Randomized, Double-Blind Clinical Research Studies

Basics of the action of monochromatic visible and near IR (laser) radiation on cells

http://www.isbem.org/conf/1998/proceedi/125.pdf

 

A meta-analysis of the efficacy of laser phototherapy on pain relief

http://www.ncbi.nlm.nih.gov/pubmed/20842007

Objective:

Laser phototherapy has been widely used to relieve pain for more than 30 years, but its efficacy remains controversial. To ascertain the overall effect of phototherapy on pain, we aggregated the literature and subjected the studies to statistical meta-analysis.

Conclusion:

Laser phototherapy effectively relieves the pain of various etiologies; making it a valuable addition to contemporary pain management armamentarium

meta-analysis of the efficacy of phototherapy in tissue repair

http://www.ncbi.nlm.nih.gov/pubmed/19698019

Objective:

The effect of phototherapy on tissue repair was determined by aggregating the literature and using statistical meta-analysis to analyze pertinent studies published between 2000 and 2007.

Conclusion:

These findings indicate that phototherapy is a highly effective form of treatment for tissue repair, with stronger supporting evidence resulting from experimental animal studies than human studies

 

Therapeutic and Analgesic Efficacy of Laser in Conjunction With Pharmaceutical Therapy for Trigeminal Neuralgia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775958/

Objective:

Trigeminal neuralgia (TN) is the most common neuralgia in the head and neck region and a common cause of orofacial pain. It is routinely treated with carbamazepine. Laser, acupuncture and radiofrequency are among other treatment modalities for this condition. This study sought to assess the efficacy of laser therapy in conjunction with carbamazepine for the treatment of TN.

Conclusion:

It is difficult to reach a conclusion regarding a specific dosage, wavelength or type of laser with the highest analgesic efficacy. In most cases, minimum dosage is not known and various doses have been reported for each type of laser. Selection of the most appropriate wavelength is also difficult because the conclusions have been drawn mainly based on the clinical experiences of the operators, and a widely accepted protocol does not exist in this regard. For instance, it has been suggested that laser therapy activates the somatosensory receptors and decreases regional pain perception, causing relaxation at the trigger points. However, this theory does not apply to deeper trigger points. Thus, variability in the results of studies may be explained by differences in laser parameters. Further studies are required on different types, wavelengths and energy densities of laser for trigger points at different depths in patients with TN.

Laser therapy (LLLT) reduces oxidative stress in primary cortical neurons

https://www.ncbi.nlm.nih.gov/pubmed/23281261

Objective:

Low-level laser (light) therapy (LLLT) involves absorption of photons being in the mitochondria of cells leading to improvement in electron transport, increased mitochondrial membrane potential (MMP), and greater ATP production. Low levels of reactive oxygen species (ROS) are produced by LLLT in normal cells that are beneficial. We exposed primary cultured murine cortical neurons to oxidative stressors: hydrogen peroxide, cobalt chloride and rotenone in the presence or absence of LLLT (3 J/cm², CW, 810 nm wavelength laser, 20 mW/cm²). Cell viability was determined by Prestoblue™ assay. ROS in mitochondria was detected using Mito-sox, while ROS in the cytoplasm was detected with CellRox™. MMP was measured with tetramethylrhodamine. In normal neurons, LLLT elevated MMP and increased ROS.

Conclusion:

In oxidatively-stressed cells, LLLT increased MMP but reduced high ROS levels and protected cultured cortical neurons from death. Although LLLT increases ROS in normal neurons, it reduces ROS in oxidatively-stressed neurons. In both cases, MMP is increased. These data may explain how LLLT can reduce clinical oxidative stress in various lesions while increasing ROS in cells in vitro.

 

Photobiomodulation of Pain in Carpal Tunnel Syndrome: Review of Seven Laser Therapy Studies

https://www.liebertpub.com/doi/10.1089/pho.2006.24.101

Objective:

In this review, seven studies using photo radiation to treat carpal tunnel syndrome (CTS) are discussed: two controlled studies that observed real laser to have a better effect than sham laser, to treat CTS; three open protocol studies that observed real laser to have a beneficial effect to treat CTS; and two studies that did not observe real laser to have a better effect than a control condition, to treat CTS. In the five studies that observed beneficial effect from real laser, higher laser dosages (9 Joules, 12–30 Joules, 32 J/cm2, 225 J/cm2) were used at the primary treatment sites (median nerve at the wrist, or cervical neck area), than dosages in the two studies where real laser was not observed to have a better effect than a control condition (1.8 Joules or 6 J/cm2). The average success rate across the first five studies was 84% (SD, 8.9; total hands = 171). The average pain duration prior to successful photoirradiation was 2 years.

Conclusion:

Photoirradiation is a promising new, conservative treatment for mild/moderate CTS cases; It is cost-effective compared to current treatments.

 

Low-level laser therapy for wound healing: mechanism and efficacy

https://www.ncbi.nlm.nih.gov/pubmed/15841638

Objective:

In examining the effects of LLLT on cell cultures in vitro, some articles report an increase in cell proliferation and collagen production using specific and somewhat arbitrary laser settings with the helium-neon (HeNe) and gallium arsenide lasers, but none of the available studies address the mechanism, whether photothermal, photochemical, or photomechanical, whereby LLLT may be exerting its effect. Some studies, especially those using HeNe lasers, report improvements in surgical wound healing in a rodent model; however, these results have not been duplicated in animals such as pigs, which have skin that more closely resembles that of humans. In humans, beneficial effects on superficial wound healing found in small case series have not been replicated in larger studies.

Conclusion:

To better understand the utility of laser therapy in cutaneous wound healing, good clinical studies that correlate cellular effects and biologic processes are needed. Future studies should be well-controlled investigations with rational selection of lasers and treatment parameters. In the absence of such studies, the literature does not appear to support the widespread use of LLLT in wound healing at this time. Although applications of high-energy (10-100 W) lasers are well established with significant supportive literature and widespread use, conflicting studies in the literature have limited low-level laser therapy (LLLT) use in the United States to investigational use only. Yet LLLT is used clinically in many other areas, including Canada, Europe, and Asia, for the treatment of various neurologic, chiropractic, dental, and dermatologic disorders. To understand this discrepancy, it is useful to review the studies on LLLT that have, to date, precluded Food and Drug Administration approval of many such technologies in the United States. The fundamental question is whether there is sufficient evidence to support the use of LLLT. (LLLT or Low-Level Laser Therapy does not recognize Primary Tissue Variability Factors and is therefore ineffective.

 

Lasers and photodynamic therapy in the treatment of onychomycosis: a review of the literature

https://escholarship.org/uc/item/0js6z1kw

Objective:

Onychomycosis is a widespread problem. Oral antifungal medications are currently the gold standard of care, but treatment failure is common and oral therapy is contraindicated in many cases. There is a need for effective treatment without the systemic complications posed by oral therapy. Laser and photodynamic therapy may have the potential to treat onychomycosis locally without adverse systemic effects; some small studies have even reported achieving clinical and mycologic cure. However, there is a reason for restraint; these therapies are expensive and time-consuming. Furthermore, they may not be covered by insurance and have not been proven effective with randomized, controlled clinical trials.

Conclusion:

This paper will review the current literature regarding the use of laser and photodynamic therapy as potential treatments for onychomycosis.

 

A Systematic Review With Procedural Assessments and Meta-analysis of Laser Therapy in Lateral Elbow Tendinopathy (Tennis Elbow)

https://www.medscape.org/viewarticle/579379

Objective:

Recent reviews have indicated that low-level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing the validity of treatment procedures and doses or the influence of prior steroid injections.

Conclusion:

LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews that failed to assess treatment procedures, wavelengths, and optimal doses.

Efficacy of high-intensity laser therapy in the management of foot ulcers: a systematic review

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181666/

Objective:

The aim of this systematic review was to assess the efficacy of high-intensity laser therapy (HILT) on wound surface area in patients with foot ulcers. [Methods] Four databases including PubMed, MEDLINE, the Cochrane library, and the Physiotherapy Evidence Database (PEDro) were searched up to the end of April 2018 to identify relevant studies. Studies were included if they met the following criteria: randomized controlled trial (RCT), assessed the efficacy of HILT in patients with foot ulcers, evaluated wound surface area, and written in the English language with available full text. The PEDro scale was used to evaluate the quality of studies. [Results] A total of three RCTs met the inclusion criteria, with two studies of the efficacy of HILT in adult patients with diabetic foot ulcers and one in spina bifida children with neuropathic foot ulcers. According to the PEDro scale assessment, all three studies were rated as a fair quality. All studies found that HILT provided significantly better outcomes compared to sham laser or standard medical therapy.

Conclusion:

This systematic review suggests that HILT is an effective modality for wound healing in patients with foot ulcers, but further large-scale studies are required to confirm its efficacy.

 

The effects of high-intensity laser therapy on pain and function in patients with knee osteoarthritis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140828/

Objective:

The purpose of this study was to examine the effects of high-intensity laser therapy (HILT) on pain and function in patients with knee osteoarthritis

Conclusion:

High-intensity laser therapy is considered an effective non-surgical intervention for reducing pain in patients with knee osteoarthritis and helping them to perform daily activities.

 

Effects of high-intensity laser therapy on pain and function of patients with chronic back pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468204/

Objective:

This study examined the effects of High-Intensity Laser Therapy on pain and function of patients with chronic back pain.

Conclusion:

In this study, VAS and ODI significantly decreased in a within-group comparison of CPTG and HLTG (p<0.05). In a between-group comparison after the treatment, VAS and ODI of HLTG were significantly lower than CPTG… This study has several limitations. First, the number of subjects was small. The sample only included patients who visited our hospital during one four-week period. Second, we could not perfectly control the daily routine of the subjects. Third, as the treatment duration was short, we could not check the long-term effects. We believe that many new studies on the effects of HILT will be required in order to complement the limitations of this study.

 

The efficacy of laser therapy in tissue repair and pain control: a meta-analysis study

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=OBJECTIVE&list_uids=15345176&query_hl=10&itool=pubmed_DocSum

Objective:

We used statistical meta-analysis to determine the overall treatment effects of laser phototherapy on tissue repair and pain relief.

Conclusion:

These findings mandate the conclusion that laser phototherapy is a highly effective therapeutic modality for tissue repair and pain relief

Efficacy of laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials

http://www.ncbi.nlm.nih.gov/pubmed/19913903

Objective:

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 randomized controlled trials to assess the efficacy of LLLT in neck pain.

Conclusion:

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.

In chronic low back pain, laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomized trial

http://www.ncbi.nlm.nih.gov/pubmed/17725472?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Objective:

Is laser therapy an effective adjuvant intervention for chronic low back pain?

Conclusion:

In chronic low back pain, laser therapy combined with exercise is more beneficial than exercise alone in the long term

 

The effect of laser irradiation for nucleus pulposus: an experimental study.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=OBJECTIVE&list_uids=15845216&query_hl=18&itool=pubmed_DocSum

Objective:

The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra-disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study.

Conclusion:

One of the mechanisms thought to be responsible for PLDD's effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation.

The role of laser biostimulation in early post-surgery rehabilitation and its effect on wound healing

http://www.ncbi.nlm.nih.gov/pubmed/20203347

Objective:

Low energy infrared laser radiation had a beneficial effect on the covering of the scar with stratified squamous cornifying epithelium and intensified wound healing.

Conclusion:

The gross and microscopic findings indicated a beneficial effect of laser stimulation on wound healing. These results underscore the utility of biostimulation lasers in the early postoperative period. Physio-mechanical investigations did not reveal an effect of infrared laser biostimulation on the breaking strength of the cutaneous scar.

 

The efficacy of laser therapy in wound repair: a meta-analysis of the literature.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=OBJECTIVE&list_uids=15315732&query_hl=10&itool=pubmed_DocSum

Objective:

We determined the overall effects of laser therapy on tissue healing by aggregating the literature and subjecting studies meeting the inclusion and exclusion criteria to statistical meta-analysis

Conclusion:

We conclude that laser therapy is an effective tool for promoting wound repair.

 

A meta-analysis of the efficacy of laser phototherapy on pain relief

https://www.ncbi.nlm.nih.gov/pubmed/20842007

Objective:

Laser phototherapy has been widely used to relieve pain for more than 30 years, but its efficacy remains controversial. To ascertain the overall effect of phototherapy on pain, we aggregated the literature and subjected the studies to statistical meta-analysis.

Conclusion:

These findings warrant the conclusion that laser phototherapy effectively relieves pain of various etiologies; making it a valuable addition to contemporary pain management armamentarium.

Wound healing of animal and human body sport and traffic accident injuries using low-level laser therapy treatment: a randomized clinical study of seventy-four patients with a control group

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=OBJECTIVE&list_uids=11800105&query_hl=10&itool=pubmed_DocSum

OBJECTIVE:

CONCLUSION:

In addition to accelerated wound healing, the main advantages of LLLT for postoperative sport- and traffic-related injuries include prevention of side effects of drugs, significantly accelerated functional recovery, earlier return to work, training and sports competition compared to the control group of patients, and cost-benefit.

 

Role of laser therapy in neurorehabilitation

https://www.ncbi.nlm.nih.gov/pubmed/21172691

Objective:

In recent years, LLLT has become an increasingly mainstream modality, especially in the areas of physical medicine and rehabilitation. At first, used mainly for wound healing and pain relief, the medical applications of LLLT have broadened to include diseases such as stroke, myocardial infarction, and degenerative or traumatic brain disorders. This review will cover the mechanisms of LLLT that operate both on a cellular and a tissue level. Mitochondria are thought to be the principal photoreceptors, and increased adenosine triphosphate, reactive oxygen species, intracellular calcium, and release of nitric oxide are the initial events. Activation of transcription factors then leads to the expression of many protective, anti-apoptotic, anti-oxidant, and pro-proliferation gene products. Animal studies and human clinical trials of LLLT for indications with relevance to neurology, such as stroke, traumatic brain injury, degenerative brain disease, spinal cord injury, and peripheral nerve regeneration, will be covered.

Conclusion:

Laser Therapy is steadily moving into mainstream medical practice. As the Western populations continue to age, the incidence of the degenerative diseases of old age will only continue to increase and produce severe financial and societal burden. Moreover, despite the best efforts of “big pharma,” distrust of pharmaceuticals is growing in general because of uncertain efficacy and troublesome adverse effects. Laser therapy has no reported adverse effects, and no reports of adverse events can be directly attributed to laser or light therapy. We believe that the high benefit-risk ratio of laser therapy should be better appreciated by medical professionals in the rehabilitation and physical medicine specialties. The introduction of safe and affordable therapy laser devices will lead to many home-use photo medical applications. The particular benefits of LLLT to both the central and peripheral nervous systems suggest that much wider use of quantum energy medicine could or should be made in cases of both brain diseases and injuries.

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