1
|
Ghasemi A, Olyaei GR, Bagheri H, Hadian MR, Jalaei S, Otadi K, Malmir K. A randomized clinical trial on the changing of median nerve cross-sectional area and pain after extracorporeal shock wave and low-level laser therapy added to conventional physical therapy in patients with mild-to-moderate carpal tunnel syndrome. J Hand Ther 2024:S0894-1130(23)00197-7. [PMID: 38278695 DOI: 10.1016/j.jht.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/07/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common mononeuropathy in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients. PURPOSE This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the median nerve and pain in mild-to-moderate CTS patients. STUDY DESIGN This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1. METHODS Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample t-tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's d effect size was used to assess the intervention's magnitude. RESULTS Both ESWT and LLLT groups showed significant improvements in CSA (p = 0.002) and pain (p < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy. CONCLUSION The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction.
Collapse
Affiliation(s)
- Amirhossein Ghasemi
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Olyaei
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Bagheri
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Hadian
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaei
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Otadi
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kazem Malmir
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
He K, Zhou X, Zheng F, Ju X, Fu SN, Wong AYL. Histological, Physiological and Biomechanical Effects of Low-Level Laser Therapy on Tendon Healing in Animals and Humans: A Systematic Review. Ann Biomed Eng 2023; 51:2659-2707. [PMID: 37899380 DOI: 10.1007/s10439-023-03364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023]
Abstract
Low-level Laser Therapy (LLLT) was widely used in clinical practice for tendon disorders. However, the underlying mechanisms and effectiveness of LLLT in treating tendon injury remain unclear. Therefore, the present study was conducted aiming to summarize the evidence regarding the histological, physiological, and biomechanical effects of LLLT on tendon healing in animal and human models. Four databases were searched for relevant literature. Four independent reviewers screened abstracts and full-text articles, extracted relevant data, evaluated the risk of bias, and quantified the quality of evidence. Database searches yielded 1400 non-duplicated citations. Fifty-five studies were included (50 animal and five human studies). Animal studies revealed that LT had stimulating effects on collagen organization, collagen I and collagen II formation, matrix metalloproteinase (MMP)-8, transforming growth factor β1, vascular endothelial growth factor, hydroxyproline, maximum load, maximum elongation before breaking, and tendon stiffness. However, LLLT had inhibitory effects on the number of inflammatory cells, histological scores, relative amount of collagen III, cyclooxygenase-2, prostaglandin E2 (PGE2), interleukin-6, tumor necrosis factor-α, MMP-1, and MMP-3. Although one human study found that LLLT reduced the concentration of PGE2 in peritendinous tissue of the Achilles tendon, other human studies revealed that the effects of LLLT on the physiology and biomechanics of human tendons remained uncertain. LLLT facilitates tendon healing through various histological, physiological, and biomechanical effects in animal models. Only post-LLLT anti-inflammatory effects were found in human studies.
Collapse
Affiliation(s)
- Kexu He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Feisheng Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Xiaojie Ju
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Siu-Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
| |
Collapse
|
3
|
Bismaya K, Singh VK, Pathak A, Kumar A, Mishra VN, Joshi D, Chaurasia RN. Evaluating the Effect of Pregabalin in the Treatment of Carpal Tunnel Syndrome: A Prospective, Randomized, Triple-Blinded, Placebo-controlled Trial. Clin J Pain 2023; 39:604-610. [PMID: 37584413 DOI: 10.1097/ajp.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of pregabalin for the control of symptoms in mild to moderate idiopathic Carpal tunnel syndrome (CTS). METHODS In this randomized, placebo-controlled trial, 146 mild to moderate idiopathic CTS patients were randomized into pregabalin (n=74) and placebo groups (n=72). Per protocol, analysis was conducted with 131 patients; pregabalin (n=65) and placebo (n=66). The drug titration dose was 50 mg once daily for the first week, twice daily for the second week and thrice daily for the next 6 weeks. The primary outcome included a change in the Symptom Severity Scale and Functional Status Scale (FSS) of the Boston Carpal Tunnel Questionnaire after the eighth week. The secondary outcome was the change in clinical and electrophysiological grading after 8 weeks of therapy. RESULTS There was a statistically significant improvement in the mean Symptom Severity Scale (14.92±3.72 vs. 16.55±4.45; P =0.025) and FSS (10.77±2.64 vs. 12.0±2.55; P =0.007) in the pregabalin group after 8 weeks. Mean clinical and electrophysiological grading changed significantly from 2.3±0.7 to 2.1±0.8 ( P =0.001) and 1.9±0.7 to 1.8±0.8 ( P =0.020), respectively in the pregabalin group but not in the placebo group. DISCUSSION The results of this study demonstrates that pregabalin is effective in ameliorating symptoms and improving functional outcomes in mild to moderate idiopathic CTS.
Collapse
Affiliation(s)
- Kumar Bismaya
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | | | | | | | | | | | | |
Collapse
|
4
|
Garcia JO, Scott D, Parikh P, Curley KL, Turkmani A. Understanding carpal tunnel syndrome. JAAPA 2022; 35:19-26. [PMID: 36346923 DOI: 10.1097/01.jaa.0000892708.87945.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT Carpal tunnel syndrome (CTS) is an entrapment neuropathy affecting the median nerve. Prevalence is estimated at 4% to 5% of the population. A solid understanding of the anatomy, presentation, and diagnostics is key to efficient diagnosis and appropriate referral. Both surgical and nonsurgical interventions have led to improved clinical outcomes. Clinicians who have an in-depth knowledge of CTS symptoms and treatment options can prepare patients and streamline referrals for improved patient outcomes.
Collapse
Affiliation(s)
- Jose Omar Garcia
- At the Mayo Clinic Arizona, Jose Omar Garcia, Derek Scott , and Parth Parikh are students in the School of Medicine; Kara L. Curley practices in neurosurgery, is an assistant professor of neurologic surgery, and is program director of the neurosurgery PA fellowship; and Ali Turkmani is an assistant professor. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | | | |
Collapse
|
5
|
Nalbant M, Ümit Yemişci O, Özen S, Tezcan Ş. Ultrasonographic and electrophysiological outcomes of carpal tunnel syndrome treated with low-level laser therapy: A double-blind, prospective, randomized, sham-controlled study. Arch Rheumatol 2021; 37:19-30. [PMID: 35949869 PMCID: PMC9326377 DOI: 10.46497/archrheumatol.2022.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives
The aim of this study was to investigate the therapeutic effects of low-level laser therapy (LLLT) on clinical, ultrasonographic (US), and electrophysiological findings in carpal tunnel syndrome (CTS). Patients and methods
Between January 2015 and August 2015, 42 patients (7 males, 35 females; mean age: 50.4±8.7 years; range, 32 to 65 years) with mild-to-moderate CTS were randomly assigned to one of two groups: active LLLT (therapy group, n=22) 0.8 J/painful point and sham LLLT groups (n=20). Both groups wore neutral wrist orthoses. The patients were evaluated before and after 15 sessions of therapy (670 nm, 4 J/session over the carpal tunnel). Follow-up parameters included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), nerve conduction studies and US evaluation of the median nerve cross-sectional area (CSA), vascularization (via power Doppler), flattening ratio (FR), and palmar bowing of the flexor retinaculum. Results
Nocturnal paresthesia improved in both groups; however, pain and patients with a positive Phalen’s test reduced only in the therapy group (p=0.031). The FSS and SSS scores also improved only in the therapy group (p<0.001). Electrophysiologically, median sensory nerve conduction velocities showed a significant improvement only in the therapy group (p=0.002). The CSA, FR, and vascularization of the median nerve showed a significant improvement in the therapy group alone (p<0.001, p=0.048, and p=0.021, respectively). Conclusion
Improvements in the signs and symptoms of CTS and hand function, the improvements in sensory nerve conduction studies, and reduction in median nerve CSA, FR and vascularity in the LLLT group can be attributed to the anti-inflammatory and analgesic effects of LLLT. This study provides new US data demonstrating efficacy of LLLT along with a clinical and electrophysiological improvement. The LLLT seems to be an easily applied, non-invasive treatment option.
Collapse
Affiliation(s)
- Merve Nalbant
- Department of Rheumatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Oya Ümit Yemişci
- Department of Physical Medicine and Rehabilitation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Selin Özen
- Department of Physical Medicine and Rehabilitation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Şehnaz Tezcan
- Department of Radiology, Koru Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Muniz XC, de Assis ACC, de Oliveira BSA, Ferreira LFR, Bilal M, Iqbal HMN, Soriano RN. Efficacy of low-level laser therapy in nerve injury repair-a new era in therapeutic agents and regenerative treatments. Neurol Sci 2021; 42:4029-4043. [PMID: 34292450 DOI: 10.1007/s10072-021-05478-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Traumatic nerve injuries may result in severe motor dysfunctions. Although the microenvironment of peripheral axons favors their regeneration, regenerative process is not always successful. PURPOSE We reviewed and discussed the main findings obtained with low-level laser therapy (LLLT), a therapeutic intervention that has been employed in order to achieve an optimized regeneration process in peripheral axons. SCOPE Disseminating the best available evidence for the effectiveness of this therapeutic strategy can potentially improve the statistics of success in the clinical treatment of nerve injuries. We found evidence that LLLT optimizes the regeneration of peripheral axons, improving motor function, especially in animal models. Nonetheless, further clinical evidence is still needed before LLLT can be strongly recommended. Although the results are promising, the elucidation of the mechanisms of action and safety assessment are necessary to support highquality clinical studies. CONCLUSION The present careful compilation of findings with consistent pro-regenerative evidence and published in respected scientific journals can be valuable for health professionals and researchers in the field, possibly contributing to achieve more promising results in future randomized controlled trials and interventions, providing better prognosis for clinical practice.
Collapse
Affiliation(s)
- Xellen Cunha Muniz
- Department of Physical Therapy, Federal University of Juiz de Fora, 35032-620, Governador Valadares-MG, Brazil
| | | | | | - Luiz Fernando Romanholo Ferreira
- Graduate Program in Process Engineering, Tiradentes University (UNIT), Av. Murilo Dantas, 300, Farolândia, Aracaju-Sergipe, 49032-490, Brazil
- Institute of Technology and Research (ITP), Tiradentes University (UNIT), Av. Murilo Dantas, 300, Farolândia, Aracaju-Sergipe, 49032-490, Brazil
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian, 223003, China.
| | - Hafiz M N Iqbal
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Monterrey, Ave. Eugenio Garza Sada 2501, CP 64849, Monterrey, N.L., Mexico
| | - Renato Nery Soriano
- Division of Physiology and Biophysics, Department of Basic Life Sciences, Federal University of Juiz de Fora, 35010-177, Governador Valadares-MG, Brazil.
| |
Collapse
|
7
|
Akgol G, Elbasti MS, Gulkesen A, Alkan G, Kaya A, Ulusoy H. Comparison of low power laser and kinesio taping for the treatment of carpal tunnel syndrome: A prospective randomized study. J Back Musculoskelet Rehabil 2021; 34:545-553. [PMID: 33554885 DOI: 10.3233/bmr-200179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although carpal tunnel syndrome (CTS) is a common neuromuscular disorder, studies on its conservative treatment are inadequate and contradictory. OBJECTIVES This study aimed to investigate and compare the effectiveness of low power laser therapy (LPLT) and Kinesio taping (KT) for the treatment of CTS. METHODS Sixty patients with CTS were included in this study. One group received 15 sessions of KT, and the second group underwent 15 sessions of LPLT within three weeks. All patients were assessed with hand grip strength (HGS), Visual Analogue Scale (VAS)-pain, Douleur Neuropathique-4 (DN4) score, Boston Questionnaire (BQ), and electroneuromyography before and after treatment. RESULTS Before treatment, all clinical and neurophysiological parameters were similar between the groups. After treatment, both groups significantly improved in terms of HGS, VAS-pain, DN4, and BQ. However, the LPLT group had significantly better HGS, VAS-pain, DN4, and BQ than the KT group. In addition, while median nerve motor distal latency and median nerve sensory conduction velocity improved significantly with treatment in both groups, the LPLT group's improvement was significantly better than that of the KT group. CONCLUSIONS In patients with CTS, both LPLT and KT were effective treatments. However, the LPLT group had significantly better improvements than the KT group.
Collapse
Affiliation(s)
- Gurkan Akgol
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Muhammet Sahin Elbasti
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Arif Gulkesen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Gokhan Alkan
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Arzu Kaya
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Hasan Ulusoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| |
Collapse
|
8
|
Bula-Oyola E, Belda-Lois JM, Porcar-Seder R, Page Á. Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis. PLoS One 2021; 16:e0248484. [PMID: 33735212 PMCID: PMC7971482 DOI: 10.1371/journal.pone.0248484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION People with ulnar, radial or median nerve injuries can present significant impairment of their sensory and motor functions. The prescribed treatment for these conditions often includes electrophysical therapies, whose effectiveness in improving symptoms and function is a source of debate. Therefore, this systematic review aims to provide an integrative overview of the efficacy of these modalities in sensorimotor rehabilitation compared to placebo, manual therapy, or between them. METHODS We conducted a systematic review according to PRISMA guidelines. We perform a literature review in the following databases: Biomed Central, Ebscohost, Lilacs, Ovid, PEDro, Sage, Scopus, Science Direct, Semantic Scholar, Taylor & Francis, and Web of Science, for the period 1980-2020. We include studies that discussed the sensorimotor rehabilitation of people with non-degenerative ulnar, radial, or median nerve injury. We assessed the quality of the included studies using the Risk of Bias Tool described in the Cochrane Handbook of Systematic Reviews of Interventions and the risk of bias across studies with the GRADE approach described in the GRADE Handbook. RESULTS Thirty-eight studies were included in the systematic review and 34 in the meta-analysis. The overall quality of evidence was rated as low or very low according to GRADE criteria. Low-level laser therapy and ultrasound showed favourable results in improving symptom severity and functional status compared to manual therapy. In addition, the low level laser showed improvements in pinch strength compared to placebo and pain (VAS) compared to manual therapy. Splints showed superior results to electrophysical modalities. The clinical significance of the results was assessed by effect size estimation and comparison with the minimum clinically important difference (MCID). CONCLUSIONS We found favourable results in pain relief, improvement of symptoms, functional status, and neurophysiological parameters for some electrophysical modalities, mainly when applied with a splint. Our results coincide with those obtained in some meta-analyses. However, none of these can be considered clinically significant. TRIAL REGISTRATION PROSPERO registration number CRD42020168792; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168792.
Collapse
Affiliation(s)
- Ena Bula-Oyola
- Universitat Politècnica de València, Valencia, Spain
- Departamento de Diseño, Universidad del Norte, Barranquilla, Colombia
| | - Juan-Manuel Belda-Lois
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
- Grupo de Tecnología Sanitaria del IBV, CIBER de Bioingeniería, Biomateriales y Nanomedicina, Valencia, Spain
| | - Rosa Porcar-Seder
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
| | - Álvaro Page
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
- Departamento de Física Aplicada, Universitat Politècnica de València, Valencia, Spain
| |
Collapse
|
9
|
Gesslbauer C, Mickel M, Schuhfried O, Huber D, Keilani M, Crevenna R. Effectiveness of focused extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome : A randomized, placebo-controlled pilot study. Wien Klin Wochenschr 2020; 133:568-577. [PMID: 33351153 PMCID: PMC7754699 DOI: 10.1007/s00508-020-01785-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Background The carpal tunnel syndrome is the most common entrapment neuropathy in the general population. A conservative treatment should be considered in mild to moderate cases. The aim of this study was to assess the effect of a focused extracorporeal shock wave therapy in the treatment of mild to moderate carpal tunnel syndrome. Material and Methods In this study 30 patients were randomly assigned into 2 groups. Subjects in the study group received three sessions of focused extracorporeal shock wave therapy, whereas the control group underwent a sham therapy. Patients were evaluated 3 and 12 weeks after treatment. The primary outcome was the visual analogue scale score. Secondary outcome measurements included hand grip strength, Boston Carpal Tunnel Syndrome Questionnaire, SF-36 Health Survey and electrodiagnostic measurements. Results A significant improvement of visual analogue scale at week 3 (p = 0.018) and week 12 (p = 0.007) as well as hand grip strength at week 12 (p = 0.019) could be observed in the study group. The study group showed a significantly better sensory nerve conduction velocity at week 12 than the control group, before correcting for multiple testing, and also a significant improvement in distal motor latency of the median nerve at week 12 (p = 0.009) as well as in both questionnaires (SF-36 subscale bodily pain, p = 0.020 and severity symptom scale, p = 0.003). No such improvement was observed in the control group. Conclusion Focused extracorporeal shock wave therapy is an effective and noninvasive treatment method for mild to moderate carpal tunnel syndrome.
Collapse
Affiliation(s)
- Christina Gesslbauer
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Mickel
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Othmar Schuhfried
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dominikus Huber
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
10
|
Marvulli R, Ianieri G, De Venuto G, Falcicchio M, Gallo GA, Mennuni C, Gallone MF, Fiore P, Ranieri M, Megna M. Electrophysiological and Clinical Improvement in Non-Invasive Treatment of Carpal Tunnel Syndrome. Endocr Metab Immune Disord Drug Targets 2020; 21:345-351. [PMID: 32723265 DOI: 10.2174/1871530320666200728152953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Carpal tunnel syndrome (CTS) is the most common form of nerve entrapment. Clinically, various signs and symptoms compare due to overexposure to mechanical vibrations transmitted to the wrist bones and cartilage, resulting in compression of the sensory and motor nerve fibers of the median nerve. Early symptoms include nocturnal paresthesia and electromyography reveals reduced sensory nerve conduction velocity. Aim of this study was to evaluate the efficacy of a dietary integrator composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins in patients with early (minimal) carpal tunnel syndrome. METHODS 36 patients (28 female and 8 male) with early CTS characterized by sensory nerve demyelination and inflammation of the transverse carpal ligament. Patients were divided into two groups, group A (18 patients received physical therapy) and group B (18 patients received physical therapy and an oral integrator). Clinical (sleep quality questionnaire to measure severity of paresthesia) and neurophysiological assessment (Sensory Nerve Conduction Velocity) performed at baseline, and then at 30 and 60 days after treatment. RESULTS Sleep quality and Sensory Nerve Conduction Velocity data analysis show improvement in both groups at 30 and 60 days, with statistical difference between them in both time of analysis. CONCLUSION In the early CTS, with sensory fibers damage, use of dietary integrator, such as Micronil Dol®, composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins can be effective in quick recovery of median nerve sensory.
Collapse
Affiliation(s)
- Riccardo Marvulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giancarlo Ianieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Grazia De Venuto
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marta Falcicchio
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giulia A Gallo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Catia Mennuni
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | | | - Pietro Fiore
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maurizio Ranieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marisa Megna
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| |
Collapse
|
11
|
Gendron DJ, Hamblin MR. Applications of Photobiomodulation Therapy to Musculoskeletal Disorders and Osteoarthritis with Particular Relevance to Canada. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 37:408-420. [PMID: 31265376 DOI: 10.1089/photob.2018.4597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Musculoskeletal disorders caused by osteoarthritis (MSDs/OA) are a growing problem in the modern industrialized society in Canada. Overall aging of the general population and a progressive lack of exercise contribute to this alarming increase. Moreover, a range of chronic conditions including cardiovascular and mental diseases show significantly higher comorbidity with MSDs/OA. Conventional medical treatment for MSDs/OA includes nonsteroidal anti-inflammatory drugs and opiate pain killers. These drugs have major drawbacks such as a relative lack of efficacy, potential for addiction, and even death (Vioxx scandal). Photobiomodulation (PBM) was discovered over 50 years ago but has still not attained widespread acceptance by the medical community. This is partly due to uncertainty about the precise molecular mechanisms of action and a bewildering array of different wavelengths and dosimetric parameters employed in reported studies. Objective: The goal of this review was to survey literature reports of PBM, also known as low-level laser therapy used for treatment of MSDs/OA, concentrating on the growth over time, different wavelengths employed, and application to different joints. Methods: We searched the PubMed database for publication of study on PBM to treat the most common joints. Results: We show that the field of PBM to treat MSDs/OA is expanding exponentially over the past 20 years. A trend has emerged over time for more power to achieve better effective treatments, and the understanding of the physiological effect of safe parameters has improved. There is, however, no consensus on the best set of parameters to treat a specific patient indication. Conclusions: Finally, we highlight gaps in our knowledge and the barriers to further clinical trials. We suggest that the growing body of evidence indicating efficacy, and the almost total lack of side effects, should encourage continued clinical research to support clinical applications where better rehabilitation treatments are much needed.
Collapse
Affiliation(s)
| | - Michael R Hamblin
- 2 Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts.,3 Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,4 Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| |
Collapse
|
12
|
Zupin L, Ottaviani G, Rupel K, Biasotto M, Zacchigna S, Crovella S, Celsi F. Analgesic effect of Photobiomodulation Therapy: An in vitro and in vivo study. JOURNAL OF BIOPHOTONICS 2019; 12:e201900043. [PMID: 31219220 DOI: 10.1002/jbio.201900043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
Laser therapy, also known as Photobiomodulation (PBM) is indicated to reduce pain associated with different pathologies and applied using protocols that vary in wavelength, irradiance and fluence. Its mechanisms of action are still unclear and possibly able to directly impact on pain transmission, reducing nociceptor response. In our study, we examined the effect of two specific laser wavelengths, 800 and 970 nm, extensively applied in the clinical context and known to exert important analgesic effects. Our results point to mitochondria as the primary target of laser light in isolated dorsal root ganglion (DRG) neurons, reducing adenosine triphosphate content and increasing reactive oxygen species levels. Specifically, the 800 nm laser wavelength induced mitochondrial dysregulation, that is, increased superoxide generation and mitochondrial membrane potential. When DRG neurons were firstly illuminated by the different laser protocols and then stimulated with the natural transient receptor potential cation channel subfamily V member 1 (TRPV1) ligand capsaicin, only the 970 nm wavelength reduced the calcium response, in both amplitude and frequency. Consistent results were obtained in vivo in mice, by subcutaneous injection of capsaicin. Our findings demonstrate that the effect of PBM depends on the wavelength used, with 800 nm light mainly acting on mitochondrial metabolism and 970 nm light on nociceptive signal transmission.
Collapse
Affiliation(s)
- Luisa Zupin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Ottaviani
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Katia Rupel
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Biasotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Sergio Crovella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Fulvio Celsi
- Institute for Maternal and Child Health, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| |
Collapse
|
13
|
Wickenheisser VA, Zywot EM, Rabjohns EM, Lee HH, Lawrence DS, Tarrant TK. Laser Light Therapy in Inflammatory, Musculoskeletal, and Autoimmune Disease. Curr Allergy Asthma Rep 2019; 19:37. [PMID: 31267251 DOI: 10.1007/s11882-019-0869-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to summarize the field to date and to discuss strengths and limitations of low-level laser (light) therapy (LLLT) for the future investigation as a treatment of inflammatory disease. RECENT FINDINGS LLLT is a promising therapeutic, particularly for those diseases of skin and joints because they are most accessible to treatment. Indeed, the known mechanisms of LLLT support its use for anti-inflammatory purposes, as well as stimulation of tissue growth and repair. Although the standard of care for the majority of inflammatory diseases is immunosuppressive agents such as corticosteroids with undesirable toxicities, LLLT offers a unique approach by being non-invasive and incurring minimal side effects. It is also relatively inexpensive and accessible and even has the possibility to be patient directed at home. There is evidence that LLLT is able to modulate the immune system at the skin and joint, and it has been shown to be efficacious in humans by affecting bacterial colonization as it may pertain to chronic rhinosinusitis. However, there is variability in the methods of laser application as well as a lack of evidence for laser type, dose-ranging studies, and wavelength selection that create barriers to the implementation of LLLT without further more rigorous and standardized study. The heterogeneity makes it difficult to draw strong conclusions about the efficacy of LLLT and its mechanisms.
Collapse
Affiliation(s)
| | - Emilia Marta Zywot
- Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Emily Mary Rabjohns
- Duke Department of Medicine, Division of Rheumatology and Immunology, DUMC 3874, 200 Trent Dr., Durham, NC, 27710, USA
| | - Hyun Ho Lee
- Duke Department of Medicine, Division of Rheumatology and Immunology, DUMC 3874, 200 Trent Dr., Durham, NC, 27710, USA
| | - David S Lawrence
- Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
- Department of Chemistry, University of North Carolina, Chapel Hill, USA
- Department of Pharmacology, School of Medicine, University of North Carolina, Chapel Hill, USA
| | - Teresa Kathleen Tarrant
- Duke School of Medicine, Durham, NC, USA.
- Duke Department of Medicine, Division of Rheumatology and Immunology, DUMC 3874, 200 Trent Dr., Durham, NC, 27710, USA.
| |
Collapse
|
14
|
Chen CC, Wu YT, Su YC, Shen YP, Chen FP. Efficacy of laser acupuncture for carpal tunnel syndrome: A study protocol for a prospective double-blind randomized controlled trial. Medicine (Baltimore) 2019; 98:e16516. [PMID: 31348263 PMCID: PMC6709042 DOI: 10.1097/md.0000000000016516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that causes hand discomfort and work disability. Since no satisfactory conventional treatments for mild to moderate CTS exist, we apply complementary alternative medicine (CAM) to this problem. Laser acupuncture (LA), a new, non-invasive therapy which uses low-level-laser therapy (LLLT) in acupuncture could help to manage CTS. However, only one small randomized, double-blind and crossover trial had been conducted, which is not enough to provide an evidence-based assessment of the effects of LA on CTS. OBJECTIVES The aim of this study protocol is to investigate the efficacy of LA therapy on patients with mild to moderate CTS through sonography of the median nerve and offer clear parameters of LLLT. METHODS This study protocol is a prospective double-blind randomized controlled trial. Forty subjects aged 20 to 80 years old and diagnosed as having mild to moderate CTS will be randomly assigned to the intervention group (real LA, 3-sessions a week for 2 weeks) and control group (sham LA, 3-sessions a week for 2 weeks). All subjects will be asked to wear night splints as the fundamental management approach. The laser parameters will include a wavelength of 808 nm, power output of 300 mW and power density of 300 mW/mm, with ten seconds of treatment for each acupuncture point (PC4, PC6, PC7, PC8, LI4, LI10, LI11, HT3, HT7, and LU10). Sham LA treatment will be applied without any laser power output. The primary outcome will be based the Boston Carpal Tunnel Syndrome Questionnaire and secondary outcomes included a visual analog scale, cross sectional area of median nerve by sonography and electrophysiological test before interventions and after 2, 4, 8, 12 weeks postintervention. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT03580265).
Collapse
Affiliation(s)
- Chuan-Chih Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University
- Department of Chinese Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center
- Integrated Pain Management Center, Tri-Service General Hospital
| | - Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center
| | - Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center
| | - Fang-Pey Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University
- Department of Traditional Chinese Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
15
|
Bartkowiak Z, Eliks M, Zgorzalewicz-Stachowiak M, Romanowski L. The Effects of Nerve and Tendon Gliding Exercises Combined with Low-level Laser or Ultrasound Therapy in Carpal Tunnel Syndrome. Indian J Orthop 2019; 53:347-352. [PMID: 30967707 PMCID: PMC6415562 DOI: 10.4103/ortho.ijortho_45_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common medical condition that doctors and physiotherapists come across in clinical practice. There are no explicit recommendations concerning which physical therapy methods should be applied in its treatment; however, there have also been no studies on the effects of combining low-level laser therapy (LLLT) or ultrasound with nerve and tendon gliding exercises. The purpose of this study was to evaluate the therapeutic efficacy of ultrasound and LLLT combined with gliding exercises. MATERIALS AND METHODS A total of seventy patients with mild to moderate CTS, divided into two groups, were included in this study. Group 1 received ultrasound treatment, whereas Group 2 underwent LLLT. The treatment lasted 2 weeks (5 sessions/week). In addition, both groups were treated with nerve and tendon gliding exercises three times daily. The clinical evaluation involved an interview on subjective and objective sensory abnormalities, the intensity of pain, the measurement of grip strength, Phalen's test, Tinel's sign, and the Boston Carpal Tunnel Questionnaire. The assessment was performed before and after the treatment. RESULTS A decrease in sensory impairments, improvement in visual analog scale, hand grip strength and the Boston Questionnaire results were significant in all patients after therapy. No meaningful differences between groups were noted in any of the examined variables after treatment. No adverse effects were observed. CONCLUSIONS The results of this study may suggest the clinical efficacy of LLLT or ultrasound combined with gliding exercises in patients with mild to moderate CTS.
Collapse
Affiliation(s)
- Zuzanna Bartkowiak
- Department of Health Prophylaxis, Laboratory of Medical Electrodiagnostics, Poznan University of Medical Sciences, Poznań, Poland
| | - Małgorzata Eliks
- Department of Health Prophylaxis, Laboratory of Medical Electrodiagnostics, Poznan University of Medical Sciences, Poznań, Poland,Address for correspondence: Mrs. Małgorzata Eliks, Department of Health Prophylaxis, Laboratory of Medical Electrodiagnostics, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-101 Poznań, Poland. E-mail:
| | | | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
16
|
Rankin IA, Sargeant H, Rehman H, Gurusamy KS. Low-level laser therapy for carpal tunnel syndrome. Cochrane Database Syst Rev 2017; 8:CD012765. [PMID: 35611937 PMCID: PMC6483673 DOI: 10.1002/14651858.cd012765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of low-level laser therapy (LLLT) in the management of carpal tunnel syndrome (CTS) is controversial. While some trials have shown distinct advantages of LLLT over placebo and some other non-surgical treatments, other trials have not. OBJECTIVES To assess the benefits and harms of LLLT versus placebo and versus other non-surgical interventions in the management of CTS. SEARCH METHODS On 9 December 2016 we searched CENTRAL, MEDLINE, Embase, and Science Citation Index Expanded for randomised controlled trials (RCTs). We also searched clinical trial registries for ongoing studies. We checked the references of primary studies and review articles, and contacted trial authors for additional studies. SELECTION CRITERIA We considered for inclusion RCTs (irrespective of blinding, publication status or language) comparing LLLT versus placebo or non-surgical treatment for the management of CTS. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials for inclusion and extracted the data. For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) with a 95% confidence interval (CI) using the random-effects model, calculated using Review Manager. For dichotomous data, we reported risk ratio (RR) and 95% CI. MAIN RESULTS We identified 22 trials randomising 1153 participants that were eligible for inclusion; nine trials (525 participants, 256 randomised to LLLT) compared LLLT with placebo, two (150 participants, 75 randomised to LLLT) compared LLLT with ultrasound, one compared LLLT with placebo and LLLT with ultrasound, two compared LLLT with steroid injection, and one trial each compared LLLT with other non-surgical interventions: fascial manipulation, application of a pulsed magnetic field, transcutaneous electrical nerve stimulation (TENS), steroid injection, tendon gliding exercises, and applying a wrist splint combined with non-steroidal anti-inflammatory drugs. Three studies compared LLLT as part of multiple interventions. Risk of bias varied across the studies, but was high or unclear in most assessed domains in most studies. Most studies were small, with few events, and effect estimates were generally imprecise and inconsistent; the combination of these factors led us to categorise the quality of evidence for most outcomes as very low or, for a small number, low. At short-term follow-up (less than three months), there was very low-quality evidence for any effect over placebo of LLLT on CTS for the primary outcome of Symptom Severity Score (scale 1 to 5, higher score represents worsening; MD -0.36, 95% CI -0.78 to 0.06) or Functional Status Scale (scale 1 to 5, higher score represents worsened disability; MD -0.56, 95% CI -1.03 to -0.09). At short-term (less than three months) follow-up, we are uncertain whether LLLT results in a greater improvement than placebo in visual analogue score (VAS) pain (scale 0 to 10, higher score represents worsening; MD -1.47, 95% CI -2.36 to -0.58) and several aspects of nerve conduction studies (motor nerve latency: higher score represents worsening; MD -0.09 ms, 95% CI -0.16 to -0.03; range 3.1 ms to 4.99 ms; sensory nerve latency: MD -0.10 ms, 95% CI -0.15 to -0.06; range 1.8 ms to 3.9 ms), as the quality of the evidence was very low. When compared with placebo at short-term follow-up, LLLT may slightly improve grip strength (MD 2.58 kg, 95% CI 1.22 to 3.95; range 14.2 kg to 25.23 kg) and finger-pinch strength (MD 0.94 kg, 95% CI 0.43 to 1.44; range 4.35 kg to 5.7 kg); however, the quality of evidence was low. Only VAS pain and finger-pinch strength results reached the minimal clinically important difference (MCID) as previously published. We are uncertain about the effect of LLLT in comparison to ultrasound at short-term follow-up for improvement in VAS pain (MD 2.81, 95% CI 1.21 to 4.40) and motor nerve latency (MD 0.61 ms, 95% CI 0.27 to 0.95), as the quality of evidence was very low. When compared with ultrasound at short-term follow-up, LLLT may result in slightly less improvement in finger-pinch strength (MD -0.71 kg, 95% CI -0.94 to -0.49) and motor nerve amplitude (MD -1.90 mV, 95% CI -3.63 to -0.18; range 7.10 mV to 9.70 mV); however, the quality of evidence was low. There was insufficient evidence to assess the long-term benefits of LLLT versus placebo or ultrasound. There was insufficient evidence to show whether LLLT is better or worse in the management of CTS than other non-surgical interventions. For all outcomes reported within these other comparisons, the quality of evidence was very low. There was insufficient evidence to assess adverse events, as only one study reported this outcome. AUTHORS' CONCLUSIONS The evidence is of very low quality and we found no data to support any clinical effect of LLLT in treating CTS. Only VAS pain and finger-pinch strength met previously published MCIDs but these are likely to be overestimates of effect given the small studies and significant risk of bias. There is low or very low-quality evidence to suggest that LLLT is less effective than ultrasound in the management of CTS based on short-term, clinically significant improvements in pain and finger-pinch strength. There is insufficient evidence to support LLLT being better or worse than any other type of non-surgical treatment in the management of CTS. Any further research of LLLT should be definitive, blinded, and of high quality.
Collapse
Affiliation(s)
- Iain A Rankin
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenUKAB25 2ZN
| | - Harry Sargeant
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenUKAB25 2ZN
| | - Haroon Rehman
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenUKAB25 2ZN
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | | |
Collapse
|
17
|
Franke TP, Koes BW, Geelen SJ, Huisstede BM. Do Patients With Carpal Tunnel Syndrome Benefit From Low-Level Laser Therapy? A Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil 2017. [PMID: 28629992 DOI: 10.1016/j.apmr.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome. DATA SOURCES The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. STUDY SELECTION Two reviewers independently applied the inclusion criteria to select potential studies. DATA EXTRACTION Two reviewers independently extracted the data and assessed the methodologic quality. DATA SYNTHESIS A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively). CONCLUSIONS In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse.
Collapse
Affiliation(s)
- Thierry P Franke
- Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sven J Geelen
- Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bionka M Huisstede
- Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
18
|
Bekhet AH, Ragab B, Abushouk AI, Elgebaly A, Ali OI. Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis. Lasers Med Sci 2017; 32:1439-1448. [PMID: 28580494 DOI: 10.1007/s10103-017-2234-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/12/2017] [Indexed: 02/06/2023]
Abstract
We performed this meta-analysis to investigate the efficacy of low-level laser therapy (LLLT), a physiotherapy modality with anti-inflammatory and analgesic effects, in the management of mild-to-moderate carpal tunnel syndrome (CTS). We searched PubMed, Web of Knowledge, Scopus, Cochrane Central, and Virtual Health Library for randomized controlled trials (RCTs) that compared the effects of LLLT with or without splinting versus placebo on functional and electromyographic outcomes in CTS. All outcomes were pooled as mean differences (MD) under the inverse variance or random effects model, using the statistical add-in (MetaXL, version 5.0). Eight RCTs (473 patients/631 wrists) were eligible for the final analysis. The overall effect estimates did not favor LLLT therapy group over placebo in all primary outcomes: visual analogue scale (MD -1.11, 95% CI [-2.58, 0.35]), symptom severity scale score (MD -1.41, 95% CI [-5.12, 2.29]), and functional status scale score (MD -1.33, 95% CI [-3.27, 0.61]). However, LLLT was superior to placebo in terms of grip strength (MD 2.19, 95% CI [1.63, 2.76]) and inferior to placebo in terms of sensory nerve action potential (MD -2.74, 95% CI [-3.66, -1.82]). Laser therapy is superior to placebo in terms of improving the grip strength; however, no significant difference was found between both groups in terms of functional status improvement, pain reduction, or motor electrodiagnostic evaluations. Further high-quality trials with longer follow-up periods are required to establish the efficacy of LLLT for CTS treatment.
Collapse
Affiliation(s)
- Amira Hassan Bekhet
- Faculty of Physical Therapy, Cairo University, Cairo, 11566, Egypt. .,Physical Therapy Egypt Research Society, Cairo, Egypt. .,Medical Research Group of Egypt, Cairo, Egypt.
| | - Basma Ragab
- Faculty of Physical Therapy, Cairo University, Cairo, 11566, Egypt.,Physical Therapy Egypt Research Society, Cairo, Egypt.,Medical Research Group of Egypt, Cairo, Egypt
| | - Abdelrahman Ibrahim Abushouk
- Medical Research Group of Egypt, Cairo, Egypt.,NovaMed Medical Research Association, Cairo, Egypt.,Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Elgebaly
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Olfat Ibrahim Ali
- Faculty of Physical Therapy, Cairo University, Cairo, 11566, Egypt.,Physical Therapy Egypt Research Society, Cairo, Egypt
| |
Collapse
|
19
|
Burger M, Kriel R, Damon A, Abel A, Bansda A, Wakens M, Ernstzen D. The effectiveness of low-level laser therapy on pain, self-reported hand function, and grip strength compared to placebo or “sham” treatment for adults with carpal tunnel syndrome: A systematic review. Physiother Theory Pract 2017; 33:184-197. [PMID: 28272964 DOI: 10.1080/09593985.2017.1282999] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marlette Burger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Réna Kriel
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrea Damon
- Phillo Beukes Physiotherapy, Hunters Medical Services, Knysna, South Africa
| | - Amy Abel
- Department of Physiotherapy, Jacquie Kieck Physiotherapy, Port Alfred, South Africa
| | - Anisha Bansda
- Linksfield Netcare Hospital and New Life Kensington Hospital, Johannesburg, South Africa
| | - Marinique Wakens
- Department of Physiotherapy, Prof ZK Matthews Hospital, Barkly West, South Africa
| | - Dawn Ernstzen
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
20
|
Clinical effectiveness of low-level laser treatment on peripheral somatosensory neuropathy. Lasers Med Sci 2017; 32:721-728. [DOI: 10.1007/s10103-016-2137-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/26/2016] [Indexed: 12/12/2022]
|
21
|
Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016; 15:1273-1284. [PMID: 27751557 DOI: 10.1016/s1474-4422(16)30231-9] [Citation(s) in RCA: 373] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 08/05/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2022]
Abstract
Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.
Collapse
Affiliation(s)
- Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Don Carlo Gnocchi Onlus Foundation, Milan, Italy.
| | - Daniele Coraci
- Don Carlo Gnocchi Onlus Foundation, Milan, Italy; Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy
| | - Carmen Erra
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Pietro Caliandro
- Institute of Neurology, Policlinico A Gemelli Foundation University Hospital, Rome, Italy
| | | |
Collapse
|
22
|
Borzabadi-Farahani A. Effect of low-level laser irradiation on proliferation of human dental mesenchymal stem cells; a systemic review. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2016; 162:577-582. [PMID: 27475781 DOI: 10.1016/j.jphotobiol.2016.07.022] [Citation(s) in RCA: 292] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Identification of factors that enhance the proliferation of human dental mesenchymal stem cells (DMSCs) is vital to facilitate tissue regeneration. The role of low-level laser irradiation (LLLI) on proliferation of human DMSCs has not been well established. OBJECTIVE To assess the effect of LLLI on proliferation of human DMSCs when applied in-vitro. DATA SOURCES Electronic search of literature was conducted (2000-2016) on PubMed, Web of Science, and Scopus databases. Search terms included low-level light therapy, low-level laser irradiation, low-level light irradiation, LLLT, humans, adolescent, adult, cells, cultured, periodontal ligament, dental pulp, stem cells, dental pulp stem cells, mesenchymal stem cells, periodontal ligament stem cell, deciduous teeth, cell proliferation, adult stem cells, radiation, and proliferation. RESULTS The literature search identified 165 studies with 6 being eligible for inclusion; all used diode lasers; 5 studies used InGaAIP diode lasers; 4 used 660nm, and the other two applied 810nm or 980nm wavelength LLLI. The distance between the DMSCs and the laser spot ranged between 0.5mm to 2mm. The time intervals of cell proliferation analysis ranged from 0h to 7days after LLLI. After 660nm LLLI, an increase in the DMSC's proliferation was reported [DMSCs extracted from dental pulp of deciduous teeth (two irradiations, 3J/cm(2), 20mW was more effective than 40mW), adult teeth (two irradiations, 0.5 and 1.0J/cm(2), 30mW), and from adult periodontal ligament (two irradiations, 1.0J/cm(2) was more effective than 0.5J/cm(2), 30mW)]. Similarly, an increase in the proliferation of DMSCs extracted from dental pulp of adult teeth was reported after 810nm LLLI (7 irradiations in 7days, 0.1 and 0.2J/cm(2), 60mW) or 980nm LLLI (single irradiation, 3J/cm(2), 100mW). However, 660nm LLLI in one study did not increase the proliferation of DMSCs (single irradiation, energy densities of 0.05, 0.30, 7, and 42J/cm(2), 28mW). CONCLUSION There is limited evidence that in-vitro LLLI (660/810/980nm, with energy densities of 0.1-3J/cm(2)) increases the proliferation of DMSCs. Considering the limited evidence and their method heterogeneity it is difficult to reach a firm conclusion. Further research is necessary to identify the optimal characteristics of the LLLI setting (wave length, energy density, power output, frequency/duration of irradiations, distance between the cells and the laser spot/probe) to increase proliferation of DMSCs, and assess its impact on replicative senescence, as well as determine feasibility of the use in the clinical setting.
Collapse
Affiliation(s)
- Ali Borzabadi-Farahani
- Orthodontics, Department of Clinical Sciences and Translational Medicine, Univeristy of Rome Tor Vergata, Rome, Italy; Warwick Medical School, University of Warwick, Coventry, and Specialist Orthodontic Practice, London, United Kingdom.
| |
Collapse
|
23
|
Barbosa RI, Fonseca MDCR, Rodrigues EKDS, Tamanini G, Marcolino AM, Mazzer N, Guirro RRDJ, MacDermid J. Efficacy of low-level laser therapy associated to orthoses for patients with carpal tunnel syndrome: A randomized single-blinded controlled trial. J Back Musculoskelet Rehabil 2016; 29:459-66. [PMID: 26444330 DOI: 10.3233/bmr-150640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS). METHODS 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength. RESULTS Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms. CONCLUSION LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS.
Collapse
Affiliation(s)
- Rafael Inácio Barbosa
- Rehabilitation and Performance Program, University of São Paulo, Ribeirão Preto, Brazil.,Federal University of Santa Catarina, Araranguá, Brazil
| | - Marisa de Cássia Registro Fonseca
- Rehabilitation and Performance Program, University of São Paulo, Ribeirão Preto, Brazil.,Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Guilherme Tamanini
- Rehabilitation and Performance Program, University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Marcio Marcolino
- Rehabilitation and Performance Program, University of São Paulo, Ribeirão Preto, Brazil.,Federal University of Santa Catarina, Araranguá, Brazil
| | - Nilton Mazzer
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, University of São Paulo, Ribeirão Preto, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- Rehabilitation and Performance Program, University of São Paulo, Ribeirão Preto, Brazil.,Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, University of São Paulo, Ribeirão Preto, Brazil
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
24
|
Li ZJ, Wang Y, Zhang HF, Ma XL, Tian P, Huang Y. Effectiveness of low-level laser on carpal tunnel syndrome: A meta-analysis of previously reported randomized trials. Medicine (Baltimore) 2016; 95:e4424. [PMID: 27495063 PMCID: PMC4979817 DOI: 10.1097/md.0000000000004424] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review. METHODS We conducted electronic searches of PubMed (1966-2015.10), Medline (1966-2015.10), Embase (1980-2015.10), and ScienceDirect (1985-2015.10), using the terms "carpal tunnel syndrome" and "laser" according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes. RESULTS Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MD = 2.04; 95% CI: 0.08-3.99; P = 0.04; I = 62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MD = 0.97; 95% CI: 0.84-1.11; P < 0.01; I = 0%). The sensory nerve action potential (SNAP) (at 12 weeks) was better in the LLLT group (MD = 1.08; 95% CI: 0.44-1.73; P = 0.001; I = 0%). However, 1 included study was weighted at >95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups. CONCLUSION This study revealed that low-level laser improve hand grip, VAS, and SNAP after 3 months of follow-up for mild to moderate CTS. More high-quality studies using the same laser intervention protocol are needed to confirm the effects of low-level laser in the treatment of CTS.
Collapse
Affiliation(s)
- Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital
- Correspondence: Zhi-Jun Li, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China (e-mail: )
| | - Yao Wang
- Department of Oncological Surgery, Tianjin Nankai Hospital, Tianjin Integrated Traditional Chinese and Western Medicine Hosptial
| | - Hua-Feng Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Hospital, Tianjin, People's Republic of China
| | - Peng Tian
- Department of Orthopedics, Tianjin Hospital, Tianjin, People's Republic of China
| | - Yuting Huang
- Cancer & Immunology Research, Children's Research Institute, Children's National Medical Center, Washington DC
| |
Collapse
|
25
|
George E, Elman I, Becerra L, Berg S, Borsook D. Pain in an era of armed conflicts: Prevention and treatment for warfighters and civilian casualties. Prog Neurobiol 2016; 141:25-44. [PMID: 27084355 DOI: 10.1016/j.pneurobio.2016.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/23/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
Chronic pain is a common squealae of military- and terror-related injuries. While its pathophysiology has not yet been fully elucidated, it may be potentially related to premorbid neuropsychobiological status, as well as to the type of injury and to the neural alterations that it may evoke. Accordingly, optimized approaches for wounded individuals should integrate primary, secondary and tertiary prevention in the form of thorough evaluation of risk factors along with specific interventions to contravene and mitigate the ensuing chronicity. Thus, Premorbid Events phase may encompass assessments of psychological and neurobiological vulnerability factors in conjunction with fostering preparedness and resilience in both military and civilian populations at risk. Injuries per se phase calls for immediate treatment of acute pain in the field by pharmacological agents that spare and even enhance coping and adaptive capabilities. The key objective of the Post Injury Events is to prevent and/or reverse maladaptive peripheral- and central neural system's processes that mediate transformation of acute to chronic pain and to incorporate timely interventions for concomitant mental health problems including post-traumatic stress disorder and addiction We suggest that the proposed continuum of care may avert more disability and suffering than the currently employed less integrated strategies. While the requirements of the armed forces present a pressing need for this integrated continuum and a framework in which it can be most readily implemented, this approach may be also instrumental for the care of civilian casualties.
Collapse
Affiliation(s)
- E George
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, MGH, HMS, Boston, MA, United States; Commander, MC, USN (Ret), United States
| | - I Elman
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Psychiatry, Boonshoft School of Medicine and Dayton VA Medical Center, United States; Veterans Administration Medical Center, Dayton, OH, United States
| | - L Becerra
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, BCH, HMS, Boston, MA, United States; Departments of Psychiatry and Radiology, MGH, Boston, MA, United States
| | - Sheri Berg
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, MGH, HMS, Boston, MA, United States
| | - D Borsook
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, BCH, HMS, Boston, MA, United States; Departments of Psychiatry and Radiology, MGH, Boston, MA, United States.
| |
Collapse
|
26
|
Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ ORTHOPEDICS & RHEUMATOLOGY 2015; 2:00068. [PMID: 26858986 PMCID: PMC4743666 DOI: 10.15406/mojor.2015.02.00068] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pain is the most common reason for physician consultation in the United States. One out of three Americans is affected by chronic pain annually. The number one reason for missed work or school days is musculoskeletal pain. Currently accepted therapies consist of non-steroidal anti-inflammatory drugs, steroid injections, opiate pain medications and surgery, each of which carries their own specific risk profiles. What is needed are effective treatments for pain which have an acceptably low risk-profile. For over forty years, low level laser (light) therapy (LLLT) and LED (light emitting diode) therapy (also known as photobiomodulation) has been shown to reduce inflammation and edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies. The purpose of this paper is to review the use of LLLT for pain, the biochemical mechanisms of action, the dose response curves, and how LLLT may be employed by orthopedic surgeons to improve outcomes and reduce adverse events. With the predicted epidemic of chronic pain in developed countries, it is imperative to validate cost-effective and safe techniques for managing painful conditions which would allow people to live active and productive lives. Moreover the acceptance of LLLT (which is currently being used by many specialties around the world) into the armamentarium of the American health care provider would allow for additional treatment options for patients. A new cost-effective therapy for pain could elevate quality of life while reducing financial strains.
Collapse
Affiliation(s)
| | - Roberta T Chow
- Brain and Spine Research Institute, University of Sydney, Australia
| | - Michael R Hamblin
- Wellman Center for Photo medicine, Massachusetts General Hospital, USA
- Department of Dermatology, Harvard Medical School, USA
- Division of Health Sciences and Technology, USA
| | | |
Collapse
|