Laser Therapy for Arthritis

Low-level laser therapy in different stages of rheumatoid arthritis: a histological study.

Lasers Med Sci. 2012 Apr 27. [Epub ahead of print]
Alves AC, de Carvalho PD, Parente M, Xavier M, Frigo L, Aimbire F, Leal Junior EC, Albertini R.
Source: Post Graduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Rua Vergueiro, 235, 01504-001, São Paulo, São Paulo, Brazil.
Abstract: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease of unknown etiology. Treatment of RA is very complex, and in the past years, some studies have investigated the use of low-level laser therapy (LLLT) in treatment of RA. However, it remains unknown if LLLT can modulate early and late stages of RA. With this perspective in mind, we evaluated histological aspects of LLLT effects in different RA progression stages in the knee. It was performed a collagen-induced RA model, and 20 male Wistar rats were divided into 4 experimental groups: a non-injured and non-treated control group, a RA non-treated group, a group treated with LLLT (780 nm, 22 mW, 0.10 W/cm(2), spot area of 0.214 cm(2), 7.7 J/cm(2), 75 s, 1.65 J per point, continuous mode) from 12th hour after collagen-induced RA, and a group treated with LLLT from 7th day after RA induction with same LLLT parameters. LLLT treatments were performed once per day. All animals were sacrificed at the 14th day from RA induction and articular tissue was collected in order to perform histological analyses related to inflammatory process. We observed that LLLT both at early and late RA progression stages significantly improved mononuclear inflammatory cells, exudate protein, medullary hemorrhage, hyperemia, necrosis, distribution of fibrocartilage, and chondroblasts and osteoblasts compared to RA group (p?<?0.05). We can conclude that LLLT is able to modulate inflammatory response both in early as well as in late progression stages of RA.

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Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study.

Clin Rehabil. 2011 Dec 14. [Epub ahead of print]
Alfredo PP, Bjordal JM, Dreyer SH, Meneses SR, Zaguetti G, Ovanessian V, Fukuda TY, Junior WS, Martins RA, Casarotto RA, Marques AP.
Source: Department of Speech Therapy, Physical Therapy and Occupational Therapy, School of Medicine, Sao Paulo University, Sao Paulo, Brazil.
Abstract
OBJECTIVE: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee.
Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups.
Setting: Special Rehabilitation Services.
Subjects: Forty participants with knee osteoarthritis, 2-4 osteoarthritis degree, aged between 50 and 75 years and both genders.Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises).
Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks).
Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group.
Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

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Infrared (810-nm) low-level laser therapy on rat experimental knee inflammation.

Lasers Med Sci. 2011 Apr 12. [Epub ahead of print]
Pallotta RC, Bjordal JM, Frigo L, Leal Junior EC, Teixeira S, Marcos RL, Ramos L, de Moura Messias F, Lopes-Martins RA.
Source: Laboratory of Pharmacology and Experimental Therapeutics, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil, 05508-900.
Abstract
Arthritis of the knee is the most common type of joint inflammatory disorder and it is associated with pain and inflammation of the joint capsule. Few studies address the effects of the 810-nm laser in such conditions. Here we investigated the effects of low-level laser therapy (LLLT; infrared, 810-nm) in experimentally induced rat knee inflammation. Thirty male Wistar rats (230-250 g) were anesthetized and injected with carrageenan by an intra-articular route. After 6 and 12 h, all animals were killed by CO(2) inhalation and the articular cavity was washed for cellular and biochemical analysis. Articular tissue was carefully removed for real-time PCR analysis in order to evaluate COX-1 and COX-2 expression. LLLT was able to significantly inhibit the total number of leukocytes, as well as the myeloperoxidase activity with 1, 3, and 6 J (Joules) of energy. This result was corroborated by cell counting showing the reduction of polymorphonuclear cells at the inflammatory site. Vascular extravasation was significantly inhibited at the higher dose of energy of 10 J. Both COX-1 and 2 gene expression were significantly enhanced by laser irradiation while PGE(2) production was inhibited. Low-level laser therapy operating at 810 nm markedly reduced inflammatory signs of inflammation but increased COX-1 and 2 gene expression. Further studies are necessary to investigate the possible production of antiinflammatory mediators by COX enzymes induced by laser irradiation in knee inflammation.

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Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review.

Arthritis Res Ther. 2011 Feb 18;13(1):R28. [Epub ahead of print]
Ye L, Kalichman L, Spittle A, Dobson F, Bennell K.
Abstract
INTRODUCTION: Hand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion and joint stiffness leading to impaired hand function and difficulty with daily activities. The effectiveness of different rehabilitation interventions on specific treatment goals has not yet been fully explored. The objective of this systematic review is to provide evidence based knowledge on the treatment effects of different rehabilitation interventions for specific treatment goals for hand OA.
METHODS: A computerized literature search of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, the Physiotherapy Evidence Database (PEDro) and SCOPUS was performed. Evidence level 2b or higher studies that compared a rehabilitation intervention with a control group and assessed at least one of the following outcome measures: pain, physical hand function or other measures of hand impairment, were included. The eligibility and methodological quality of trials were systematically assessed by two independent reviewers using the PEDro scale. Treatment effects were calculated using standardized mean difference and 95% confidence intervals.
RESULTS: Ten studies were included, of which six were of higher-quality (PEDro score>6). The rehabilitation techniques reviewed included three studies on exercise, two studies each on laser and heat, and one study each on splints, massage and acupuncture. One higher quality trial showed a large positive effect of 12-months use of a night splint on hand pain, function, strength and range of motion. Exercise had no effect on hand pain or function although it may be able to improve hand strength. Low level laser therapy may be useful to improving range of motion. No rehabilitation interventions were found to improve stiffness.
CONCLUSION: There is emerging high quality evidence to support that rehabilitation interventions can offer significant benefits to individuals with hand OA. A summary of the higher quality evidence is provided to assist with clinical decision making based on current evidence. Further high-quality research is needed concerning the effects of rehabilitation interventions on specific treatment goals for hand OA.

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

Photomed Laser Surg. 2009 Aug;27(4):577-84.
Hegedus B, Viharos L, Gervain M, Gálfi M. Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. arthrodent@freemail.hu
Abstract
Introduction: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).
METHODS AND MATERIALS: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded. RESULTS: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature–and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.
CONCLUSION: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

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Low-power laser treatment in patients with frozen shoulder: preliminary results.

Photomed Laser Surg. 2008 Apr;26(2):99-105.
Stergioulas A
Laboratory of Health, Fitness, and Rehabilitation Management, Faculty of Humam Movement and Quality of Life, Peloponnese University, Sparta, Greece. asterg@uop.gr
OBJECTIVE: In this study I sought to test the efficacy of low-power laser therapy (LLLT) in patients with frozen shoulder.
BACKGROUND DATA: The use of low-level laser energy has been recommended for the management of a variety of musculoskeletal disorders.
MATERIALS AND METHODS: Sixty-three patients with frozen shoulder were randomly assigned into one of two groups. In the active laser group (n = 31), patients were treated with a 810-nm Ga-Al-As laser with a continuous output of 60 mW applied to eight points on the shoulder for 30 sec each, for a total dose of 1.8 J per point and 14.4 J per session. In the placebo group (n = 32), patients received placebo laser treatment. During 8 wk of treatment, the patients in each group received 12 sessions of laser or placebo, two sessions per week (for weeks 1-4), and one session per week (for weeks 5-8).
RESULTS: Relative to the placebo group, the active laser group had: (1) a significant decrease in overall, night, and activity pain scores at the end of 4 wk and 8 wk of treatment, and at the end of 8 wk additional follow-up (16 wk post-randomization); (2) a significant decrease in shoulder pain and disability index (SPADI) scores and Croft shoulder disability questionnaire scores at those same intervals; (3) a significant decrease in disability of arm, shoulder, and hand questionnaire (DASH) scores at the end of 8 wk of treatment, and at 16 wk posttreatment; and (4) a significant decrease in health-assessment questionnaire (HAQ) scores at the end of 4 wk and 8 wk of treatment. There was some improvement in range of motion, but this did not reach statistical significance.
CONCLUSION: The results suggested that laser treatment was more effective in reducing pain and disability scores than placebo at the end of the treatment period, as well as at follow-up.

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Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.

BMC Health Serv Res. 2008 Jul 8;8:145
Jamtvedt G, Dahm KT, Holm I, Flottorp S.
Norwegian Knowledge Centre for Health Services, PO Box 7004, St. Olavs plass, 0103Oslo, Norway. grj@kunnskapssenteret.no
BACKGROUND: Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews.
METHODS: We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA.
RESULTS: A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching.
CONCLUSION: Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.

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Low-level laser therapy for zymosan-induced arthritis in rats: Importance of illumination time.

Lasers Surg Med. 2007 Jul;39(6):543-50.
Castano AP, Dai T, Yaroslavsky I, Cohen R, Apruzzese WA, Smotrich MH, Hamblin MR. Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Norwegian Knowledge Centre for Health Services, PO Box 7004, St. Olavs plass, 0103Oslo, Norway. grj@kunnskapssenteret.no
ABSTRACT
BACKGROUND: It has been proposed for many years that low-level laser (or light) therapy (LLLT) can ameliorate the pain, swelling, and inflammation associated with various forms of arthritis. Light is thought to be absorbed by mitochondrial chromophores leading to an increase in adenosine triphosphate (ATP), reactive oxygen species and/or cyclic AMP production and consequent gene transcription via activation of transcription factors. However, despite many reports about the positive effects of LLLT in arthritis and in medicine in general, its use remains controversial. For all indications (including arthritis) the optimum optical parameters have been difficult to establish and so far are unknown.
METHODS: We tested LLLT on rats that had zymosan injected into their knee joints to induce inflammatory arthritis. We compared illumination regimens consisting of a high and low fluence (3 and 30 J/cm(2)), delivered at high and low irradiance (5 and 50 mW/cm(2)) using 810-nm laser light daily for 5 days, with the positive control of conventional corticosteroid (dexamethasone) therapy.
RESULTS: Illumination with 810-nm laser was highly effective (almost as good as dexamethasone) at reducing swelling and a longer illumination time (10 or 100 minutes compared to 1 minute) was more important in determining effectiveness than either the total fluence delivered or the irradiance. LLLT induced reduction of joint swelling correlated with reduction in the inflammatory marker serum prostaglandin E2 (PGE2).
CONCLUSION: LLLT with 810-nm laser is highly effective in treating inflammatory arthritis in this model. Longer illumination times were more effective than short times regardless of total fluence or irradiance. These data will be of value in designing clinical trials of LLLT for various arthritides.

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

Clinical Rheumatology. 2001; 20(3): 181-184.
Oezdemir F, Birtane M, Kokino S
ABSTRACT
Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restrictio n 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.

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THE EFFECT OF LOW POWER LASER THERAPY ON OSTEOARTHRITIS OF THE KNEE

Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.
ABSTRACT: Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval .The total number of applications was 12 sessions. Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. We achieved significant improvement in pain relief and quality of life in 70% of patients, comparing to their previous status (p<0.05). There was no significant change in range of motion of the knee

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Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial.

Source: Orthopedics Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, smj_abrisham@ssu.ac.ir

Abrisham SM, Kermani-Alghoraishi M, Ghahramani R, Jabbari L, Jomeh H, Zare M.
ABSTRACT
The subacromial syndrome is the most common source of shoulder pain. The mainstays of conservative treatment are non-steroidal anti-inflammatory drugs and exercise therapy. Recently, low-level laser therapy (LLLT) has been popularized in the treatment of various musculoskeletal disorders. The aim of this study is to evaluate the additive effects of LLLT with exercise in comparison with exercise therapy alone in treatment of the subacromial syndrome. We conducted a randomised clinical study of 80 patients who presented to clinic with subacromial syndrome (rotator cuff and biceps tendinitis). Patients were randomly allocated into two groups. In group I (n?=?40), patients were given laser treatment (pulsed infrared laser) and exercise therapy for ten sessions during a period of 2 weeks. In group II (n?=?40), placebo laser and the same exercise therapy were given for the same period. Patients were evaluated for the pain with visual analogue scale (VAS) and shoulder range of motion (ROM) in an active and passive movement of flexion, abduction and external rotation before and after treatment. In both groups, significant post-treatment improvements were achieved in all parameters (P?=?0.00). In comparison between the two groups, a significant improvement was noted in all movements in group I (P?=?0.00). Also, there was a substantial difference between the groups in VAS scores (P?=?0.00) which showed significant pain reduction in group I. This study indicates that LLLT combined exercise is more effective than exercise therapy alone in relieving pain and in improving the shoulder ROM in patients with subacromial syndrome.

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Frozen shoulder: the effectiveness of conservative and surgical interventions–systematic review.

Lasers Surg Med. 2014 Feb;46(2):144-51. doi: 10.1002/lsm.22170. Epub 2013 Aug 23.
Favejee MM, Huisstede BM, Koes BW.
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
ABSTRACT: Background A variety of therapeutic interventions is available for restoring motion and diminishing pain in patients with frozen shoulder. An overview article concerning the evidence for the effectiveness of these interventions is lacking.
OBJECTIVES:To provide an evidence-based overview regarding the effectiveness of conservative and surgical interventions to treat the frozen shoulder.
METHODS: The Cochrane Library, PubMed, Embase, Cinahl and Pedro were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently selected relevant studies, assessed the methodological quality and extracted data. A best-evidence synthesis was used to summarise the results.
RESULTS: Five Cochrane reviews and 18 RCTs were included studying the effectiveness of oral medication, injection therapy, physiotherapy, acupuncture, arthrographic distension and suprascapular nerve block (SSNB).
CONCLUSION:We found strong evidence for the effectiveness of steroid injections and laser therapy in short-term and moderate evidence for steroid injections in mid-term follow-up. Moderate evidence was found in favour of mobilisation techniques in the short and long term, for the effectiveness of arthrographic distension alone and as an addition to active physiotherapy in the short term, for the effectiveness of oral steroids compared with no treatment or placebo in the short term, and for the effectiveness of SSNB compared with acupuncture, placebo or steroid injections. For other commonly used interventions no or only limited evidence of effectiveness was found. Most of the included studies reported short-term results, whereas symptoms of frozen shoulder may last up to 4 years. High quality RCTs studying long-term results are clearly needed in this field.

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Laser therapy of painful shoulder and shoulder-hand syndrome in treatment of patients after the stroke.

Bosn J Basic Med Sci. 2009 Feb;9(1):59-65.
Karabegovi? A, Kapidzi-Durakovi S, Ljuca F.
Clinic for Physical Medicine and Rehabilitation, University Clinical Centre, Faculty of Medicine, University of Tuzla, Trnovac b.b., 75 000 Tuzla, Bosnia and Herzegovina.
ABSTRACT: The common complication after stroke is pain and dysfunction of shoulder of paralyzed arm, as well as the swelling of the hand. The aim of this study was to determine the effects of LASER therapy and to correlate with electrotherapy (TENS, stabile galvanization) in subjects after stroke. We analyzed 70 subjects after stroke with pain in shoulder and oedema of paralyzed hand. The examinees were divided in two groups of 35, and they were treated in the Clinic for Physical Medicine and Rehabilitation in Tuzla during 2006 and 2007. Experimental group (EG) had a treatment with LASER, while the control group (CG) was treated with electrotherapy. Both groups had kinesis therapy and ice massage. All patients were examined on the admission and discharge by using the VAS, DASH, Barthel index and FIM. The pain intensity in shoulder was significantly reduced in EG (p<0,0001), swelling is lowered in EG (p=0,01). Barthel index in both groups was significant higher (p<0,01). DASH was significantly improved after LASER therapy in EG (p<0,01). EG had higher level of independency (p<0,01). LASER therapy used on EG shows significantly better results in reducing pain, swelling, disability and improvement of independency.

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Low-power laser treatment in patients with frozen shoulder: preliminary results.

Photomed Laser Surg. 2008 Apr;26(2):99-105.
Stergioulas A.
Laboratory of Health, Fitness, and Rehabilitation Management, Faculty of Humam Movement and Quality of Life, Peloponnese University, Sparta, Greece. asterg@uop.gr
OBJECTIVE: In this study I sought to test the efficacy of low-power laser therapy (LLLT) in patients with frozen shoulder. Background Data: The use of low-level laser energy has been recommended for the management of a variety of musculoskeletal disorders.
METHODS AND MATERIALS: Sixty-three patients with frozen shoulder were randomly assigned into one of two groups. In the active laser group (n = 31), patients were treated with a 810-nm Ga-Al-As laser with a continuous output of 60 mW applied to eight points on the shoulder for 30 sec each, for a total dose of 1.8 J per point and 14.4 J per session. In the placebo group (n = 32), patients received placebo laser treatment. During 8 wk of treatment, the patients in each group received 12 sessions of laser or placebo, two sessions per week (for weeks 1-4), and one session per week (for weeks 5-8).
RESULTS: Relative to the placebo group, the active laser group had: (1) a significant decrease in overall, night, and activity pain scores at the end of 4 wk and 8 wk of treatment, and at the end of 8 wk additional follow-up (16 wk post-randomization); (2) a significant decrease in shoulder pain and disability index (SPADI) scores and Croft shoulder disability questionnaire scores at those same intervals; (3) a significant decrease in disability of arm, shoulder, and hand questionnaire (DASH) scores at the end of 8 wk of treatment, and at 16 wk posttreatment; and (4) a significant decrease in health-assessment questionnaire (HAQ) scores at the end of 4 wk and 8 wk of treatment. There was some improvement in range of motion, but this did not reach statistical significance.
CONCLUSION: The results suggested that laser treatment was more effective in reducing pain and disability scores than placebo at the end of the treatment period, as well as at follow-up.

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Effects of LLLT on the periarthritis of the shoulder: A clinical study on different treatments with low level laser therapy, corticosteroid injections or a wait-and-see policy

EMLA Laser Health J 2007;2:46-67
European Medical Laser Association (EMLA)
G. Tam
Laser Center, Villa Santina – Italy
Low level laser irradiation is a treatment method widely used in medical science. Many disorders, such as osteoarthritis and musculoskeletal conditions with pain, have been treated with LLLT. With respect to pain the action of the laser interferes in the cytokines TNF-a, interleukin-1, interleukin-6 that drive inflammation in the arthritis and are secreted from CD4 and T cells. LLLT also increases the endorphin synthesis in the dorsal horn of the spinal cord, stopping the production of bradykinin and serotonin, and increases the production of nitric oxide into the endothelia cells and into the smooth muscular cells of the vessels walls having a vasodilatory, anti-inflammatory and analgesic action.
Patients, suffering from periarthritis of the shoulder of at least 6 weeks’ duration, were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment n. 20 (33%) with corticosteroid injection, n. 21 (35%) with LLLT and with wait-and-see policy n.19 (31%). We applied a number of 12 sessions with infrared Diode Laser Ga-As (904 nm), 60 W maximum power, peak power per pulse 27 W, pulse frequency 1280 Hz, average point region 2-8 J; dose/point = 3-4 J; total energy density 24 J/cm 2. Outcome measures included general improvement, severity of the main complaint, pain, shoulder disability, and patient satisfaction. Severity of shoulder complaints, abduction and elevation of the arm, and the pressure pain threshold were assessed. The principal analysis was done on an intention treatment basis. We assessed all outcomes at 3, 6, 12, 26, 52 weeks.
We randomly assigned 60 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 90% (18) compared with 52% (11) for LLLT and 35% (7) for wait-and-see policy. Long-term differences between injections and LLLT were significantly in favour of LLLT. Success rate at 52 weeks were 14 (70%) for injections, 19 (90.5%) for LLLT, and 16 (83%) for wait-and-see policy. Low Level Laser Therapy had better results than a wait-and-see policy, but differences were not significant (p <0.001).
Patients should be properly informed about the advantages and disadvantages of the treatment options for the periarthritis of the shoulder. The decision to treat with LLLT or to adopt a wait-and-see policy might depend on available resources, since the relative gain of Low Level Laser Therapy is better, but also small at long-term.

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THE USE OF LOW LEVEL LASER THERAPY (LLLT) IN THE TREATMENT OF TRIGGER POINTS THAT ARE ASSOCATED WITH ROTATOR CUFF TENDONITIS.

Al-Shenqiti, J Oldham
60 patients were randomly allocated to either sham or laser therapy. The active laser parameters included a wavelength 820 nm, power output 100 mW, frequency 5000 Hz (modulated) and energy density 32 J/cm2. 12 treatments were given over four weeks. The blinded outcome measures were pain, range of motion (ROM), functional activities and pressure pain threshold (PPT). Outcome measures were carried out pre and post treatment, then 3 months later. Considerable improvement in pain (p < 0.001) was seen for the laser compared to sham group post treatment, and at follow-up (6 points on a 10 VAS compared to 2 points respectively). Similarly, significant differences in favour of laser were seen for ROM (p < 0.01), functional activities (p < 0.001) and PPT (p < 0.05).

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Application of laser acupuncture in the treatment of periarthritis humeroscapularis.

Branka Nikolic
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.

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LLLT is as well documented as NSAIDs and steroid injections for shoulder tendinitis/bursitis and epicondylalgia.

EMLA Laser Health J 2007;2:46-67
Norwegian physiotherapist Jan M Bjordal published his thesis “Low level laser therapy in shoulder tendinitis/bursitis, epicondylalgia and ankle sprain” in 1997, at the Division of Physiotherapy Science, University of Bergen. It has also been published in Physical Therapy Reviews. 1998; 3: 121-132.
Here is the Conclusion of the thesis: “A systematic review has been performed on the effect of LLLT for three diagnoses. LLLT was evaluated on similar criteria for methodological assessments of trials as previously established for medical interventions. No evidence was found to indicate that randomized controlled trials on LLLT for tendinitis/bursitis of the shoulder, lateral epicondylalgia and ankle sprains were methodologically inferior to RCTs on medical interventions. The clinical effects of LLLT were found to be supported by scientific evidence regarding short (0-4 weeks) and medium term (3 months) for subacute or chronic lateral epicondylitis, and short term efficacy (> 3 months) for subacute or chronic shoulder tendinitis/bursitis. The evidence of effect from LLLT for acute ankle sprain is inconclusive, although there seems to be a slight tendency in favour of LLLT. Adverse effects of LLLT are rarely seen and only in minor forms (nausea, headache) compared to medication, where more serious gastrointestinal discomfort or ulcers are not uncommon. It has also been shown that trials in favour of active treatment had more treatments per week than the trials showing no difference in effect. In short one could say that LLLT should be used much in the same way as NSAID are used for short periods of time. Most trials showing significant effects used an IR 904 nm laser, but some results in favour of IR lasers with wavelengths of 780, 820 and 830 nm were also observed. Clinical effects of LLLT were best in subacute conditions. In chronic conditions a higher dosage and more treatments seem to be needed. The results of the high quality LLLT trials were all in favour of treatment with confidence intervals not including zero, and the trials came from several different research groups. Evidence was found to be at the highest or the second highest level depending on what level of clinical significance is decided according to the classification of Oxman (1994) and McQuay (1997). The review found little support for the alleged large placebo effects of LLLT. In chronic cases the placebo effect is probably less that 10%, after the natural history of the complaints is taken into account.”
In the “Summary of discussion on clinical effect estimates for LLLT” the author writes:
“The majority of the included LLLT-trials found significant clinical effect from LLLT. Seven of the eleven LLLT-trials with acceptable methods included calculations of 95% confidence limits above zero, and one LLLT-trial on anke sprain included zero (Axelsen & Bjerno 1993). The clincal effect estimates from LLLT-trials for shoulder tendinitis/bursitis are similar or higher than for NSAID or steroid injections. For lateral epicondylalgia estimates for short term clinical effects are similar or lower for LLLT than for steroid injections, but medium clinical effect estimates are similar or higher for LLLT. Recurrence of symptoms in lateral epicondylalgia is less likely after LLLT than after steroid injections. Evidence of clinical effects from ankle sprain is inconclusive. Adverse effects from LLLT are seldom seen and they appear less serious than for patients treated with NSAID and steroid injections.”

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

Dr Roberta T Chow MBBS a , Prof Mark I Johnson PhD b, Prof Rodrigo AB Lopes-Martins PhD c, Prof Jan M Bjordal PT d e
SUMMARY:
BACKGROUND: Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.
METHODS: We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.
FINDINGS: We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1·69 (95% CI 1·22—2·33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4·05 (2·74—5·98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19·86 mm (10·04—29·68). Seven trials provided follow-up data for 1—22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22·07 mm (17·42—26·72). Side-effects from LLLT were mild and not different from those of placebo.
INTERPRETATION: We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.

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

Clin Rheumatol. 2001;20(3):181-4.
Ozdemir F, Birtane M, Kokino S.
Source: Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.
Abstract: Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

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