LLLT Literature Watch for January 2010

Some very interesting papers in this edition including a large back pain RCT of 546 patients, LLLT for major depression and anxiety from Harvard Medical School, Allergic Rhinitis  and another from Harvard on mechanism and dose.

Acute Low Back Pain with Radiculopathy: A Double-Blind, Randomized, Placebo-Controlled Study.

Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND

1 Clinic for Rehabilitation, Medical School , Belgrade, Serbia.

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

Photomed Laser Surg 2009 Dec 9

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20001318

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Psychological benefits 2 and 4 weeks after a single treatment with near infrared light to the forehead: a pilot study of 10 patients with major depression and anxiety.

Schiffer F, Johnston AL, Ravichandran C, Polcari A, Teicher MH, Webb RH, Hamblin MR

The Department of Psychiatry, Harvard Medical School and the Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street Belmont, MA 02478 USA. fschiffer@mclean.harvard.edu.

ABSTRACT: BACKGROUND: Many studies have reported beneficial effects from the application of near-infrared (NIR) light photobiomodulation (PBM) to the body, and one group has reported beneficial effects applying it to the brain in stroke patients. We have reported that the measurement of a patient’s left and right hemispheric emotional valence (HEV) may clarify data and guide lateralized treatments. We sought to test whether a NIR treatment could 1. improve the psychological status of patients, 2. show a relationship between immediate psychological improvements when HEV was taken into account, and 3. show an increase in frontal pole regional cerebral blood flow (rCBF), and 4. be applied without side effects. METHODS: We gave 10 patients, (5 M/5 F) with major depression, including 9 with anxiety, 7 with a past history of substance abuse (6 with an opiate abuse and 1 with an alcohol abuse history), and 3 with post traumatic stress disorder, a baseline standard diagnostic interview, a Hamilton Depression Rating Scale (HAM-D), a Hamilton Anxiety Rating Scale (HAM-A), and a Positive and Negative Affect Scale (PANAS). We then gave four 4-minute treatments in a random order: NIR to left forehead at F3, to right forehead at F4, and placebo treatments (light off) at the same sites. Immediately following each treatment we repeated the PANAS, and at 2-weeks and at 4-weeks post treatment we repeated all 3 rating scales. During all treatments we recorded total hemoglobin (cHb), as a measure of rCBF with a commercial NIR spectroscopy device over the left and the right frontal poles of the brain. RESULTS: At 2-weeks post treatment 6 of 10 patients had a remission (a score

Behav Brain Funct 2009 5 46

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19995444

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Biphasic dose response in low level light therapy.

Huang YY, Chen AC, Carroll JD, Hamblin MR

Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA; Department of Dermatology, Harvard Medical School, Boston, MA; Aesthetic and Plastic Center of Guangxi Medical University, Nanning, P.R. China.

The use of low levels of visible or near infrared light for reducing pain, inflammation and edema, promoting healing of wounds, deeper tissues and nerves, and preventing cell death and tissue damage has been known for over forty years since the invention of lasers. Despite many reports of positive findings from experiments conducted in vitro, in animal models and in randomized controlled clinical trials, LLLT remains controversial in mainstream medicine. The biochemical mechanisms underlying the positive effects are incompletely understood, and the complexity of rationally choosing amongst a large number of illumination parameters such as wavelength, fluence, power density, pulse structure and treatment timing has led to the publication of a number of negative studies as well as many positive ones. A biphasic dose response has been frequently observed where low levels of light have a much better effect on stimulating and repairing tissues than higher levels of light. The so-called Arndt-Schulz curve is frequently used to describe this biphasic dose response. This review will cover the molecular and cellular mechanisms in LLLT, and describe some of our recent results in vitro and in vivo that provide scientific explanations for this biphasic dose response.

Dose Response 2009 7(4) 358-83

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20011653

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Effect of LED Phototherapy of Three Distinct Wavelengths on Fibroblasts on Wound Healing: A Histological Study in a Rodent Model.

de Sousa AP, Santos JN, Dos Reis JA, Ramos TA, de Souza J, Cangussu MC, Pinheiro AL

1 Laser Center, School of Dentistry, Federal University of Bahia , Salvador, Bahia, Brazil.

Abstract Aim: The aim of the present investigation was to evaluate histologically fibroblastic proliferation on dorsal cutaneous wounds in a rodent model treated or not with light-emitting diodes (LEDs) of three wavelengths. Background: Fibroblasts secrete substances essential for wound healing. There are few reports of LED phototherapy on fibroblast proliferation, mainly in vivo. Animals and Methods: Following approval by the Animal Experimentation Committee of the School of Dentistry of the Federal University of Bahia, we obtained 16 young adult male Wistar rats weighing between 200 and 250 g. Under general anesthesia, one excisional wound was created on the dorsum of each animal; they were then randomly distributed into four groups of four animals each: G0, untreated control; G1, red LED (700 nm +/- 20 nm, 15 mW, 10 J/cm(2)); G2, green LED (530 nm +/- 20 nm, 8 mW, 10 J/cm(2)); and G3, blue LED (460 nm +/- 20 nm, 22 mW, 10 J/cm(2)). The irradiation started immediately after surgery and was repeated every other day for 7 days. Animals were killed 8 days after surgery. The specimens were removed, routinely processed to wax, cut, and stained with hematoxylin/eosin (HE). Fibroblasts were scored by measuring the percentage of these cells occupying the area corresponding to wound healing on stained sections. Results: The quantitative results showed that red LED (700 +/- 20 nm) and green LED (530 +/- 20 nm) showed a significant increase in fibroblast numbers (p < 0.01 and p = 0.02) when compared with the control group. Conclusion: The use of green and red LED light is effective in increasing fibroblastic proliferation on rodents.

Photomed Laser Surg 2009 Dec 9

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20001321

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Effect of low-level laser therapy (GaAs 904 nm) in skeletal muscle fatigue and biochemical markers of muscle damage in rats.

Leal Junior EC, Lopes-Martins RA, de Almeida P, Ramos L, Iversen VV, Bjordal JM

Section for Physiotherapy Science, Department of Public Health and Primary Health Care, University of Bergen (UiB), Kalfarveien 31, 5020, Bergen, Norway, ernesto.leal.junior@gmail.com.

We wanted to test if pre-exercise muscle irradiation with 904 nm laser affects the development of fatigue, blood lactate levels and creatine kinase (CK) activity in a rat model with tetanic contractions. Thirty male Wistar rats were divided into five groups receiving either one of four different laser doses (0.1, 0.3, 1.0 and 3.0 J) or a no-treatment control group. Laser irradiation was performed immediately before the first contraction for treated groups. Electrical stimulation was used to induce six tetanic tibial anterior muscle contractions with 10 min intervals between them. Contractions were stopped when the muscle force fell to 50% of the peak value for each contraction; blood samples were taken before the first and immediately after the sixth contraction. The relative peak forces for the sixth contraction were significantly better (P < 0.05) in the two laser groups irradiated with highest doses [151.27% (SD +/- 18.82) for 1.0 J, 144.84% (SD +/- 34.47) for 3.0 J and 82.25% (SD +/- 11.69) for the control group]. Similar significant (P < 0.05) increases in mean performed work during the sixth contraction for the 1.0 and 3.0 J groups were also observed. Blood lactate levels were significantly lower (P < 0.05) than the control group in all irradiated groups. All irradiated groups except the 3.0 J group had significantly lower post-exercise CK activity than the control group. We conclude that pre-exercise irradiation with a laser dose of 1.0 J and 904 nm wavelength significantly delays muscle fatigue and decreases post-exercise blood lactate and CK in this rat model.

Eur J Appl Physiol 2009 Dec 19

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20024577

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Endonasal phototherapy with Rhinolight for the treatment of allergic rhinitis.

Brehmer D

University of Witten/Herdecke, Faculty of Medicine, Friedrichstrasse 3/4, 37073 Goettingen, Germany. dr.d.brehmer@t-online.de

Allergic rhinitis, although not life threatening, significantly affects the quality of the patient’s daily life. The three major steps in the treatment of the condition are avoidance of allergens, treatment of symptoms (in particular, antihistaminics and topical nasal corticosteroids) and specific immunotherapy. Avoidance of the allergen is usually not possible and symptom relief is often limited, despite the availability of a number of pharmacological options. Specific immunotherapy demands a high level of cooperation on the part of the patient for at least 3 years. Endonasal phototherapy with the Rhinolight device (Rhinolight Ltd, Szeged, Hungary) for the treatment of immunoglobulin E-mediated allergic rhinitis is a new option that utilizes the immunosuppressive effects of UV radiation. The method directs a combination of UV-B (5%), UV-A (25%) and visible light (70%) into the nasal cavity, and its effectiveness has been demonstrated in one double-blind, placebo-controlled study. The results of additional studies have been presented at various medical conferences and in abstracts. Reports in the literature confirm that phototherapy is a well-established and successful treatment of atopic dermatitis and other skin diseases.

Expert Rev Med Devices 2010 Jan 7(1) 21-6

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20021238

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Laser acupuncture does not improve menopausal symptoms.

O’Brien KA, Varigos E, Black C, Komesaroff PA

From the 1Victoria University Faculty of Health, Engineering, and Science, Melbourne, Australia; 2Monash University Department of Medicine, Alfred Hospital, Melbourne, Australia; 3Monash Surgical Private Hospital, Melbourne, Australia; and 4The Menopause and Midlife Women’s Clinic, The Oxford Clinic, Christchurch, New Zealand.

OBJECTIVE:: Acupuncture is commonly used to treat menopausal symptoms and other gynecological conditions. Laser acupuncture, more accurately named “laser acupoint stimulation,” has the advantages of being noninvasive, reproducible, and convenient. A few studies of conventional acupuncture have suggested a beneficial effect in treating menopausal symptoms. This study sought to investigate the effectiveness of laser acupoint stimulation in relieving symptoms associated with menopause. METHODS:: A double-blind, randomized, placebo-controlled study was conducted in 40 women experiencing active symptoms of menopause. Outcome variables were numbers of diurnal and nocturnal flushes and symptom score, determined using a previously validated scale. A laser acupoint stimulation device was altered to produce identical flashing lights whether or not the laser was operating to allow for a placebo (“laser off”) control. Participants received either active or placebo treatment on a fortnightly basis for 12 weeks. The acupoint selection in both groups was individualized to each participant, selected from a set of 10 acupoints. RESULTS:: There were no significant differences between the active and placebo treatment groups in numbers of diurnal or nocturnal flushes or in nonflushing symptom scores. CONCLUSIONS:: Laser acupoint stimulation chosen from a fixed set of acupoints is no more efficacious than manual stimulation with an inert laser probe in altering menopausal symptoms.

Menopause 2010 Jan 8

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20065886

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Effects of low power laser irradiation on bone healing in animals: a meta-analysis.

Bashardoust Tajali S, Macdermid JC, Houghton P, Grewal R

ABSTRACT: Purpose: The meta-analysis was performed to identify animal research defining the effects of low power laser irradiation on biomechanical indicators of bone regeneration and the impact of dosage. Methods: We searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment). Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of bone fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis. Results: Studies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08 – 1.37, p 0.028). While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.

J Orthop Surg Res 2010 Jan 4 5(1) 1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20047683

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[Reaction on ‘Less need for insulin, a surprising effect of phototherapy in insulin-dependent diabetes mellitus’]

Meesters Y

Tijdschr Psychiatr 2009 51(12) 975-7

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20047170

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Histological evaluation of the effect of low-level laser on distraction osteogenesis in rabbit mandibles.

Kreisner PE, Blaya D, Gaiao L, Maciel-Santos ME, Etges A, Santana-Filho M, de Oliveira MG

Av. Cel. Lucas de Oliveira, 1841/203, Petropolis CEP: 90460-001 – Porto Alegre, RS, Brazil, mogerhardt@yahoo.com.br.

Objectives: This study evaluated the action of low level laser therapy (LLLT) on the percentage of newly formed bone in rabbit mandibles that underwent distraction osteogenesis (DO). Study design: Ten rabbits underwent bone lengthening according to the following protocol: Latency – 3 days; Activation – 7 days 0.7 mm/d; and Consolidation – 10 days. The control group was composed of 4 rabbits. The experimental group, composed of 6 rabbits, received infrared GaAlAs LLLT (wavelength=830 nm, 40 mW) according to the following protocol: point dose of 10 J/cm(2) applied directly on the bone site that underwent DO during bone consolidation at 48-hour intervals. Results: The percentage of newly formed bone was greater in the LLLT group (57.89%) than in the control group (46.75%) (p=0.006). Conclusion: The results suggest that LLLT had a positive effect on the percentage of newly formed bone. Better-quality bone sites may allow early removal of the osteogenic distractors, thus shortening total treatment time.

Med Oral Patol Oral Cir Bucal 2009 Dec 29

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20038884

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Conservative management of posterior interosseous neuropathy in an elite baseball pitcher’s return to play: a case report and review of the literature.

Robb A, Sajko S

Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College. Tel: 416.482.2340. Email: arobb@cmcc.ca.

This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented.

J Can Chiropr Assoc 2009 Dec 53(4) 300-10

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20037695

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The effects of helium-neon light therapy on healing of partial osteotomy of the tibia in streptozotocin induced diabetic rats.

Abdi S, Bayat M, Javadieh F, Mohsenifar Z, Rezaie F, Bayat M

Medical Faculty, Cellular and Molecular Biology Research Center, Department of Pathology, Ayatollah Taleghani Hospital, Shahid Beheshti University, M.C., Tehran, Iran.

OBJECTIVE: The effect of light therapy (LT) on surgically created partial osteotomy in streptozotocin (STZ)-induced diabetic rats was examined. BACKGROUND DATA: LT has been shown to enhance bone repair in healthy human and animal models. MATERIALS AND METHODS: Forty male rats were divided into groups 1 to 5. Diabetes was induced in rats of groups 1, 2, and 3 using an intraperitoneal injection of STZ. All diabetic rats were maintained for 30 days after STZ injection. Under general anesthesia and sterile conditions, a partial transversal standardized osteotomy was made in the mid-portion of the right tibia. The defects in groups 2, 3, and 5 were treated using a helium-neon (He-Ne) laser (632.8 nm, 10 mW, circular beam shape). Groups 1 and 4 were diabetic placebo and normal placebo groups, respectively. A dose of 369.4 J/cm2 for groups 2 and 5 and a dose of 66.8 J/cm2 for group 3 were applied three times a week. Six weeks after surgery, the right tibia was collected. The specimen was subjected to a three-point bending test. RESULTS: LT with 369.4 J/cm2 energy density resulted in significantly greater bending stiffness in group 5 (41.8+/-5.2) than in groups 1 (18.5+/-4.1), 2 (17.7+/-1.6), and 3 (11.5+/-4) (least significant difference (LSD) test, p<0.01, p<0.001, and p<0.001, respectively). LT with 369.4 J/cm2 energy density resulted in a significantly higher stress load in group 5 (10+/-0.4) than in groups 1 (4.9+/-1.5), 2 (5.7+/-0.52), and 3 (3.9+/-1.1) (LSD test, p<0.01, p<0.01, p<0.001, respectively). CONCLUSION: LT with a He-Ne laser in STZ-induced diabetic rats did not enhance bone repair of a partial transversal standardized osteotomy.

Photomed Laser Surg 2009 Dec 27(6) 907-12

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20035603

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Choice of treatment modalities was not influenced by pain, severity or co-morbidity in patients with knee osteoarthritis.

Jamtvedt G, Dahm KT, Holm I, Odegaard-Jensen J, Flottorp S

Norwegian Knowledge Centre for the Health Services, Oslo, and Centre for Evidence-Based Practice, University College Bergen, Bergen, Norway.

Background and Purpose. Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA. Methods. Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses. Results. Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08-3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19-0.68 and OR = 8.92, 95% CI = 4.37-18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12-11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice. Conclusions. Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet access at work, physiotherapists having searched databases for the last six months and the gender of the therapist. There is a need for more studies of determinants for physiotherapy practice. Copyright (c) 2009 John Wiley & Sons, Ltd.

Physiother Res Int 2009 Dec 23

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20033888

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Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study.

Jackson RF, Dedo DD, Roche GC, Turok DI, Maloney RJ

River View Surgery Center, Marion, Indiana 46952, USA.

BACKGROUND AND OBJECTIVE: Transmission electron microscopic images have demonstrated the formation of transitory pores in adipocyte cell membranes followed by the collapse of adipose cells subsequent to laser irradiation of 635 nm. The objective is to evaluate the application of a 635 nm and 17.5 mW exit power per multiple diode laser for the application of non-invasive body contouring of the waist, hips, and thighs. STUDY DESIGN/PATIENTS AND METHODS: Double-blind, randomized, placebo-controlled trial of a 2-week non-invasive laser treatment conducted from May 2007 to June 2008 across multiple-private practice sites in the United States of America. Sixty-seven volunteers between the ages of 18-65 with a body mass index (BMI) between 25 and 30 kg/m(2) and who satisfied the set inclusion criteria participated. Eight of the 67 subjects did not have circumference measurements recorded at the 2-week post-procedure measurement point. Participants were randomly assigned to receive low-level laser treatments or a matching sham treatment three times per week for 2 weeks. Reduction in the total combined inches of circumference measurements of the waist, hip and bilateral thighs from baseline to the completion of the 2-week procedure administration phase was assessed. RESULTS: Participants in the treatment group demonstrated an overall reduction in total circumference across all three sites of -3.51 in. (P < 0.001) compared with control subjects who revealed a -0.684 reduction (P < 0.071745). Test group participants demonstrated a reduction of -0.98 in. (P < 0.0001) across the waist, -1.05 in. (P < 0.01) across the hip, and -0.85 in. (P < 0.01) and -0.65 in. (P < 0.01) across the right and left thighs from baseline to 2 weeks (end of treatment). At 2 weeks post-procedure, test group subjects demonstrated a gain of 0.31 total inches collectively across all three sites. CONCLUSION: These data suggest that low-level laser therapy can reduce overall circumference measurements of specifically treated regions.

Lasers Surg Med 2009 Dec 41(10) 799-809

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20014253

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A multimodal approach to management of suspected neuropathic pain in a prairie falcon (Falco mexicanus).

Shaver SL, Robinson NG, Wright BD, Kratz GE, Johnston MS

Professional Veterinary Medicine Program, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 W Drake Rd, Fort Collins, CO 80523-1678, USA.

An adult male prairie falcon (Falco mexicanus) was presented for evaluation and treatment of self-inflicted wounds along the right proximal patagium. The bird had started self-traumatizing approximately 1 month after fracturing the right metacarpus, although the fracture had stabilized, surface wounds had healed completely, and treatment with a nonsteroidal antiinflammatory drug had been administered. The bird was treated with gabapentin (11 mg/kg p.o. q12h), ketamine (0.5 mg/kg i.m. q24h), and low level laser therapy (LLLT) (<5 mW, 630-680 nm, 5-second application per site) for 3 weeks, but, despite initial improvement, new self-inflicted wounds appeared at the same site. Approximately 1.5 months later, a radial and medianoulnar nerve block was performed by using bupivacaine (2 mg/kg) and medetomidine (0.5 microg/kg). In addition, the dosing interval of ketamine was increased to q12h, and the dose of gabapentin was increased 7.5-fold. A higher energy and wavelength of LLLT (1040 mW, 830 nm, 2 J/cm2) was applied once to the injured region and fracture site, then the original LLLT protocol was applied once daily. After 2.5 months, the wounds healed completely and no further mutilation took place. Once deemed ready for release, the falcon was returned to the wild after 181 days in captivity. This is the first reported application of successful multimodal analgesia in a raptor with uncontrolled neuropathic pain.

J Avian Med Surg 2009 Sep 23(3) 209-13

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19999765

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Laser Photobiomodulation of Wound Healing: A Review of Experimental Studies in Mouse and Rat Animal Models.

Peplow PV, Chung TY, Baxter GD

1 Department of Anatomy & Structural Biology, University of Otago , Dunedin, New Zealand .

Abstract This investigation reviewed experimental studies of laser irradiation of wound healing in mice and rats published from 2003 to August 2008, respectively, to assess putative stimulatory effects of this treatment. Animal models, including rodents, attempt to reflect human wound healing and associated problems such as dehiscence, ischemia, ulceration, infection, and scarring. They have played a key role in furthering understanding of underlying mechanisms involved in impaired wound healing, and in testing new therapeutic strategies including laser irradiation. Original research papers investigating effects of laser or monochromatic light therapy on wound healing in mice and rats and published from January 2003 to August 2008 were retrieved from library sources, PubMed and Medline databases, reference lists from retrieved papers, and hand searches of relevant journals. Papers were selected for this review with regard to specific inclusion and exclusion criteria. Studies were critically reviewed in terms of study design, methodology, and appropriateness of laser irradiation parameters. The literature search identified eight studies in mice and 39 in rats. A variety of wound models were investigated, including acute-wound, impaired-healing, and chronic-wound models. Considerable variation was observed in research design, methodology, and irradiation parameters employed, limiting comparison of research findings between studies. Inadequate reporting of key experimental details, or errors in specification and/or calculation of key irradiation parameters was also found. Evidence from the studies reviewed suggested that use of red or infrared wavelength at a range of dosage parameters (median 4.2 Jcm(-2)) results in significant benefits in measured parameters of wound healing. Interestingly, coherence does not seem essential to the photobiomodulatory effects of ‘laser’ phototherapy. Studies reviewed consistently demonstrated the ability of laser or monochromatic light to photobiomodulate wound healing processes in experimental wounds in rats and mice, and strongly support the case for further controlled research in humans.

Photomed Laser Surg 2009 Dec 8

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19995230

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Physiotherapy treatments for breast cancer-related lymphedema: a literature review.

Leal NF, Carrara HH, Vieira KF, Ferreira CH

Universidade de Sao Paulo, Brazil. nanda.taz@bol.com.br

Breast cancer is the second most frequent cancer among women. Surgery is part of the therapeutic process to prevent metastases, but it can also cause some complications, including lymphedema. Physiotherapy contributes to its treatment, using different techniques that have been developed over the years. This systematic literature review aims to present physiotherapy modalities applied for lymphedema therapy. The literature review was conducted using textbooks and Lilacs, Pubmed and Scielo databases, from 1951 to 2009. Physiotherapy resources used for lymphedema treatment include complex decongestive therapy (CDT), pneumatic compression (PC), high voltage electrical stimulation (HVES) and laser therapy. The analyzed literature shows that better results are obtained with combined techniques. CDT is the most used protocol, and its association with PC has demonstrated efficacy. The new techniques HVES and laser present satisfactory results.

Rev Lat Am Enfermagem 2009 Sep-Oct 17(5) 730-6

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19967225

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Low level laser therapy does not modulate the outcomes of a highly bioactive glass-ceramic (Biosilicate((R))) on bone consolidation in rats.

Oliveira P, Ribeiro DA, Pipi EF, Driusso P, Parizotto NA, Renno AC

Department of Physiotherapy, Federal University of Sao Carlos, Rodovia Washington Luis (SP-310), Km 235, Sao Carlos, SP, Brazil.

The main purpose of the present work was to evaluate if low level laser therapy (LLLT) can improve the effects of novel fully-crystallized glass-ceramic (Biosilicate((R))) on bone consolidation in tibial defects of rats. Forty male Wistar rats with tibial bone defects were used. Animals were divided into four groups: group bone defect control (CG); group bone defect filled with Biosilicate((R)) (BG); group bone defect filled with Biosilicate((R)), irradiated with LLLT, at 60 J cm(-2) (BG 60) and group bone defect filled with Biosilicate((R)), irradiated with LLLT, at 120 J cm(-2) (BG 120). A low-energy GaAlAs 830 nm, CW, 0.6 mm beam diameter, 100 W cm(-2), 60 and 120 J cm(-)(2) was used in this study. Laser irradiation was initiated immediately after the surgery procedure and it was performed every 48 h for 14 days. Fourteen days post-surgery, the three-point bending test revealed that the structural stiffness of the groups CG and BG was higher than the values of the groups BG60 and BG120. Morphometric analysis revealed no differences between the control group and the Biosilcate((R)) group. Interestingly, the groups treated with Biosilicate((R)) and laser (BG 60 and BG120) showed statistically significant lower values of newly formed bone in the area of the defect when compared to negative control (CG) and bone defect group filled with Biosilicate (CB). Our findings suggest that although Biosilicate((R)) exerts some osteogenic activity during bone repair, laser therapy is not able to modulate this process.

J Mater Sci Mater Med 2009 Nov 27

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19943088

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The diagnosis and treatment of peripheral lymphedema.

Piller N, Carati C

Lymphology 2009 Sep 42(3) 146-7

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19938271

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Laser as a therapy for dry mouth symptoms in a patient with Sjogren’s syndrome: a case report.

Simoes A, Platero MD, Campos L, Aranha AC, Eduardo Cde P, Nicolau J

Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil. lysimoes@usp.br

This clinical case study reports on dry mouth symptoms in a patient with Sjogren’s syndrome (SS) who was treated with laser phototherapy (LPT). A 60-year-old woman diagnosed with SS was referred to the laboratory for lasers in dentistry to treat her severe xerostomia. A diode laser (780 nm, 3.8 J/cm2, 15 mW) was used to irradiate the parotid, submandibular, and sublingual glands, three times per week, for a period of 8 months. The salivary flow rate and xerostomia symptoms were measured before, during, and after LPT. Dry mouth symptoms improved during LPT. After LPT, the parotid salivary gland pain and swelling were no longer present. Treatment with LPT was an effective method to improve the quality of life of this patient with SS.

Spec Care Dentist 2009 May-June 29(3) 134-7

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19938253

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The effect of low-level laser irradiation (In-Ga-Al-AsP – 660 nm) on melanoma in vitro and in vivo.

Frigo L, Luppi JS, Favero GM, Maria DA, Penna SC, Bjordal JM, Bensadoun RJ, Lopes-Martins RA

Laboratory of Pharmacology and Phototherapy of Inflammation, Department of Pharmacology, Institute of Biomedical Sciences, University of Sao Paulo – Sao Paulo 05508-900 SP – Brasil. luciofrigo@uol.com.br

BACKGROUND: It has been speculated that the biostimulatory effect of Low Level Laser Therapy could cause undesirable enhancement of tumor growth in neoplastic diseases. The aim of the present study is to analyze the behavior of melanoma cells (B16F10) in vitro and the in vivo development of melanoma in mice after laser irradiation. METHODS: We performed a controlled in vitro study on B16F10 melanoma cells to investigate cell viability and cell cycle changes by the Tripan Blue, MTT and cell quest histogram tests at 24, 48 and 72 h post irradiation. The in vivo mouse model (male Balb C, n = 21) of melanoma was used to analyze tumor volume and histological characteristics. Laser irradiation was performed three times (once a day for three consecutive days) with a 660 nm 50 mW CW laser, beam spot size 2 mm(2), irradiance 2.5 W/cm(2) and irradiation times of 60s (dose 150 J/cm(2)) and 420s (dose 1050 J/cm(2)) respectively. RESULTS: There were no statistically significant differences between the in vitro groups, except for an increase in the hypodiploid melanoma cells (8.48 +/- 1.40% and 4.26 +/- 0.60%) at 72 h post-irradiation. This cancer-protective effect was not reproduced in the in vivo experiment where outcome measures for the 150 J/cm(2) dose group were not significantly different from controls. For the 1050 J/cm(2) dose group, there were significant increases in tumor volume, blood vessels and cell abnormalities compared to the other groups. CONCLUSION: LLLT Irradiation should be avoided over melanomas as the combination of high irradiance (2.5 W/cm(2)) and high dose (1050 J/cm(2)) significantly increases melanoma tumor growth in vivo.

BMC Cancer 2009 9 404

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19930543

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The Effects of Low Level Laser Irradiation on Gingival Inflammation.

Pejcic A, Kojovic D, Kesic L, Obradovic R

Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis , Nis, Serbia .

Abstract Objective: The goal of this study was to analyze the effects of low level laser irradiation treatment and conservative treatment on gingival inflammation. Background: It is widely accepted today that the primary etiological factor for the onset of periodontitis is dental plaque, although the exact mechanism of damage remains unknown. Inflammation is a basic response of periodontal tissue to damage and serves as a fast first line of defense against damage and infections. The treatment of gingivitis and periodontitis has gone through various stages: from the simplest, classical treatment methods, through improved radical interventions, to a new era marked by laser technology. Low level laser irradiation has an anti-inflammatory effect, both general and local. Materials and methods: The research was done on patients who had chronic periodontal disease (mild periodontitis) with expressed clinical symptoms of gingival inflammation. All patients in the study underwent conservative treatment. After conservative therapy, the patients from the experimental group were subjected to 10 low level laser treatment sessions. Both groups underwent regular follow-up visits 1, 3, and 6 months after treatment, which involved only clinical examination using plaque index (PI), gingival index (GI), and bleeding on probing index (BOP index). Results: A considerable decrease in all three indexes after the application of both therapies was noticed. The follow-up visits revealed the difference in index values. With laser therapy, the values of indexes decreased steadily, whereas with conservative therapy they increased up to a certain point, but did not reach the pre-therapy values. Conclusions: A general conclusion can be drawn that low level laser irradiation (semiconductor, 670 nm) can be used as a successful physical adjuvant method of treatment, which, together with traditional periodontal therapy, leads to better and longer-lasting therapeutic results.

Photomed Laser Surg 2009 Nov 22

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19929224

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[Phototherapy for chronic pain treatment]

Ide Y

Department of Anesthesia, Toho University Sakura Medical Center Sakura 285-8741.

Three types of machines are used in the field of phototherapy for chronic pain. One type is an instrument for low reactive level laser therapy (LLLT), one is an instrument for linear polarized infrared light irradiation (SUPER LIZER), and the last one is an instrument for Xenon light irradiation (beta EXCEL Xe10). The available machines for LLLT all project laser by semiconductor. The newest machine (MEDILASER SOFT PULSE10) has peak power of 10 W and mean power of 1 W. This machine is as safe as 1 W machine and is effective twice as deep as the 1 W machine. The irradiation by low reactive level laser induces hyperpolarization, decreased resistance of neuronal membrane, and increased intra-cellular ATP concentrations. The effects of low reactive level laser might be induced by the activation of ATP-dependent K channel. The significant analgesic effects of 1 W and 10 W LLLT were reported with double blind test. The significant analgesic effects of linear polarized near infrared light irradiation with double blind test were also reported. The effects of low reactive level laser upon the sympathetic nerve system were thought to result from its normalization of the overloaded sympathetic nerve system.

Masui 2009 Nov 58(11) 1401-6

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19928507

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[Diagnostic and therapeutic instruments for the pain clinic: introduction]

Hanaoka K

JR Tokyo General Hospital, Tokyo 151-8528.

Pain, a very unpleasant feeling often difficult to treat, is the most common complaint of patients visiting hospital. When a patient with pain visits our institution, first of all, we have to diagnose the pain including the grade of pain and stress associated with sympathetic-adrenal-medullary system. We then treat the pain of the patient using available devices. In the following special articles, functional magnetic imaging, device for measurement of salivary alpha-amylase and PainVisionTM for pain measurement are described as devices for diagnosis of pain. As devices for treatment of pain, epidural infuser pump, intrathecal infusion pump, spinal cord stimulation device and phototherapy device are also described. The mechanism and grade of intractable pain often confuse us to recognize pain. The devices, described in this special issue, are very useful for the evaluation and treatment of intractable pain. I feel happy if these articles greatly contribute to the treatment of patients with pain by pain clinicians.

Masui 2009 Nov 58(11) 1348-9

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19928500

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Notalgia paresthesica successfully treated with narrow-band UVB: report of five cases.

Perez-Perez L, Allegue F, Fabeiro JM, Caeiro JL, Zulaica A

Department of Dermatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.

Abstract Background Notalgia paresthesica is a disorder of unknown origin characterized by pruritus localized to the patients’ back. Local pain, burning or paresthesias have also been described. No definite treatments have been found for this disorder and most of those reported to date are anecdotal. Topical capsaicin is the option most widely used among dermatologists. Transcutaneous electrical nerve stimulation, gabapentin, oxcarbazepine and botulinum toxin have recently shown promising effects. UVB has been used for decades to treat different pruritic skin diseases, but its benefits in the management of NP have not been stated to date. Objectives To test the effects of UVB in notalgia paresthesica. Methods We used a course of UVB narrow band to treat five patients with notalgia paresthesica. The treatment was administered following a phototype protocol in a UV 7002 cabinet. Results We provide the results of a course of UVB narrow-band phototherapy in five patients. Phototherapy contributed substantially to improve pruritus in all of them. Conclusion Given the benefits achieved, we stress the interest of UVB narrow-band as a safe and well tolerated alternative treatment for notalgia paresthetica.

J Eur Acad Dermatol Venereol 2009 Nov 18

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19925596

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About James Carroll

Founder and CEO at THOR Photomedicine Ltd. About THOR
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2 Responses to LLLT Literature Watch for January 2010

  1. Jo Murphy says:

    I have been pleased to read the above articles. Thank you. I use LLLT for fibromyalgia and pain management at least every second day.It is very noticable that LLLT also improves mood and energy levels as well as appetite. I am surprised that these positive effects on mood are not widely acknowledged and discussed by health professionals, as there is desperate need for this kind of therapy – among the elderly and the chronically ill especially. Jo Murphy, NZ.

  2. J.C. Australia says:

    It is a shame that more clinical research funds are not directed as a priority for preventative health care. Laser Therapy is as a non-invasive, relatively easily administered mode of therapy which patients can attest is often a last ditch mode to offer people who are seen as difficult to treat.

    As a therapist I worked in pain management, stress management and treatment of mood disorders. I also have first hand experience of chronic neuropathic pain, which evolved with time from 2 incidents major physical traumas requiring neurosurgeries, along with the best efforts of senior practitioners across the medical and paramedical spectrum. Almost by accident, I came across LLLT. I have been fortunate that my enlightened team of practitioners are open to the evidence of reduced swelling, redness, allodynia, severe head pain etc. ..
    I also endorse the mood enhancing effect, and that sleep comes easier after an afternoon therapy session.
    I do look forward to a safe economical device for use at home ~ as travel itself with its vibration can stir things up if my therapist is absent on leave.
    It is good to see major medical schools like Harvard are currently on target.

    It is good to see

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