences in the inflammatory signs and the SF. The lack of effects may have been due to the short irradiation time.

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Laser-Accelerated INFLAMMATION/PAIN REDUCTION AND HEALING

by Richard Martin, BS, CLT

Practical Pain Management, Nov/Dec 2003

Injured cells and tissues have greater affinity for LLLT than healthy cells and tissues. LLLT in the treatment of inflammation, pain and healing is a highly integrated process, but the author separates those processes categorically for identification.

Acute Inflammation Reduction(flowchart provided in the original article) – After injury, tissues initiate a series of biological responses and cellular membrane reactions which manifest in a combination of edema, inflammation, pain and functional debility. LLLT mediates by: (1) Stabilizing cellular membranes; (2) Enhancing molecule ATP production and synthesis; (3) Stimulating vasodilation via increased Histamine, Nitric Oxide and Serotonin; (4) Accelerating leukocytic activity; (5) Increasing Prostaglandin synthesis; (6) Reducing Interleukin-1; (7) Enhancing lymphocyte response; (8) Increasing angiogenesis; (9) Modulation temperature; (10) Enhancing superoxide dismutase levels; and (11) Decreasing C-reactive protein and neopterin levels.

Pain Reduction(flowchart provided in the original article) – Evidence justifies a conclusion that LLLT reduces pain by combination of processes: (1) Increase in b-Endorphins; (2) Blocked depolarization of C-fiber afferent nerves; (3) Increased nitric oxide production; (4) Increased nerve cell action potential; (5) Axonal sprouting and nerve cell regeneration; (6) Decreased Bradykinin levels; (7) Increased release of acetylcholine; and (8) Ion channel normalization.

Tissue HealingLLLT enhances wound healing by: (1) Enhanced leukocyte infiltration; (2) Increased macrophage activity; (3) Increased neovascularization; (4) Increased fibroblast proliferation; (5) Keratinocyte proliferation; (6) Early epithelialization; (7) Growth factor increases; (8) Enhanced cell proliferation and differentiation, and (9) Greater healed wound tensile strength.

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Anti-Inflammatory Effect of Low-Level Laser and Light-Emitting Diode in Zymosan-Induced Arthritis

de Morais NC, Barbosa AM, Vale ML, Villaverde AB, de Lima CJ, Cogo JC, Zamuner SR.
Laboratory of Inflammation, Institute of Research and Development, University of Vale do Paraí ba , Sáo José dos Campos, Brazil.

Photomed Laser Surg. 2009 Sep 25. [PMID: 19780633]

Abstract Objective: The aim of this work was to investigate the effect of low-level laser therapy (LLLT) and light-emitting diode (LED) on formation of edema, increase in vascular permeability, and articular joint hyperalgesia in zymosan-induced arthritis.

Background Data: It has been suggested that low-level laser and LED irradiation can modulate inflammatory processes.

Material and Methods: Arthritis was induced in male Wistar rats (250-280 g) by intra-articular injection of zymosan (1 mg in 50 muL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1 h, and 2 h after zymosan administration with a semiconductor laser (685 nm and 830 nm) and an LED at 628 nm, with the same dose (2.5 J/cm(2)) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1 h prior to the zymosan administration. Edema was measured by the wet/dry weight difference of the articular tissue, the increase in vascular permeability was assessed by the extravasation of Evans blue dye, and joint hyperalgesia was measured using the rat knee-joint articular incapacitation test.

Results: Irradiation with 685 nm and 830 nm laser wavelengths significantly inhibited edema formation, vascular permeability, and hyperalgesia. Laser irradiation, averaged over the two wavelengths, reduced the vascular permeability by 24%, edema formation by 23%, and articular incapacitation by 59%. Treatment with LED (628 nm), with the same fluence as the laser, had no effect in zymosan-induced arthritis.

Conclusion: LLLT reduces inflammatory signs more effectively than LED irradiation with similar irradiation times (100 sec), average outputs (20 mW), and energy doses (2 J) in an animal model of zymosan-induced arthritis. The anti-inflammatory effects of LLLT appear to be a class effect, which is not wavelength specific in the red and infrared parts of the optical spectrum.

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Effect of low-level laser therapy after implantation of poly-L-lactic/polyglycolic acid in the femurs of rats.

Freddo AL, Rodrigo SM, Massotti FP, Etges A, de Oliveira MG.
School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.

Lasers Med Sci. 2009 Sep;24(5):721-8. Epub 2008 Nov 15. [PMID: 19011949]

This study evaluated the use of red and infrared lasers on tissue surrounding the femurs of 60 rats randomly divided into three groups after implantation of bioabsorbable plates. The control group were not subjected to laser irradiation; group A was treated with red laser [indium-gallium-aluminum-phosphide (InGaAlP) laser, wavelength 685 nm, 35 mW, continuous wave (CW), Ø = 0.06 cm, 2.23 min], and group B was subjected to infrared laser [gallium-aluminum-arsenium (GaAlAs) laser, wavelength 830 nm, 50 mw, CW, Ø = 0.06 cm, 1.41 min], both at 10 J/cm(2). Samples were stained with hematoxylin and eosin (H&E) and examined microscopically. Results showed that the laser irradiation had had a positive photobiomodulation effect on inflammation, confirmed by a better histologic pattern than that of the control group at 3 days and 7 days. Semiquantitative analysis revealed that groups A and B had a histologic score significantly greater than that of the control group at 3 days. At 21 days, histomorphometric analysis revealed a more intense inflammation in the red laser group than in the other groups. We concluded that low-level laser therapy (LLLT) has positive effects on the photobiomodulation of inflammation in the tissues surrounding the poly-L-lactic/polyglycolic acid (PLLA/PGA) bioabsorbable plate. It stimulated vascularization, fibroblast proliferation, and collagen deposition.

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Effect of low-level laser therapy on Candida albicans growth in patients with denture stomatitis.

Maver-Biscanin M, Mravak-Stipetic M, Jerolimov V.
Department of Prosthodontics, Clinical Hospital Centre, Zagreb, Croatia. mirela.maver@zg.htnet.hr

Photomed Laser Surg. 2005 Jun;23(3):328-32. [PMID: 15954824]

OBJECTIVE: The purpose of our report is to present the effect of low-level laser therapy on Candida albicans growth and palatal inflammation in two patients with denture stomatitis.

BACKGROUND DATA: The most common oral mucosal disorder in denture wearers is denture stomatitis, a condition that is usually associated with the presence of the yeast Candida albicans. Different treatment methods have been suggested to treat this symptom, none of which is proven to be absolutely effective.

METHODS: Two denture-wearing patients, both with palatal inflammation diagnosed as Newton type II denture stomatitis were treated with low-power semiconductor diode laser (BTL-2000, Prague, Czech Republic) at different wavelengths (685 and 830 nm) for 5 d consecutively. In both patients, palatal mucosa and acrylic denture base were irradiated in noncontact mode (probe distance of 0.5 cm from irradiated area) with different exposure times-5 min (830 nm, 3.0 J/cm2, 60 mW) and 10 min (685 nm, 3.0 J/cm2, 30 mW). The effect of laser light on fungal growth in vivo was evaluated after the final treatment using the swab method and semiquantitative estimation of Candida albicans colonies growth on agar plates. The severity of inflammation was evaluated using clinical criteria.

RESULTS: After lowlevel laser treatment, the reduction of yeast colonies on the agar plates was observed and palatal inflammation was diminished.

CONCLUSION: LLLT is effective in the treatment of denture stomatitis. Further placebo controlled studies are in progress.

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Arthralgia of the temporomandibular joint and low-level laser therapy.

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic. hfikackova@hotmail.com

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

OBJECTIVE:: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

BACKGROUND DATA: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system's natural healing ability.

METHODS:: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

RESULTS: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

CONCLUSION: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

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Ga-Al-As laser irradiation inhibits neuronal activity associated with inflammation.

Sato T, Kawatani M, Takeshige C, Matsumoto I.
Department of Anesthesiology, Saitama Medical College, Saitama, Japan.

Acupunct Electrother Res. 1994 Jun-Sep;19(2-3):141-51. [PMID: 7863838]

A Ga-Al-As diode system that produces low-energy red light (830 nm, 40 mW) has been used for the treatment of many kinds of pain. The mechanism of action of this new laser irradiation for analgesia was studied in anesthetized rats. The effect of laser irradiation of the saphenous nerve was studied by recording neuronal activity at the L4 dorsal root filaments after the injection of a chemical irritant, turpentine. Laser irradiation inhibited both the asynchronous firing by that was induced by turpentine and increased part of the slow components of the action potentials. Thus, the laser irradiation selectively inhibited nociceptive signals at peripheral nerves.

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Joint pain

Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders.

Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME.

Dental School, University of Pernambuco, Pernambuco, Brazil, janainasalmos@hotmail.com.

Lasers Med Sci. 2012 Feb 25. [Epub ahead of print] [PMID: 22367394]

Abstract: The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

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Effectiveness of physiotherapy and GaAlAs laser in the management of temporomandibular joint disorders.

Dostalová T, Hlinakova P, Kasparova M, Rehacek A, Vavrickova L, Navrátil L.

Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic. tatjana.dostalova@fnmotol.cz

Photomed Laser Surg. 2012 May;30(5):275-80. [PMID: 22551049]

OBJECTIVE: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.

BACKGROUND DATA: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives.

MATERIALS AND METHODS: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of ~0.2 cm(2).

RESULTS: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm.

CONCLUSIONS: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.

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Arthralgia of the temporomandibular joint and low-level laser therapy.

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic. hfikackova@hotmail.com

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

OBJECTIVE:: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

BACKGROUND DATA: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system's natural healing ability.

METHODS:: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

RESULTS: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

CONCLUSION: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

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Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study.

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

OBJECTIVE:: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders.

BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD.

METHODS:: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire.

RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain.

CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

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LLLT with trigger points technique: clinical study on 243 patients

Simunovic Z

Journal of Clinical Laser Medicine and Surgery (Aug. 1996) 14(4):163-167.

Among the various methods of application techniques in LLLT (He-Ne 632.8 nm visible red or infrared 820-830 nm continuous wave and 904 nm pulsed emission) there are very promising “trigger points”, i.e., myofascial zones of particular sensibility and of highest projection of focal pain points, due to ischemic conditions. The effect of LLLT and the results obtained after clinical treatment of >200 patients (headaches and facial pain, skeletomuscular ailments, myogenic neck pain, shoulder and arm pain, epicondylitis, tenosynovitis, low back and radicular pain, Achilles tendonitis) to whom the “trigger points” were applied were better than expected. It was also observed that rigidity decreases, mobility is restored (functional recovery), and spontaneous or induced pain decreases or even disappears, by movement.
LLLT improves local microcirculation and it can also improve oxygen supply to hypoxic cells in the treated areas and can remove collected waste products. Normalization of the microcirculation interrupts the “circulus vitiosus” of the origin of the pain and its development (Melzak: muscular tension→pain→increased tension→increased pain, etc.). Results measured according to VAS/VRS/PTM: in acute pain, diminished >70%; in chronic pain >60%. Clinical effectiveness depends on correctly applied energy dose – over/under dosage produces opposite, negative effects on cellular metabolism. No negative effects were noted and the use of analgesic drugs could be reduced or completely excluded. LLLT may be used as monotherapy or as a supplement to other therapeutic procedures for pain treatment.

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Lesions and Ulcers

Low level laser therapy in oral mucositis: a pilot study.

Cauwels RG, Martens LC.
Dept of Paediatric Dentistry, University Hospital, De Pintelaan 158, B 9000 Ghent, Belgium. rita.cauwels@ugent.be

Eur Arch Paediatr Dent. 2011 Apr;12(2):118-23. [PMID: 21473845]

Aim: The goal of this pilot study was to investigate the capacity of pain relief and wound healing of low level laser therapy (LLLT) in chemotherapy-induced oral mucositis (OM) in a paediatric oncology population group.

STUDY DESIGN AND METHODS: 16 children (mean age 9.4 years) from the Gent University Hospital - Department Paediatric Oncology/haematology, suffering from chemotherapy-induced OM were selected. During clinical investigations, the OM grade was assessed using the WHO classification. All children were treated using a GaAlAs diode laser with 830 nm wavelength and a potency of 150 mW. The energy released was adapted according to the severity of the OM lesions. The same protocol was repeated every 48 hrs until healing of each lesion occurred. Subjective pain was monitored before and immediately after treatment by an appropriate pain scale and functional impairment was recorded. At each visit, related blood cell counts were recorded.

Results: After 12 mths, records were evaluated and information about treatment sequence, treatment sessions and frequencies related to the pain sensation and comfort were registered. Immediately after beaming the OM, pain relief was noticed. Depending on the severity of OM, on average, 2.5 treatments per lesion in a period of 1 week were sufficient to heal a mucositis lesion.

Conclusions: LLLT, one of the most recent and promising treatment therapies, has been shown to reduce the severity and duration of mucositis and to relieve pain significantly. In the present study similar effects were obtained with the GaAlAs 830nm diode laser. It became clear that using the latter diode device, new guidelines could be developed as a function of the WHO-OM grades i.e. the lower the grade, the less energy needed. Immediate pain relief and improved wound healing resolved functional impairment that was obtained in all cases.

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Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon.

Oliveira FS, Pinfildi CE, Parizoto NA, Liebano RE, Bossini PS, Garcia EB, Ferreira LM.
Department of Plastic Surgery, São Paulo Federal University-UNIFESP, São Paulo, SP 04024-900, Brazil.

Lasers Surg Med. 2009 Apr;41(4):271-6. [PMID: 19347936]

BACKGROUND AND OBJECTIVE: Calcaneous tendon is one of the most damaged tendons, and its healing may last from weeks to months to be completed. In the search after speeding tendon repair, low intensity laser therapy has shown favorable effect. To assess the effect of low intensity laser therapy on the process of tissue repair in calcaneous tendon after undergoing a partial lesion.

STUDY DESIGN/MATERIALS AND METHODS: Experimentally controlled randomized single blind study. Sixty male rats were used randomly and were assigned to five groups containing 12 animals each one; 42 out of 60 underwent lesion caused by dropping a 186 g weight over their Achilles tendon from a 20 cm height. In Group 1 (standard control), animals did not suffer the lesion nor underwent laser therapy; in Group 2 (control), animals suffered the lesion but did not undergo laser therapy; in Groups 3, 4, and 5, animals suffered lesion and underwent laser therapy for 3, 5, and 7 days, respectively. Animals which suffered lesion were sacrificed on the 8th day after the lesion and assessed by polarization microscopy to analyze the degree of collagen fibers organization.

Results:Both experimental and standard control Groups presented significant values when compared with the control Groups, and there was no significant difference when Groups 1 and 4 were compared; the same occurred between Groups 3 and 5.

Conclusions: Low intensity laser therapy was effective in the improvement of collagen fibers organization of the calcaneous tendon after undergoing a partial lesion.

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Effects of a single near-infrared laser treatment on cutaneous wound healing: biometrical and histological study in rats.

Rezende SB, Ribeiro MS, Núñez SC, Garcia VG, Maldonado EP.
Center for Lasers and Applications, IPEN-CNEN/SP, São Paulo, SP, Brazil.

J Photochem Photobiol B. 2007 Jun 26;87(3):145-53. Epub 2007 Mar 19. [PMID: 17475503]

BACKGROUND:Low intensity laser therapy has been recommended to support the cutaneous repair; however, so far studies do not have evaluated the tissue response following a single laser treatment. This study investigated the effect of a single laser irradiation on the healing of full-thickness skin lesions in rats.

METHODS:Forty-eight male rats were randomly divided into three groups. One surgical lesion was created on the back of rats using a punch of 8mm in diameter. One group was not submitted to any treatment after surgery and it was used as control. Two energy doses from an 830-nm near-infrared diode laser were used immediately post-wounding: 1.3 J cm(-2) and 3 J cm(-2). The laser intensity 53 m W cm(-2) was kept for both groups. Biometrical and histological analyses were accomplished at days 3, 7 and 14 post-wounding.

Results:Irradiated lesions presented a more advanced healing process than control group. The dose of 1.3 J cm(-2) leaded to better results. Lesions of the group irradiated with 1.3 J cm(-2) presented faster lesion contraction showing quicker re-epithelization and reformed connective tissue with more organized collagen fibers.

Conclusions: Low-intensity laser therapy may accelerate cutaneous wound healing in a rat model even if a single laser treatment is performed. This finding might broaden current treatment regimens.

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Treatment of Skin Ulcers with 830 nm GaAIAs Diode Laser Therapy.

Junichiro Kubota
Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan.

Abstract:Persistant skin ulcers are still a major problem for the plastic and reconstructive surgeon. These ulcers of various aetiologies are often resistant to conventional therapeutic methodologies, and present both patient and surgeon with severe problems. Low level laser therapy (LLLT) has been proved to accelerate wound healing by enhancing blood flow, macrophage activity and lymphatic drainage in the inflammatory stage; by increasing fibroblast proliferation and collagen deposition in the proliferative stage; by encouraging more fibroblast to myofibroblast trasformation in the contractile stage; and by assisting with remodeling in the final stage of repair. It was considered that these LLLT associated actions, coupled with others, would be of assistance in treating persistent ulcers in a painless, side-effect free and noninvasive manner. The laser used was a near infrared 830 nm gallium aluminium arsenide (GaAIAs) semiconductor laser delivering 150 mW in continuous wave. The laser was applied in the contact mode for 15 to 30 sec per point, irradiating the intact skin around the periphery of the ulcer. The incident energy density was approximately 66 J/cm2 or 132 J/cm2 per point, depending on the exposure time. Nine representative case reports are presented of persistent therapy-resistant ulcers of a variety of aetiologies which responded very well to 830 nm diode LLLT. Although further research is needed to elucidate completely the mechanisms and pathways of LLLT in wound healing enhancement, enough has been scientifically proved to date to justify the application of LLLT for persistent ulcers as a safe, effective, painless and side effect free modality, particularly when used as an adjunctive therapy together with good wound care.

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A case report of low intensity laser therapy (LILT) in the management of venous ulceration: potential effects of wound debridement upon efficacy.

Lagan KM, Mc Donough SM, Clements BA, Baxter GD.
Rehabilitation Sciences Research Group, School of Health Sciences, University of Ulster at Jordanstown, BT37 OQB, North Ireland.

J Clin Laser Med Surg. 2000 Feb;18(1):15-22. [PMID: 11189107]

Objective:This single case report (ABA design) was undertaken as a preliminary investigation into the clinical effects of low intensity laser upon venous ulceration, applied to wound margins only, and the potential relevance of wound debridement and wound measurement techniques to any effects observed.

METHODS:Ethical approval was granted by the University of Ulster's Research Ethical Committee and the patient recruited was required to attend 3 times per week for a total of 8 weeks. Treatments were carried out using single source irradiation (830 nm; 9 J/cm2, CB Medico, Copenhagen, Denmark) in conjunction with dry dressings during each visit. Assessment of wound surface area, wound appearance, and current pain were completed by an independent investigator. Planimetry and digitizing were completed for wound tracings and for photographs to quantify surface areas. Video image analysis was also performed on photographs of wounds.

Results:The primary findings were changes in wound appearance, and a decrease in wound surface area (range 33.3-46.3%), dependent on the choice of measurement method. Video image analysis was used, but rejected as an accurate method of wound measurement. Treatment intervention produced a statistically significant reduction in wound area using the C statistic on digitizing data for photographs (at Phase one only; Z = 2.412; p < 0.05). Wound debridement emerged as an important procedure to be carried out prior to measuring wounds. Despite fluctuating pain levels recorded throughout the duration of the study, VAS scores showed a decrease of 15% at the end of the study. This hypoalgesic effect was, however, statistically significant (using the C statistic) at Phase one only (Z = 2.554; p < 0.05).

Conclusions: Low intensity laser therapy at this dosage, and using single source irradiation would seem to be an effective treatment for patients suffering venous ulceration. Further group studies are indicated to establish the most effective therapeutic dosage for this and other types of ulceration.

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Low-level laser therapy (LLLT) at 830 nm positively modulates healing of tracheal incisions in rats: a preliminary histological investigation.

Grendel T, Sokolský J, Vaščáková A, Hrehová B, Poláková M, Bobrov N, Sabol F, Gál P.
Department of Medical Biophysics, Pavol Jozef Šafárik University, Košice, Slovak Republic.

Photomed Laser Surg. 2011 Sep;29(9):613-8. Epub 2011 Apr 1.[PMID: 21456943]

Objective:The aim of the present study was to evaluate whether LLLT at 830 nm is able to positively modulate trachea incisional wound healing in Sprague-Dawley rats.

BACKGROUND DATA:Tracheotomy may be associated with numerous complications. Development of excess granulation tissue represents a late complication that may lead to airway occlusion. Low-level laser therapy (LLLT) has been shown to have stimulatory effects on wound healing of different tissues. Therefore, it may be suggested that LLLT could be able to positively modulate trachea wound healing as well.

MATERIALS AND METHODS:Using general anesthesia, a median incision was performed from the second to the fifth tracheal cartilage ring in 24 rats. Animals were then randomly divided into sham-irradiated control and laser-treated groups. LLLT (power density: 450 mW/cm(2); total daily dose: 60 J/cm(2); irradiated area ∼1 cm(2)) treatment was performed daily during the first week after surgery. Samples for histological evaluation were removed 7 and 28 days after surgical procedure. Histological sections were stained with hematoxylin-eosin and van Gieson.

Results:Results from our investigation showed that LLLT was able to reduce granulation tissue formation and simultaneously increase new cartilage development at both evaluated time intervals.

Conclusions: From this point of view, LLLT at 830 nm may be a valuable tool in trachea wound healing modulation. Nevertheless, further detailed research is needed to find optimal therapeutic parameters and to test these findings on other animal models.

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830-nm irradiation increases the wound tensile strength in a diabetic murine model.

Stadler I, Lanzafame RJ, Evans R, Narayan V, Dailey B, Buehner N, Naim JO.
The Laser Center, Rochester General Hospital, Rochester, New York 14621, USA. Istvan.Stadler@viahealth.org

Lasers Surg Med. 2001;28(3):220-6.[PMID: 11295756]

BACKGROUND AND OBJECTIVE:The purpose of this study was to investigate the effects of low-power laser irradiation on wound healing in genetic diabetes.

STUDY DESIGN/MATERIALS AND METHODS:Female C57BL/Ksj/db/db mice received 2 dorsal 1 cm full-thickness incisions and laser irradiation (830 nm, 79 mW/cm(2), 5.0 J/cm(2)/wound). Daily low-level laser therapy (LLLT) occurred over 0-4 days, 3-7 days, or nonirradiated. On sacrifice at 11 or 23 days, wounds were excised, and tensile strengths were measured and standardized.

RESULTS:Nontreated diabetic wound tensile strength was 0.77 +/- 0.22 g/mm(2) and 1.51 +/- 0.13 g/mm(2) at 11 and 23 days. After LLLT, over 0-4 days tensile strength was 1.15 +/- 0.14 g/mm(2) and 2.45 +/- 0.29 g/mm(2) (P = 0.0019). Higher tensile strength at 23 days occurred in the 3- to 7-day group (2.72 +/- 0.56 g/mm(2) LLLT vs. 1.51 +/- 0.13 g/mm(2) nontreated; P < or = 0.01).

Conclusions: Low-power laser irradiation at 830 nm significantly enhances cutaneous wound tensile strength in a murine diabetic model. Further investigation of the mechanism of LLLT in primary wound healing is warranted.

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Analysis of Low-Level Laser Radiation Transmission in Occlusive Dressings

de Jesus Guirro RR, de Oliveira Guirro EC, Martins CC, Nunes FR.
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirã o Preto, University Sã o Paulo, Brazil

Photomed Laser Surg. 2009 Oct 9. [PMID: 19817516]

Abstract Objective: The purpose of this study is to analyze the power transmitted by low-level laser therapy (LLLT) into occlusive dressings using different wavelengths for the treatment of cutaneous lesions.

Background Data: LLLT has been largely used to treat several cutaneous lesions commonly associated with occlusive dressings to accelerate the healing process.

Materials and Methods: Radiation transmission was measured by a digital power analyzer connected to a laser emitter with wavelengths of 660, 830, and 904 nm and mean levels of 30, 30, 6.5 mW, respectively, previously calculated. Thirteen different occlusive dressings were analyzed and interposed between the laser emitter and the power analyzer sensor, with 15 measurements made for each dressing. Statistics were provided by the analysis of variance (ANOVA), followed by Student’s t-test (p < 0.05).

Results: The power transmitted ranged between 98.6% and 0%, depending on the material and wavelength. The dressings tested were BioFill, Hydrofilm, Confeel Plus 3533, Confeel 3218, DuoDERM Extra Thin, Hydrocoll, Micropore Nexcare, CIEX tape, Emplasto Sábia, CombiDERM, Band-aid, Actisorb Plus, in addition to polyvinylchloride (PVC) film, and transmitted power higher than 40% of the incident power, independently from the wavelength indicated for the association with LLLT.

Conclusion: The results showed that LLLT transmission depends on the occlusive dressing material and the wavelength irradiated.

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Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon

Oliveira FS, Pinfildi CE, Parizoto NA, Liebano RE, Bossini PS, Garcia EB, Ferreira LM.
Department of Plastic Surgery, Sã o Paulo Federal University-UNIFESP, Sã o Paulo, SP 04024-900, Brazil.

Lasers Surg Med. 2009 Apr;41(4):271-6. [PMID: 19347936]

BACKGROUND AND OBJECTIVE: Calcaneous tendon is one of the most damaged tendons, and its healing may last from weeks to months to be completed. In the search after speeding tendon repair, low intensity laser therapy has shown favorable effect. To assess the effect of low intensity laser therapy on the process of tissue repair in calcaneous tendon after undergoing a partial lesion.

STUDY DESIGN/MATERIALS AND METHODS: Experimentally controlled randomized single blind study. Sixty male rats were used randomly and were assigned to five groups containing 12 animals each one; 42 out of 60 underwent lesion caused by dropping a 186 g weight over their Achilles tendon from a 20 cm height. In Group 1 (standard control), animals did not suffer the lesion nor underwent laser therapy; in Group 2 (control), animals suffered the lesion but did not undergo laser therapy; in Groups 3, 4, and 5, animals suffered lesion and underwent laser therapy for 3, 5, and 7 days, respectively. Animals which suffered lesion were sacrificed on the 8th day after the lesion and assessed by polarization microscopy to analyze the degree of collagen fibers organization.

RESULTS: Both experimental and standard control Groups presented significant values when compared with the control Groups, and there was no significant difference when Groups 1 and 4 were compared; the same occurred between Groups 3 and 5.

CONCLUSION: Low intensity laser therapy was effective in the improvement of collagen fibers organization of the calcaneous tendon after undergoing a partial lesion.

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Muscle

Comparative effects of low-intensity pulsed ultrasound and low-level laser therapy on injured skeletal muscle.

Rennó AC, Toma RL, Feitosa SM, Fernandes K, Bossini PS, de Oliveira P, Parizotto N, Ribeiro DA.
Department of Medical Biophysics, Pavol Jozef Šafárik University, Košice, Slovak Republic.

Photomed Laser Surg. 2011 Jan;29(1):5-10. Epub 2010 Dec 18. [PMID: 21166589]

Objective:The main purpose of this study was to compare the effects of low-intensity pulsed ultrasound (US) and low-level laser therapy (LLLT) on injured skeletal muscle after cryolesion by means of histopathological analysis and immunohistochemistry for cyclo-oxygenase-2 (COX-2).

BACKGROUND AND METHODS:Thirty-five male Wistar rats were randomly distributed into four groups: intact control group with uninjured and untreated animals; injured control group with muscle injury and no treatment; LLLT-treated group with muscle injury treated with 830-nm laser; and US-treated group with muscle injury treated with US. Treatments started 24 h postsurgery and were performed during six sessions.

Results:LLLT-treated animals presented minor degenerative changes of muscle tissue. Exposure to US reduced tissue injuries induced by cryolesion, but less effectively than LLLT. A large number of COX-2 positive cells were found in untreated injured rats, whereas COX-2 immunoexpression was lower in both LLLT- and US-treated groups.

Conclusions: This study revealed that both LLLT and US therapies have positive effects on muscle metabolism after an injury in rats, but LLLT seems to produce a better response.

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The Effect of GaAlAs Laser Irradiation on the Recovery Process of Muscular Strength Following Muscle Fatigue

Yasushi Ishide, Toshio Ohshiro, Fumio Ueda, Mitsuyoshi Murayama, Takafumi Ohshiro, Kiyofumi Takenouchi and Mitsuaki Kohzuma
Keio University Institute of Physical Education. Japan Medical Laser Laboratory. Ohshiro Clinic

JSTAGE(Received October 5, 2009) (Accepted January 21, 2010)

ABSTRACT:Low reactive-level laser therapy (LLLT) has been reported to reduce chronic and acute pain. Recently, some studies have shown that LLLT may also delay skeletal muscle fatigue during high-intensity exercise. We have hypothesized that laser irradiation may also attenuate muscle fatigue or pain experienced after sports or exercise. However, only a few reports have described the use of lasers in sports medicine. This study was conducted to determine the effectiveness of LLLT in aiding the recovery from exercise-induced skeletal muscle fatigue.

SUBJECTS AND METHODS:Isometric plantar flexion was repeatedly performed on 9 students until the force output declined to 50% maximal voluntary contraction (MVC). Subjects were assigned to perform 3 experiments under different LLLT conditions: laser irradiation to the neck (NKL), to the muscle (MSL), and no laser irradiation (CON). MVC and muscle hardness, girth, blood oxygen saturation, and heart rate were measured during the pre-exercise, post-exercise, and recovery phases. The neck and muscle were irradiated for 15 s using the Oh-Lase HT 2001 semi-conductor laser (830 nm; 60 mW, continuous wave), immediately after MVC measurement during the post-exercise phase.

Results:The total exercise time and mean output forces were analyzed using repeated-measures and one-factor ANOVA with post-hoc tests; no significant differences were observed among the 3 conditions for the pre and post-exercise MVC levels before irradiation (NKL, 68.1% MVC; MSL, 66.4% MVC; CON, 66.1% MVC). However, the MVC at 5 and 10 min after exercise was significantly greater in the NKL and MSL groups than in the CON group (MVC after 5 min: 80.4%, 76.9%, and 69.7% for the NKL, MSL, and CON groups, respectively; MVC after 10 min: 81.8%, 81.2%, and 74.4%). Further, no significant differences were observed in the MVC recorded at 15 and 30 min. Therefore, compared to the CON group, the NKL and MSL groups exhibited early muscle-strength recovery from fatigue caused by repeated contractions.

Conclusions: We concluded that LLLT at the parameters used in the present study effectively promoted the recovery of the isometric force output after muscle fatigue induced by repeated contractions, especially in the acute-exhaustion phase.

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Low-level laser irradiation promotes the recovery of atrophied gastrocnemius skeletal muscle in rats.

Nakano, Jiro; Kataoka, Hideki; Sakamoto, Jyunya; Origuchi, Tomoki; Okita, Minoru; Yoshimura, Toshiro
Unit of physical therapy and occupational therapy sciences, Nagasaki University Graduate School of Biomedical Sciences. Department of Rehabilitation, Nagasaki Memorial Hospital

Experimental Physiology, 94(9), pp.1005-1015; 2009 [PMID: 21166589]

ABSTRACT:Low-level laser (LLL) irradiation promotes proliferation of muscle satellite cells, angiogenesis and expression of growth factors. Satellite cells, angiogenesis and growth factors play important roles in the regeneration of muscle. The objective of this study was to examine the effect of LLL irradiation on rat gastrocnemius muscle recovering from disuse muscle atrophy. Eight-week-old rats were subjected to hindlimb suspension for 2 weeks, after which they were released and recovered. During the recovery period, rats underwent daily LLL irradiation (Ga-Al-As; 830 nm; 60 mW; total, 180 sec) to the right gastrocnemius muscle through the skin. The untreated left gastrocnemius muscle served as the control. In conjunction with LLL irradiation, 5-bromo-2'-deoxyuridine (BrdU) was injected subcutaneously for labeling of nuclei of proliferating cells. After 2 weeks, myofiber diameters of irradiated muscle increased in comparison with those of untreated muscle, but did't recover back to normal levels. Additionally, in the superficial region of muscle, the number of capillaries and fibroblast growth factor levels in irradiated muscle exhibited meaningful elevation relative to those of untreated muscle. In the deep region of muscle, BrdU-positive nuclei of satellite cells and / or myofibers of irradiated muscle increased significantly relative to that of the untreated muscle.

RESULTS: The results of this study suggested that LLL irradiation can promote recovery from disuse muscle atrophy in association with proliferation of satellite cells and angiogenesis.

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Effect of 830 nm low-level laser therapy applied before high-intensity exercises on skeletal muscle recovery in athletes.

Leal Junior EC, Lopes-Martins RA, Baroni BM, De Marchi T, Taufer D, Manfro DS, Rech M, Danna V, Grosselli D, Generosi RA, Marcos RL, Ramos L, Bjordal JM.
Sports Medicine Institute (IME), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil. ecplealj@ucs.br

Lasers Med Sci. 2009 Nov;24(6):857-63. Epub 2008 Dec 5. [PMID: 19057981]

ABSTRACT:Our aim was to investigate the immediate effects of bilateral, 830 nm, low-level laser therapy (LLLT) on high-intensity exercise and biochemical markers of skeletal muscle recovery, in a randomised, double-blind, placebo-controlled, crossover trial set in a sports physiotherapy clinic. Twenty male athletes (nine professional volleyball players and eleven adolescent soccer players) participated. Active LLLT (830 nm wavelength, 100 mW, spot size 0.0028 cm(2), 3-4 J per point) or an identical placebo LLLT was delivered to five points in the rectus femoris muscle (bilaterally). The main outcome measures were the work performed in the Wingate test: 30 s of maximum cycling with a load of 7.5% of body weight, and the measurement of blood lactate (BL) and creatine kinase (CK) levels before and after exercise. There was no significant difference in the work performed during the Wingate test (P > 0.05) between subjects given active LLLT and those given placebo LLLT. For volleyball athletes, the change in CK levels from before to after the exercise test was significantly lower (P = 0.0133) for those given active LLLT (2.52 U l(-1) +/- 7.04 U l(-1)) than for those given placebo LLLT (28.49 U l(-1) +/- 22.62 U l(-1)). For the soccer athletes, the change in blood lactate levels from before exercise to 15 min after exercise was significantly lower (P < 0.01) in the group subjected to active LLLT (8.55 mmol l(-1) +/- 2.14 mmol l(-1)) than in the group subjected to placebo LLLT (10.52 mmol l(-1) +/- 1.82 mmol l(-1)). LLLT irradiation before the Wingate test seemed to inhibit an expected post-exercise increase in CK level and to accelerate post-exercise lactate removal without affecting test performance. These findings suggest that LLLT may be of benefit in accelerating post-exercise recovery.

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Neck pain

Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials

Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM.
Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia. robertachow@iinet.net.au

Lancet. 2009 Dec 5;374(9705):1897-908. Epub 2009 Nov 13. [PMID: 19913903]

BACKGROUND: Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.

METHODS: We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.

FINDINGS: We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo.

INTERPRETATION: We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. FUNDING: None.

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The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study

Chow RT, Heller GZ, Barnsley L.
Castle Hill Medical Centre, 269-271 Old Northern Road, Castle Hill, NSW 2154, Australia. rtchow@bigpond.net.au

Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27. [PMID: 16806710]

A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain was conducted with the aim of determining the efficacy of 300 mW, 830 nm laser in the management of chronic neck pain. Subjects were randomized to receive a course of 14 treatments over 7 weeks with either active or sham laser to tender areas in the neck. The primary outcome measure was change in a 10 cm Visual Analogue Scale (VAS) for pain.
Secondary outcome measures included Short-Form 36 Quality-of-Life questionnaire (SF-36), Northwick Park Neck Pain Questionnaire (NPNQ), Neck Pain and Disability Scale (NPAD), the McGill Pain Questionnaire (MPQ) and Self-Assessed Improvement (SAI) in pain measured by VAS. Measurements were taken at baseline, at the end of 7 weeks’ treatment and 12 weeks from baseline. The mean VAS pain scores improved by 2.7 in the treated group and worsened by 0.3 in the control group (difference 3.0, 95% CI 3.8-2.1). Significant improvements were seen in the active group compared to placebo for SF-36-Physical Score (SF36 PCS), NPNQ, NPAD, MPQVAS and SAI.

The results of the SF-36 – Mental Score (SF36 MCS) and other MPQ component scores (afferent and sensory) did not differ significantly between the two groups. Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.

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Systematic review of the literature of low-level laser therapy (LLLT) in the management of neck pain

Chow RT, Barnsley L.
Castle Hill Medical Centre, Castle Hill Medical Centre, 269-271 Old Northern Road, Castle Hill, New South Wales 2154, Australia. rtchow@bigpond.net.au

Lasers Surg Med. 2005 Jul;37(1):46-52. [PMID: 15954117]

BACKGROUND AND OBJECTIVES: Low-level laser therapy (LLLT) is widely used in the treatment of musculoskeletal pain. However, there is controversy over its true efficacy. We aimed to determine the efficacy of LLLT in the treatment of neck pain through systematically reviewing the literature.

STUDY DESIGN/MATERIALS AND METHODS: A search of computerized bibliographic databases covering medicine, physiotherapy, allied health, complementary medicine, and biological sciences was undertaken undertaken from date of inception until February 2004 for randomized controlled trials of LLLT for neck pain. A comprehensive list of search terms was applied and explicit inclusion criteria were developed a priori. Twenty studies were identified, five of which met the inclusion criteria.

RESULTS: Significant positive effects were reported in four of five trials in which infrared wavelengths (lambda = 780, 810-830, 904, 1,064 nm) were used. Heterogeneity in outcome measures, results reporting, doses, and laser parameters precluded formal meta-analysis. Effect sizes could be calculated for only two of the studies.

CONCLUSIONS: This review provides limited evidence from one RCT for the use of infrared laser for the treatment of acute neck pain (n = 71) and chronic neck pain from four RCTs (n = 202). Larger studies are required to confirm the positive findings and determine the most effective laser parameters, sites and modes of application. © 2005 Wiley-Liss, Inc.

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Neuralgia

Low Reactive Level Laser Therapy in the Treatment of Post Herpetic Neuralgia

Katsumi Sasaki, Toshio Ohshiro, Takafumi Ohshiro and Yuki Taniguchi
Laser Therapy. 2010, Vol. 19, No. 2, p.101-105 .

Abstract:Post herpetic neuralgia (PHN) can be an extremely painful condition which in many cases proves resistant to all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course. Since 1980, we have been applying low reactive level laser therapy (LLLT) for patients with PHN. We report herein on the results of a retrospective study concerning those patients in whom LLLT has been applied for pain attenuation of PHN. One hundred and twenty-three patients (73 male, 50 female, mean age: 66.11yr) have received LLLT for various entities of PHN over the past 29 years. In these cases the affected tissue area(s) was as follows: thorax and back (48 cases); head and neck (41 cases); abdomen and lumbar (17 cases); upper limb (9 cases); and lower limb (8 cases). The overall total improvement rate was 60.16%. Patient whose treatment was given within six month of onset obtained the highest improvement rate (mean, 76.34%). LLLT was effective for PHN in the acute and chronic phase, but LLLT was particularly effective for the acute phase patients whose onset before treatment was 6 months or less. The results demonstrate a significant reduction in PHN pain intensity, hypersensitivity and other complaints

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Laser Therapy for Chronic Pain Syndromes

Osamu Kemmotsu

Abstract:Pain attenuation by laser therapy was evaluated in 441 patients with various kinds of chronic pain syndromes at our clinic with mainly a 60mW CW GaAlAs system operating at 830 nm. There has been found no consistently reliable therapy for neuropathic pain including postherpetic neuralgia. Our clinical data showed 76% patients with postherpetic neuralgia achieved either excellent or good results by laser therapy. Laser therapy is also useful to shorten the pathogenesis of herpes zoster and lower the incidence of postherpetic neuralgia. Laser therapy is a noninvasive, painless and complication-free modality of pain attenuation, and it is safely used even in elderly patients who has cardiovascular and endocrine disorders. Laser therapy has been surely contributing to the improvement of the quality of life and activity of daily life of patients who have painful and debilitating conditions by chronic pain syndromes.

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Double Blind Crossover Trial Of Low Level Laser Therapy In The Treatment Of Post Herpetic Neuralgia

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

Abstract:Post herpetic. neuralgia can he an extremely painful condition which in many cases proves resistant lo all the accepted forms of treatment. II is frequently most severe in the elderly and may persist for years with no predictable course. This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received tour consecutive laser treatments. The results demonstrate a significant reduction in both pain intensity and distribution following a course of low level laser therapy.

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

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

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

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

Osamu Kemmotsu, Kenichi Sato,Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura
Department of Anaesthesiology, Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan.

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

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Mucositis

Low level laser therapy in oral mucositis: a pilot study.

Cauwels RG, Martens LC.
Dept of Paediatric Dentistry, University Hospital, De Pintelaan 158, B 9000 Ghent, Belgium. rita.cauwels@ugent.be

Eur Arch Paediatr Dent. 2011 Apr;12(2):118-23. [PMID: 21473845]

Aim: The goal of this pilot study was to investigate the capacity of pain relief and wound healing of low level laser therapy (LLLT) in chemotherapy-induced oral mucositis (OM) in a paediatric oncology population group.

STUDY DESIGN AND METHODS: 16 children (mean age 9.4 years) from the Gent University Hospital - Department Paediatric Oncology/haematology, suffering from chemotherapy-induced OM were selected. During clinical investigations, the OM grade was assessed using the WHO classification. All children were treated using a GaAlAs diode laser with 830 nm wavelength and a potency of 150 mW. The energy released was adapted according to the severity of the OM lesions. The same protocol was repeated every 48 hrs until healing of each lesion occurred. Subjective pain was monitored before and immediately after treatment by an appropriate pain scale and functional impairment was recorded. At each visit, related blood cell counts were recorded.

Results: After 12 mths, records were evaluated and information about treatment sequence, treatment sessions and frequencies related to the pain sensation and comfort were registered. Immediately after beaming the OM, pain relief was noticed. Depending on the severity of OM, on average, 2.5 treatments per lesion in a period of 1 week were sufficient to heal a mucositis lesion.

Conclusions: LLLT, one of the most recent and promising treatment therapies, has been shown to reduce the severity and duration of mucositis and to relieve pain significantly. In the present study similar effects were obtained with the GaAlAs 830nm diode laser. It became clear that using the latter diode device, new guidelines could be developed as a function of the WHO-OM grades i.e. the lower the grade, the less energy needed. Immediate pain relief and improved wound healing resolved functional impairment that was obtained in all cases.

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Patients with moderate chemotherapy-induced mucositis: pain therapy using low intensity lasers.

Nes AG, Posso MB.
Buskerud University, Drammen, Norway. s-oddmun@online.no

Int Nurs Rev. 2005 Mar;52(1):68-72.[PMID: 15725279]

Background: Intensive cancer therapy normally affects malignant and normal cells with high replication rates. Cells in the gastrointestinal tract are therefore commonly affected by cytotoxins. This often results in the development of chemotherapy-induced oral mucositis (COM). COM is the inflammatory response of the oral mucous membrane to the chemotherapy drugs. Low level laser therapy (LLLT) has proved to be effective in treating and repairing biologically damaged tissue and to reduce pain. LLLT has also proven to be an efficient method for the prevention of oral mucositis.

Objective: To investigate the effect of LLLT on pain relief among patients who have developed COM.

Method: The study was performed as a clinical test with a sample consisting of 13 adult patients receiving oncology treatment. The patients were treated during a 5-day period, and the pain was measured before and after each laser application. The laser used was an AsGaAl, with a wavelength of 830 nm and a potency of 250 mW. The energy given was 35 J cm(-2).

Analysis: The results were analysed using the Wilcoxon test.

Results: There was a significant (P = 0.007) 67% decrease in the daily average experience of pain felt before and after each treatment, confirming that LLLT can relieve pain among patients who have developed COM.

Study Limitations: The low number of COM patients at the hospital did not allow a control group to be included in the study, and therefore the results contain a potential placebo effect. IMPLICATIONS FOR NURSING CARE: The most important benefit the authors consider to be the value for the patients of better and quicker treatment with a drastic reduction in painful mucositis.

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Efficacy of low-level laser therapy and aluminum hydroxide in patients with chemotherapy and radiotherapy-induced oral mucositis.

Lima AG, Antequera R, Peres MP, Snitcosky IM, Federico MH, Villar RC.
Clinics Hospital, University of São Paulo, SP, Brazil. alinegov@yahoo.com

Braz Dent J. 2010;21(3):186-92 [PMID: 21203698]

Abstract:This study evaluated the efficacy of low-level laser therapy (LLLT) and aluminum hydroxide (AH) in the prevention of oral mucositis (OM). A prospective, comparative and non-randomized study was conducted with 25 patients with head and neck cancer subjected to radiotherapy (RT) or radiochemotherapy (RCT). Twelve patients received LLLT (830 nm, 15 mW, 12 J/cm²) daily from the 1st day until the end of RT before each sessions during 5 consecutive days, and the other 13 patients received AH 310 mg/5 mL, 4 times/day, also throughout the duration of RT, including weekends. OM was measured using an oral toxicity scale (OTS) and pain was measured using the visual analogue scale (VAS). EORTC questionnaires were administered to the evaluate impact of OM on quality of life. The LLLT group showed lower mean OTS and VAS scores during the course of RT. A significant difference was observed in pain evaluation in the 13th RT session (p=0.036). In both groups, no interruption of RT was needed. The prophylactic use of both treatments proposed in this study seems to reduce the incidence of severe OM lesions. However, the LLLT was more effective in delaying the appearance of severe OM.


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Low-Intensity Laser Therapy in the Treatment of Mucositis induced by Chemotherapy and Radiotherapy

Alessandra Kuhn, Joao Carlos B. Wagner, Algemir Lunardi Brunetto, Mauricio R. Volkweis, Eduardo Dall'Magro

Purpose: The aim of this article was to develop a protocol for the treatment of oral mucositis induced by chemotherapy and radiotherapy. A pilot trial was conducted with low-intensity laser therapy (GaAIAs/InGaAIP laser) to decrease the lesions' manifestation time and to promote pain control.

Materials and Methods: Fifty patients for whom chemotherapy or chemoradiotherapy was indicated were evaluated in this study. Fifteen patients developed mucositis (30%) and were divided into 3 groups of 5, receiving low-intensity laser therapy 3 times a week, with a specific dosage in each group. Group A: GaAIAs laser, wavelength 830 nm (infrared), power 70 mW, dose 5 J/cm2; Group B: InGaAIP Laser, wavelength 685 nm (red), power 35 mW, dose 5 J/cm2; Group C: Placebo. The presence and severity of mucositis was clinically evaluated using the WHO scale, and pain was measured by using a visual analogue scale (VAS). The Kruskal-Wallis test was used to test differences among groups. Results were considered statically significant when p <0.05.

Results: The infrared laser 830 nm (Group A) showed therapeutic superiority when compared with the red laser 685 nm (Group B) and the Group C (Placebo). Group B showed intermediate results between groups A and C in terms of mucositis duration and the decrease of the lesion grade at 7 and 15 days. However, the pain level at 7 days of the treatment continued to be high compared to Group C (placebo)

Conclusions: Low-intensity laser therapy with a 830-nm (infrared) wavelength can be indicated for oral mucositis induced by chemoradiotherapy, due to its better therapy results compared to the red laser (685 nm) and the placebo group in the same application periods.


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The Effect of Low Level Laser Therapy in Different Wavelengths in the Treatment of Oral Mucositis—Proposal for ExtraOral Implementation

J. J. C. Moraesa, A. S. Queiroga, R. C. C. G. De Biase, E. P. Leite, C. R. Cabral Júnior, and F. A. Limeira Júnior

Abstract:The oral mucositis is the most frequent acute oral complication resulting from antineoplastic treatment and may worsen the clinical condition of the patient and interfere with his/her quality of life. This study aimed to comparatively evaluate, from a clinical point of view, the effect of Laser Therapy λ660 nm (wavelength of the red Laser) and λ830 nm (wavelength of the infrared Laser), at extraoral points, in remission of severity of oral mucositis and pain associated with it in pediatric oncological patients undergoing chemotherapy with the anticancer drug methotrexate, noting which of the two wavelength is the most appropriate to this new technique. The sample consisted of 13 patients placed at random in each group and subjected to sessions of Low Level Laser Therapy, at predetermined extraoral points for five consecutive days, starting at the beginning of the observation of mucositis injuries. It became possible to note that from the group of patients in the group of Laser λ830 nm (n = 6; 46.15%), four (n = 4; 66.67%) of these patients had remission of injuries to grade 0 (WHO), and as for pain, five patients (n = 5; 83.33%) showed no painful symptoms for mucositis injuries. In the Laser λ660 nm group (n = 7; 53.85%), only two patients (n = 2; 28.57%) achieved a regression of lesions to grade 0 (WHO), while four patients (n = 4; 57.14%) had no pain. So, the extraoral application of Laser Therapy was effective in treating injuries of oral mucositis in the patients treated; and Laser Therapy in the infrared spectrum (λ830 nm) was more effective in the treatment of oral mucositis injuries compared to the red spectrum (λ660 nm), which can be explained by the greater power of penetration of infrared rays, acting in a more expressive way in deeper places.


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Plantar Fasciitis

The Use of Microlight Laser Therapy to Treat Plantar Fasciitis

B. Glinsky, L. Monthieth, J. Murphy, D. Underkofler-Mercer
From the Department of Logan Research, Logan University, Chesterfield, MO, USA

Abstract Purpose:The purpose of this study was to attempt to find evidence that Microlight Laser therapy treatment will have a direct effect on pain management and a reduction in the inflammation assosciated with plantar fasciitis through an increase in the cellular metabolism rate.

Methods: The study consisted of seven total subjects including one drop-out subject, five completed test subjects and one control subject suffering from plantar fascitis who were treated with low level laser thearpy. The subjects were treated with 830 nm wavelength with a mean power output of 90 mW. "Before" and "After" symptom survey forms were completed by each subject as well as "Before" and "After" measurements of ankle dorsiflexion on the affected foot/feet. Treatment was directed at four locations on the plantar surface of the foot at the origin and insertion of the plantar fascia. Treatment was administered three times a week for two weeks.

Results: Overall there was an average increase of ankle dorsiflexion by 11%. Every subject reported an improvement in pain perception on the visual analog pain scale with an average improvement of 51%.

Conclusions: Microlight laser therapy proved to have an effect on pain associated with plantar fascitis. Howerver, this laser therapy appears to be more beneficial to acute cases or periods of acute inflammation. Chronic cases showed minimal short-term improvement which may be due to the fact that after one year the plantar fascia will become scarred over, making it much more difficult to treat and manage than acute cases.

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Post-surgical pain

The Effect of Infra-Red Diode Laser Irradiation on the Duration and Severity of Post-Operative Pain: A Double Blind Trial

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

Laser Therapy Volume 4: 1992 Pp: 145-148

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of postoperative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6-8 min treatment (GaAlAs: 830 nm: 60 mWCW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand postoperative analgesia (IM or oral according to pain severity). Recordings of pain score (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups. Controls n = 5.5: LLLT n = 2.5. No patient in the LLLT group required IM analgesia after 24 hours. Similarly the requirement for oral analgesia was reduced in the LLLT group. Controls n = 9: LLLT n = 4. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. This trial of LLLT in the treatment of postoperative pain has demonstrated that it is possible with one short treatment at the end of surgery to reduce by more than 50% the extent and severity of patients' postoperative pain and as a consequence reduce their need for analgesia. The technique requires the provision of one low powered laser system, one therapist and beyond that no additional supervision, treatment or expense during the full extent of the postoperative period. It is concluded therefore that the use of LLLT following operative procedures offers a new and cost-effective method of reducing both the extent of postoperative pain severity and the analgesic requirement following surgery.

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Laser and Sports Medicine in Plastic and Reconstructive Surgery

Junichiro Kubota M.D.
Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan.

Flap survival with diode laser therapy: Skin flap or graft surgery are major procedures in plastic and reconstructive surgery. Skin flap necrosis has been a problem. The author reported on the enhanced blood flow following the low reactive laser therapy in skin flaps. The 830 nm diode laser (20 – 60 mw) irradiated flaps showed a greater perfusion, a greater number of blood vessels, and a higher rate of survival areas than the control flaps in the rat models and clinical cases. Improvement of wound healing with diode laser therapy: Diode laser therapy was indicated for traumatic skin ulcers from sport activities and traffic accidents which were resistant to conservative treatment. The diode laser system with a wavelength of 830 nm. and output power of 150or 1000mw in continuous wave was applied with the non-contact method to the area on the wound for one minute once a day every day during the treatment period. The diode laser was used successfully for the rapid enhanced healing of traumatic skin ulcers.

Discussion: Most injured patients hope to avoid a surgical operation, trying instead conservative treatments. The diode laser therapy improved the flap circulation and wound healing of severe skin ulcers. This therapy has been applied for temporomandibular joint pain and favorable results were obtained. The diode laser therapy proved to be particularly effective for pain attenuation. The diode laser therapy offers an additional convenient, safe, and side-effect free method. On the other hand, the Q-switched Nd:YAG laser system consistently achieved good results concomitant with easy and safe operation, with lightening of the target lesions.

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Effects of Low-Level Laser Therapy on Pain and Scar Formation after Inguinal Herniation Surgery: A Randomized Controlled Single-Blind Study

de Paiva Carvalho RL, Alcâ ntara PS, Kamamoto F, Cressoni MD, Casarotto RA.
Postgraduate Program in Rehabilitation Sciences , University of Sã o Paulo, Sã o Paulo, Brazil.

Photomed Laser Surg. 2009 Oct 12. [PMID: 19821701]

Abstract Objective: The aim of this study was to investigate the efficacy of an infrared GaAlAs laser operating with a wavelength of 830 nm in the postsurgical scarring process after inguinal-hernia surgery.

Background: Low-level laser therapy (LLLT) has been shown to be beneficial in the tissue-repair process, as previously demonstrated in tissue culture and animal experiments. However, there is lack of studies on the effects of LLLT on postsurgical scarring of incisions in humans using an infrared 830-nm GaAlAs laser.

Method: Twenty-eight patients who underwent surgery for inguinal hernias were randomly divided into an experimental group (G1) and a control group (G2). G1 received LLLT, with the first application performed 24 h after surgery and then on days 3, 5, and 7. The incisions were irradiated with an 830-nm diode laser operating with a continuous power output of 40 mW, a spot-size aperture of 0.08 cm(2) for 26 s, energy per point of 1.04 J, and an energy density of 13 J/cm(2). Ten points per scar were irradiated. Six months after surgery, both groups were reevaluated using the Vancouver Scar Scale (VSS), the Visual Analog Scale, and measurement of the scar thickness.

Results: G1 showed significantly better results in the VSS totals (2.14 +/- 1.51) compared with G2 (4.85 +/- 1.87); in the thickness measurements (0.11 cm) compared with G2 (0.19 cm); and in the malleability (0.14) compared with G2 (1.07). The pain score was also around 50% higher in G2.

Conclusion: Infra-red LLLT (830 nm) applied after inguinal-hernia surgery was effective in preventing the formation of keloids. In addition, LLLT resulted in better scar appearance and quality 6 mo postsurgery.

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Combined Infrared Laser and LED for Postmastectomy Pain and Discomfort: A Case Report

Mario A Trelles1 and R Glen Calderhead1,2
1: Instituto Médico Vilafortuny /Antoni De Gimbernat Foundation, Cambrils, Spain; and 2: LG Biomedical, Tochigi, and Japan Phototherapy Laboratory, Tokyo, Japan

Mastectomies can sometimes be associated with prolonged pain and discomfort. Low reactive-level laser therapy (LLLT) at 830 nm has been reported as effective in pain attenuation. A new generation of quasimonochromatic light emitting diodes at a nominal 830 nm has offered the clinician an alternative IR phototherapy source for the hands-off treatment of large areas. The combination of the LED therapy over a large area combined with punctal application of laser therapy is an interesting concept. The present study evaluated this combination phototherapy in a patient with comparatively long-term postmastectomy pain. A 44-year-old female had suffered from postmastectomy pain and discomfort for over 3 months, despite taking a nonsteroidal anti-inflammatory drug at high doses. A GaAlAs diode laser (60 mW, CW, 20 sec and 60 J/cm2 per point) in punctal application was combined with an LED array (830 nm± 5 nm, 20 min/irradiation, CW, 60 J/cm2) in the dermatomal approach. Three consecutive daily sessions were given at the above parameters. The Hospital Anxiety and Depression Scale (HADS) was administered one day before and one day after the treatment regimen. Range of movement (ROM) and pain relief scores were recorded. The pre- and posttreatment HADS scores for depression and anxiety were 14 and 9, and 4 and 4, respectively. Pain and discomfort decreased somewhat after the first session, and more rapidly with the subsequent 2 sessions. At 24 hours after the third session, the patient was completely pain free with a full ROM. After an 8-week follow-up,ROMwas still good, but mild discomfort was noted around the right breast, and a single 'top-up' session with the LED array alone was required, which was effective. The combination of punctal laser and area LED therapy at 830 nm over three consecutive daily sessions improved postmastectomy pain and restored full ROM in this one patient, with good latency which was extended with a single 'top-up' IR LED session. Further controlled studies with larger patient populations and longer follow-ups are warranted.

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Comparative study using 685-nm and 830-nm lasers in the tissue repair of tenotomized tendons in the mouse

Carrinho PM, Renno AC, Koeke P, Salate AC, Parizotto NA, Vidal BC.
Laboratory of Electro-Thermo-Phototherapy, Department of Physiotherapy, Federal University of Sã o Carlos, Sã o Carlos, Brazil.

Photomed Laser Surg. 2006 Dec;24(6):754-8. [PMID: 17199477]

OBJECTIVE: The objective of this study was to evaluate the effects of 685- and 830-nm laser irradiations, at different fluences on the healing process of Achilles tendon (Tendon calcaneo) of mice after tenotomy.

BACKGROUND DATA: Some authors have shown that low-level laser therapy (LLLT) is able to accelerate the healing process of tendinuos tissue after an injury, increasing fibroblast cell proliferation and collagen synthesis. However, the mechanism by which LLLT acts on healing process is not fully understood.

METHODS: Forty-eight male mice were divided into six experimental groups: group A, tenomized animals, treated with 685 nm laser, at the dosage of 3 J/cm(2); group B, tenomized animals, treated with 685-nm laser, at the dosage of 10 J/cm(2); group C, tenomized animals, treated with 830-nm laser, at dosage of 3 J/cm(2); group D, tenomized animals, treated with 830-nm laser, at the dosage of 10 J/cm(2); group E, injured control (placebo treatment); and group F, non-injured standard control. Animals were killed on day 13 post-tenotomy, and their tendons were surgically removed for a quantitative analysis using polarization microscopy, with the purpose of measuring collagen fibers organization through the birefringence (optical retardation [OR]).

RESULTS: All treated groups showed higher values of OR when compared to injured control group. The best organization and aggregation of the collagen bundles were shown by the animals of group A (685 nm, 3 J/cm(2)), followed by the animals of group C and B, and finally, the animals of group D.

CONCLUSION: All wavelengths and fluences used in this study were efficient at accelerating the healing process of Achilles tendon post-tenotomy, particularly after the 685-nm laser irradiation, at 3 J/cm(2). It suggests the existence of wavelength tissue specificity and dose dependency. Further studies are required to investigate the physiological mechanisms responsible for the effects of laser on tendinuos repair.

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Post-trauma acute pain

THE USE OF LASER THERAPY AND ADDITIONAL THERAPEUTIC MODALITIES AFTER ARTHROSCOPY OF THE KNEE AT ALPINE SKI TEAM

Lilic Alen, physiotherapist; 2Kozlevcar ivec Maja, dr. med. spec.fiz.reh.med.; 3Marcan Radoslav, dr.med., spec.ortop 1FIZIO, Ilirska Bistrica, Slovenija, 2Iskra Medical, Ljubljana, Slovenija, 3Ortopedska bolninica Valdoltra, Slovenija.

We review different kinds of injuries in the alpine ski sport concentrate on the injuries of the ligamentar part of the knees and meniscs in slovenian ski team. After the description of the injuries is a detailed presentation of the rehabilitational procedures from the first day of the injury till the return in to the competition arena. We explain the modalities of the rehabilitational procedures and their influence in the tissues, their main and side effects. Our main attention is focused on the use of the biostimulative lasers of higher power – 1,2 W and wavelength of 830 nm and their influence speedy recovery of the patients and their success in later competitions.

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Effect of low power laser treatment on a traumatized disc in a rat model.

Adah F, Benghuzzi H, Tucci M, Ragab A, Greenwald N.
University of Mississippi Medical Center, Jackson, MississippI, USA.

Biomed Sci Instrum. 2008;44:34-40. [PMID: 19141889 ]

Abstract: This study investigated the effects of low power laser on the healing process of a traumatized disc in an animal model. The experimental design consisted of 14 rats divided into the following three groups: Animals in group I (n = 5) served as controls with no surgery. Animals in group II (n = 5), the sham group, received a surgically created defect in the disc at L4/L5 level and received no other treatment. Animals in the third group (n = 4) received a similar defect to L4/L5 in similar fashion as described for animals in the sham group (group II) with the exception that they received laser of 830 nm wavelength treatment or irradiation for a period of 4 weeks. The animals were euthanized at 30 days post-implantation using overdose of isoflurane. The discs were then harvested in addition to the vital organs, the reproductive organs, and sample of the adjacent skeletal muscles. The hard and soft tissues were evaluated histopathologically by following laboratory standard techniques. The results of this study indicated that the discs of the laser treated animals healed in a greater magnitude than the sham group. Image analysis revealed that there was more disc formation in the laser irradiated animals than the sham. In conclusion, data obtained from this study demonstrated that laser irradiation delivered on traumatized discs resulted in a remarkable increase in discs regeneration and healing following trauma.

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Posterior facet syndrome

coming soon - Laser Therapy for Posterior Facet Syndrome

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Scar and Keloid

A Prospective Study Of The Influence That Topical Steroid Exerts In Low Reactive Level Laser Therapy (LLLT) For The Treatment Of Hypertrophic Scars And Keloids.

K Sasaki, T Ohshiro, T Ohshiro and Y Taniguchi
1) Keikoukai Ohshiro Clinic_2) Japan Medical Laser Laboratory

LASER THERAPY. 2009, Vol. 18, No. 3, p.151-159

Abstract: The application of Low reactive Level Laser Therapy (LLLT) for the treatment of hypertrophic scars and keloids has been already reported and investigated. According to these reports, LLLT for hypertrophic scars and keloids was accepted very quickly into routine practice. In this prospective study, we assessed LLLT for the treatment of hypertrophic scars and keloids and examined the influence of a topical steroid. Subjects comprised 20 patients who were treated for hypertrophic scars and keloids, 9 patients treated with LLLT but no topical steroid and 11 patients treated with LLLT plus a topical steroid. Clinical photography of the lesions was performed, and 5 items were assessed for each lesion, namely Itching, Pain, Erythema, Hardness and Pliability on an 11-point scale for each value. The actual measurement values in mm and cm2 of 2 items (Thickness and size) were used. Each treatment session consisted of direct local application of an 830nm, 60mW, continuous wave, GaAlAs diode laser (Oh-lase 3D1, JMLL Tokyo Japan) to the target area for 30 seconds to 2 minutes per lesion depending on the size and number of lesions existing on each patient. The attending clinician firmly pinched the lesion between fingers and thumb during laser therapy. In both groups, a significant difference (p<0.01) between pretreatment and the 5th or 10th treatment session was recognized in the Erythema, Hardness and Pliability items. In the Itching and Thickness items, a significant difference (p<0.05) between pretreatment and the 5th or 10th treatment session was also recognized. There were no statistically significant differences between the group with no topical steroid and the group with topical steroid in most of the items, but the topical steroid group achieved better improvement in the Erythema and Hardness items after 10th treatment session, compared to the group with no topical steroid.

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Effects of Low-Level Laser Therapy on Pain and Scar Formation after Inguinal Herniation Surgery: A Randomized Controlled Single-Blind Study

de Paiva Carvalho RL, Alcâ ntara PS, Kamamoto F, Cressoni MD, Casarotto RA.
Postgraduate Program in Rehabilitation Sciences , University of Sã o Paulo, Sã o Paulo, Brazil.

Photomed Laser Surg. 2009 Oct 12. [PMID: 19821701]

Abstract Objective: The aim of this study was to investigate the efficacy of an infrared GaAlAs laser operating with a wavelength of 830 nm in the postsurgical scarring process after inguinal-hernia surgery.

Background: Low-level laser therapy (LLLT) has been shown to be beneficial in the tissue-repair process, as previously demonstrated in tissue culture and animal experiments. However, there is lack of studies on the effects of LLLT on postsurgical scarring of incisions in humans using an infrared 830-nm GaAlAs laser.

Method: Twenty-eight patients who underwent surgery for inguinal hernias were randomly divided into an experimental group (G1) and a control group (G2). G1 received LLLT, with the first application performed 24 h after surgery and then on days 3, 5, and 7. The incisions were irradiated with an 830-nm diode laser operating with a continuous power output of 40 mW, a spot-size aperture of 0.08 cm(2) for 26 s, energy per point of 1.04 J, and an energy density of 13 J/cm(2). Ten points per scar were irradiated. Six months after surgery, both groups were reevaluated using the Vancouver Scar Scale (VSS), the Visual Analog Scale, and measurement of the scar thickness.

Results: G1 showed significantly better results in the VSS totals (2.14 +/- 1.51) compared with G2 (4.85 +/- 1.87); in the thickness measurements (0.11 cm) compared with G2 (0.19 cm); and in the malleability (0.14) compared with G2 (1.07). The pain score was also around 50% higher in G2.

Conclusion: Infra-red LLLT (830 nm) applied after inguinal-hernia surgery was effective in preventing the formation of keloids. In addition, LLLT resulted in better scar appearance and quality 6 mo postsurgery.

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Low Reactive Level Laser Therapy (LLLT) for the Treatment of Hypertrophic Scars and Keloids. A Re-Introduction

Shunji Fujii MD, Toshio Ohshiro MD PHD, Takafumi Ohshiro MD, Katsumi Sasaki MD, and Yuki Taniguchi MD
1) Ohshiro Clinic, Tokyo, Japan 2) Japan Medical Laser Laboratory, Tokyo, Japan

Abstract: Low reactive Level Laser Therapy (LLLT) is now well into its 30th decade, and its beneficial effects such as pain attenuation, accelerated or enhanced wound healing have been very well reported and investigated. For clinics such as ours which utilizes LLLT for medical treatments, LLLT for hypertrophic scars and keloids very quickly became, and remains, routine. We believed that many facilities and institutions have also been using LLLT for the treatment of hypertrophic scars and keloids, but to our surprise there were very few medical facilities using LLLT and practically none for the treatment of scars. Recently, starting in the 1990's, there have been several reports where High reactive Laser Treatment (HLLT) has been used in an attempt to treat hypertrophic scars and keloids. However no literature concerning LLLT for these lesions appears in MedLine, even though the treatment is safe and effective with no side effects and complications when compared to HLLT. The authors herein re-introduce the technique and protocol of LLLT which they have used for the past twenty years for the treatment of hypertrophic scars and keloids. We present a series of representative cases and discuss the most efficient treatment modality in combination with conventional treatment methods

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Sciatica

Low Level Laser Therapy, at 830 nm, for Pain Reduction in Experimental Model of Rats with Sciatica

Gladson Ricardo Flor Bertolini; Elisangela Lourdes Artifon; Taciane Stein da Silva; Daniela Martins Cunha; Priscila Regina Vigo
Injury and Physiotherapeutic Resource Study Laboratory, Western Paraná State University (UNIOESTE), Cascavel PR - Brazil

Arq Neuropsiquiatr. 2011;69(2B):356-9. [PMID: 21625765]

Abstract: Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm2; and G8J (n=6), sciatica and irradiation with 8 J/cm2. The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.

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Sinusitis and Rhinosinusitis

Low Level Laser Therapy of Sinusitis

M. Hacarova, ENT and Allergology, Dobnerova 26, Olomouc, CZ. J. Hubacek, Faculty Hospital, ENT Clinic, I. P. Pavlova 6, Olomouc, CZ

Abstract: The authors have been monitoring influence of a therapeutic laser (LLLT), wavelength 830 nm, output 40 - 120 mW, on treatment of acute sinusitis in 194 patients in group I (consisting of 20 patients with diagnosis of sinusitis maxillaris unilat., bilateralis - 145, frontalis unilat. - 2, pansinusitis - 24 patients). Control group II consisted of 241 patients with the same diagnosis, treated without the use of a laser. Energy density applied on children was 1.6 J/cm2, 3 times every other day, on adults 2.5 J/cm2, 5 times every other day on every affected sinus. Laser probe was applied externally on the skin of frontal wall of the sinus. 30 patients were treated with laser only, 91 patients were treated with laser and antihistaminics, 73 patients were treated with laser, antihistaminics and antibiotics. A significant analgetic effect of laser irradiation was noticed in all groups, the number of punctures decreased substantially in comparison with group II, presumably thanks to release of outlets of the sinus and improved drainage, the time of treatment decreased significantly. No complications were noticed.

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A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis.

Naghdi S, Ansari NN, Fathali M, Bartley J, Varedi M, Honarpishe R.
Assistant Professor, Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran.

Physiotherapy Theory and Practice. 2013 Mar.22 [PMID: 23521568]

ABSTRACT: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients' quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest-posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0-3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (ηp2 ηp2  =  0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.

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Sprains and strains

Soft tissue injury during sport activities and traffic accidents – treatment with low level laser therapy: A multicenter double blind, placebo controlled clinical study on 132 patients.

Simunovic Z, Trobonjaca T, Switzerland/Croatia.
Khirurgiia (Mosk). 1998;(5):40-2.

Abstract: 132 patients were treated with lllt as a monotherapy. Indications were distortion and sprain of the ankle; lesion of the Achilles tendon; dislocation of the knee, shoulder and interfalangeal joints; wrist and cervical spine injuries and both types of epicondylitis. All patients represented acute cases. Two types of irradiation techniques were used: skin contact for trigger points (830 nm) and scanning technique (633/904) for larger surface areas. The laser group was compared to a group of patients treated with conventional therapies. In the lllt group the recovery progress was accelerated by 35-50% in 85% of the patients, as compared to the control group. More abstracts will follow.
Wound healing on animal and human body with use of low level laser therapy – treatment of operated sport and traffic accident injuries: a randomized clinical study on 74 patients with control group. Simunovic Z, Ivankovich A D, Depolo A.
A wound healing study on rabbits suggested that 4 J/cm2 was the optimal dose. A clinical study was performed on 74 patients suffering from injuries of soft tissue upon traffic accidents and sport activities. Two types of lasers were used: 830 nm for Trigger point treatment and a ciombined 633/904 for scanning, both applied in monotherapy. Clinical parameters studied were redness, heat, pain, swelling, itching and loss of function. Wound healing was accelerated 25-35% in the laser group compared to the control group. Pain relief and functional recovery was significantly improved in the laser group as well.

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Tendonitis

A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow)

Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI.
Institute of Physiotherapy, Faculty of Health and Social Sciences, Bergen University College, Moellendalsvn, 6, 5009 Bergen, Norway. jmb@hib.no

BMC Musculoskelet Disord. 2008 May 29;9:75. [PMID: 18510742]

BACKGROUND: Recent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections.

METHODS: Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures.

RESULTS: 18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger’s graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported.

CONCLUSION: LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.

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Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon.

Oliveira FS, Pinfildi CE, Parizoto NA, Liebano RE, Bossini PS, Garcia EB, Ferreira LM.
Department of Plastic Surgery, São Paulo Federal University-UNIFESP, São Paulo, SP 04024-900, Brazil.

Lasers Surg Med. 2009 Apr;41(4):271-6. [PMID: 19347936]

BACKGROUND AND OBJECTIVE: Calcaneous tendon is one of the most damaged tendons, and its healing may last from weeks to months to be completed. In the search after speeding tendon repair, low intensity laser therapy has shown favorable effect. To assess the effect of low intensity laser therapy on the process of tissue repair in calcaneous tendon after undergoing a partial lesion.

STUDY DESIGN/MATERIALS AND METHODS: Experimentally controlled randomized single blind study. Sixty male rats were used randomly and were assigned to five groups containing 12 animals each one; 42 out of 60 underwent lesion caused by dropping a 186 g weight over their Achilles tendon from a 20 cm height. In Group 1 (standard control), animals did not suffer the lesion nor underwent laser therapy; in Group 2 (control), animals suffered the lesion but did not undergo laser therapy; in Groups 3, 4, and 5, animals suffered lesion and underwent laser therapy for 3, 5, and 7 days, respectively. Animals which suffered lesion were sacrificed on the 8th day after the lesion and assessed by polarization microscopy to analyze the degree of collagen fibers organization.

Results:Both experimental and standard control Groups presented significant values when compared with the control Groups, and there was no significant difference when Groups 1 and 4 were compared; the same occurred between Groups 3 and 5.

Conclusions: Low intensity laser therapy was effective in the improvement of collagen fibers organization of the calcaneous tendon after undergoing a partial lesion.

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Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy.

Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM.
Institute of Physical Therapy, Bergen University College, Mollendalsvn 6, 5009 Bergen, Norway.

Am J Sports Med. 2008 May;36(5):881-7. Epub 2008 Feb 13. [PMID: 18272794]

BACKGROUND DATA: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.

HYPOTHESIS:The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.

METHODS: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (lambda = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm(2) and a total dose of 5.4 J per session.

RESULTS: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.

CONCLUSION:Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

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The efficacy of low-level laser therapy in supraspinatus tendinitis

Liz Saunders
Physiotherapy Department, Derby City General Hospital, Derby

Abstract:Twenty-four subjects were randomly assigned to two groups to assess the effectiveness of low-power laser therapy for supraspinatus tendinitis. A low- power laser using a 820 nm, 40 mW probe operating at 5000 Hz to produce a dose of 30 J/cm2 was used to treat one group (L); the other group was treated with a similar, but dummy, laser (DL). The design of the trial was double-blind; patients, therapists and assessors being ignorant of the form of treatment used. The two groups each received a course of nine treatments and identical advice and educational material. Perceived pain was assessed and tenderness and secondary muscle weakness measured before and after the course of treatment.
The data revealed that the L group had less pain (p < 0.05), less secondary weakness (p < 0.01) and tenderness (p < 0.05) after the treatment than before. No such changes occurred in the DL group; indeed, secondary weakness and tenderness increased slightly in the latter group after treatment.
The degree of pain, tenderness and weakness of the two groups was similar before treatment. Comparing the two groups after treatment, L had less pain (p < 0.05) and less weakness (p < 0.001) than DL.
These data suggest that, in this small group of patients, laser therapy, advice and education improved certain symptoms of supraspinatus tendinitis, while the same advice and education but treatment with a dummy laser had no such beneficial consequences. Based on the results, low-power laser therapy with the parameters and dosage used in this study is recommended as a useful treatment for tendinitis, but the trial was limited by small numbers.

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Effect of Low Level Lasers in de Quervains Tenosynovitis

Renu Sharma, Anjeli Thukral, Sudhir Kumar, S K Bhargava

Physiotherapy December 2002/vol 88/no 12

Abstract: Low level laser is one of the relatively new therapeutic modalities being used in physical medicine. However, its efficacy as a therapeutic tool is controversial. The purpose of this study was to observe the effect of lowlevel laser therapy using ultrasonography for assessment in de Quervains tenosynovitis. A double-blind placebo-controlled trial was conducted on 30 limbs (28 patients) with de Quervains tenosynovitis. Fifteen limbs received the placebo treatment and 15 received a maximum of ten laser applications. The area to be treated was divided into a grid of approximately 1 cm squares, and a dosage of 2-4 joules/cm2 with continuous output of 100% was given. The placebo group followed the same protocol but with the laser switched off. Pre- and post-treatment grip strength, pinch strength, ultrasonographic measurement of antero-posterior and medio-lateral diameters of the abductor pollicis longus and extensor pollicis brevis within the sheath in transverse section were measured. The placebo group showed no improvement. A significant increase in grip (p < 0.001) and pinch strength (p = 0.0241 and significant decrease in antero-posterior (p = 0.011) and medio-lateral (p < 0.001) diameters of tendon sheaths occurred in the laser therapy group. Laser therapy may prove to be a useful modality in the treatment of de Quervains tenosynovitis.

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TMJ

ML830 Laser Therapy for the Treatment of TMJ & TMD

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

There are a variety of treatment modalities, which can be divided into Phase I and Phase II. The purpose of Phase I is to eliminate muscle spasms, TMJ swelling, bruxism (grinding of the teeth) and any dislocation, and generally reduce any type of pain. This treatment usually includes the use of the TMJ appliance (mouth splint), exercises, medication, different therapy, and natural muscles relaxants, and Micro-light Cold Laser Treatments (ML830) to relieve TMJ pain. The ML830 ia a non-invasive, non-thermal laser, capable of penetrating deep into tissue. It is one of the most fascinatingnew healing advances, and is FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief.
The purpose of Phase I therapy is to definitively correct any discrepancies, if necessary, between the upper and lower jaws. Phase 1 therapy may include adjustments of the TMJ joint, orthodontics, surgery or a combination of treatments. It is important to note that Phase II therapy should not be attempted without successful Phase 1 treatment.
Phase I Therapy is usually composed of three types of treatment, all aimed at reducing or eliminating muscle and joint pain.
Therapy No.1
The use of an intra-oral splint (The TMJ Appliance). The TMJ appliance is a computer designed intra oral device that fits most adult mouths without adjusting. It is specifically designed to assist in the treatments of TMJ disorders. The TMJ appliance has been designed by Australian Dentist Dr. Chris Farrell, in response to the need for a low cost intra-oral splint that could be implemented by health care providers, as well as dentists, for the many patients who present with symptoms of TMJ disorders. It is specifically designed to assist in treatments of TMJ disorder. No molding, adjusting or custom fitting is required.
Therapy No. 2
The use of different modes of treatment to reduce muscle and nerve pain. This is a special natural pain relief supplement called (SERENITOL). Proven effective in reducing the reversing the effect if Sleep Apnea, Bruxism, nightly TMJ dysfunction, insomnia, Anxiety Neurosis, Chronic Fatigue and other sleep related disorders. Use of Serenitol, used properly and conservatively is very benefical.
Therapy No.3
The use of MicroLight ML830 Cold Laser Therapy. The ML830 Laser is a non-thermal laser capable of penetrating deep into tissue. FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief, the ML830 Laser is also used to treat carpal tunnel syndrome at our office.
One of the most fascinating and used healing advances is the ML830 low level laser. We are pleased to announce that the ML830 laser has received clearance for the treatment of TMJD and Carpal Tunnel Syndrome.
Laser therapy has been successfully used around the world for over 25 years, with no reported long-term or irreversible side effect. TMJD sufferers are now free to seek relief from TMJ jaw pain through a new non-invasive form of therapy before resorting to surgery. We have had excellent results using the non-thermal laser to relieve pain and promote healing of the painful tissue.
Phase I therapy is considered reversible. In other words, if treatment of phase 1 therapy is discontinued, no detrimental changes will have occurred. If the patient sees no improvement, then they are no worse off than before they began treatment.

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

Click Here to Read the Full Article on ML830 Laser for TMJ

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The Influence of Low Intensity Laser Therapy on Temporomandibular Disorder Pain. TMD

S. Sattayut, DDS (KKU); PhD (Lond) and P. Bradley MD; FRCS; FDSRCS; FDSRCS (Edin)

Lasers in Dentistry Research Group, Faculty of Dentistry, Khon Kaen University, Khon Kaen Thailand
Oral Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale Florida USA

Abstract: A double-blind clinical trial was conducted on 30 femal Temporomandibular Disorders (TMD) patients who had pain as a chief complaint. The patients were randomly allocated into three groups based on Low Intensity Laser (LILT) regimes namely 820nm Gallium Aluminium Arsenide (GaAIAs) laser at energy densities of 21.4 J/cm2, 107 J/cm2 and placebo laser. Each patient had three LILT treatments in a week. The pressure pain threshold (PPT) of trigger points in masticatory muscles, unassested maximum mouth opening without pain (MOSP) and symptom severity index (SSI) were recorded as baseline data and monitored after every treatmnet. Jaw kinesiology, electromyography (EMG) and pain ratingn index from McGill pain questionnaire were also recorded as baseline and final results. The analysis of vocariance and further analysis showed that the higher energy density laser group had significant inclreases in PPT and EMG amplitude recorded from voluntary clenching (cEMG) compared with the placebo group at P values 0.0001 and 0.022 respectively. A significantly greater number of patients recovered from myofascial pain and TMJ arthralgia as assessed clinically in the higher energy group campared with the placebo (P value = 0.0. and 0.006 respectively). There was no statistically significant difference in the other parameters of assessment among the groups at a P value 0.05. At a period of 2 to 4 weeks review after LILT, there was an average 52% reduction of pain as assessed by SSI.

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Treatment of Temporomandibular Joint (TMJ) Pain with Diode Laser Therapy

Mikiko Kobayashi and Junichiro Kubota

Department of Plastic and Reconstructive Surgery,
Kyorin University School of Medicine, Mitaka City Tokyo Japan

Abstract: Temporomandibular joint (TMJ) pain can be very debilitating for the affected patient, particulary when it is a chronic disorder associated with temporomandibular disorder (TMD). Low reactive laser therapy (LLLT) has been proved effective in a variety of pain etiologies, and low incident levels of diode laser irradiation and are very effective in relieving TMJ joint painn associated with TMD, as the first stage in a two-staged strategy in the successful treatment of TMD. The present study reports on four representative cases of TMJ pain treated with a GaAIAs diode laser, 830nm continuous wave, 150mW for 5 to 10 sec/point, once per week. Incident energy densities were from approximately 20 J/cm2 to 40 J/cm2. One of the possible pain relief mechanisms involves the LLLT-mediated improved microcirculation in the temporal and masseter muscles, thereby relaxing and softening the affected muscles and relieving the pain. This also helps with cases of trismus. LLLT is side-effect free, is easy to apply and is well-tolerated by all ages and conditions of patient. When used in combination with conventional orthodontic maneuvers to remedy the functional defecs behind the TMD, LLLT offers the practitioner a safe and effective method for pain relief in troublesome TMJ pain paitients.

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Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders.

Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME.

Dental School, University of Pernambuco, Pernambuco, Brazil, janainasalmos@hotmail.com.

Lasers Med Sci. 2012 Feb 25. [Epub ahead of print] [PMID: 22367394]

Abstract: The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

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Effectiveness of physiotherapy and GaAlAs laser in the management of temporomandibular joint disorders.

Dostalová T, Hlinakova P, Kasparova M, Rehacek A, Vavrickova L, Navrátil L.

Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic. tatjana.dostalova@fnmotol.cz

Photomed Laser Surg. 2012 May;30(5):275-80. [PMID: 22551049]

OBJECTIVE: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.

BACKGROUND DATA: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives.

MATERIALS AND METHODS: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of ~0.2 cm(2).

RESULTS: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm.

CONCLUSIONS: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan. yoko@dentc.hal.kagoshima-u.ac.jp

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

PURPOSE: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

CLINICAL FEATURES: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

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Measurements of Jaw Movements and TMJ Pain Intensity in Patients Treated with GaAlAs Laser

Marcelo Oliveira MAZZETTO 1; Takami Hirono HOTTA 1,2; Renata Campi de Andrade PIZZO 1
1) Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil; 2) Dental School, University of Franca, Franca, SP, Brazil

Braz Dent J (2010) 21(4): 356-360 [PMID: 20976388]

Abstract: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser λ 830 nm, 40 mW, 5J/cm²) and Group 2 received the placebo application (0 J/cm²), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

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Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders.

BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD.

METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire.

RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain.

CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

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Arthralgia of the temporomandibular joint and low-level laser therapy

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic. hfikackova@hotmail.com

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

OBJECTIVE: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

BACKGROUND DATA: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system’s natural healing ability.

METHODS: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

RESULTS: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

CONCLUSION: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

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Vertigo

The Treatment of Dizziness and Vertigo with Low Reactive Level Laser Therapy (LLLT): A Case Report and a Historical Review of Patients Presenting at the Ohshiro Clinic

Shunji Fujii MD, Toshio Ohshiro MD PhD, Takafumi Ohshiro MD, Katsumi Sasaki MD, Yuki Taniguchi MD
Ohshiro Clinic, Tokyo Japan
Japan Medical Laser Laboratory, Tokyo Japan

Abstract: Dizziness is a fairly common ailment. Symptoms among patients range from slight occasional discomfort to complete debilitation due to nausea and vomiting and deterioration of the affected patient's activities of daily living (ADL). Treatment of dizziness varies according to its etiology, but is mostly pharmacological. The authors present a case where Low Reactive Level Laser Thearpy (LLLT) applied in the Proximal Priority Technique (PPT) was effective in controlling dizziness in a patient suffering from severe spells which occurred several times a week and which caused nausea and vomitint. The authors also retrospectively examine patient records in the Ohshiro Clinic. A total of 11 patients, includeing the patient in the present case report, report, have been treated for some form of dizziness, and the efficacy of LLLT for the treatment of dizziness is discussed.

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Wound and Ulcer healing

Effect of low-level laser therapy on inflammatory reactions during wound healing: comparison with meloxicam

Viegas VN, Abreu ME, Viezzer C, Machado DC, Filho MS, Silva DN, Pagnoncelli RM.
School of Dentistry, Laser Center, Pontif í cia Universidade Cató lica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

Photomed Laser Surg. 2007 Dec;25(6):467-73. [PMID: 18158747]

OBJECTIVE: This study evaluated the action of low-level laser therapy (LLLT) on the modulation of inflammatory reactions during wound healing in comparison with meloxicam.

BACKGROUND DATA: LLLT has been recommended for the postoperative period because of its ability to speed healing of wounds. However, data in the literature are in disagreement about its anti-inflammatory action.

METHODS: Standardized circular wounds were made on the backs of 64 Wistar rats. The animals were divided into four groups according to the selected postoperative therapy: group A-control; group B-administration of meloxicam; and groups C and D-irradiation with red (lambda = 685 nm) and infrared (lambda = 830 nm) laser energy, respectively. The animals were killed at 12, 36, and 72 h and 7 days after the procedure.

RESULTS: Microscopic analysis revealed significant vascular activation of irradiated sites in the first 36 h. Only group B showed decreases in the intensity of polymorphonuclear infiltrates and edema. Group D showed a higher degree of organization and maturation of collagen fibers than the other groups at 72 h. The animals in group C showed the best healing pattern at 7 days. The anti-inflammatory action of meloxicam was confirmed by the results obtained in this research. The quantification of interleukin-1beta (IL-1beta) mRNA by real-time polymerase chain reaction (PCR) did not show any reduction in the inflammatory process in the irradiated groups when compared to the other groups.

CONCLUSIONS: LLLT improves the quality of histologic repair and is useful during wound healing. However, with the methods used in this study the laser energy did not minimize tissue inflammatory reactions.

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Hyperbaric Oxygen Therapy Versus Laser Therapy on the Acceleration of Venous Leg Ulcer Healing

Emad T. Ahmad PT.D
Faculty of Physical Therapy, Cairo University Egypt

Abstract: The purpose of the current study was to determine the effectiveness of hyperbaric oxygen therapy (HBOT) or Laser Therapy in the acceleration of chronic venous ulcer healing. Thirty hospital inpatients with venous ulcers participated in this study for a treatment period of five weeks. They were divided randomly and equally into three groups (2 treatment groups and one control group). Patients in group (1) (HBOT group) received two 90 minutes treatments daiily with 2 to 3 L of humidified oxygen / minute at 22 mmHg. On the other hand, patients in group (2) (Laser Thearpy group) received 1 J/cm2 infrared laser (Ga As), three times weekly. Patients in group (3) (control group) received standard wound care only. Wound surface area (WSA) and wound volume (WV) were used to measure the outcomes before starting the study and after the 3rd and 5th weeks post-treatment. It was found that, at the 5th week post-treatment there was a significant reduction in both WSA and WV in both the HBOT group and the Laser Therapy group when compared to the control group (P <0.0001), also there was a significant reduction in WSA and WV in the Laser Thearpy group at the 5th week post-treatment when compared to the HBOT group (P <0.001). The findings strongly suggest that the application of infrared laser therapy at a dose of 1 J/cm2, three times/week is more effective than the application of HBOT daily in the management of chronic venous ulcers.

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Low-Level Laser Therapy Facilitates Superficial Wound Healing in Humans: A Triple-Blind, Sham-Controlled Study

Hopkins JT, McLoda TA, Seegmiller JG, David Baxter G.
Brigham Young University, Provo, UT.

J Athl Train. 2004 Sep;39(3):223-229. [PMID: 15496990]

OBJECTIVE: Low-level laser therapy (LLLT) has been promoted for its beneficial effects on tissue healing and pain relief. However, according to the results of in vivo studies, the effectiveness of this modality varies. Our purpose was to assess the putative effects of LLLT on healing using an experimental wound model.

DESIGN AND SETTING: We used a randomized, triple-blind, placebo-controlled design with 2 within-subjects factors (wound and time) and 1 between-subjects factor (group). Data were collected in the laboratory setting.

SUBJECTS: Twenty-two healthy subjects (age = 21 +/- 1 years, height = 175.6 +/- 9.8 cm, mass = 76.2 +/- 14.2 kg). MEASUREMENTS: Two standardized 1.27-cm(2) abrasions were induced on the anterior forearm. After wound cleaning, standardized digital photos were recorded. Each subject then received LLLT (8 J/cm(2); treatment time = 2 minutes, 5 seconds; pulse rate = 700 Hz) to 1 of the 2 randomly chosen wounds from either a laser or a sham 46-diode cluster head. Subjects reported back to the laboratory on days 2 to 10 to be photographed and receive LLLT and on day 20 to be photographed. Data were analyzed for wound contraction (area), color changes (chromatic red), and luminance.

RESULTS: A group x wound x time interaction was detected for area measurements. At days 6, 8, and 10, follow-up testing revealed that the laser group had smaller wounds than the sham group for both the treated and the untreated wounds (P < .05). No group x wound x time differences were detected for chromatic red or luminance.

CONCLUSIONS: The LLLT resulted in enhanced healing as measured by wound contraction. The untreated wounds in subjects treated with LLLT contracted more than the wounds in the sham group, so LLLT may produce an indirect healing effect on surrounding tissues. These data indicate that LLLT is an effective modality to facilitate wound contraction of partial-thickness wounds.

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Dose and wavelength of laser light have influence on the repair of cutaneous wounds

Mendez TM, Pinheiro AL, Pacheco MT, Nascimento PM, Ramalho LM.
IP&D, Univap & School of Dentistry, Universidade do Vale do Paraí ba, Sã o José dos Campos, Sã o Paulo, Brazil.

J Clin Laser Med Surg. 2004 Feb;22(1):19-25. [PMID: 15117483]

OBJECTIVE: The objective of the present study was to compare histologically the effect of GaAlAs (lambda 830 nm, phi approximately 2 mm(2), 35 mW) and InGaAlP (lambda 685 nm, phi approximately 2 mm(2), 35 mW) lasers, alone or in association with doses of 20 or 50 J/cm(2) on cutaneous wounds in the dorsum of the Wistar rat.

Background Data: The healing time of surgical wounds is of extreme importance and it is usually associated with a post-operative period free of infection and with less pain and inflammation.

MATERIALS AND METHODS: Sixty Wistar rats were divided into seven groups: Group I – control (non-irradiated); Group II – lambda 685 nm, 20 J/cm(2); Group III – lambda 830 nm, 20 J/cm(2); Group IV – lambda 685 nm and lambda 830 nm, 20 J/cm(2); Group V – lambda 685 nm, 50 J/cm(2)); Group VI – lambda 830 nm, 50 J/cm(2); and Group VII – lambda 685 nm and 830 nm, 50 J/cm(2). The animals were sacrificed 3, 5, and 7 days after surgery.

RESULTS: Light microscopic analysis using H&E and Picrosí rius stains showed that, at the end of the experimental period, irradiated subjects showed increased collagen production and organization when compared to non-irradiated controls. Inflammation was still present in all groups at this time.

CONCLUSION: Group IV (lambda 830 nm and lambda 685 nm, 20 J/cm(2)) presented better results at the end of the experimental period. It is concluded that low-level light therapy (LLLT) can have a positive biomodulatory effect on the repair of cutaneous wounds.

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Wound healing of animal and human body sport and traffic accident injuries using low-level therapy treatment; a randomized clinical study of seventy-four patients with control group

Simunovic Z, Ivankovich AD, Depolo A.

Journal of Clinical Laser Medicine and Surgery (2000) Apr;18(2):67-73

The main objective was to assess the efficacy of low level laser therapy (LLLT) on wound healing in rabbits and humans. The initial research was a randomized controlled animal study, to evaluate the effects of laser irradiation on the healing of surgical wounds in rabbits. The application of LLLT on the human body is analogous to those of similar physiologic structure in animal tissue.
This study was continued on humans, 74 patients with injuries to the following anatomic locations: ankle and knee, bilaterally, Achilles tendon; epicondylitis; shoulder; wrist; interphalangeal joints of hands, unilaterally. All patients has surgery prior to LLLT. Two laser devices were used: infrared diode laser (GaAIAs) 830 nm continuous wave for treatment of trigger points (TPs) and HeNe 632.8 nm combined with diode laser 904 nm pulsed wave for scanning procedure. Both were applied as monotherapy during the study. Results were observed and measured according to these clinical parameters: redness, heat, pain, swelling and loss of function, and finally submitted to statistical analysis via chi2 test.

Results: After comparing the healing process between two groups of patients, the following results were noted: wound healing was significantly accelerated (25%-35%) in the patients treated with LLLT. Pain relief and functional recovery of those treated with LLLT were significantly improved compared to untreated patients. In addition to accelerated wound healing, LLLT for postoperative sport-and traffic-related injuries avoids side effects of drugs, accelerates functional recovery, allows earlier return to work, training and sport competition.

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A Preliminary Double Blind Controlled Study on Free Amino Acid Analysis in Burn Wounds in the Mouse Following 830 nm Diode Laser Thearpy

K. Sasaki, T. Ohshiro, and T. Hoshino
Ohshiro Clinic, Shinanomachi, Japan Medical Laser Laboratory, Shinanomachi, and Department of Biochemistry, Keio University School of Medicine, Shinanomachi, Tokyo, Japan

Abstract: A double-blind controlled study is presented on the amino acid analysis of levels of a selected group of 26 free amino acids (FAA) in CO2 laser generated standardized burn wounds on the bilateral dorsum in the ddy mouse model. Four groups of ddy white mice (male, 5 weeks old, average weight 20 g), 6 animals per group, were anaesthetized with ether. The hair on the bilateral dorsum of all animals was carefully removed with a depilatory cream, and in three of the groups standardized burn injuries were inflicted using the defocused beam of the the CO2 laser (25 W, continuous wave, 1.45 cm diameter spot, 0.99 sec/shot). The injuries were made bilaterally 1 cm laterally from the dorsal midline, 1.5 cm caudally from the line drawn between the base of the ears. The 4th group was the unburned control group for assessing base FAA levels. In experimental group A (LLLT group), the center of the right hand burn injury was irradiated daily on days 0, 1, 2, 3, 4, and 5 with an 830 nm GaAIAs diode laser system (60 mW continuous wave). The left hand injury was unirradiated. The laser was held 1 mm from the surface of the wound, giving a spot size of approimately 0.03 cm2, 20 sec per exposure per day, energy density per exposure of 40 J/cm2. Group B (sham irradiation group) was handled in exactly the same way, but a non-emitting probe was used. Group C (unirradiated burned controls) was not handled at all. The animals were killed (ether overdose) on post-burn day 10. The size of the burn injury and the degree of wound healing were measured macroscopically on days 2, 5, and 7 and 10. The LLLT group A demonstrated better wound healing than groups B and C, between which there was no difference. On days 0, 1, 3, 5, 7 and 10, sample tissue was collected from both burned sites in the burned animals and from the unburned controls and subjected to automated AA analysis. The unburned controls were used as standards. On day 7 specimens were taken from the burn wounds in groups A, B, and C and routinely processed for histological assessment with haematoxylin and eosin and elastica van Giesen's stains. Automated AA analysis in general revealed higher levels of total FAA in group A, with no statistical difference between groups B and C. When looked at individually as spider graphs, the 26 AA isolated in this study at fell into 6 typical patterns. At day 10 histology revealed more advanced wound healing between the LLLT group and groups B and C, between which there was no difference. Although the present study was only designed to isolate patterns in FAA associated with healing burns, the authors conclude that 830 nm diode LLLT certainly appears to accelerate wound healing, and there is a higher level of those FAA associated with protein synthesis.

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Laser and Sports Medicine in Plastic and Reconstructive Surgery

Junichiro Kubota M.D.
Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan.

Flap survival with diode laser therapy: Skin flap or graft surgery are major procedures in plastic and reconstructive surgery. Skin flap necrosis has been a problem. The author reported on the enhanced blood flow following the low reactive laser therapy in skin flaps. The 830 nm diode laser (20 – 60 mw) irradiated flaps showed a greater perfusion, a greater number of blood vessels, and a higher rate of survival areas than the control flaps in the rat models and clinical cases. Improvement of wound healing with diode laser therapy: Diode laser therapy was indicated for traumatic skin ulcers from sport activities and traffic accidents which were resistant to conservative treatment. The diode laser system with a wavelength of 830 nm. and output power of 150or 1000mw in continuous wave was applied with the non-contact method to the area on the wound for one minute once a day every day during the treatment period. The diode laser was used successfully for the rapid enhanced healing of traumatic skin ulcers.

Discussion: Most injured patients hope to avoid a surgical operation, trying instead conservative treatments. The diode laser therapy improved the flap circulation and wound healing of severe skin ulcers. This therapy has been applied for temporomandibular joint pain and favorable results were obtained. The diode laser therapy proved to be particularly effective for pain attenuation. The diode laser therapy offers an additional convenient, safe, and side-effect free method. On the other hand, the Q-switched Nd:YAG laser system consistently achieved good results concomitant with easy and safe operation, with lightening of the target lesions.

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Effects of a single near-infrared laser treatment on cutaneous wound healing: biometrical and histological study in rats.

Rezende SB, Ribeiro MS, Núñez SC, Garcia VG, Maldonado EP.
Center for Lasers and Applications, IPEN-CNEN/SP, São Paulo, SP, Brazil.

J Photochem Photobiol B. 2007 Jun 26;87(3):145-53. Epub 2007 Mar 19. [PMID: 17475503]

BACKGROUND:Low intensity laser therapy has been recommended to support the cutaneous repair; however, so far studies do not have evaluated the tissue response following a single laser treatment. This study investigated the effect of a single laser irradiation on the healing of full-thickness skin lesions in rats.

METHODS:Forty-eight male rats were randomly divided into three groups. One surgical lesion was created on the back of rats using a punch of 8mm in diameter. One group was not submitted to any treatment after surgery and it was used as control. Two energy doses from an 830-nm near-infrared diode laser were used immediately post-wounding: 1.3 J cm(-2) and 3 J cm(-2). The laser intensity 53 m W cm(-2) was kept for both groups. Biometrical and histological analyses were accomplished at days 3, 7 and 14 post-wounding.

Results:Irradiated lesions presented a more advanced healing process than control group. The dose of 1.3 J cm(-2) leaded to better results. Lesions of the group irradiated with 1.3 J cm(-2) presented faster lesion contraction showing quicker re-epithelization and reformed connective tissue with more organized collagen fibers.

Conclusions: Low-intensity laser therapy may accelerate cutaneous wound healing in a rat model even if a single laser treatment is performed. This finding might broaden current treatment regimens.

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Low Level Laser Therapy in Ambulatory Patients with Venous Stasis Ulcers

D. Lichtenstein FICA, B. Morag
Maccabi Health Care Services and Department of Vascular Surgery, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv Israel

Abstract: The effectiveness of laser therapy in accelerating wound healing has been clinically well documented. We used two devices: one, a He-Ne laser with a wavelength of 632.8nm and power output of 8mW; the other, a Ga-Al-As laser with a wavelength of 830nm and power output of 120mW. The indication for treatment was stasis ulcers (Ulcer cruris) due to chronic venous insufficiency syndrome. Sixty-two patients were treated in this study. The challenge of obtaining good results when treating patients with long-standing vascular ulcers and wounds caused us to explore this technique. We achieved complete wound healing, classified as good, in 53 patients (85.48%) of the patients durig a two to 14 week period of treatment, and a moderate partial wound closure with clinical improvement in 4 patients (6.46%) with chronic long-term venous leg ulcers. The efficiency of treatment was 91.94%. No patient had to stop treatment because of adverse side effects. Two patients (3.2%), had recurrent ulcers. These finding indicate that the appropriate doses of laser can be beneficial in promoting tissue repair.

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Treatment of Skin Ulcers with 830 nm GaAIAs Diode Laser Therapy.

Junichiro Kubota
Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan.

Abstract:Persistant skin ulcers are still a major problem for the plastic and reconstructive surgeon. These ulcers of various aetiologies are often resistant to conventional therapeutic methodologies, and present both patient and surgeon with severe problems. Low level laser therapy (LLLT) has been proved to accelerate wound healing by enhancing blood flow, macrophage activity and lymphatic drainage in the inflammatory stage; by increasing fibroblast proliferation and collagen deposition in the proliferative stage; by encouraging more fibroblast to myofibroblast trasformation in the contractile stage; and by assisting with remodeling in the final stage of repair. It was considered that these LLLT associated actions, coupled with others, would be of assistance in treating persistent ulcers in a painless, side-effect free and noninvasive manner. The laser used was a near infrared 830 nm gallium aluminium arsenide (GaAIAs) semiconductor laser delivering 150 mW in continuous wave. The laser was applied in the contact mode for 15 to 30 sec per point, irradiating the intact skin around the periphery of the ulcer. The incident energy density was approximately 66 J/cm2 or 132 J/cm2 per point, depending on the exposure time. Nine representative case reports are presented of persistent therapy-resistant ulcers of a variety of aetiologies which responded very well to 830 nm diode LLLT. Although further research is needed to elucidate completely the mechanisms and pathways of LLLT in wound healing enhancement, enough has been scientifically proved to date to justify the application of LLLT for persistent ulcers as a safe, effective, painless and side effect free modality, particularly when used as an adjunctive therapy together with good wound care.

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A case report of low intensity laser therapy (LILT) in the management of venous ulceration: potential effects of wound debridement upon efficacy.

Lagan KM, Mc Donough SM, Clements BA, Baxter GD.
Rehabilitation Sciences Research Group, School of Health Sciences, University of Ulster at Jordanstown, BT37 OQB, North Ireland.

J Clin Laser Med Surg. 2000 Feb;18(1):15-22. [PMID: 11189107]

Objective:This single case report (ABA design) was undertaken as a preliminary investigation into the clinical effects of low intensity laser upon venous ulceration, applied to wound margins only, and the potential relevance of wound debridement and wound measurement techniques to any effects observed.

METHODS:Ethical approval was granted by the University of Ulster's Research Ethical Committee and the patient recruited was required to attend 3 times per week for a total of 8 weeks. Treatments were carried out using single source irradiation (830 nm; 9 J/cm2, CB Medico, Copenhagen, Denmark) in conjunction with dry dressings during each visit. Assessment of wound surface area, wound appearance, and current pain were completed by an independent investigator. Planimetry and digitizing were completed for wound tracings and for photographs to quantify surface areas. Video image analysis was also performed on photographs of wounds.

Results:The primary findings were changes in wound appearance, and a decrease in wound surface area (range 33.3-46.3%), dependent on the choice of measurement method. Video image analysis was used, but rejected as an accurate method of wound measurement. Treatment intervention produced a statistically significant reduction in wound area using the C statistic on digitizing data for photographs (at Phase one only; Z = 2.412; p < 0.05). Wound debridement emerged as an important procedure to be carried out prior to measuring wounds. Despite fluctuating pain levels recorded throughout the duration of the study, VAS scores showed a decrease of 15% at the end of the study. This hypoalgesic effect was, however, statistically significant (using the C statistic) at Phase one only (Z = 2.554; p < 0.05).

Conclusions: Low intensity laser therapy at this dosage, and using single source irradiation would seem to be an effective treatment for patients suffering venous ulceration. Further group studies are indicated to establish the most effective therapeutic dosage for this and other types of ulceration.

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Low-level laser therapy (LLLT) at 830 nm positively modulates healing of tracheal incisions in rats: a preliminary histological investigation.

Grendel T, Sokolský J, Vaščáková A, Hrehová B, Poláková M, Bobrov N, Sabol F, Gál P.
Department of Medical Biophysics, Pavol Jozef Šafárik University, Košice, Slovak Republic.

Photomed Laser Surg. 2011 Sep;29(9):613-8. Epub 2011 Apr 1.[PMID: 21456943]

Objective:The aim of the present study was to evaluate whether LLLT at 830 nm is able to positively modulate trachea incisional wound healing in Sprague-Dawley rats.

BACKGROUND DATA:Tracheotomy may be associated with numerous complications. Development of excess granulation tissue represents a late complication that may lead to airway occlusion. Low-level laser therapy (LLLT) has been shown to have stimulatory effects on wound healing of different tissues. Therefore, it may be suggested that LLLT could be able to positively modulate trachea wound healing as well.

MATERIALS AND METHODS:Using general anesthesia, a median incision was performed from the second to the fifth tracheal cartilage ring in 24 rats. Animals were then randomly divided into sham-irradiated control and laser-treated groups. LLLT (power density: 450 mW/cm(2); total daily dose: 60 J/cm(2); irradiated area ∼1 cm(2)) treatment was performed daily during the first week after surgery. Samples for histological evaluation were removed 7 and 28 days after surgical procedure. Histological sections were stained with hematoxylin-eosin and van Gieson.

Results:Results from our investigation showed that LLLT was able to reduce granulation tissue formation and simultaneously increase new cartilage development at both evaluated time intervals.

Conclusions: From this point of view, LLLT at 830 nm may be a valuable tool in trachea wound healing modulation. Nevertheless, further detailed research is needed to find optimal therapeutic parameters and to test these findings on other animal models.

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830-nm irradiation increases the wound tensile strength in a diabetic murine model.

Stadler I, Lanzafame RJ, Evans R, Narayan V, Dailey B, Buehner N, Naim JO.
The Laser Center, Rochester General Hospital, Rochester, New York 14621, USA. Istvan.Stadler@viahealth.org

Lasers Surg Med. 2001;28(3):220-6.[PMID: 11295756]

BACKGROUND AND OBJECTIVE:The purpose of this study was to investigate the effects of low-power laser irradiation on wound healing in genetic diabetes.

STUDY DESIGN/MATERIALS AND METHODS:Female C57BL/Ksj/db/db mice received 2 dorsal 1 cm full-thickness incisions and laser irradiation (830 nm, 79 mW/cm(2), 5.0 J/cm(2)/wound). Daily low-level laser therapy (LLLT) occurred over 0-4 days, 3-7 days, or nonirradiated. On sacrifice at 11 or 23 days, wounds were excised, and tensile strengths were measured and standardized.

RESULTS:Nontreated diabetic wound tensile strength was 0.77 +/- 0.22 g/mm(2) and 1.51 +/- 0.13 g/mm(2) at 11 and 23 days. After LLLT, over 0-4 days tensile strength was 1.15 +/- 0.14 g/mm(2) and 2.45 +/- 0.29 g/mm(2) (P = 0.0019). Higher tensile strength at 23 days occurred in the 3- to 7-day group (2.72 +/- 0.56 g/mm(2) LLLT vs. 1.51 +/- 0.13 g/mm(2) nontreated; P < or = 0.01).

Conclusions: Low-power laser irradiation at 830 nm significantly enhances cutaneous wound tensile strength in a murine diabetic model. Further investigation of the mechanism of LLLT in primary wound healing is warranted.

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Analysis of Low-Level Laser Radiation Transmission in Occlusive Dressings

de Jesus Guirro RR, de Oliveira Guirro EC, Martins CC, Nunes FR.
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirã o Preto, University Sã o Paulo, Brazil

Photomed Laser Surg. 2009 Oct 9. [PMID: 19817516]

Abstract Objective: The purpose of this study is to analyze the power transmitted by low-level laser therapy (LLLT) into occlusive dressings using different wavelengths for the treatment of cutaneous lesions.

Background Data: LLLT has been largely used to treat several cutaneous lesions commonly associated with occlusive dressings to accelerate the healing process.

Materials and Methods: Radiation transmission was measured by a digital power analyzer connected to a laser emitter with wavelengths of 660, 830, and 904 nm and mean levels of 30, 30, 6.5 mW, respectively, previously calculated. Thirteen different occlusive dressings were analyzed and interposed between the laser emitter and the power analyzer sensor, with 15 measurements made for each dressing. Statistics were provided by the analysis of variance (ANOVA), followed by Student’s t-test (p < 0.05).

Results: The power transmitted ranged between 98.6% and 0%, depending on the material and wavelength. The dressings tested were BioFill, Hydrofilm, Confeel Plus 3533, Confeel 3218, DuoDERM Extra Thin, Hydrocoll, Micropore Nexcare, CIEX tape, Emplasto Sábia, CombiDERM, Band-aid, Actisorb Plus, in addition to polyvinylchloride (PVC) film, and transmitted power higher than 40% of the incident power, independently from the wavelength indicated for the association with LLLT.

Conclusion: The results showed that LLLT transmission depends on the occlusive dressing material and the wavelength irradiated.

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