Neuropathy – Neuropathic Pain

Lasers Med Sci. 2017 Jul 28. doi: 10.1007/s10103-017-2284-9. [Epub ahead of print]

Photobiomodulation therapy by NIR laser in persistent pain: an analytical study in the rat.

Micheli L1, Di Cesare Mannelli L2, Lucarini E1, Cialdai F3, Vignali L3, Ghelardini C1, Monici M3.

Author information

1
Department of Neuroscience, Psychology, Drug Research and Child Health-NEUROFARBA-Pharmacology and Toxicology Section, University of Florence, VialePieraccini 6, 50139, Florence, Italy.
2
Department of Neuroscience, Psychology, Drug Research and Child Health-NEUROFARBA-Pharmacology and Toxicology Section, University of Florence, VialePieraccini 6, 50139, Florence, Italy. lorenzo.mannelli@unifi.it.
3
ASA Campus Joint Laboratory, ASA Res. Division-Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy.

Abstract

Over the past three decades, physicians have used laser sources for the management of different pain conditions obtaining controversial results that call for further investigations. In order to evaluate the pain relieving possibilities of photobiomodulation therapy (PBMT), we tested two near infrared (NIR) laser systems, with different power, against various kinds of persistent hyperalgesia animal models. In rats, articular pain was reproduced by the intra-articular injection of sodium monoiodoacetate (MIA) and complete Freund’s adjuvant (CFA), while compressive neuropathy was modelled by the chronic constriction injury of the sciatic nerve (CCI). In MIA and CFA models, (NIR) laser (MLS-Mphi, ASA S.r.l., Vicenza, Italy) application was started 14 days after injury and was performed once a day for a total of 13 applications. In MIA-treated animals, the anti-hyperalgesic effect of laser began 5 min after treatment and vanished after 60 min. The subsequent applications evoked similar effects. In CFA-treated rats, laser efficacy started 5 min after treatment and disappeared after 180 min. In rats that underwent CCI, two treatment protocols with similar fluence but different power output were tested using a new experimental device called Multiwave Locked System laser (MLS-HPP). Treatments began 7 days after injury and were performed during 3 weeks for a total of 10 applications. Both protocols reduced mechanical hyperalgesia and hindlimb weight bearing alterations until 60 min after treatment with a higher efficacy recorded for the animals treated using the higher power output. In conclusion, this study supports laser therapy as a potential treatment for immediate relief of chronic articular or neuropathic pain.

Lasers Med Sci. 2016 Sep 17. [Epub ahead of print]

Photobiomodulation therapy reduces apoptotic factors and increases glutathione levels in a neuropathic pain model.

Janzadeh A1, Nasirinezhad F2, Masoumipoor M1, Jameie SB3, Hayat P4.

Author information

  • 1Research Center of Physiology, Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
  • 2Research Center of Physiology, Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran. nasirinezhad.f@iums.ac.ir.
  • 3Department of Medical Basic Sciences, Faculty of Allied Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
  • 4Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Neuropathic pain (NP) is caused by damage to the nervous system due to reactive oxygen spices (ROS) increase, antioxidants reduction, ATP production imbalance, and induction of apoptosis. In this investigation, we applied low-level laser 660 nm (photobiomodulation therapy) as a new strategy to modulate pain. In order to study the effects of photobiomodulation therapy (660 nm) on NP, chronic constriction injury (CCI) model was selected. Low-level laser of 660 nm was used for 2 weeks. Thermal and mechanical hyperalgesia were measured before and after surgery on days 7 and 14, respectively. Paw withdrawal thresholds were also evaluated. Expression of p2x3, Bax, and bcl2 protein was measured by western blotting. The amount of glutathione (GSH) was measured in the spinal cord by continuous spectrophotometric rate determination method. The results are presented as mean ± SD. Statistical analysis of data was carried out using SPSS 21. CCI decreased the pain threshold, 2-week photobiomodulation therapy significantly increased mechanical and thermal threshold, decreased P2X3 expression (p<0.001), and increased bcl2 expression (p<0.01), but it was not effective on the Bax expression. We speculated that although photobiomodulation therapy increased ROS generation, it increased antioxidants such as GSH. Increase in bcl2 is another mitochondrial protection mechanism for cell survival and that pain relief and decrease in P2X3 expression confirm it.

Acupunct Med. 2016 Sep 9. pii: acupmed-2016-011112. doi: 10.1136/acupmed-2016-011112. [Epub ahead of print]

Laser acupuncture attenuates oxaliplatin-induced peripheral neuropathy in patients with gastrointestinal cancer: a pilot prospective cohort study.

Hsieh YL1, Chou LW2, Hong SF3, Chang FC4, Tseng SW5, Huang CC6, Yang CH1, Yang CC7, Chiu WF7.

Author information

  • 1Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.
  • 2Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
  • 3Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital Chung Shing Branch, Taichung, Taiwan.
  • 4Nursing Department, Chung Shan Medical University Hospital, Taichung, Taiwan.
  • 5Department of Internal Medicine, Division of Medical Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan.
  • 6School of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Surgery, Division of Colon and Rectum, Chung Shan Medical University Hospital, Taichung, Taiwan.
  • 7Department of Physical Medicine and Rehabilitation, Cheng Ching General Hospital, Taichung, Taiwan.

Abstract

BACKGROUND:

Oxaliplatin is a platinum compound that is widely used in the treatment of some solid tumours. Oxaliplatin-induced peripheral neuropathy (OIPN) in the upper and lower extremities is the major adverse side effect and represents the main dose-limiting factor of this drug. The aim of this single-arm study was to evaluate the feasibility and effects of laser acupuncture (LA) in the treatment of OIPN in patients with advanced gastrointestinal cancers.

METHODS:

17 gastrointestinal cancer survivors (14 colorectal and 3 gastric cancers), who had been treated with oxaliplatin-based chemotherapies, were recruited. Low-level laser stimulation (50?mW) bilaterally at PC6, PC7, PC8, P9, LU11, SP6, KI3, BL60, KI1, and KI2 was administered for 20?min/point for 12 sessions over 4?weeks. The pain quality assessment scale (PQAS), chemotherapy-induced neurotoxicity questionnaire (CINQ), oxaliplatin-specific neurotoxicity scale (OSNS), quantitative touch-detection threshold (using von Frey filaments), and cold-triggered pain withdrawal latency (using the cold-water immersion test) were measured before and after completion of the 12 treatment sessions.

RESULTS:

PQAS, CINQ, and OSNS scores, as well as touch-detection threshold and cold-trigger pain withdrawal latency all improved significantly after LA in the cancer patients with OIPN (p<0.05). LA significantly relieved both oxaliplatin-induced cold and mechanical allodynia and also decreased the incidence and severity of neurotoxicity symptoms in the patients’ upper and lower extremities and impact on their daily activities (all p<0.05).

CONCLUSIONS:

Following treatment with LA, neurotoxicity symptoms were significantly improved in cancer patients with OIPN. Further randomised controlled trials are needed to evaluate the role of LA as a therapeutic option in the management of OIPN.

Pain Med. 2016 Aug 6. pii: pnw144. [Epub ahead of print]

Characterization of Macrophage/Microglial Activation and Effect of Photobiomodulation in the Spared Nerve Injury Model of Neuropathic Pain.

Kobiela Ketz A1, Byrnes KR2, Grunberg NE3, Kasper CE4, Osborne L4, Pryor B5, Tosini NL6, Wu X7, Anders JJ7.

Author information

  • 1*Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl, Germany annketz@gmail.com.
  • 2Department of Neuroscience.
  • 3Department of Neuroscience Department of Military & Emergency Medicine Department of Medical & Clinical Psychology.
  • 4Department of Nursing.
  • 5Department of Lite Cure, LLC, Newark, Delaware, USA;
  • 6**Department of St. Mary’s College of Maryland, St. Mary’s City, MD.
  • 7Department of Anatomy, Physiology & Genetics, The Uniformed Services University of the Health Sciences, Bethesda, MD.

Abstract

OBJECTIVE:

Neuropathic pain is common and debilitating with limited effective treatments. Macrophage/microglial activation along ascending somatosensory pathways following peripheral nerve injury facilitates neuropathic pain. However, polarization of macrophages/microglia in neuropathic pain is not well understood. Photobiomodulation treatment has been used to decrease neuropathic pain, has anti-inflammatory effects in spinal injury and wound healing models, and modulates microglial polarization in vitro. Our aim was to characterize macrophage/microglia response after peripheral nerve injury and modulate the response with photobiomodulation.

METHODS:

Adult male Sprague-Dawley rats were randomly assigned to sham (N?=?13), spared nerve injury (N?=?13), or injury?+?photobiomodulation treatment groups (N?=?7). Mechanical hypersensitivity was assessed with electronic von Frey. Photobiomodulation (980?nm) was applied to affected hind paw (output power 1 W, 20 s, 41cm above skin, power density 43.25?mW/cm2, dose 20 J), dorsal root ganglia (output power 4.5W, 19s, in skin contact, power density 43.25?mW/cm2, dose 85.5 J), and spinal cord regions (output power 1.5 W, 19s, in skin contact, power density 43.25?mW/cm2, dose 28.5 J) every other day from day 7-30 post-operatively. Immunohistochemistry characterized macrophage/microglial activation.

RESULTS:

Injured groups demonstrated mechanical hypersensitivity 1-30 days post-operatively. Photobiomodulation-treated animals began to recover after two treatments; at day 26, mechanical sensitivity reached baseline. Peripheral nerve injury caused region-specific macrophages/microglia activation along spinothalamic and dorsal-column medial lemniscus pathways. A pro-inflammatory microglial marker was expressed in the spinal cord of injured rats compared to photobiomodulation-treated and sham group. Photobiomodulation-treated dorsal root ganglion macrophages expressed anti-inflammatory markers.

CONCLUSION:

Photobiomodulation effectively reduced mechanical hypersensitivity, potentially through modulating macrophage/microglial activation to an anti-inflammatory phenotype.

Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

Support Care Cancer. 2016 Jan;24(1):233-42. doi: 10.1007/s00520-015-2773-y. Epub 2015 May 26.

Low-level laser therapy alleviates mechanical and cold allodynia induced by oxaliplatin administration in rats.

Hsieh YL1, Fan YC1, Yang CC2.

Author information

  • 1Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.
  • 2Department of Physical Medicine and Rehabilitation, Cheng Ching General Hospital, Taichung, Taiwan. s901100@gmail.com.

Abstract

PURPOSE:

Cold and mechanical allodynia caused by oxaliplatin-induced acute peripheral neuropathy frequently occur after drug infusion. Low-level laser therapy (LLLT) has been used to improve pain symptoms associated with various conditions and may have potential as a therapy for oxaliplatin-induced allodynia. The purpose of the present study was to investigate the antiallodynic effect of LLLT in an oxaliplatin-treated animal model by assessing sensory behavioral responses, levels of nerve growth factor (NGF), and transient receptor potential M8 (TRPM8) in dorsal root ganglia (DRG) neurons, as well as substance P (SP) in the spinal dorsal horn.

METHODS:

Adult male Sprague-Dawley rats each received a total of four doses of oxaliplatin (4 mg/kg, i.p.), injected at 3-day intervals. Following oxaliplatin administration, LLLT (7.5 J/cm(2)) was applied for 12 consecutive days to the skin surface directly above sites where the sciatic nerve is distributed. Behavioral assessments were then performed, followed by immunoassays for NGF, TRPM8, and SP proteins.

RESULTS:

LLLT relieved both cold and mechanical allodynia induced by oxaliplatin in rats. Oxaliplatin-related increases in protein levels of NGF and TRPM8 in DRG and SP in the dorsal horn were also reduced after LLLT.

CONCLUSION:

The findings of this study support LLLT as a potential treatment for oxaliplatin-induced neuropathy. Moreover, our findings suggest that SP, TRPM8, and NGF proteins in the superficial dorsal horn and DRG may be involved in an antiallodynic effect for LLLT.

Support Care Cancer. 2015 May 26. [Epub ahead of print]

Low-level laser therapy alleviates mechanical and cold allodynia induced by oxaliplatin administration in rats.

Hsieh YL1, Fan YC, Yang CC.

Author information

  • 1Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.

Abstract

PURPOSE:

Cold and mechanical allodynia caused by oxaliplatin-induced acute peripheral neuropathy frequently occur after drug infusion. Low-level laser therapy (LLLT) has been used to improve pain symptoms associated with various conditions and may have potential as a therapy for oxaliplatin-induced allodynia. The purpose of the present study was to investigate the antiallodynic effect of LLLT in an oxaliplatin-treated animal model by assessing sensory behavioral responses, levels of nerve growth factor (NGF), and transient receptor potential M8 (TRPM8) in dorsal root ganglia (DRG) neurons, as well as substance P (SP) in the spinal dorsal horn.

METHODS:

Adult male Sprague-Dawley rats each received a total of four doses of oxaliplatin (4 mg/kg, i.p.), injected at 3-day intervals. Following oxaliplatin administration, LLLT (7.5 J/cm2) was applied for 12 consecutive days to the skin surface directly above sites where the sciatic nerve is distributed. Behavioral assessments were then performed, followed by immunoassays for NGF, TRPM8, and SP proteins.

RESULTS:

LLLT relieved both cold and mechanical allodynia induced by oxaliplatin in rats. Oxaliplatin-related increases in protein levels of NGF and TRPM8 in DRG and SP in the dorsal horn were also reduced after LLLT.

CONCLUSION:

The findings of this study support LLLT as a potential treatment for oxaliplatin-induced neuropathy. Moreover, our findings suggest that SP, TRPM8, and NGF proteins in the superficial dorsal horn and DRG may be involved in an antiallodynic effect for LLLT.

Acta Neurol Belg. 2014 Oct 16. [Epub ahead of print]

New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy.

Ozkan FU1, Saygi EK, Senol S, Kapci S, Aydeniz B, Aktal I, Gozke E.

Author information

  • 1Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, E-5 Karayolu Içerenköy-Atalehir, 34752, Istanbul, Turkey, feyzamd@yahoo.com.

 

Abstract

Ulnar nerve entrapment at the elbow (UNE) is the second most common entrapment neuropathy of the arm. Conservative treatment is the treatment of choice in mild to moderate cases. Elbow splints and avoiding flexion of the involved elbow constitute majority of the conservative treatment; indeed, there is no other non-invasive treatment modality. The aim of this study was to investigate the efficacy of ultrasound (US) and low-level laser therapy (LLLT) in the treatment of UNE to provide an alternative conservative treatment method. A randomized single-blind study was carried out in 32 patients diagnosed with UNE. Short-segment conduction study (SSCS) was performed for the localization of the entrapment site. Patients were randomized into US treatment (frequency of 1 MHz, intensity of 1.5 W/cm2, continuous mode) and LLLT (0.8 J/cm2 with 905 nm wavelength), both applied five times a week for 2 weeks. Assessments were performed at baseline, at the end of the treatment, and at the first and third months by visual analog scale, hand grip strength, semmes weinstein monofilament test, latency change at SSCS, and patient satisfaction scale. Both treatment groups had significant improvements on clinical and electrophysiological parameters (p < 0.05) at first month with no statistically significant difference between them. Improvements in all parameters were sustained at the third month for the US group, while only changes in grip strength and latency were significant for the LLLT group at third month. The present study demonstrated that both US and LLLT provided improvements in clinical and electrophysiological parameters and have a satisfying short-term effectiveness in the treatment of UNE.

Acta Med Iran.  2013 Sep 9;51(8):543-7.

Evaluation of low level laser therapy in reducing diabetic polyneuropathy related pain and sensorimotor disorders.

Bashiri H.

Source

Department of Internal Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. hbashirimd@yahoo.com.

Abstract

Over the past three decades physicians have used light level laser therapy (LLLT) for the management and the treatment of diabetic peripheral neuropathy and have obtained results that calls for further investigations. This study aimed to investigate the effectiveness of LLLT in treatment of pain symptoms in patients with diabetic polyneuropathy. In this study 60 patients with diabetic peripheral neuropathy were matched based on their sex, age, BMI, type of diabetes, duration of diabetes, and duration of pain, and randomized to case and control groups based on their established scores on the visual analog scale (VAS) and the Toronto clinical scoring system (TCSS). Cases received laser therapy with wavelength of 78 nm and 2.5 j/cm2 two times a week, each time for 5 min, for one month. During the same period, controls received sham laser therapy. Comparing the differences between the two groups’ VAS and TCSS mean scores before the intervention with that of the 2 weeks and 4 weeks after the intervention we were able to see a statistically significant difference between the two groups (P&lt;0.05). On the other hand, when we compared their VAS and TCSS mean scores 4 weeks and 2 weeks after the intervention we did not find any statistically significant difference between the two groups. We achieved the same results when we examined cases’ and controls’ pre and post VAS and TCSS scores independent from each other; no improvement in the assessment based on their 2 and 4 weeks comparisons tests. Laser therapy resulted in improved neuropathy outcomes in diabetic patients who received it relative to the group that received sham therapy, evaluating before and after LLLT assessments. Further studies are needed to test types of lasers, as well as different dosage and exposure levels required in different phase of neuropathic care, so as to obtain reproducible results.

Masui.  2012 Jul;61(7):718-27.

Pain treatment with low reactive level laser (LLLT).

[Article in Japanese]
Hosokawa T, Kawabata Y.

Source

Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto.

Abstract

Noninvasive and low reactive level laser (LLLT) is used as one of the light therapies without giving pain to the patient. Therefore, it is used often clinically in pain treatment, orthopedics, plastic surgery, dermatology, and dentistry. In the pain clinic field, it is one of the procedures indispensable to treatment of various pain including postherpetic neuralgia, diabetic neuropathy or myofascial pain. In recent years the mechanism has been gradually elucidated by basic study. The action is on sensory nerve, sympathetic nerve, blood vessel, immunity, inflammation and central nervous system, and is thought to contribute to analgesia. Also, many reports such as action to inhibit “itch”, a promotor action of the bone metabolism, and the follicular maturation acceleration action have tested and elucidated these mechanisms, and will add further adaptation that will be new in future. Furthermore, development and downsizing of the free electron laser will promote elucidation of the low response level laser therapy. We expect much in the future of the LLLT.

Int J Gen Med. 2012; 5: 739–742.
Published online 2012 Sep 5. doi:  10.2147/IJGM.S18511
PMCID: PMC3459668

Use of low intensity laser treatment in neuropathic pain refractory to clinical treatment in amputation stumps

Eduardo Santamaria Carvalhal Ribas, Wellingson Silva Paiva, Natali Cordeiro Pinto, Lin Tchia Yeng, Massako Okada, Erich Talamoni Fonoff, Maria Cristina Chavantes, and Manoel Jacobsen Teixeira
Pain Center, Department of Neurology, Hospital das Clínicas School of Medicine, University of São Paulo, Brazil
Correspondence: Wellingson Silva Paiva, Eneas Aguiar 255 Office 4080, Zip code 05403010, São Paulo, Brazil, Tel +55 11 2548 6900, Fax +55 11 2548 6906, Email moc.liamtoh@aviapnosgnillew
Author information ? Copyright and License information ?

Abstract

Debilitating stump pain following amputation surgery is a major problem when it affects the patient’s quality of life, often making the patient totally dependent on others for their day-to-day care. Attempts have been made to treat those patients through pharmacological, psychological, and physical therapies, but in many cases these fail to relieve the pain. This article focuses on three patients with chronic, intense, and debilitating stump pain who were previously treated with pain medications, but with little success. These patients underwent nine sessions of low-intensity laser therapy (LILT) to the stump – this is a new treatment that has been used to treat other pain disorders. All patients reported a decrease in the intensity of their pain and increased ability to perform daily living activities during a 4-month follow-up.

Introduction

There are an estimated 150,000 surgical amputations per year in the US, most of which are secondary in nature, arising from diabetes mellitus, vascular disease, trauma, and cancer.1 Residual pain in amputation stumps can extend beyond the normal recovery time, and is seen in 13%–71% of cases.2,3 After the nerve injury, spontaneous nerve activity develops at the site of injury and the corresponding dorsal root ganglia. These changes are followed by sensitization, reduction of the pain threshold, exaggerated response to nociceptive stimuli (hyperalgesia) or non-nociceptive (alodinea), and phantom sensations.4 The syndrome of a phantom limb with associated pain is found in 70%–85% of amputees, and pain persists in 5%–10% of these people.3,5 Sensory abnormalities are also described in more than 50% of patients with amputation stumps.6

In a study of 96 upper limb amputees, Schley et al7 found that 44.6% of patients suffered from phantom pain, 53.8% had phantom sensations, 61.5% had stump pain, and 78.5% had stump sensation. The authors reported that stump pain gradually decreased in 19 (47.5%) of 40 amputees in the first year following amputation, but was stable in 12 (30%) patients, and some may present with severe stump pain that is resistant to treatment.

The residual pain may be due to several factors, such as an underlying disease, bone deformities, wound healing, or neuropathic pain.3 Many treatments have been reported for pain in a stump following amputation, and these can be divided into three categories: pharmacological, psychological, and physical. The first includes the use of anti-inflammatory drugs, opioids, anti-depressants, and anti-convulsion drugs, in addition to the use of injections of steroids, analgesic nerve blocks, and painkiller adhesives.7,8 The second is represented mainly by antidepressant therapy, and the third included transcutaneous electrical stimulation of nerves, spinal electrical stimulation, low-intensity laser therapy, rehabilitation exercises and massage, and surgery.911

The use of low-intensity laser therapy (LILT) started in Europe and Russia in the 1960s. LILT – also known as photobiology or biostimulation – makes use of low levels of radiation, with the use of a single wavelength.12,13 It is suggested that the biological effect of this therapy is secondary to the direct effects of the light radiation, and not the result of thermal processes.14

Clinically, there have been many uses of LILT demonstrated, but most require further studies before conclusions can be drawn. It is proposed that LILT accelerates recovery after trauma. One study indicated that tensor strength of wounds increased considerably after 1–2 weeks of laser treatment, with this improvement associated with a significant increase in collagen after 2 weeks of treatment.15 The effects of LILT on the peripheral nervous system are also encouraging. When treated with transcutaneous LILT, rats with facial nerve injuries caused by crushing had an increased rate of nerve regeneration.16 In a double-blind controlled study, LILT and transcutaneous electrical stimulation were associated with a significant reduction of subjective pain and improved sensory latency in patients with carpal tunnel syndrome.17 Patients with maxillofacial pain including trigeminal neuralgia also reported decreased pain in response to laser therapy.18

It is unclear how LILT promotes an analgesic effect. In the case of neuropathic pain, LILT may affect the release of neurotransmitters such as serotonin,19 increase production of mitochondrial ATP,20 increase the release of endorphins,21 and have anti-inflammatory effects.22 In controlled laboratory studies it has been shown that LILT may reduce inflammation by lowering the levels of prostaglandin PGE2 and inhibiting cyclo-oxygenase -2 (COX -2) in cell cultures.2326

Materials and methods

Three patients with neuropathic pain in an amputation stump were selected in the pain clinic of our hospital. All patients experienced significant neuropathic pain in the form of the sensation of shock or needles on the scar of the amputation stump – in all cases, this pain was represented by high scores on the visual analog scale (VAS) of pain, and the pain persisted despite analgesics or functional rehabilitation. The patients also had functional limitations in the activities they could perform as a result of this pain. We selected three patients with higher pain intensity (VAS > 8), pain that did not respond to medical treatment, homogeneity of previous treatment (the patients were treated with the same medications and rehabilitation), and all three patients had undergone their traumatic amputation over 1 year prior to this study.

These patients were evaluated in a medical interview prior to LILT application. Three assessments were made of each patient. The first of these was the pain VAS, which consists of a horizontal line ten centimeters long with “No pain” and “Pain as bad as it could be” marked on the left and right ends of the line, respectively. The patients were required to make a mark on the line indicating how bad the pain was in their amputation stump, and the distance from the left end to the mark on the scale was measured and recorded as the VAS score. The second assessment was the Barthel scale, which aims to quantify the patient’s ability to carry out daily living activities such as eating or using a toilet, and ranges from the highest dependency (0 points) to the highest independency (100 points).27 The third assessment, the Lawton scale, quantifies impairment to the carrying out of daily tasks and ranges from the highest dependency (8 points) to the highest independency (24 points).28

After assessment, patients received nine sessions (three treatment sessions per week for three weeks, as reported by Lam and Cheing)29 of low-intensity laser (laser diode, ? = 830 nm, dose ranging from 8–15 J/cm2, P = 70 mW) on the amputation stump scar. A continuous wave diode laser was used (DMC, São Paulo, Brazil). Following treatment, the patients were re-evaluated using the three scales described above, and patients were monitored for 4 months. No side effects were observed in response to the LILT.

This project was analyzed and approved by the Ethics Committee of our institution (Research Protocol # 01254/09).

The main objective of the study was to assess whether this treatment would result in pain relief in the amputated stump, expressed by a decrease in VAS scores. As a secondary objective of the study, the effect of LILT on the improvement of independency and functionality of the patient was also assessed (this would be expressed by an increase in the Barthel and Lawton scales).

Results

All three patients reported subjective pain relief after nine sessions of low-intensity laser. The patients had allodynia and hyperpathia prior to treatment, and the LILT treatment produced a verified remission in hyperpathia and significant control of allodynia. The patients’ post-treatment reporting of pain through the VAS also showed a significant reduction in pain in all three cases, as shown in Figure 1, with pain dropping by five to seven points.

Figure 1

Analysis of visual analog scale before and after low-intensity laser therapy.

The functionality and independence of the patients were also significantly improved – measured on the Barthel scale, improvements of 45 to 55 points were seen, and in the Lawton scale the improvements ranged from eight to ten points (Figure 2).

Figure 2

Analysis of the Barthel and Lawton scales before and after low-intensity laser therapy.

Discussion

The application of low-intensity laser treatment contributed to an improvement in our patients’ reported pain intensity, their ability to carry out daily living activities (Barthel scale), and their impairment in the carrying out of daily tasks (Lawton scale).

Reported pain was reduced by the LILT treatment, with 50%–70% less pain after nine sessions. This improvement should be interpreted with caution since all of the patients studied had high scores of pain intensity on the VAS before treatment, and the same outcome should not be expected in patients who begin treatment with lower intensities of pain. Also, the study group is small, and the results should be seen only as a descriptive study of a new tool.

Although the exact mechanism is unknown, LILT has been beneficial in many studies that have used a range of different pain models. Generally these studies do not show a good evidence level due to a lack of randomization, doubleblind design, or the use of a placebo group.30

A reduction in pain without the use of analgesic drugs can help reduce the excessive use of medication, reducing the potential side effects of high doses. Since no side effects were observed in the use of LILT, its use can probably be started at a very early stage and on patients suffering from less pain.

There are no similar studies presented in the current literature, and thus the results of the current study may not be directly compared to other work. In a meta-analysis of the use of LILT in patients with low back pain by Cochrane,31 laser treatment was beneficial in reducing pain unless patients were subjected to physical exercise as an adjunct treatment.

It is known that pain causes loss of function and decreased independence of the individual, often leading to reduced mobility and increased rates of depression. The present study shows that LILT can result in an improvement in patient independence, with an average gain of 50% in the Barthel scale and 37.5% in the Lawton scale, and all improved to the point where they gave themselves the highest scores possible for the scales used in the study. This indicates that LILT can be used in the future to decrease pain in patients following amputations.

This study’s sample is small and no control group was used, which prevents any extrapolation of the results. The reported results should be seen as a stimulus for randomized studies with larger sample sizes to confirm the effectiveness of LILT in the treatment of chronic pain in patients with amputated limbs.

Footnotes

Disclosure

The authors report no conflicts of interest in this work.

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Vopr Kurortol Fizioter Lech Fiz Kult.  2011 May-Jun;(3):3-6.

The influence of photochromotherapy on the injured nerve under experimental conditions (a histological study).

[Article in Russian]
Guzalov PI, Kir’ianova VV, Skopichev VG, Mitrofanov AS, Golovachev PS, Rashidov NA.

Abstract

The objective of the present neurohistological study using an experimental model of compressive-ischemic neuropathy (40 white rats) was to estimate the influence of photochromotherapy on the injured nerve filament. It was shown that light of different wavelengths had differential effect on the nerve tissue. The exposure to blue light reduced the severity of traumatic lesion as apparent from a decrease in the number of filaments undergoing degenerative changes and their enhanced argentophilia. Irradiation with red light caused a marked decrease in the degree of vacuolization with moderate argentophilia suggesting normalization of ion transport and recovery of nerve conductivity. Green light irradiation promoted remyelinization of nerve filaments (a marked increase of the number of Schwann cells).

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

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

Robb A, Sajko S.

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

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

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

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

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

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

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

Srp Arh Celok Lek. 2007 May-Jun;135(5-6):257-63

Influence of low-intensity laser therapy on spatial perception threshold and electroneurographic finding inpatients with diabetic polyneuropathy.

[Article in Serbian]

Peri? Z.

INTRODUCTION: Low-intensity laser therapy (LILT) can be applied in cases when patients with diabetic polyneuropathy (DPN) suffer from chronic severe neuropathic pain.

OBJECTIVE: We wanted to analyse influence of LILT on spatial perception threshold (SPT) and electroneurographic (ENG) parameters in patients with painful DPN.

METHOD: We analysed 45 patients (25 males), average age 54.3 years (54.3 +/- 10.9), with clinical and ENG signs of painful DPN. The patients were divided into two groups: A and B. Group A consisted of 30 patients with DPN who had 30 LILT treatments over the period of 12 weeks and group B consisted of 15 patients with DPN who received only vitamin therapy per os within the same period. Prior to and after 12 weeks of treatment, the following ENG parameters were determined using surface electrodes: motor (MCV) and sensory conduction velocities (SCV) values (in m/s) of nervus (n.) peroneus (NP), n. tibialis (NT) and n. medianus (NM) and their motor distal latency (MDL) values (in ms). SPT value (score as number from 1 to 8) was determined with Tactile Circumferential Discriminator on dorsal part of foot’s big toe skin. For statistical analysis, we used Student’s t-test and Pearson correlation (sig. 2 tailed) study.

RESULTS; We registered statistically significant difference between SPT (p < 0.01) values prior to (5.25 +/- 1.11) and after (4.87 +/- 0.90) LILT, as well as NMMCV (p < 0.05) values prior to (47.18 +/- 5.08) and after (49.12 +/- 3.72) LILT. Besides, we registered, only after LILT, statistically significant correlation beetwen SPT and NMDML (p < 0.01) values and also beetwen SPT and NMSCV (p < 0.05) values. The differences and correlations beetwen other analysed parameters before and after treatments were not significant (p > 0.05).

CONCLUSION: In this study we registered significant decrease of SPT and increase of NMMCV after LILT and that indicated a favourable effect of this treatment in analysed patients with painful DPN. In our opinion these results need further investigation.

J Am Podiatr Med Assoc. 2005 Mar-Apr;95(2):143-7.

 Improved sensitivity in patients with peripheral neuropathy: effects of monochromatic infrared photo energy.

DeLellis SL, Carnegie DH, Burke TJ.

Gulf Coast Foot, Ankle and Wound Center, Tarpon Springs, FL, USA.

The medical records of 1,047 patients (mean age, 73 years) with established peripheral neuropathy were examined to determine whether treatment with monochromatic infrared photo energy was associated with increased foot sensitivity to the 5.07 Semmes-Weinstein monofilament. The peripheral neuropathy in 790 of these patients (75%) was due to diabetes mellitus. Before treatment with monochromatic infrared photo energy, of the ten tested sites (five on each foot), a mean +/- SD of 7.9 +/- 2.4 sites were insensitive to the 5.07 Semmes-Weinstein monofilament, and 1,033 patients exhibited loss of protective sensation. After treatment, the mean +/- SD number of insensate sites on both feet was 2.3 +/- 2.4, an improvement of 71%. Only 453 of 1,033 patients (43.9%) continued to have loss of protective sensation after treatment. Therefore, monochromatic infrared photo energy treatment seems to be associated with significant clinical improvement in foot sensation in patients, primarily Medicare aged, with peripheral neuropathy. Because insensitivity to the 5.07 Semmes-Weinstein monofilament has been reported to be a major risk factor for diabetic foot wounds, the use of monochromatic infrared photo energy may be associated with a reduced incidence of diabetic foot wounds and amputations.

Adv Skin Wound Care. 2004 Jul-Aug;17(6):295-300.

Reversal of diabetic peripheral neuropathy and new wound incidence: the role of MIRE.

Powell MW, Carnegie DE, Burke TJ.

Northwest Orthopedic Center, Springdale, AR, USA.

OBJECTIVE: To determine if improved foot sensitivity to the Semmes-Weinstein 10-g (5.07) monofilament, originally impaired because of diabetic peripheral neuropathy, might be associated with a reduced incidence of new diabetic foot wounds.

DESIGN: Retrospective cohort study using a health status questionnaire.

SUBJECTS: Sixty-eight individuals over age 64 with diabetes, diabetic peripheral neuropathy, and loss of protective sensation who had clinically demonstrable increases in foot sensation to the Semmes-Weinstein monofilament after treatment with monochromatic near infrared photo energy.

MAIN RESULTS: After reversal of diabetic peripheral neuropathy following treatment with monochromatic near infrared photo energy, only 1 of 68 patients developed a new diabetic foot wound, for an incidence of 1.5%. Comparatively, the incidence previously reported in the Medicare-aged population with diabetes was 7.3%.

CONCLUSIONS: Improved foot sensitivity to the Semmes-Weinstein monofilament in patients previously suffering from loss of protective sensation due to diabetic neuropathy appears to be associated with a lower incidence of new diabetic foot ulcers when compared with the expected incidence in the Medicare-aged population with diabetes. CLINICAL RELEVANCE: Therapeutic interventions that effectively improve foot sensitivity that has been previously diminished due to diabetic peripheral neuropathy may substantially reduce the incidence of new foot wounds in the Medicare-aged population with diabetes.

Diabetes Care. 2004 Apr;27(4):921-4.

Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy: a controlled trial.

Zinman LH, Ngo M, Ng ET, Nwe KT, Gogov S, Bril V.

Toronto General Hospital, Toronto, Ontario, Canada.

OBJECTIVE: Low-intensity laser therapy (LILT) has been advocated for treatment of chronic pain disorders. Although the mechanism of pain relief is uncertain, this therapy has been suggested for relief of painful symptoms of diabetic sensorimotor polyneuropathy (DSP). The objective of this study was to determine whether LILT relieves the pain of DSP.

RESEARCH DESIGN AND METHODS: We conducted a randomized, double-masked, sham therapy-controlled clinical trial in 50 patients with painful DSP diagnosed with the Toronto Clinical Neuropathy Score. All patients received sham therapy over a 2-week baseline period and were then randomized to receive biweekly sessions of either sham or LILT for 4 weeks. The primary efficacy parameter was the difference in the weekly mean pain scores on a visual analog scale (VAS).

RESULTS: The patients had similar baseline characteristics for pain intensity, HbA(1c), and duration of DSP. Both groups noted a decrease in weekly mean pain scores during sham treatment. After the 4-week intervention, the LILT group had an additional reduction in weekly mean pain scores of -1.0 +/- 0.4 compared with -0.0 +/- 0.4 for the sham group (P = 0.07). LILT had no effect on the Toronto Clinical Neuropathy Score, nerve conduction studies, sympathetic skin response, or quantitative sensory testing.

CONCLUSIONS: Although an encouraging trend was observed with LILT, the study results do not provide sufficient evidence to recommend this treatment for painful symptoms of DSP.

Vopr Kurortol Fizioter Lech Fiz Kult. 2003 Sep-Oct;(5):28-30.

Laser therapy and cryomassage in rehabilitation of patients with facial nerve neuropathy.

[Article in Russian]

Maslovskaia SG, Gusarova SA, Gorbunov FE, Strel’tsova EN.

Cryomassage and its combination with low-intensity infra-red laser radiation have been introduced as a novel treatment of facial nerve neuropathy (FNN) in 32 patients. Electrophysiological investigations (facial thermography, classical electrodiagnosis, electromyography of the mimic muscles) and clinical data including those of long-term follow-up show that neither cryomassage nor infra-red laser radiation studied promote transformation of facial tissues in FNN patients. Use of the above factors is effective in a preclinical stage of forming contracture of the mimic muscles. Special techniques of application of local hypothermia and laser radiation can be used in multimodality treatment of both the established contracture and sluggish paresis of the facial muscles.

Vopt Kurortol Fizioter Lech Fiz Kult.  2003 May-Jun;(3):39-41.

[Photochromotherapy of experimental compression-ischemic neuropathy].

[Article in Russian]
Guzalov PI, Kir’ianova VV, Zhulev NM, Veselovski? AB, Vlasov TD, Zhulev SN, Ziganshina DP, Korniushin OV.

Abstract

Effects of monochrome light of the green and red spectra (mean wave length 540 and 670 nm, respectively) were studied on experimental rat model of compression-ischemic neuropathy (40 animals). The nerve under compression was exposed to green and red light using light-diode physiotherapeutic unit “Spectr-LC” with different intensity. Electromyographic parameters of the compressed nerve improved significantly after exposure to monochrome green light with intensity 500 mJ/cm2. The effect was dose dependent. Green light produced better effect.

Vopr Kurortol Fizioter Lech Fiz Kult. 2002 Jul-Aug;(4):25-7.

[Laser therapy and electric stimulation in rehabilitation treatment of peripheral neuropathy]

[Article in Russian]

Miriutova NF, Abdulkina NG, Luksha LV, Levitski? EF.

73 patients with compression-ischemic myeloradiculopathy received treatment including infrared laser radiation on the paravertebral fields, motor points of the affected nerves and biologically active points Y63, Y67, YB34, YB42, YB43, E34, E42 (1.0-5.0 mW/cm2; 5 and 5000 Hz), electrostimulation of motor nerve points and innervated by them muscles by double square impulses with a fixed gap 5 ms. Impulse infrared laser therapy relieves pain syndrome, stimulates repair processes in the affected nerve structures. Further modified electric stimulation activates a regenerative growth of the nerve fibers, reinnervation of the limb muscles.

Vopr Kurortol Fizioter Lech Fiz Kult. 2002 Jul-Aug;(4):25-7.

 

Laser therapy and electric stimulation in rehabilitation treatment of peripheral neuropathy.

[Article in Russian]

Miriutova NF, Abdulkina NG, Luksha LV, Levitskii EF.

73 patients with compression-ischemic myeloradiculopathy received treatment including infrared laser radiation on the paravertebral fields, motor points of the affected nerves and biologically active points Y63, Y67, YB34, YB42, YB43, E34, E42 (1.0-5.0 mW/cm2; 5 and 5000 Hz), electrostimulation of motor nerve points and innervated by them muscles by double square impulses with a fixed gap 5 ms. Impulse infrared laser therapy relieves pain syndrome, stimulates repair processes in the affected nerve structures. Further modified electric stimulation activates a regenerative growth of the nerve fibers, reinnervation of the limb muscles.

Lik Sprava. 2002 Jul-Sep;(5-6):62-5.

Use of physical factors in the complex therapy of patients with diabetic angio- and polyneuropathies of the lower extremities.

[Article in Ukrainian]

Shablinskaia NB.

Results are submitted of treatment of 110 patients with diabetes mellitus (61 male and 49 female subjects) presenting with angio- and polyneuropathies of the lower extremities. 70 patients, in addition to a drug therapy, were administered physiotherapeutic treatments, such as amplipulsetherapy, darsonvalization, and laserotherapy. Forty patients received medicamentous therapy only. Based on clinical findings and laboratory methods of investigation expediency has been shown of employment of physiotherapeutic methods in the treatment of the above pathology.

J Am Podiatr Med Assoc. 2002 Mar;92(3):125-30.

 

Symptomatic reversal of peripheral neuropathy in patients with diabetes.

Kochman AB, Carnegie DH, Burke TJ.

The Medical Center of Aurora, Aurora, CO, USA.

Forty-nine consecutive subjects with established diabetic peripheral neuropathy were treated with monochromatic near-infrared photo energy (MIRE) to determine if there was an improvement of sensation. Loss of protective sensation characterized by Semmes-Weinstein monofilament values of 4.56 and above was present in 100% of subjects (range, 4.56 to 6.45), and 42 subjects (86%) had Semmes-Weinstein values of 5.07 or higher. The ability to discriminate between hot and cold sensation was absent (54%) or impaired (46%) in both groups prior to the initiation of MIRE treatment. On the basis of Semmes-Weinstein monofilament values, 48 subjects (98%) exhibited improved sensation after 6 treatments, and all subjects had improved sensation after 12 treatments. Therefore, MIRE may be a safe, drug-free, noninvasive treatment for the consistent and predictable improvement of sensation in diabetic patients with peripheral neuropathy of the feet.

Laser therapy and cryomassage in rehabilitation of patients with facial nerve neuropathy.

[Article in Russian]

Maslovskaia SG, Gusarova SA, Gorbunov FE, Strel’tsova EN.

Cryomassage and its combination with low-intensity infra-red laser radiation have been introduced as a novel treatment of facial nerve neuropathy (FNN) in 32 patients. Electrophysiological investigations (facial thermography, classical electrodiagnosis, electromyography of the mimic muscles) and clinical data including those of long-term follow-up show that neither cryomassage nor infra-red laser radiation studied promote transformation of facial tissues in FNN patients. Use of the above factors is effective in a preclinical stage of forming contracture of the mimic muscles. Special techniques of application of local hypothermia and laser radiation can be used in multimodality treatment of both the established contracture and sluggish paresis of the facial muscles.

HELIUM-NEON LASERTHERAPY IN TREATMENT OF FACIAL NERVE NEUROPATHY

A. Scherbonosova, V.V. Skupchenko

Medical university, Far Eastern Medical Center, Khabarovsk, Russia

Facial nerve damage is the result of different factors influence and it appears at the background of ischemia anoxia. Elimination of a local pathologically fixed ergothroimages ischemia condition with the help of helium-neon laser therapy (FTNLT) has been conducted taking into consideration initial vegetative pattern of patients. It allowed to adjust treatment methods based on laser effect individually for every patient. Mimic muscles function restoration in the course of treat­ment had begun after 5 treatment sessions with HNLT and matched vegetative status normalization as well as reofaciogram, ultrasound Dopplerography of temporal and ophthalmic arteries and general conjunctive index. Thus, HNLT is a gentle corrector of vegetative homeostasis and sanogenic mechanisms. It allows to synchronize local and cerebral hemodynamics rhythms and trigger reparative re­generation of the facial nerve.

Zh Nevrol Psikhiatr Im S S Korsakova. 1998;98(6):23-5.

 

Infrared laser therapy in distal diabetic polyneuropathy

[Article in Russian]

Kalinina OV, Alekseeva NV, Burtsev EM.

A course of laser therapy was applied to 50 patients with diabetic polyneuropathy by laser irradiation of low intensiveness in the nearest infrared spectrum. 20 patients from the group were treated by monotherapy only by laser exposure. Control group consisted of 24 patients treated by conventional therapy without laser exposure. According to the changes of vibratory and algesic sensitivity and electromyographic data the efficiency of therapy was estimated. It was found that laser exposure resulted in more pronounced restoration of functional state of nervous fibers than conventional therapy. Application of laser irradiation of low intensiveness was effective while in combined therapy of distal diabetic polyneuropathy as well as monotherapy.

Infrared laser therapy influence on blood circulation in patients with diabet distgal polyneuropathy.

Protasyeva L.G., Burtsev E.M., Alekseyeva N.V., Osnovina I.P., Cheida A.A., Nazarov S.B.

I.S.M.A. Ivanovo. Russia.

96 patients with DDPNP received infrared lasertherapy. Their bloodflow including parameters of microcirculation issas carefeully exarnined.  Laser therapy stimulated microcirculation in both groups of patients with microcirculation disorders alone and with the combination of marked micro -and makrocirculation therapy disturbances. High effectiveness of Laser in DDPNP was proved.  Authors conclude that laser therapy is a pathogenic method of DDPNP treatment.

Proc. 2nd Congress World Assn for Laser Therapy, Kansas City, September 1998; p. 28

 

Laser irradiation suppresses hyperalgesia in neuropathic rats.

Katsuyama I et al.

Katsuyama studied the effect of 830 nm laser in a neuropathic pain model of rat. The left side sciatic nerves of two groups of rats were ligated loosely to produce a neuropathic pain. The latency of the foot withdrawal reflex to noxious heat stimuli was measured before the ligation, immediately after laser/placebo radiation and at 14 days after ligation. The laser group received 72 J through the dermis. This group showed a significant reduction in left foot withdrawal immediately after irradiation and at 14 days, the right foot being unchanged. Placebo irradiation did not change the latency in the ligated in the ligated group, nor in non-ligated rats.

Klin Khir. 1994;(5):27-9.

[The use of continuous plasmapheresis and extracorporeal laser irradiation of the blood in treating diabetic angiopathies of the lower extremities]

[Article in Ukrainian]

Podil’chak MD, Nevzhoda OA.

The plasmapheresis (PP) with the help of the PP-05 apparatus was applied in the treatment of 70 patients with the low extremities diabetic angiopathy. The optimal plasma exfusion dose is from 600 to 1100 ml. Under the PP influence the blood glucose level reduced proportionally to the excreted plasma quantity, the rheovasographic index on the low extremities increased from 0.41 +/- 0.15 to 0.64 +/- 0.6; the bloodflow velocity in the peripheral arteries of low extremities have got the 2.2-fold rise according to the dopplerography data. In comparison with a control group of patients the exarticulation conduction frequency decreased from 20 to 8, and extremities amputation–from 14 to 5.