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Duggan Chiropractic

2439 Broadway Suite 100

Boulder, CO 80304

(303) 443-1553

 


 

SOFT LASER


 

laser_knee.gif


 

What Does Laser Do?

Soft laser penetrates the skin, and is absorbed into the surrounding tissue. It accelerates your natural healing process to reduce pain and inflammation. Cold laser light irradiation is excellent for reducing and eliminating pain, edema, and inflammation in both acute and chronic conditions.  Laser light is absorbed in the mitochondria and increases the production of energy in the cell by increasing ATP production, thereby speeding up healing.  Secondary effects are pain reduction by increasing endorphins, enhanced lymphatic drainage, and tissue regeneration of collegen and bone. 

What Conditions Does It Treat?

 

 * Soft Tissue Injuries  * Plantar Fasciitis
 * Tendonitis  * Tennis Elbow
 * Sprains & Strains  * Herniated Disc
 * Back, Neck & Shoulder Pain  * Nerve Pain
 * Repetitive Strain Injuries  * Whiplash
 * Carpal Tunnel Syndrome  * Bell's Palsy
 * Chondromalacia Patellae  * Fractures
 * Muscle Pain  * Lymphedema
 * Peripheral Neuropathy  * Non-Healing Wounds
 * RSD (CRPS)  * Sciatica
 * Headaches & Migraines  * Skin Problems
 * Herpes (Shingles)  * Bursitis
 * Arthritis  * Jaw Pain / TMJ

 

We have three different lasers to address all conditions.

Wavelengths for Pain Relief

Diverse tissue and cell types in the body all have their own unique light absorption characteristics or chromophores;  that is, each type of tissue will absorb light at a specific wavelength - not all wavelengths.

660nm wavelength (Continuous and modulated)

This wavelength is readily absorbed by hemoglobin in blood, melanin, and water content areas found in the skin.  Beneficial in treating pain and wound conditions close to the surface.

830nm wavelength (Continuous and modulated)

This wavelength treats the pain associated with tendons, joints and muscles.

904nm (Superpulsed)

This particular wavelength, powered at 75 W penetrates deep, making it viable for treating lower back, hip, knee, and other joint pain.   The 904nm outperforms wavelengths for reduction of inflammation and is used in conjunction with 660nm and 830nm for complete results.

IN BOTH OPEN SURFACE WOUNDS AND CLOSED CONNECTIVE OR SOFT TISSUE INJURIES, LASER THERAPY PROVIDES PAIN RELIEF

RESEARCH 

The following is a summary of some of the clinical studies that were conducted using cold laser to treat Arthritis. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

Helium-Neon Laser Reduces the Inflammatory Process of Arthritis

Claudia Reinoso Rubio, David Cremonezzi, Monica Moya, Fernando Soriano, Jose Palma, Vilma Campana. Photomedicine and Laser Surgery. -Not available-, ahead of print. doi:10.1089/pho.2008.2472.

Objective: A histological study of the anti-inflammatory effect of helium-neon laser in models of arthropathies induced by hydroxyapatite and calcium pyrophosphate in rats.
Background: Crystal deposition diseases are inflammatory pathologies induced by cellular reaction to the deposit of crystals in the joints.
Methods: Fifty-six Suquia strain rats were distributed in seven groups. Two mg of each crystal diluted in 0.05ml physiologic solution were injected six times in each back limb joint, during two weeks on alternate days. Eight J/cm2 were applied daily to the crystal-injected joints on five consecutive days. The joints were cut and put in 10% formaldehyde, stained with hematoxylin-eosin and observed by light microscopy. The percentage of area with inflammatory infiltrates was determined in five optical microscopy photographs (100X) for each group and analyzed using the Axionvision 4.6 program. A Pearson's Chi Squared test was applied, with significance level set at p < 0.05.
Results: Both crystals produced an inflammatory process in the osteoarticular structures, consisting of predominantly mononuclear infiltration, fibrosis, and granulomas of foreign body-type giant cells containing phagocytosed remains of crystals. In the arthritic joints treated with laser, a marked decrease (p < 0.0001) was found in the percentage of area with inflammatory infiltrates, although the granulomas remained in a less ostensible form, with adipose tissue cells, fibrosis bands with light residual inflammation, and an absence of or very few crystals. Laser alone or physiologic solution injection did not produce histological changes.
Conclusions: Helium-neon laser reduced the intensity of the inflammatory process in the arthritis model induced by hydroxyapatite and calcium pyrophosphate crystals.

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

Núbia Cristina Rodrigues de Morais, Ana Maria Barbosa, Mariana Lima Vale, Antonio Balbin Villaverde, Carlos José de Lima, José Carlos Cogo, Stella Regina Zamuner. Photomedicine and Laser Surgery. -Not available-, ahead of print. doi:10.1089/pho.2008.2422.

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 (250â??280g) by intra-articular injection of zymosan (1mg in 50µL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1h, and 2h after zymosan administration with a semiconductor laser (685nm and 830nm) and an LED at 628nm, with the same dose (2.5J/cm2) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1h 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 685nm and 830nm 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 (628nm), 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 (100sec), average outputs (20mW), and energy doses (2J) 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.

Application of laser acupuncture in the treatment of periarthritis humeroscapularis.

Branka Nikolic,. spec. Sport's med. Address Zavod za zdravstvenu zastitu radnika ZTP-a "Beograd", 11000 Beograd, Slobodana Penezica Dr. 23 Yugoslavia

The effect of low intensity semi conductor laser was used as treatment methods for periarthritis humeroscapularis. The CC laser (Computer Controlled laser) was applied. Laser therapy has positive biological effects and antiinflamatory, antioedema effects and analgesia. We treated 18 patients with periarthritis humeroscapularis, 14 were female patients.
The laser was locally applied at the AC points Sj 14, Sj 15, Li 15, Li 10, Sj 5, Si 3, three times a week for the first week and twice a week for the second and the third week. After first treatment 12 of patients had pain - alleviating effect. After 6-7 treatments al had pain - alleviating effect and complete recovery of shoulder's motor activity. Low intensity therapy has its place for treatment of periarthritis humeroscapularis.

Treatment of the acute Periarthritis humeroscapular with laserpuncture.

Odalys Gonzáles �lvarez, Main Educational Clinic of Urgencies "Antonio Maceo", Cerro Municipality, Havana City.

The periarthritis humeroscapular is a syndrome that contains very precise affections: the bursitis, the calcified tendinitis of supraespinoso, the bicipital tendinitis, among others. Pain and limitation of the joint movements of the shoulder characterize it. The treatment with laser of low power can produce resolution of the lesion, whenever it is made in early phases of the disease. In this study we propose the use of the laserpuncture, due to our accumulated experience in the treatment of these affection in acute phase, with acupuncture. A prospective study was carried out during 2 years (1997 - 1999), where 62 patients were selected because they accomplished the Approaches of Inclusion for the study. The sample was divided by aleatory assignment in 2 Groups of Treatment. Th study Group I was treated with laserpuncture, using Cuban laser equipment of HeNe of 632,8 nm and a dose of joule/cm2 was applied, and the Control Group II was treated with acupuncture needles. The conventional medical treatment was suspended. Daily sessions were given from Monday to Friday, for two weeks, until a total of 10. Both techniques demonstrated to be effective in the treatment of these affections, improving the clinical and radiological symptoms significantly when the treatment sessions was concluded. The patients accepted the laserpuncture better because of its painless character, less time of application, and the absence of bleeding and stress.

 

Acute Spinal Cord Injury Cold Laser Clinical Studies

The following is a summary of some of the clinical studies that were conducted using cold laser to treat Acute Spinal Cord Injury. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

Light therapy (lllt) alters gene expression after acute spinal cord injury

K.R. Byrnes 1, R.W. Waynant 2, I.K. Ilev 2, B. Johnson 1, Pollard H. 1, Srivastava M. 1, Eidelman O. 1, Huang, W. 1, J.J. Anders1 1. Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA; 2. Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD, USA

Secondary injury in the spinal cord, which results in axonal degeneration, scar and cavity formation and cell death, occurs around the site of the initial trauma and is a primary cause for the lack of axonal regeneration observed after spinal cord injury (SCI). The immune response after SCI is under investigation as a potential mediator of secondary injury. Treatment of SCI with 810 nm light suppresses the immune response and improves axonal regeneration.
We hypothesize that these beneficial effects observed in the injured spinal cord are accompanied by alterations in gene expression within the spinal cord, particularly of those genes involved in secondary injury and the immune response. To test this hypothesis, a dorsal hemisection at vertebral level T9 was performed. The injured spinal cord from rat was then exposed to laser light (810nm, 150mW, 2,997 seconds, 0.3cm2 spot area, 1589 J/cm2) and spinal cord samples, including the injury site, were harvested at 6 and 48 hours and 4 days post-injury. Total RNA was extracted and purified from the lesioned spinal cord and cDNA copies were either labeled with [32P] for microarray analysis or amplified and analyzed with a polymerase chain reaction (PCR).
Microarray results revealed a suppression of genes involved in the immune response and excitotoxic cell death at 6 hours post-injury, as well as cell proliferation and scar formation at 48 hours post-injury in the light treated group. Analysis of the PCR products revealed that light treatment resulted in a significant suppression of expression of genes that normally peak between 6 and 24 hours post-injury, including the pro-inflammatory cytokine interleukin 6 (IL6), the chemokine monocyte chemoattractant protein 1 (MCP-1) and inducible nitric oxide synthase (iNOS; p < 0.05). Genes expressed earlier than 6 hours post-injury, such as IL1b, tumor necrosis factor a (TNFa) and macrophage inflammatory protein 1a (MIP-1a) were not affected by light treatment.
Although the precise role some of these genes play in axonal regeneration after spinal cord injury is currently unclear, these data demonstrate that light therapy has an anti-inflammatory effect on the injured spinal cord, and may reduce secondary injury, thus providing a possible mechanism by which light therapy may result in axonal regeneration.

The following is a summary of some of the clinical studies that were conducted using cold laser to treat bone regeneration. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

Bone Stimulation by Low Level Laser - A Theoretical Model for the Effects

Philip Gable, B App Sc P.T. G Dip Sc Res (LLLT) MSc, Australia Jan Tun�©r, D.D.S., Sweden

The anecdotal and researched evidence for the effects of Low Level Laser Therapy (LLLT) on the stimulation of bone have been reported for over 20 years. This has been in the form of local as well as systematic effects ââ?¬â?? including contra-lateral effects. Reports of stimulation of rabbit radii fractures and mice femurs were made as early as 1986 and 1987 with irradiated bones healing faster than controls and contra-lateral non-treated fractures similarly demonstrating faster healing times. Over the following decade and a half, further studies have also investigated and demonstrated that LLLT is effective for the stimulation of bone tissue.
The reasons for this have been attributed to the general effects of LLLT and its ability to increase the rates of healing through mitochondrial ATP production and alteration in the cellular lipid bi-layer. Additional hypothesis include the subsequent capacity of irradiated cells to alter their ion exchange rate and thus influence the catalytic effects of the specific enzymes and substrates. These in turn initiate and promote the healing process completing the cascading cycle of events.
In the area of bone specific research, Dr. Tony Pohl of the Royal Adelaide Hospital in South Australia, has provided a new theory that postulates that the majority of fluid transfer and exchange within living bone is predominantly influenced by the lymphatic circulation.
LLLT is well documented and known as having effects that influence the lymphatic circulation and wound healing process. A coupling of these two areas of theory can demonstrate a positive description and explanation of the predominant effects of LLLT in bone stimulation. In reality, LLLT�s effects on bone may well be a further consequence of its actions on the lymphatic circulation.

Reports of stimulation of Rabbit radii fractures were made by Tang in 1986 and similar reports by Trelles in 1987 on mice femurs. In both situations the irradiated bones healed faster than the controls. In another study by Hernandez-Ros, in 1987, LLLT demonstrated stimulation of fresh fractures on Sprague-Dawley rats that were fractured bilaterally. The unexpected results of this study were that the contra-lateral fractured non-treated limb also healed faster than the control group. Over the following decade and a half further studies (Yamada 1991; Pyczek, Sopala et al. 1994; Ozawa 1995; Horowitz 1996; Yaakobi 1996; Saito and Shimizu 1997) have also investigated and demonstrated that LLLT is effective for promoting the stimulation of bone healing. Recently Nicolau and colleagues (2002) from Brazil demonstrated the positive effect of LLLT on the stimulation of bone in mice with latent promotion of bone remodulation at injury sites without changes in bone architecture, increased bone volume and increased osteoblast surface through increased resorption and formation of bone with higher apposition rates. A positive effect on bony implants has been demonstrated by D�¶rtbudak (2002) and Guzzardella (2003). The effect of laser irradiation on osteoblastic cells has been reported by Yamamoto (2001) and Guzzardella (2002).
The reasoning for this amelioration in all experimental circumstances, based on electron microscopy as well as macroscopic histological evidence, was concluded to be due to i.a. improved vascularisation as a consequence of blood vessel formation, absorption of the haematoma, macrophage action, fibroblast proliferation, chondrocyte activity, bone remodeling from increased osteoblastic activity and deposition of calcium salts.
These changes and evidence based studies attribute the macro- and microscopic effects to the known and accepted general actions of LLLT and its ability to increase rates of healing through stimulation of ATP production, (Karu 1989; Smith 1990) promoting repair and polarization of the cellular lipid bilayer (Fenyo 1990) as well as LLLT�s capacity to affect cells through alterations in their exchange rate of ions (Robinson and Walters 1991) and influences the catalytic effects of the specific enzymes and substrates (Pouyssegur 1985; Karu 1988) which in turn initiate and promote the healing process.
More recent work by Dr. Tony Pohl, an internationally renowned Orthopaedic Surgeon from the Royal Adelaide Hospital in South Australia and lecturer at the Adelaide and South Australian Universities, has given rise to a new theory on bone circulation through reconsideration of fluid and protein transfer within bone (Pohl 1999). This theory suggests that the general understanding of the circulatory action within bone has been incorrect. Pohl postulates that the majority of fluid transfer and exchange within the living bone is predominantly influenced by the lymphatic rather than the vascular circulation. This is justified through studies on bone fluid input and output levels that have demonstrated that the venous and arterial aspect of circulation alone cannot account for the demonstrated levels of output nor the presence of free radical molecules which exceed those of the vascular input. Furthermore, the diameter of large protein cells within the bone exceed the diameter of the vessels that form the terminal aspects of the circulatory system making it impossible for them to have been delivered via this system. Consequently, an additional circulatory system must be present that will account for both the increased output and the presence of the large diameter protein cells as well as the free radicals.
If LLLT is then considered within the context of this new theory on bone circulation and the contribution of the lymphatic circulation then a further logical reasoned deduction for the action of LLLT on bone stimulation can be made. LLLT has a well documented and known effect influencing the lymphatic circulation. This has been demonstrated from the early works of Lievens, (1985) that demonstrated the influence of "Laser Irradiation" on the motricity of the lymphatic system and on the wound healing process. This is supported by several wound studies that demonstrate that the levels of protein rich exudates in non-healing wounds increase markedly from exposure to LLLT. This demonstrated action is determined to be as a result of the increase in lymphatic circulation (Robinson and Walters 1991; Gabel 1995). More recent work at the Flinders Medical Center in Adelaide South Australia has been completed and presented at the World Association of Laser Therapy conference in Tokyo Japan (Anderson, Carati et al. 2002). This study has demonstrated the positive effects of LLLT on the lymphatic circulation and its consequential benefits to the post mastectomy patient.
An understanding of the existing knowledge of the effects of LLLT on the lymphatic system combined with the hypothesis of bone fluid transport provides a coupled theory that would demonstrate a positive description and explain of the predominant effects of LLLT in bone stimulation.
In the trauma situation of direct or indirect damage to the bone, including fractures and periosteal induced damage such as stress fractures, the tissue damage leads to compromises that include but are not limited to, physical blockage from the trauma and waste / debris, increased fluid and circulatory viscosity from added cellular content within the lymphatics, lower speed motility and energy deficit in the tissue and cells from the loss of ATP production as a general effect from the trauma, cell changes and inability of mitochondria to function at the normal higher level to promote self repair and regeneration.
LLLT with its known general effects and specific direct effects on the lymphatic system would act to stimulate mitochondria ATP that increases cellular and circulatory motility as well as directly influencing lymphatic flow. LLLT also promotes increased permeability in interstitial tissue and facial layers (Gabel 1995) reducing stagnation and blockage. These actions would assist the increase in lymphatic flow and consequently the circulation within the affected bone. There is also a hypothetical potential that the presence of LLLT by increasing lymphatic circulation does so by virtue of an increase in the diameter of the lymphatic vessels, not just by increased flow rates within the vessel at an unchanged diameter. This diameter increase, if definitively present, would also explain the presence of large diameter protein cells within the normal bone circulation that cannot be attributed to the vascular circulation and would additionally explain a facilitated process for removal of debris and larger protein cells passing out of traumatized areas that is additionally stimulated by the use of LLLT.
Stimulation of bone healing by LLLT has till now has been generally classified as a consequence of the general healing effects of LLLT. In reality LLLT�s effect on bone may well be a further consequence of its actions on the lymphatic circulation.

References:

Anderson, S, Carati, C et al. (2002). Low Level Laser Therapy (LLLT) as a Treatment for Postmatestectomy Lymhoedema. WALT 2002, Tokyo Japan.
Coombe, A R et al (2001). The effect of low level laser irradiation on osteoblastic cells. Clin Ort Res. 4: 3-14.
D�¶rtbudak, O et al (2002). Effect of low-power laser irradiation on bony implant sites. Clin Oral Implants Res 13(3):288-292.
Fenyo, M. (1990). Theoretical and Experimental Basis of Biostimulation by Bioptron, Bioptron AG, Monchaltorf, Switzerland.
Gabel, C. P. (1995). ââ?¬Å?Does Laser enhance bruising in acute sporting injuries.ââ?¬Â? Aust. J. Physio. 41(4): 267-269.
Gabel, C. P. (1995). The effect of LLLT on slow healing wounds and ulcers. Health Sciences. Darwin, Northern Territory.
Guzzardella, G A et al (2002). Laser stimulation on bone defect healing: An in vitro study. Lasers Med Sci. 17(3): 216-220.
Guzzardella, G A et al (2003). Osseointegration of endosseous ceramic implants after postoperative low-power laser stimulation: an in vivo comparative study. Clin Oral Implants Res. 14: 226-232.
Horowitz, I. et al. (1996). ââ?¬Å?Infrared spectroscopy analysis of the effect of low power laser irradiation on calvarial bone defect healing in the rat (abstract).ââ?¬Â? Laser Therapy 8: 29.
Karu, T. I. (1988). ââ?¬Å?Molecular mechanism of the therapeutic effects of low intensity laser radiation.ââ?¬Â? Lasers in Life Science 2: 53-74.
Karu, T. I. (1989). Photobiology of low-power laser therapy. London, Harwood Academic Publishers.
Lievens, P. (1985). The influence of "Laser Irradiation" on the motricity of the lymphatical system and on the wound healing process. International Congress on Laser in Medicine and Surgery., Bologna.
Nicolau, R A., Jorgetti, V, Rigau, J et al. "Effect of low power laser Ga-Al-As (660nm) in the bone tissue remodulation in mice�
Ozawa, Y. et al (1995). ââ?¬Å?Stimulatory effects of low-power laser irradiation on bone formation in vitro.ââ?¬Â? SPIE Proc. 1995 Vol. 1984: 281-288.
Pohl, T. (1999). Bone circulation, the lymphaitic system contribution. Personal Communication to C. P. Gabel. Adelaide Oct 1999.
Pouyssegur, J. (1985). ââ?¬Å?The growth factor-activatable Na+/H+ exchange system: a genetic approach. In Karu, T.I. 1988, 'Molecular mechanism of the therapeutic effects of low intensity laser radiation', Lasers in Life Science, vol.2, p.53-74.ââ?¬Â? Trends in Biochemical Science 10: 453-455.
Pyczek, M., Sopala, M et al. (1994). ââ?¬Å?Effect of low-energy laser power on the bone marrow of the rat.ââ?¬Â?. Folia Biol (Krakow) 42(3-4): 151-156.
Robinson, B. and Walters, J (1991). ââ?¬Å?The use of low level laser therapy in diabetic and other ulcerations.ââ?¬Â? Journal of British Podiatric Medicine 46(10): 186-189.
Saito, S. and. Shimizu, N. (1997). ââ?¬Å?Stimulatory effects of low-power laser irradiation on bone regeneration in midpalatal suture during expansion in the rat.ââ?¬Â? Am J Ortod Dentofac Orthop 11(5): 525-.
Smith, K. C. (1990). Light and life: The photobiological basis of the therapeutic use of radiation from lasers. International Laser Therapy Association Conference, Osaka.
Yaakobi, T. et. al. (1996). ââ?¬Å?Promotion of bone repair in the cortical bone of the tibia in rats by low energy laser (He-Ne) irradiation.ââ?¬Â? Calcif Tissue Int. 59(4): 297-300.
Yamada, K. (1991). ââ?¬Å?Biological effects of low power laser irradiation on clonal osteoblastic cells (MC3T3-E1).ââ?¬Â? Nippon Seikeigeka Gakkai Zasshi 65(9): 787-799.
Yamamoto, M et al (2001). Stimulation of MCM3 gene expression in osteoblast by low level laser irradiation. Laser in Med Sci. Abstract issue. 16(3): 213-217.

The following is a summary of some of the clinical studies that were conducted using cold laser to treat brain injury. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

Low-Level Laser Therapy Applied Transcranially to Mice following Traumatic Brain Injury Significantly Reduces Long-term Neurological Deficits

Amir Oron Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin, Israel.
Uri Oron Photothera Inc., Carlsbad, California.
Jackson Streeter Photothera Inc., Carlsbad, California.
Luis De Taboada Photothera Inc., Carlsbad, California.
Alexander Alexandrovich Department of Pharmacology, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel.
Victoria Trembovler Department of Pharmacology, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel.
Esther Shohami Department of Pharmacology, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel.

To cite this paper: Amir Oron, Uri Oron, Jackson Streeter, Luis De Taboada, Alexander Alexandrovich, Victoria Trembovler, Esther Shohami. Journal of Neurotrauma. April 1, 2007, 24(4): 651-656. doi:10.1089/neu.2006.0198.

Low-level laser therapy (LLLT) has been evaluated in this study as a potential therapy for traumatic brain injury (TBI). LLLT has been found to modulate various biological processes. Following TBI in mice, we assessed the hypothesis that LLLT might have a beneficial effect on their neurobehavioral and histological outcome. TBI was induced by a weight-drop device, and motor function was assessed 1 h post-trauma using a neurological severity score (NSS). Mice were then divided into three groups of eight mice each: one control group that received a sham LLLT procedure and was not irradiated; and two groups that received LLLT at two different doses (10 and 20 mW/cm2 ) transcranially. An 808-nm Ga-As diode laser was employed transcranially 4 h post-trauma to illuminate the entire cortex of the brain. Motor function was assessed up to 4 weeks, and lesion volume was measured. There were no significant changes in NSS at 24 and 48 h between the laser-treated and non-treated mice. Yet, from 5 days and up to 28 days, the NSS of the laser-treated mice were significantly lower (p < 0.05) than the traumatized control mice that were not treated with the laser. The lesion volume of the laser treated mice was significantly lower (1.4%) than the non-treated group (12.1%). Our data suggest that a non-invasive transcranial application of LLLT given 4 h following TBI provides a significant long-term functional neurological benefit. Further confirmatory trials are warranted.

The following is a summary of some of the clinical studies that were conducted using cold laser to treat Arthritis-Rheumatoid. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

50 year old female patient diagnosed as having Class 3 RA inflammatory phase of steady development. Probes used in treatments were 820nm (50mW) and 31 cluster probe with the 820nm probe being administered on each interphalangial joint (30 seconds per point) followed by the cluster (one minute) over the whole hand. The pulsing frequency was 20 Hz and administration of treatment three times per week. Total number of treatments were 12 over a one month period.
You can see the improvement in treatment of condition and the third picture shows the progress at 13 treatments. After 6 months follow up it was found the initial inflammation was beginning to creep back, but the overall condition was much improved in comparison with the original status of patient with no LLLT treatment.

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

Contantin Ailioaie1, Laura Marinela Lupusoru-Ailioaie2 1Medical Office for Laser Therapy, 1 Bistrita, B10-2, 6600-Iassy, Romania, 2AI.I. Cuza University, Dept. of Medical Physics, Iassy, Romania

LLLT Original Articles, Laser therapy Volume. 11-2, pg.79

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 non-steroidal anti-inflammatory drugs (NSAIDSs). 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 200mW maximum 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 5 Hz or 10 Hz 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 pain phase reactants (ESR and C â?? reactive protein), T-lymphocytes and NK (natural killer) â?? cells were estimated. Synovial biopsies and Magnetic Resonance Imaging (MRI) of the synovial membrane were performed 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 laser placebo group and 40% in the NSAIDs-treated third group. After four months of treatment, our investigations showed that 830 nm infrared laser therapy promoted the restoration of function, relieved pain and limited the complications of RA.

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

C. Ailioaie, M. D.
Medical Office for Laser Therapy, Iassy, RO
Laura Marinela Lupusoru-Ailioaie, M. D.
"Al.I.Cuza" University, Dept. of Medical Physics, Iassy, RO

1.PURPOSE:
To study the effects of laser therapy, in comparison with other modality trials (NSAIDs), at the onset of (RA).
2.SUBJECTS and METHODS:
In the study 59 patients were included, in the first 6 - 12 months from RA onset. The patients were divided into three 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. A GaAIAs diode laser (830 nm, maximum output power 200 mW) was used. During 4 months, courses of laser therapy - once daily for 8 days, monthly - were administered to Group 1 and laser placebo Group 2. The density of energy (2 - 4 J/cm2) and frequency (5 Hz or 10 Hz) were dependent on the number and severity of pain in affected joints.
3.RESULTS:
The analysis of the clinical and biological parameters at the end of treatment showed a statistical 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 group 1, 50% in the placebo laser group, and 40% in group 3.
4.DISCUSSION and CONCLUSIONS:
After 4 months of treatment, our investigations showed that infra-red laser therapy was able to restore function, to relieve pain and to avoid the complications of the disease or NSAIDs therapy (digestive or renal) at RA onset, beeing the most perspective modality of treatment.

The effect of laser therapy in complex treatment of patients with rheumatoid arthritis.

Korolkova O M et al.

115 patients with rheumatoid arthritis (RA) of II-III degrees were treated with basic RA medications and infrared laser. In a control group of 20 patients only basic medication was given. 10 areas of the body were irradiated daily, increasing the dose every day during a period of 8-10 days. The effectiveness of the therapy was controlled through laboratory tests on i.a. inflammatory agents and the activity of lipid peroxidation. The results were statistically significant. The best effect was found in patients with degree II RA. Steroid medication could be reduced 8-10 days earlier in this group of patients and in some cases the medication could even be excluded. Degree III patients had a more moderate benefit of the laser treatment.

The interauricular laser therapy of rheumatoid arthritis.

Sidorov-V-D, Mamiliaeva-D-R, Gontar-E-V, Reformatskaia-SIu.
Vopr-Kurortol-Fizioter-Lech-Fiz-Kult. 1999; (3): 35-43.

Investigations have proved the ability of interauricular low- intensity infrared laser therapy (0.89 nm, 7.6 J/cm) to produce anti- inflammatory, immunomodulating action in patients with rheumatoid arthritis. The method has selective, pathogenetically directed immunomodulating effect the mechanism of which is similar to that of basic antirheumatic drugs and of intravenous laser radiation of blood. This laser therapy can be used as an alternative to intravenous blood radiation being superior as a noninvasive method. Interauricular laser therapy can potentiate the effects of nonsteroid anti-inflammatory drugs, cytostatics and diminish their side effects.

CLINICAL APPLICATION OF GaAIAs 830 NM DIODE LASER IN TREATMENT OF RHEUMATOID ARTHRITIS

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu. Department of Orthopaedic Surgery, Osaka City UniversityMedical 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). For pain attenuation, scores were: excellent&emdash;59.6%; good&emdash;30.4%; unchanged&emdash;10%. For ROM improvement the scores were: excellent&emdash;12.6%; good&emdash;43.7%; unchanged&emdash;43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

LASER THERAPY OF RHEUMATOID ARTHRITIS.

Goldman JA, Chiapella J, Casey H, Bass N, Graham J, McClatcheyW, Dronavalli RV, Brown R, Bennett WJ, Miller SB, Wilson CH, Pearson B, Haun C, Persinski L, Huey H, MuckerheideM

Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximalinterphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased. The patient, physician, and occupational therapy evaluators did not know which hand was being lased. Twenty-one patientsnoted improvement of both their MCP and PIP joints of both hands during laser therapy. Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy. Heat, erythema, pain, swelling, and tenderness all improved with time in both hands, but the lased hand had more significant improvement in erythema and pain. There was also significant improvement in grasp and tip pressure on the lased side. The level of circulating immune complexes as measured by platelet aggregation decreased during lasing. The improvement may be related to laser exposure. The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain

LASER THERAPY IN RHEUMATOLOGY

Judit OrtutayM.D., Klara Barabas M.D., Ph.D., *Adam Mester MD National Institute of Rheumatology and Physiotherapy, Budapest *Semmelweis University, Faculty of Medicine, Dept. of Diagnostic Radiology and Oncotherapy, National Laser Therapy Centre, Peterfy Sandor Teaching Hospital, Budapest

Barabas irradiated first the joints of rheumatoid arthritis (RA) patients without skin ulcer. In the first open study objectively the range of motion and circumference of the treated joints were measured, Ritchie index as semiobjective parameter, subjective parameters as joint tenderness and pain on a visual analogous scale (VAS) were registered. The walking time was registered as a functional disability parameter. Laboratory activity parameters and the 99mTechnetium index was measured. The second part of the clinical study was double blinded, Infra Red (10mWand 100 mW) lasers were used versus dummy devices with the same outlook. The third part of the study were in vitro experiments. Synovial membranes of rheumatoid arthritis patients The DNA/RNA ratio of the RA group was compared to the control group. Significant difference was detected between the two groups. The fourth phase of clinical studies was to detect the effects of laser irradiation in other rheumatic diseases: psoriatic arthritis, sacroileitis, osteoarthritis, entesopathy, tenosynovitis, bursitis calcarea, fibromyalgia, localised muscle spasm, periarthritis humeroscapularis etc. The different wavelengths (604, 630, 660, 670, 690, 750, 780, 790, 820, 830, 904, 1053, 1219 nm,) were compared (30 - 100 mW) with other physiotherapy modalities, like ultrasound. Acknowledgement: The Central Research Institute of the Hungarian Academy of Sciences and LASOTRONIC AG (Switzerland) was helping the research.

Low level laser therapy (classes I, II and III) in the treatment of rheumatoid arthritis.

Brosseau L, Welch V, Wells G, deBie R, Gam A, Harman K, Morin M, Shea B, Tugwell P. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H-8M5.

BACKGROUND: Rheumatoid arthritis (RA) affects a large proportion of the population. Low Level Laser Therapy (LLLT) was introduced as an alternative non-invasive treatment for RA about 10 years ago. LLLT is a light source that generates extremely pure light, of a single wavelength. The effect is not thermal, but rather related to photochemical reactions in the cells. The effectiveness of LLLT for rheumatoid arthritis is still controversial.
OBJECTIVES: To assess the effectiveness of LLLT in the treatment of RA.
SEARCH STRATEGY: We searched MEDLINE, EMBASE, the registries of the Cochrane Musculoskeletal group and the field of Rehabilitation and Related Therapies as well as the Cochrane Controlled Trials Register up to January 30, 2000.
SELECTION CRITERIA: Following an a priori protocol, we selected only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA were eligible. Abstracts were excluded unless further data could be obtained from the authors.
DATA COLLECTION AND ANALYSIS: Two reviewers independently select trials for inclusion, then extracted data and assessed quality using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results were analyzed as weighted mean differences (WMD) with 95% confidence intervals (CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept (e.g. pain). Dichotomous outcomes were analyzed with odds ratios.
MAIN RESULTS: A total of 204 patients were included in the five placebo-controlled trials, with 112 randomized to laser therapy. Relative to a separate control group, LLLT reduced pain by 70% relative to placebo and reduced morning stiffness duration by 27.5 minutes (95%CI: 2.9 to 52 minutes) and increased tip to palm flexibility by 1.3 cm (95% CI: 0. 8 to 1.7 cm). Other outcomes such as functional assessment, range of motion and local swelling did not differ between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application or treatment length. For RA, relative to a control group using the opposite hand, there was no difference between the control and treatment hand, but all hands improved in terms of pain relief and disease activity.
REVIEWER'S CONCLUSIONS: In summary, LLLT for RA is beneficial as a minimum of a four-week treatment with reductions in pain and morning stiffness. On the one hand, this meta-analysis found that pooled data gave some evidence of a clinical effect, but the outcomes were in conflict, and it must therefore be concluded that firm documentation of the application of LLLT in RA is not possible. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques used. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this meta-analysis lacked data on how LLLT effectiveness is affected by four important factors: wavelength, treatment duration of LLLT, dosage and site of application over nerves instead of joints.

Low level laser therapy is ineffective in the management of rheumatoid arthritic finger joints.

Hall J, Clarke AK, Elvins DM, Ring EF. Rehabilitation Laboratory, Royal National Hospital for Rheumatic Diseases, Bath.

Low level laser therapy (LLLT) is a relatively new and increasingly popular form of electrotherapy. It is used by physiotherapists in the treatment of a wide variety of conditions including RA despite the lack of scientific evidence to support its efficacy. A randomized, double-blind and placebo-controlled study was conducted to evaluate the efficacy of LLLT. The patient sample consisted of chronic RA patients with active finger joint synovitis. Forty RA patients with involvement of some or all of MCP or PIP joints were recruited. Following random allocation they received either active or placebo laser three times a week for 4 weeks. Measurements were taken prior to entry, after the treatment, 1 month and 3 months at follow-up. The groups were well matched in terms of age, sex, disease duration and severity. Few significant differences were noted in grip strength, duration of morning stiffness, joint tenderness, temperature of inflamed joints, range of movement or pain either within or between groups. Using these irradiation parameters the efficacy of LLLT is ineffective.

THE EFFECTIVENESS OF LASER THERAPY IN COMPLEX TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

O.M. Korolkova, V.T. Burlachuk, O.V. Gordienko, E.A. Afanasevskaya Voronezh State Medical Academy, Voronezh Regional Hospital, Voronezh, Russia

The purpose of this research is to evaluate the effectiveness of laser therapy among patients with different extents of rheumatoid arthritis (RA) disease. There has been a study of 115 patients with RA activity II-III (the main group) who apart from the basic therapy also received laser treatment.
The apparatus ALT "Mustang" with the power of 2-10 W and infrared wave range has been used. The laser influence has been aimed at the area of a damaged joint. The duration of laser influence is from 5 to 17 minutes, adding 1-2 minutes daily. The number of fields is 10, the number of treatment procedures -8-10, The control group consists of 20 patients with RA (basic therapy only).
The control of effectiveness of the therapy was based on the complex laboratory data, including definition of non-specific factors of inflammation and the factors of activity of lipid peroxidation.
The greatest effect of the therapy has been achieved in the main group of patients with activity II. In comparison with the control group we managed to receive improve-ment 8- 10 days earlier which allowed us to reduce the demand of steroids and in case of 20 patients even cancel taking them. We received statistically reliable fall of the activity of inflammation and lipid peroxidation. More moderate effect of the therapy was reached treating patients from the main group with activity III.

THE USE OF SUPRAVASCULAR BLOOD RADIATION WITH INFRARED LASER FOR TREATMENT OF SECONDARY VASCULITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Y.L. Grinstein, S.V. Ivlev Medical Academy. Krasnoyarsk, Russia

The purpose of this work was to study the opportunity of the use of supravascular blood radiation with infrared laser (IR-laser) for the treatment of secondary vasculitis in patients with rheumatoid arthritis (RA). The investigation included 12 patients with RA and secondary vasculitis signs. They received a course of supravascular blood radiation with IR-Iaser (wavelength 820-850 nm, 7-10 procedures). Control group consisted of 8 patients. Placebo laser therapy (LT) was administered to 7 patients. Such characteristics as hemostasis properties, a state of microcirculation in bulbar conjunctiva vessels were studied in all patients before and after treatment. It was revealed significant decrease of both XIIa-depended fibrinolysis and Willibrand's factor level. The improvement of blood rheological properties was confirmed by a decrease of erythrocyte aggregation and improvement of its deformability. Bulbar conjunctival microscopia revealed significant diminution of intravascular change index, significant increase of arteriola-venula ratio. The improvement of nephritis manifestations (significant decrease of proteinuria level). The changes of hemostasis parameters microcirculation system were not significant in patients receiving both placebo LT and conventional therapy. Conclusions: 1) It was revealed significant diminution of endothelium lesion and XIla-depended fibrinolysis restoration after IR-laser therapy in patients with RA and secondary vasculitis. 2) Both microcirculation state in bulbar conjunctiva vessels and blood rheological properties significantly improve after IR-laser therapy. It is confirmed by a significant improvement of erythrocyte deformability and a decrease of its aggregation. 3) IR-laser therapy leads to urinary syndrome regression.

DIAGNOSTIC SIGNIFICANCE OF THE IMMUNITY INDICES INVESTIGATION IN THE USE OF LASER THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS AND THE DISEASE COURSE PROGNOSIS

A.V. Nikitin, V.D. Khvan, E.F. Yevstratova Medical Academy, Voronezh, Russia

The results of the examination of the patients with rheumatoid arthritis (RA) have shown the systemic lesion of all the links of the immune system. Many-sided positive in-fluence of low energy laser irradiation on the impairment of immune homeostasis has been shown. The aim of the investigation was to study the possibility of the low energy laser irradiation use in patients with RA depending on some immunity indices and the disease course prognosis. 60 patients with RA at the age of more than 16 years old hav-ing inflammatory process activity of the I-II degrees according to the RA criteria of the American Rheumatological Association classification have been examined. 30 patients of the control group underwent the conventional treatment with non-steroid antiinflammatory drugs, basic treatment with delagil and physiotherapy. 30 patients of the main group underwent the conventional treatment and laser therapy on the joints by the infra-red laser installation "UZOR" with the wavelength of 0,89 um, the output power of 2 mW in combination with the above-vein blood irradiation by the helium-neon laser installation "ALOK-1" with the output power of 0,6 mW. The treatment was carried out daily during 15 days. The immunity indices analysis before and after the treatment in both groups has established their obvious improvement in patients treated by laser irradiation: T-lympocytes (CD3 (p < 0.05), immunoglobulins ? (p < 0.05), T-helpers inductors (CD4+) (p < 0.05). The positive dynamics of the immunity indices in the studied group cor-related with the clinical improvement of the patients condition and depended on the marked immunity indices changes before the treatment, such as T-lymphocytes (CD3), Thelpers inductors (CD4+), immunoglobulins C. The marked positive dynamics of the abo-vementioned indices were not observed in the control group.

A PATHOGENETIC RATIONALE FOR MAGNETIC-INFRARED LASER THERAPY OF RHEUMATOID ARTHRITIS

I.E. Korochina State Medical Academy, Orenburg Russia

Rheumatoid arthritis (RA) remains a crucial challenge in rheumatology, as no cure of it is in sight. RA is one of the most common inflammatory diseases affecting young and middle-age people. Its progress is unrelenting and leading to early disability of young individuals (at 5-6 years following the onset). Therefore, it is a pressing problem to find a new therapeutic approach, especially a basic intervention.
Matveikin et al. (1989) argued that all available therapeutic modalities relying on stabilization of inflammation fail to stop progressive destructive cartilage and bone abnormalities whose severity largely determines the outcome of structural and functional damage of joints. Moreover, extensively employed glucocorticoids, cytostatics and even nonsteroidal antiinflammatory drugs have been reported to have osteolytic and calciuretic effects which can promote joint surface destruction in RA (Agababov et al., 1989). Therefore, "classical" methods do not influence local and systemic osteoporosis which occurs in respectively 22-28 to 72 percent of patients with RA (Korshunov et al., 1995; Skripnikov et al., 1997). On the other hand, there is evidence to suggest that severity of osteoporosis (OP) does not provide a measure of severity of the primary disease. Certainty on this issue has important implications for prognosis and therapy of RA.
Numerous indepth studies indicate the need for osteoprotective treatment in the presence of RA (Nasonova, 1983; Nasonova and Sigidin, 1985; Revel, 1993; Nasonov, 1994; Franke adn Runge, 1995; Nasonov et al., 1997; Deuchaisnes et al., 1973; West et al., 1994).
Therefore, it is very important from both research and practical perspective to adopt therapeutic regimens which would have immunocorrective effects on the one hand and would improve bone resistance to destructive action of pannus and slow down bone mass loss on the other, with minimum side effects.
This line of research is pursued everywhere in the world. Over the recent years, inclusion of antiosteoporotic drugs as a basic therapy of RA or its component has proved fairly effective (Bolotina, 1997; Doroshenko and Korochina, 1996, 1997; Zonova et al., 1997; Mazurov et al., 1997; Gavrilovski, 1996; Jezicrinska et al., 1996; Szombati et al., 1996). Based on reported and our own clinical experience, we have proposed in 1997 a scheme for osteoprotective therapy individualization.
However, confronted by side effects of drugs, numerous contraindications and individual intolerance, we came to magnetic-infrared laser (MIL) therapy.
Since RA is an immune-inflammatory disease, various laser treatments are usually aimed at correction of immune and inflammatory abnormalities (Gracheva and Satinaeva, 1988; Yarema, 1989; Klushin, 1990; Babynina and Volobuyeva, 1988; Ferrel et al., 1996). Surgical laser interventions, intravenous and transcutaneous manipulations have been used (Dzyak and Simonova, 1988; Plotguin et al., 1996; Grazhane et al., 1989; Skobelkin et al,, 1990; Basford, 1993).
Laser therapy has been used in children and old patients with RA (Keltsev et al., 1988; Sinepesov et al., 1989). Results of these uses of the laser have been doubtless good.
Since studies used lasers with different characteristics, available evidence is heterogeneous and difficult to compare.
RA response to MIL therapy has been reported (Velitchenko, 1995; Demidov et al., 1995). However, apart from the task of quenching the activity and severity of RA, we are confronted by the problem of improving "internal" bone resistance to rheumatoid aggression to save joints in RA.
Studies reporting the efficacy of laser, magnetic and ultraviolet therapy in osteoporisis are few (Mitbreit et al., 1978; Zatsepin et al., 1984; Anishchenko and Yevtifeeva, 1988; Laing et al., 1995). In addition, these interventions have been reported to hasten fracture consolidation (Polonsky et al., 1979; Shakhov, 1995), suggesting an antiosteoporotic effect of the MILTA device.
Our study sought to elucidate whether MIL therapy has an osteoprotective effect apart from immunostabilizing, antiinflammatory and analgesic actions.
To evaluate the possibility of impeding destruction of osseous structure s of joints in RA, were used combined treatment regimens. RA patients of all groups received nonsteroidal antiinflammatory drugs (NSAID), but no other basic drugs.
Group 1 patients were on NSAID and the antiosteoporotic plant-derived drug osteochin (Sanofi, France) which was earlier used in systemic OP.
In group 2, NSAID-osteochin (OC) combination was adjuncted by conventional regimens of MIL therapy (Soroka, 1988; Korepanov, 1995).
Group 3 patients received NSAID and MIL therapy, with antiosteoporotic drugs withheld because of intolerance or contraindications. Table 1 presents clinical characteristics of these patients.


Table 1. Clinical characteristics of study patients

 

Characteristic NSAID+OC
N=15
NSAID+OC+MILTA
N=15
NSAID+MILTA
N=15
Mean age (yr) 37.40±2.3 39.12±2.2 36.5±1.9
Mean disease
duration (yr)
4.2±1.5 4.6 ± 1.9 5.16 ± 1.9
Mean RA activity
(grade)
2.3 ± 0.4 2.1 ± 0.4 2.4 ± 0.5
Mean RA stage (X-ray) 2.3 ± 0.8 2.4 ± 0.8 2.4 ± 0.7
Functional failure
(mean arbitrary
grade)
1.8 ± 0.2 1.7 ± 0.2 1.9 ± 0.2


Repeat MIL courses were given to all patients at two months. Clinical and laboratory test improvement was seen in all patient groups at 6-8 months, but the effect was best in NSAID+OC+MILTA group. Pain severity and RA activity markedly subsided, and articular functional failure did not deteriorate in these patients. Of special importance, roentgenological RA grade did not progress in this group.

Table 2. Follow-up clinical, roentgenological and laboratory findings in patients with RA

 
Indices NSAID+OC NSAID+OC+MILTA NSAID+MILTA
before after before after before after
RA activity(grade) 2.1 1.9 2.2 1.5 2.1 1.6
Roentgenological stage
of RA
2.2 2.3 2.3 2.3 2.2 2.4
Functional failure
(grade)
1.7 1.7 1.8 1.8 1.7 1.9
Pain index (score) 2.9 2.5 2.9 2.4 2.9 2.5
Articular index (score) 2.7 2.5 2.8 2.6 2.8 2.7
Inflammatory index
(score)
1.4 1.2 1.4 1.1 1.3 1.2
Morning stiffness (min) 96 74 106 84 92 82
Functional Lee test
(score)
24.5 24.1 25.1 24.2 24.8 24.6
Stanford health index
(score)
47.4 45.4 43.2 40.7 45.8 45.2
Visual pain scale 7.7 4.7 7.6 4.4 7.8 4.9
General weakness
(score)
2.6 1.5 2.8 1.5 2.5 2.0


CONCLUSION
Magnetic-infrared laser therapy of rheumatoid arthritis is effective and pathogenetically relevant.

 

The following is a summary of some of the clinical studies that were conducted using cold laser to treat Arthritis-Cervical. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

The clinical efficacy of low-power laser therapy (lllt) on pain and function in cervical osteoarthritis.

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

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

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

 

The following is a summary of some of the clinical studies that were conducted using cold laser to treat Collagen and Elastic Fibers. These studies are presented here to demonstrate the wide uses of a cold lasers in the treatment of different medical conditions.

 

Photomedicine and Laser Surgery
Effect of Low-Level Laser Therapy on Inflammatory Reactions during Wound Healing: Comparison with Meloxicam

To cite this paper: Vinicius Nery Viegas, Marcelo Emir Requia Abreu, Christian Viezzer, Denise Cantarelli Machado, Manoel Sant'Anna Filho, Daniela Nascimento Silva, Rogerio Miranda Pagnoncelli. Photomedicine and Laser Surgery. December 1, 2007, 25(6): 467-473. doi:10.1089/pho.2007.1098.

Vinicius Nery Viegas, M.S. School of Dentistry, Laser Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Marcelo Emir Requia Abreu, M.S. School of Dentistry, Laser Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Christian Viezzer Biomedical Researches Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Denise Cantarelli Machado, Ph.D. Biomedical Researches Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Manoel Sant'Anna Filho, Ph.D. School of Dentistry, Oral and Maxillofacial Surgery Department, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Daniela Nascimento Silva, Ph.D. School of Dentistry, Oral and Maxillofacial Surgery Department, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Rogério Miranda Pagnoncelli, Ph.D. School of Dentistry, Laser Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

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 Aâ€"control; group Bâ€"administration of meloxicam; and groups C and Dâ€"irradiation with red (λ = 685 nm) and infrared (λ = 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-1β (IL-1β) 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.