The Lancet, Volume 374, Issue 9705, Pages 1897-1908, 5 December 2009
doi:10.1016/S0140-6736(09)61522-1
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) Corresponding Author, 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.
Funding
None.
(a) Nerve Research
Foundation, Brain and Mind Research Institute, University of Sydney,
Sydney, NSW, Australia
(b) Faculty of Health, Leeds Metropolitan University, Leeds, UK
(c) Institute of Biomedical Sciences, Pharmacology Department,
University of São Paulo, São Paulo, Brazil
(d) Faculty of Health and Social Science, Institute of Physiotherapy,
Bergen University College, Bergen, Norway
(e) Section of Physiotherapy Science, Institute of Public Health and
Primary Health Care, University of Bergen, Bergen, Norway
Correspondence to: Dr Roberta T Chow, Honorary Research Associate, Nerve
Research Foundation, Brain and Mind Research Institute, University of
Sydney, 100 Mallett Street, Sydney, NSW 2050, Australia
Other links:
- Chow RT, Heller GZ, Barnslay L.
The effect of 300 mW, 830 nm laser on chronic neck pain:
a double-blind, randomized, placebo-controlled study.
Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27.
Link.
- LLLT relief for neck pain acknowledged in latest consensus statement by the World Health Organisation: Bone and Joint Task Force
- LLLT relief for chronic neck pain, link.
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Medical breakthrough in Laser Medicine, King Faisal Hospital, Saoudi Arabia
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Validation of observations made:
- at King Faisal Hospital on bedsores treated by LLLT laser
- by Meditech International Incorporated - Link
BEDSORE AND LASERPONCTURE®
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Case 1: bedsore on the sacrum crest and gluteal furrow treated by nursing cares since 2 years; the patient underwent 5 sessions of laserponcture between Nov. 12th, 2008 and Dec. 24th, 2008; the bedsore completely healed on Dec. 28th, 2008
Video 1 of Nov. 12th, 2008
Video 2 of Nov. 26th, 2008
Video 3 of Dec. 10th, 2008
Recap
Bedsore healed on Dec. 24th, 2008:
Feb. 11th, 2009
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Case 2: bedsore on the internal malleolus and retrocalcaaneal
Day 1:
Sep. 12th, 2008: heel 3.6/7 cm; ankle 2 cm
Day 3:
Sep. 15th, 2008: heel 3.3 x 1.5 cm; ankle 1.5 x 1 cm
Day
5 :
Sep. 17th, 2008: heel 3 x 1,7 cm; ankle 1,5 x 0,9 cm
Day
6 :
Sep. 18th, 2008: heel 2,9 x 1 cm; ankle 1,5 x 0,7 cm
Day
32
Oct. 14th, 2008
Day 36
Oct. 18th, 2008
Day 45
Oct. 27th, 2008
Day 54
Nov. 5th
Day 65
Nov. 16th
Day 71
Nov. 22nd
The Use of Light Photobiomodulation on the Treatment of Second-Degree Burns: a Histological
Source : Chagas-Oliveira, P., Silva Meireles, G.C., Ribeiro dos Santos, N., et al. (2008). The Use of Light Photobiomodulation on the Treatment of Second-Degree Burns: a Histological Study of a Rodent Model. Photomed. Laser Surg. 26, 289-297.
Abstract :
Objective: The aim of this investigation was to compare, by
light microscopy, the effects of the use of laser photobiomodulation (LPBM)
and polarized light (PL) on second-degree burns on rodents.
Background Data: Burns are severe injuries that result in the loss of tissue fluids, destruction of tissues, infection, and shock. With severe and widespread third-degree burns death may occur. Several light sources have been suggested as being effective for improving wound healing.
Materials and Methods: Forty five rats were used in this study. A second-degree burn was created on the dorsum of each animal, and the animals were divided into four groups: PL (400-2000 nm, 40 mW, 2.4 J/cm²/min); LPBM-1 (780 nm, 35/40 mW, θ ~ 2 mm, 4 x 5 J/cm²); LPBM-2 (660 nm, 35/40 mW, θ ~ 2 mm, 4 x 5 J/cm²); and untreated animals acted as controls. The treatment was started immediately post-burn at four points around the burned area (laser: 5 J/cm² per site). The illumination with PL was performed according to the manufacturer's instructions. Treatments were repeated at 24-h intervals for 7 d. The animals were sacrifice at 3, 5, and 7 d post-burn. The specimens were routinely cut and stained and analyzed by light microscopy using hematoxylin and eosin and Sirius red.
Results: The analysis of the results demonstrated that the damaged tissue was able to efficiently absorb and process the light at all tested wavelengths. LPBM at 660 nm showed better results at early stages of wound healing. However, the use of 780-nm laser light had beneficial effects throughout the experimental period, with the animals growing newly-formed tissue similar to normal dermis.
Conclusion: Despite our findings that the use of both types of light energy improved the healing of second-degree burns at the early stages, long-term assessment is needed to verify if this improvement will influence the final results of treatment.
p. 297:
"It should be noted that light penetration into skin results in a
reduction of the amount of energy that reaches the subcutaneous tissue.
Most studies of wound healing showed better results when shorter
wavelengths were used. However, we have found good results with the use of
an IR laser, alone or in association with a shorter wavelength (44). This
aspect was further confirmed in the present investigation, and it may be a
result of the deeper penetration of IR laser energy, which resulted in the
stimulation of the cells located in the deeper portions of the wounds, as
well as the effect of heating, which is usually seen when high fluencies
are used at the wavelength. The combination of wavelengths with different
levels of absorption and penetration may further improve wound healing, as
LPBM may stimulate repair at both at the surface and at deeper levels. It
is also important to note that the choice of optical parameters used for
improved wound healing depend on wavelength, dose per session, the model
used, the type of wound, and the treatment conditions, among other factors."
Last update: 19 Jan. 2010