Can intractable discogenic back pain be managed by low–level laser therapy without recourse to operative intervention?
- 1Asia Medical Pain Centre, Mong Kok, Hong Kong, People’s Republic of China.
The aim of the study reported here was to investigate the possible clinical role of low–level laser therapy (LLLT) in discogenic back pain patients who failed to respond to a conventional physical therapy program to avoid recourse to operative intervention.
The paper reports on the long-term mean 5-year prospective follow-up of a patient cohort of 50 unselected patients visiting our tertiary referral pain center for discogenic back pain who had had a single-level lesion documented by magnetic resonance imaging followed by subsequent discography to confirm the affected disc being the pain generator. All of the patients who entered the study had failed response to a combination of nonsteroidal anti-inflammatory agents and had had not less than 3 months of conventional physical therapy. LLLT, at a wavelength of 810 nm wavelength emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm(2), was employed. The treatment regimen consisted of three sessions of treatment per week for 12 consecutive weeks.
All but one patient had significant improvement in their Oswestry Disability Index score, from a mean of 50% score to a mean of 10% score, at the end of treatment at 12 weeks. In addition, surprisingly, the improvement was found maintained at follow-up assessments 1 year and 5 years later. The one patient among the 50 patients who failed to respond eventually required surgery, while the others did not require surgery.
We conclude that LLLT is a viable option in the conservative treatment of discogenic back pain, with a positive clinical result of more than 90% efficacy, not only in the short-term but also in the long-term, with lasting benefits.
Low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica.
Injury and Physiotherapeutic Resource Study Laboratory, Western Paraná State University, Cascavel, PR, Brazil.
Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.
Acta Cir Bras. 2011 Feb;26(1):12-18.
Histological analysis of low-intensity laser therapy effects in peripheral nerve regeneration in Wistar rats.
Câmara CN, Brito MV, Silveira EL, Silva DS, Simões VR, Pontes RW.
Department of Physiotherapy, UNAMA, Belem, PA, Brazil.
Purpose: Analyze the influence of low-intensity laser therapy in the sciatic nerve regeneration of rats submitted to controlled crush through histological analysis. Methods: Were used 20 Wistar rats, to analyze the influence of low-intensity laser therapy in the sciatic nerve regeneration, where the injury of the type axonotmesis was induced by a haemostatic clamp Crile (2nd level of the rack). The animals were randomly distributed in 2 groups. Control group (CG n = 10) and Laser group (LG n = 10). These were subdivided in 2 subgroups each, according to the euthanasia period: (CG14 _ n = 5 and CG21 _ n = 5) and (LG14 _ n = 5 and LG21 _ n = 5). At the end of treatment, the samples were removed and prepared for histological analysis, where were analyzed and quantified the following findings: Schwann cells, myelinic axons with large diameter and neurons. Results: In the groups submitted to low-intensity laser therapy, were observed an increase in the number of all analyzed aspects with significance level. Conclusion: The irradiation with low intensity laser (904nm) influenced positively the regeneration of the sciatic nerve in Wistar rats after being injured by crush (axonotmesis), becoming the nerve recovery more rapid and efficient.
Photomed Laser Surg.. [Epub ahead of print] Received via PubMed on 12-19-09
Acute Low Back Pain with Radiculopathy: A Double-Blind, Randomized, Placebo-Controlled Study.
Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND.
1 Clinic for Rehabilitation, Medical School , Belgrade, Serbia.
Abstract Objective: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.
Background Data: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.
Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.
Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005).
Conclusions: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.
J Manipulative Physiol Ther. 2008 Mar;31(3):191-8.
Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniateion measured by clinical evaluation and magnetic resonance imaging.
Unlu Z<>, Tasci S<>, Tarhan S<>, Pabuscu Y<>, Islak S<>.
Department of Physical Medicine and Rehabilitation, Medical Faculty, Celal Bayar University, Manisa, Turkey. firstname.lastname@example.org
OBJECTIVE: This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH).
METHODS: A total of 60 patients were enrolled in this study and randomly assigned into 1 of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at 1 and 3 months after treatment.
RESULTS: There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups.
CONCLUSIONS: This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.
EMLA Laser Health J 2007;2:46-67
Photomed Laser Surg. 2007 Feb;25(1):40-4.
Percutaneous laser disc decompression for lumbar disc hernia: indications based on Lasegue’s Sign.
Iwatsuki K<>, Yoshimine T<>, Awazu K<>.
Department of Neurosurgery, Osaka University Medical School, Osaka, Japan. email@example.com
OBJECTIVE: The present study was conducted to establish reasonable indications of patient neurological manifestations for use of percutaneous laser disc decompression (PLDD).
BACKGROUND DATA: PLDD is a less invasive surgical procedure for lumbar disc hernia, whose indications have been described on the basis of radiographical findings.
METHODS: Sixty-five consecutive patients (45 men and 20 women) with lumbar disc hernia were treated with PLDD by applying a diode laser (wavelength 805 nm). A total of 450-1,205 joules (average, 805.5 joules) were delivered per disc. All patients suffered from radicular pain. They were divided based on the presence of Lasegue’s sign. The post-procedure results at 1 week and 1 year were compared between the groups.
RESULTS: PLDD was effective for patients with Lasegue’s sign (80.0%), but ineffective for those without the sign.
CONCLUSION: The present study suggests that Lasegue’s sign in patients is an indication of PLDD for lumbar disc hernia.
Neurol Res. 2005 Apr;27(3):319-23.
The effect of laser irradiation for nucleus pulposus: an experimental study.
Iwatsuki K<>, Yoshimine T<>, Sasaki M<>, Yasuda K<>, Akiyama C<>, Nakahira R<>.
Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. firstname.lastname@example.org
BACKGROUND: The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra-disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study.
METHODS: All rabbits had the nerve root in contact with the leakage from the nucleus pulposus. One group underwent laser irradiation for the leaking nucleus pulposus including the incision site of the disc and nucleus pulposus itself. The levels of two chemical factors, prostaglandin E2 and phospholipase E2, in the intervertebral disc were measured before and after laser irradiation.
RESULTS: NCV in the laser-irradiated group was significantly faster than in the non-laser-irradiated group. The levels of chemical factors were significantly reduced after laser irradiation.
CONCLUSIONS: One of the mechanisms thought to be responsible for PLDD’s effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation.
In Vivo. 2004 Jul-Aug;18(4):489-95.
Effect of Ga-as laser on the regeneration of injured sciatic nerves in the rat.
Bae CS, Lim SC, Kim KY, Song CH, Pak S, Kim SG, Jang CH.
College of Veterinary Medicine, Biotechnology Research Institute, Chonnam National University, Gwangju, Korea.
Laser irradiation is one of the therapeutic methods for the recovery of degenerated peripheral nerves. The aim of the present study was to determine if low-power laser treatment stimulates the regeneration process of damaged nerves. A standardized crush to the sciatic nerve was applied to cause extensive axonal degeneration. After this procedure, low-power infrared laser irradiation was administered transcutaneously to the injured sciatic nerve, 3 minutes daily to each of four treatment groups for 1, 3, 5 and 7 weeks, respectively. A nerve conduction study was done, and a morphological assessment was performed using both light and electron microscopy. With trauma of the nerve, both amplitude of compound motor action potential and nerve conduction velocity decreased significantly compared to the pre-trauma state. Morphologically, the numbers of myelinated axons and degenerated axons were decreased and increased, respectively, compared with the control. Typical aspects were of onion skin-type lamellation, fragmentation, edematous swelling and rarefaction in the myelin sheath. All these parameters recovered almost to the level of the pre-trauma state with laser irradiation, in direct proportion to the time spent for treatment. These results suggest that low-power infrared laser irradiation can relieve the mechanical damage of sciatic nerves and stimulate the regeneration of peripheral nerves.
|Lik Sprava. 2004 Dec;(8):57-63.|
Complex treatment of elderly patients with pain reflectory manifestations of lumbosacral osteochondrosis and peripheral circulation disorder
[Article in Ukrainian]
Macheret IeL<>, Dzhuzha TV<>.
Involutional age makes difficult the treatment of pain syndromes of vertebra origin. Concomitant diseases, age stress syndrome, hormone disbalance constrain the management of the disease. Combination of laser stimulation, reflexotherapy, psychodiagnostics and psychocorrection enhances the efficiency of the treatment of pain syndromes in patients with lumbo-sacral radiculitis and peripheral circulation disorder.
|Lik Sprava. 2004 Dec;(8):53-7.|
Electrophysiological changes in a complex treatment of lumbosacral pain syndrome in patients of different age group
[Article in Ukrainian]
The influence of two methods of treatment (pharmacological and combination with infra-red laser puncture and manual therapy) on clinical picture, electromyographic indices in 165 patients of different age group with lumbosacral radiculitis has been studied by the author. The use of these methods in treatment of such patients is substantiated by the obtained data.
ICMART ’97 International Medical Acupuncture Symposium, Nicosia, Cyprus, March 26-29 1997:
Low energy laser in the treatment of low back pain
S. Nikolic, Z. Trojacanec, I.J.Milankovic Institute of ME Physiology, Faculty of Medicine, Skopje, F.Y.R.O.M
Low back pain is felt in the low lumbar, lumbosacral, or sacroiliac region. Most low back pain is related to acute ligamentous (sprain) or muscular(strain) problems, which tend to be self limited, or to the more chronic osteoarthritis or ankylosing spondylitis of the lumbar area. The aim of the study was to explore the pain-alleviating effect of low level laser in low back pain .Thirty-five patients with low back pain have been treated with helium-neon laser type “Bistra” with wavelength 630 nm, average output 15 mW and an irradiance of 250 mW/cm2. The laser was locally applied to 11 sites on and around the low back. After scanning each point was treated for 30 sec, five times weekly for a total of ten treatments. The statistical analysis showed that the laser treated patients had a significant faster pain-alleviating effect compared with the 30 patients treated with medicaments only. Subjective response have been achieved after first three treatments. Irradia laser treatment may be a valuable therapy in low back pain and low energy laser can be employed as a pain relieving method.