LLLT is applied to a wide variety of acute and chronic musculoskeletal pain syndromes whose main presenting symptom is pain (back pain, muscle spasm, tendonitis, tennis elbow, carpal tunnel syndrome, fibromyalgia), dermatologic conditions (telangiectasis and low extremities ulcers). LLLT has been shown to be effective in a variety of musculoskeletal conditions and associated pain presentations (2).
In Rheumatoid Arthritis, LLLT can benefit not only the pain of acute small joint inflammation but also the chronic pain (3). In a review article on rheumatology (3), some 18 papers were considered. All studies involved double-blind trials with LLLT in chronic rheumatoid, and reported significant improvement in pain (80% success rate in relieving pain). Upon comparing LLLT to a similar rate of pain attenuation using anti-inflammatory drugs (NSAIDs), the LLLT was free of any side-effects while 20% of patients treated with NSAIDs suffered unacceptable side-effects of medicationiv. In another study of 170 patients with rheumatoid arthritis using LLLT (4), pain attenuation of up to 90% was noted (5).
In a report of 1,000 treatments with LLLT (830 nm) for a wide variety of chronic pain syndromes, an overall reduction in pain levels of 70% was established (6). Trellis et al (7) used LLLT for osteoarthritis of the knee in 40 patients. He reported a significant reduction of 82% of the patients with improved joint mobility. (7) Among 36 randomized patients, with pain caused by cervical osteoarthritis, those who received infra-red and low level laser treatment improved 75% compared with the group receiving mock treatment (31%) (8). Similarly, a study of 60 patients with cervical osteoarthritis, low pulsed laser was successful in relieving pain and in improving function (9). The results of a study show that cervical myofascial pain is significantly improved with 3-months treatment with diode laser (10). A similar successful LLLT treatment has been described for whiplash injuries (11).
In a randomized study with 30 patients with supraspinatus or bicipital tendonitis, the results demonstrated the effectiveness of laser therapy in tendonitis of the shoulder (12) . Another study with a patient population (n = 324), with either medial epicondylitis (Golfer's elbow; n = 50) or lateral epicondylitis (Tennis elbow; n = 274), and randomly allocated, provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis. (13)
Treatment with low-level laser therapy (LLLT) was shown effective in treating Carpal Tunnel Syndrome pain (14). Another study showed significant decreases in McGill Pain Questionnaire scores. Median nerve sensory latency, and Phalen and Tinel signs were observed after treatment series with low level laser therapy. Patients could perform their previous work (computer typist, handyman) and were stable for 1 to 3 years (15).
In acute trauma there is a soft tissue injury comprising swelling, haematoma, pain and reduced mobility. Sporting injuries and domestic accidents usually involve damage to muscles, joint ligaments and tenclass. In the absence of bone fracture or other injury demanding priority treatment, LLLT should be instituted at the earliest opportunity. Kumar reported a comparative study in 50 patients with inversion injuries of the ankle. He found that compared to conventional physiotherapy, the LLLT treated patients showed a more rapid resolution of symptoms and an earlier return to full weight-bearing (16).
Fibromyaliga (FM) is characterized by widespread pain in the body, associated with particular tender points. It is often accompanied by disturbed sleep patterns, fatigue, headaches, irritable bowel and bladder syndrome, morning stiffness, anxiety and depression. FM can cause a high level of functional disability and have a significantly negative effect on quality of life. One study suggests that "laser therapy is effective on pain, muscle spasm, morning stiffness, fatigue, depression and total tender point number in Fibromyalgia" (17).
A randomized controlled study with 63 patients with non-radiating low back pain showed that LLLT significantly improved pain and function (18).
In summary, the bulk of published work to date supports the use of LLLT for treatment of a variety of musculoskeletal conditions and associated pain. Moreover, the LLLT proved to be not only more effective than conventional methods, but more economical as well. The added advantage of absence of side effects, non-invasive nature of therapy and the ease of application, ensures good patient acceptance of the treatment modality.
(1) Mochizuki-Oda, N., Neuroscience Letter, 323:207, 2202
(2) Simunovic Z. Laser Center, Locarno, Switzerland. J Clin Laser Med Surg 1996 Aug;14(4):163-7 Low level laser therapy with trigger points technique: a clinical study
on 243 patients.. "LLLT suggests that the laser beam can be used as monotherapy or as a supplementary treatment to other therapeutic procedures for pain treatment".
Publication Types: Clinical Trial Controlled Clinical Trial PMID: 9456632 [PubMed - indexed for MEDLINE]
(3) Fulga C. N Antiinflammatory effect of laser therapy in rheumatoid arthritis.. Rom J Intern Med 1998 Jul-Dec;36(3-4):273-9
(4) Gartner, Laser Therapy, 4:107, 1992.
(5) Asada et al, Laser Therapy 3:77, 1991.
(6) Moore, in Fontiers in Electro-optics, 283, 1990.
(7) Trellis et al, Laser Therapy 3:149, 1991.
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osteoarthrosis. Acupunct Electrother Res 1981;6(4):277-84
(9) Ozdemir F et al. The clinical efficacy of low power laser therapy on pain and function in cervical osteoarthritis. Clin Rheumatol 2001;20(3): 181-4
(10) Ceccherelli F, Diode Laser in cervical myofascial pain: a double-blind study versus placebo. Clin J Pain 1989 Dec;5(4):301-4
(11) Ohshiro, in Low-reactive level laser therapy practical application. , 103, Chichester, U.K., John Wiley & Sons, 1991.
(12) England S, Farrell AJ, Coppock JS, Struthers G, Bacon PA. Low power laser therapy of shoulder tendonitis. Scand J Rheumatol 1989;18(6):427-31
(13) Simunovic Z, Trobonjaca T, Trobonjaca Z. Treatment of medial and lateral epicondylitis--tennis and golfer's elbow--with low level laser therapy: a multicenter double
blind, placebo-controlled clinical study on 324 patients. : J Clin Laser Med Surg 1998 Jun;16(3):145-51
(14) Arch Phys Med Rehabil 2002 Jul;83(7):978-88 Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A
controlled study. Naeser MA, Hahn KA, Lieberman BE, Branco KF.
(15) Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve. Arch
Phys Med Rehabil 2002 Jul;83(7):978-88 stimulation: A controlled study.
(16) Kumar et al, Laser in Medical Science, 298, 1988.
(17)Gur A et al. Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo controlled trial. Lasers Med Sci 2002;17(1):57-61
(18) Basford JR et al. Laser therapy: a randomised controlled trial of the effects of low intensity laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabili