Low Level Laser Therapy LLLT / Cold Laser Literature watch for June 2011

22 new papers for your review. The BMJ clinical evidence recommendations for tennis elbow now include LLLT, next on the list is a systematic review with meta-analysis of LLLT on oral mucositis, this finds reduced pain, severity and duration of OM symptoms. There is also a laser vs ultrasound clinical trial on shoulder myofascial pain, and lab rat studies on red vs IR for laser-induced analgesia, reduced scarring post MI following laser irradiated stem cells transplanted to bone marrow, one on sciatic pain and another study on acute lung inflammation (an adult respiratory distress syndrome model).

Tennis elbow.

Bisset L, Coombes B, Vicenzino B

Department of Health and Rehabilitation, University of Queensland, Brisbane, Australia.

INTRODUCTION: Lateral pain in the elbow affects up to 3% of the population, and is considered an overload injury of the extensor tendons of the forearm where they attach at the lateral epicondyle. Although usually self-limiting, symptoms may persist for over 1 year in up to 20% of people. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for tennis elbow? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, autologous whole blood injections, corticosteroid injections, combination physical therapies, exercise, extracorporeal shock wave therapy, iontophoresis, low-level laser therapy, manipulation, non-steroidal anti-inflammatory drugs (oral and topical), orthoses (bracing), platelet-rich plasma injections, pulsed electromagnetic field treatment, surgery, and ultrasound.

Clin Evid (Online) 2011 2011

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21708051

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Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial.

Rayegani SM, Bahrami MH, Samadi B, Sedighipour L, Mokhtarirad MR, Eliaspoor D

Physical Medicine and Rehabilitation Department, Shohada Medical Center, Shaheed Beheshti Medical University of Medical Sciences, Tehran, Iran – bahrami7mh@gmail.com.

BACKGROUND: Myofascial pain syndrome (MPS) is one of the most prevalent musculoskeletal diseases. MPS impaired quality of life in the patients. There is a lot of controversy about different treatment options which include medical treatments, physical therapy, injections, ultrasound and laser. The effects of laser in MPS are challenging. AIM: To assess the effects of laser and ultrasound in treatment of MPS. DESIGN:Randomized single blinded clinical trial SETTING: Outpatient physical therapy clinic at university hospital POPULATION:Sixty three subjects (females: 46, males: 17), (age range: 17-55 year old) who had a RESULTS: Ultrasound was effective in VAS improvement during activity (46%), at rest (39%) and at night (35%). It also improved NDI scores (34%) and algometric assessment (37%). Laser was effective in VAS improving during activity (54%), at night (51%) and at rest (51%) and also improved NDI scores (73%). It was also found effective in algometric assessment improvement (105%). Laser resulted in more NDI score and algometric assessment improvements comparing to ultrasound (p

Eur J Phys Rehabil Med 2011 Jun 13

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21666573

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Inhibitory effects of visible 650-nm and infrared 808-nm laser irradiation on somatosensory and compound muscle action potentials in rat sciatic nerve: implications for laser-induced analgesia.

Yan W, Chow R, Armati PJ

Neuroinflammation Laboratory, Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.

Low-level laser therapy (LLLT) has been shown in clinical trials to relieve chronic pain and the World Health Organization has added LLLT to their guidelines for treatment of chronic neck pain. The mechanisms for the pain-relieving effects of LLLT are however poorly understood. We therefore assessed the effects of laser irradiation (LI) on somatosensory-evoked potentials (SSEPs) and compound muscle action potentials (CMAPs) in a series of experiments using visible (lambda = 650 nm) or infrared (lambda = 808 nm) LI applied transcutaneously to points on the hind limbs of rats overlying the course of the sciatic nerve. This approximates the clinical application of LLLT. The 650-nm LI decreased SSEP amplitudes and increased latency after 20 min. CMAP proximal amplitudes and hip/ankle (H/A) ratios decreased at 10 and 20 min with increases in proximal latencies approaching significance. The 808-nm LI decreased SSEP amplitudes and increased latencies at 10 and 20 min. CMAP proximal amplitudes and H/A ratios decreased at 10 and 20 min. Latencies were not significantly increased. All LI changes for both wavelengths returned to baseline by 48 h. These results strengthen the hypothesis that a neural mechanism underlies the clinical effectiveness of LLLT for painful conditions.

J Peripher Nerv Syst 2011 Jun 16(2) 130-5

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21692912

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Induction of autologous mesenchymal stem cells in the bone marrow by low-level laser therapy has profound beneficial effects on the infarcted rat heart.

Tuby H, Maltz L, Oron U

Department of Zoology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv 69978, Israel.

BACKGROUND AND OBJECTIVES: The adult mammalian heart is known to have a very limited regenerative capacity following acute ischemia. In this study we investigated the hypothesis that photobiostimulation of autologous bone-marrow-derived mesenchymal stem cells (MSCs) by low-level laser therapy (LLLT) applied to the bone marrow (BM), may migrate to the infarcted area and thus attenuate the scarring processes following myocardial infarction (MI). MATERIALS AND METHODS: Sprague-Dawley rats underwent experimental MI. LLLT (Ga-Al-As diode laser, power density 10 mW/cm(2) , for 100 seconds) was then applied to the BM of the exposed tibia at different time intervals post-MI (20 minutes and 4 hours). Sham-operated infarcted rats served as control. RESULTS: Infarct size and ventricular dilatation were significantly reduced (76% and 75%, respectively) in the laser-treated rats 20 minutes post-MI as compared to the control-non-treated rats at 3 weeks post-MI. There was also a significant 25-fold increase in cell density of c-kit+ cells in the infarcted area of the laser-treated rats (20 minutes post-MI) as compared to the non-laser-treated controls. CONCLUSION: The application of LLLT to autologous BM of rats post-MI offers a novel approach to induce BM-derived MSCs, which are consequently recruited from the circulation to the infarcted heart and markedly attenuate the scarring process post-MI. Lasers Surg. Med. 43:401-409, 2011. (c) 2011 Wiley-Liss, Inc.

Lasers Surg Med 2011 Jul 43(5) 401-9

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21674545

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Dual Effect of low-level laser therapy (LLLT) on the acute lung inflammation induced by intestinal ischemia and reperfusion: Action on anti- and pro-inflammatory cytokines.

de Lima FM, Villaverde AB, Albertini R, Correa JC, Carvalho RL, Munin E, Araujo T, Silva JA, Aimbire F

Research and Development Institute, Av. Shishima Hifumi, 2911, Sao Jose dos Campos, SP, Brazil. flaviafisio@hotmail.com.

BACKGROUND AND OBJECTIVE: It is unknown if pro- and anti-inflammatory mediators in acute lung inflammation induced by intestinal ischemia and reperfusion (i-I/R) can be modulated by low-level laser therapy (LLLT). STUDY DESIGN/MATERIAL AND METHODS: A controlled ex vivo study was developed in which rats were irradiated (660 nm, 30 mW, 0.08 cm(2) of spot size) on the skin over the right upper bronchus 1 hour post-mesenteric artery occlusion and euthanized 4 hours later. For pretreatment with anti-tumor necrosis factor (TNF) or IL-10 antibodies, the rats received either one of the agents 15 minutes before the beginning of reperfusion. METHODS: Lung edema was measured by the Evans blue extravasation and pulmonary neutrophils influx was determined by myeloperoxidase (MPO) activity. Both TNF and IL-10 expression and protein in lung were evaluated by RT-PCR and ELISA, respectively. RESULTS: LLLT reduced the edema (80.1 +/- 41.8 microg g(-1) dry weight), neutrophils influx (0.83 +/- 0.02 x 10(6) cells ml(-1) ), MPO activity (2.91 +/- 0.60), and TNF (153.0 +/- 21.0 pg mg(-1) tissue) in lung when compared with respective control groups. Surprisingly, the LLLT increased the IL-10 (0.65 +/- 0.13) in lung from animals subjected to i-I/R. Moreover, LLLT (0.32 +/- 0.07 pg ml(-1) ) reduced the TNF-alpha level in RPAECs when compared with i-I/R group. The presence of anti-TNF or IL-10 antibodies did not alter the LLLT effect on IL-10 (465.1 +/- 21.0 pg mg(-1) tissue) or TNF (223.5 +/- 21.0 pg mg(-1) tissue) in lung from animals submitted to i-I/R. CONCLUSION: The results indicate that the LLLT attenuates the i-I/R-induced acute lung inflammation which favor the IL-10 production and reduce TNF generation. Lasers Surg. Med. 43:410-420, 2011. (c) 2011 Wiley-Liss, Inc.

Lasers Surg Med 2011 Jul 43(5) 410-20

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21674546

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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 Parana State University, Cascavel, PR, Brazil.

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/cm(2); and G8J (n=6), sciatica and irradiation with 8 J/cm(2). 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.

Arq Neuropsiquiatr 2011 69(2B) 356-9

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21625765

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Low-intensity infrared laser increases plasma proteins and induces oxidative stress in vitro.

de Souza da Fonseca A, Presta GA, Geller M, de Paoli F, Valenca SS

Departamento de Ciencias Fisiologicas, Instituto Biomedico, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca, 94, Rio de Janeiro, 20211040, Brazil, adnfonseca@ig.com.br.

Low-intensity laser therapy is based on the excitation of endogenous chromophores in biotissues and free-radical generation could be involved in its biological effects. In this work, the effects of the low-intensity infrared laser on plasma protein content and oxidative stress in blood from Wistar rats were studied. Blood samples from Wistar rats were exposed to low-intensity infrared laser in continuous wave and pulsed-emission modes at different fluencies. Plasma protein content and two oxidative stress markers (thiobarbituric acid-reactive species formation and myeloperoxidase activity) were carried out to assess the effects of laser irradiation on blood samples. Low-intensity infrared laser exposure increases plasma protein content, induces lipid peroxidation, and increases myeloperoxidase activity in a dose- and frequency-dependent way in blood samples. The low-intensity infrared laser increases plasma protein content and oxidative stress in blood samples, suggesting that laser therapy protocols should take into account fluencies, frequencies, and wavelengths of the laser before beginning treatment.

Lasers Med Sci 2011 Jun 24

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21701880

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Effect of phototherapy on gastrointestinal smooth muscle activity and oxidative stress.

Soyer T, Aliefendioglu D, Aktuna Z, Caglayan O, Aydos TR, Cakmak M

Department of Pediatric Surgery, Medical Faculty, Kirikkale University, 71100, Kirikkale, Turkey, soyer.tutku@gmail.com.

AIM: To evaluate the effect of phototherapy on gastrointestinal smooth muscle activity and oxidative stress. METHODS: Wistar albino rats (n = 18, in the first 7 days of life) weighing 7 +/- 2 g with both sexes were included in the study. The animals were randomized into three groups. In control group (CG), median laparotomy was performed to obtain 1 cm of jejunum, terminal ileum and colonic segments. In the phototherapy group (PTG), led phototherapy with a wave density of 40 muw/cm(2)/nm were used (Bilitron 3006, Fanem, Brasil). The efficacy surface of phototherapy was 30-40 cm and the exposure distance was 30 cm. The duration of phototherapy was 24 h. Sham group (SG) received white light with the same wave density and exposure distance. The oxidative stress markers and contraction responses were investigated from intestinal segments obtained from experiments. RESULTS: The jejunum segments showed significantly lowered contraction response to carbachol in SG when compared to CG and PTG (p < 0.05). Decreased contractile response to KCl was detected in both SG and PTG in terminal ileum segments. MDA levels showed no difference between groups (p > 0.05). Total sulfhydryl (T-SH) levels were found significantly increased in PTG when compared to CG and SG (p < 0.05). When NO levels were evaluated, NO levels were found decreased in PTG and SG with respect to CG (p < 0.05). CONCLUSION: PT may cause various alterations in oxidant/antioxidant system in intestinal segments. Unlike to clinical findings, decreased contractile responses were detected in rat gastrointestinal smooth muscles after PT.

Pediatr Surg Int 2011 Jun 1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21630101

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Early response of mechanically exposed dental pulps of swine to antibacterial-hemostatic agents or diode laser irradiation.

Cannon M, Wagner C, Thobaben JZ, Jurado R, Solt D

Northwestern University, Children’s Medical Center, Chicago USA. cannon.m@comcast.net

OBJECTIVES: The purpose of this study was to compare the effectiveness of an antibacterial and hemostatic agent to diode laser irradiation in the healing of mechanically exposed porcine pulps. MATERIALS AND METHOD: The experiment required three adult swine (Sus scrofa domestica, Yorkshire) with 36 teeth prepared with occlusal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the pulps were exposed using high speed instrumentation with rubber dam isolation and a disinfected field. Following instrumentation the coronal pulpal tissue was amputated and immediately treated with ferric sulfate and chlorhexidine semi-gel (12), diluted Buckley’ formocresol solution (12) for 5 minutes or laser irradiation with a diode laser (12). After treatment, hemostasis was obtained and a ZOE base applied to the treated pulps (36). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at 4 weeks (28 days). Following fixation, the samples were de-mineralized, sectioned, stained and histologically graded with a scale of 0-4. RESULTS: The treatment groups were statistically different with the Laser Treated Group demonstrating the least inflammation. CONCLUSION: Pulpotomy treatment with the KaVo Gentle Ray Diode Laser demonstrated significantly less inflammation than the other two pulpal therapy modalities. The ferric sulfate and chlorhexidine mixture demonstrated the greatest inflammation as histologically graded. Also, the histological sections of pulpotomized swine teeth treated with the ferric sulfate and chlorhexidine mixture presented with black pigmented areas in the pulp and surrounding tissue. The formocresol group (clinical standard) and the diode laser group did not present with the black precipitate.

J Clin Pediatr Dent 2011 Spring 35(3) 271-6

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21678669

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Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review.

Vrijman C, van Drooge AM, Limpens CE, Bos JD, van der Veen JP, Spuls PI, Wolkerstorfer A

Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Centre, University of Amsterdam, NL-1105AZ, Amsterdam, the Netherlands Department of Dermatology, Academic Medical Centre, University of Amsterdam, NL-1100DD, Amsterdam, the Netherlands Medical Library, Academic Medical Centre, University of Amsterdam, NL-1100DD, Amsterdam, the Netherlands. Dutch Cochrane Centre, Academic Medical Centre, NL-1100DD, Amsterdam, the Netherlands. The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), NL-1006BE, Amsterdam, the Netherlands.

Hypertrophic scars are difficult to improve and remain a therapeutic challenge. Several lasers and light sources were evaluated in the past decades and showed to improve hypertrophic scars. However, a systematic review is not available. To assess current evidence of efficacy of all laser and intense pulsed light therapies used in the treatment of hypertrophic scars, we performed a systematic review searching electronic databases MEDLINE, EMBASE and CENTRAL. The quality of the controlled clinical trials was evaluated according to the Cochrane Collaboration’s tool for assessing risk of bias. Thirteen articles involving seven different lasers met the inclusion criteria. Most evidence was found for the pulsed dye laser (PDL) 585 nm (8 studies), followed by the PDL 595 nm (2 studies), whereas limited evidence (one trial per laser) was available for fractional non-ablative laser 1540 nm, CO2 laser 10,600 nm, low level laser therapy (LLLT), Nd:YAG laser 532 nm and ErbiumYAG laser 2940 nm. Treatment recommendations should be formulated with caution as current evidence is insufficient for comparing the efficacy of different laser therapies. The PDL 585 nm showed a low efficacy for the treatment of hypertrophic scars. With moderate efficacy, the PDL 595 nm is promising, although more research is necessary. For the efficacy of other lasers, little evidence was found. Future research, with low risk of bias, well defined scar characteristics, validated outcome measures, standardized measure methods, follow up periods of at least 6 months and well defined laser settings, is needed.

Br J Dermatol 2011 Jun 28

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21711337

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Noninvasive Brain Stimulation in Traumatic Brain Injury.

Demirtas-Tatlidede A, Vahabzadeh-Hagh AM, Bernabeu M, Tormos JM, Pascual-Leone A

Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Drs Demirtas-Tatlidede and Pascual-Leone and Mr Vahabzadeh-Hagh); Guttmann University Institute for Neurorehabilitation, Universitat Autonoma de Barcelona, Badalona, Spain (Drs Bernabeu, Tormos, and Pascual-Leone).

OBJECTIVE:: To review novel techniques of noninvasive brain stimulation (NBS), which may have value in assessment and treatment of traumatic brain injury (TBI). METHODS:: Review of the following techniques: transcranial magnetic stimulation, transcranial direct current stimulation, low-level laser therapy, and transcranial Doppler sonography. Furthermore, we provide a brief overview of TMS studies to date. MAIN FINDINGS:: We describe the rationale for the use of these techniques in TBI, discuss their possible mechanisms of action, and raise a number of considerations relevant to translation of these methods to clinical use. Depending on the stimulation parameters, NBS may enable suppression of the acute glutamatergic hyperexcitability following TBI and/or counter the excessive GABAergic effects in the subacute stage. In the chronic stage, brain stimulation coupled to rehabilitation may enhance behavioral recovery, learning of new skills, and cortical plasticity. Correlative animal models and comprehensive safety trials seem critical to establish the use of these modalities in TBI. CONCLUSIONS:: Different forms of NBS techniques harbor the promise of diagnostic and therapeutic utility, particularly to guide processes of cortical reorganization and enable functional restoration in TBI. Future lines of safety research and well-designed clinical trials in TBI are warranted to determine the capability of NBS to promote recovery and minimize disability.

J Head Trauma Rehabil 2011 Jun 17

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21691215

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About James Carroll

Founder and CEO at THOR Photomedicine Ltd. About THOR
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One Response to Low Level Laser Therapy LLLT / Cold Laser Literature watch for June 2011

  1. alex chisholm says:

    I think there is also a new article on LLLT and angina patients. It is simply fascinating. It may be on your list, and I just missed it. I enjoy your lit updates. Thank you.

    TITLE: IRANIAN HEART JOURNAL
    VOLUME/ISSUE/PAGES: 11/4 6-15
    DATE: 2011
    AUTHOR OF ARTICLE: kiaver, m
    TITLE OF ARTICLE: STUDY OF THE EFFICACY OF LOW LEVEL LASER IN MYOCARDIAL
    PERFUSION
    OF PATIENTS WITH CHRONIC STABLE ANGINA

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