Low Level Laser Therapy [LLLT]: A Bibliography of recent Papers

Philip AM Rogers MRCVS, <philrogers@eircom.net>

1 Esker Lawns, Lucan, Dublin, Ireland

| Introduction | Discussion | Summary | Abstracts |

Introduction

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Medline [http://www.ncbi.nlm.nih.gov/PubMed/medline.html] and SPIE (International Society for Optical Engineering) [http://www.spie.org/], [e-mail: <spie@spie.org>] were searched for recent abstracts on low level laser therapy (LLLT). Medline was searched for papers published within the past 2 years. Some older papers were taken from SPIE. Acupuncture Progress [terminated since then] had additional abstracts but, due to time constraints, that source was not searched.

This bibliography lists 51 abstracts on LLLT, 40 from Medline and 11 from SPIE. For ease of use, the abstracts were shortened and the terminology standardised. The bibliography follows an earlier clinical paper "Clinical use of low level laser therapy" [Web Journal of Acupuncture, http://users.med.auth.gr/~karanik/english/vet/laser1.htm].

Abstract breakdown by year of publication was:

The following table summarises the conditions or tissues treated, & the outcome (no effect, general article with no clear conclusion on outcome, or positive effect).

 Discussion

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General effects of LLLT: Of 4 overviews on LLLT, 2 were general reviews (4, 24,) & 2 indicated positive effects (41, 43). Takac & Stojanovic claimed the following general effects for LLLT:

• anti-inflammatory, analgesic & anti-edematous effect on tissues;
• absolute increase in microcirculation, higher rates of ATP, RNA & DNA synthesis, & thus better tissue oxygenation & nutrition;
• increase in the absorption of interstitial fluid, better tissue regeneration & stimulation of the analgesic effect.

They concluded "The past three decades of laser medicine & surgery have shown great progress & promise for the future" (41).

Wounds: From the mid 1980's to the mid 1990's many authors, especially those in clinical practice, hailed LLLT as a valuable method in treating superficial lesions, such as wounds, burns, granulomas. In contrast, of 5 recent studies, 2 indicated enhanced fibroblastic activity in vitro, & 2 failed to find evidence that laser per se helped wound healing in vivo. However, one of those concluded that "a combination of He-Ne laser & infrared light may promote the healing of venous leg ulcers".

Cardiovascular, vascular, cardiac, lymph system: Of 7 articles, (11, 16, 17, 18, 27, 36, 46), all claimed positive cardiovascular or circulatory effects.

Kidney function: Only one paper concluded: "After LLLT renal blood microcirculation improved in 58% of patients; secretion in 63.1%. Increased diuresis, improved filtration & concentration functions of kidneys also were marked" (19).

Lung, pulmonary function: Of 7 papers, 6 reported positive effects in bronchial & pulmonary diseases (26, 30, 31, 32, 35, 42) & one (21) inferred an immunomodulating action of LLLT in bronchial asthma but details were not available.

Pain, rheumatology, musculoskeletal, bone, joint, tendon, soft tissue, especially in dental & oro-facial applications: Of 14 papers on the use of LLLT in these conditions, 4 were negative, 2 uncommitted & 8 positive. LLLT had no significant effect in delayed-onset muscle in people involved in weight-training activity (8); in ankle sprain (9); on the hemosalivatory barrier in patients with rheumatic diseases (13) and it had no significant effect over that of whirlpool treatment in minimizing the degree of experimental joint contracture in rats (45). The papers that had no detail in the abstracts were on musculoskeletal pain (15) and arthritis (23). The positive papers were on experimental knee lesions in rats (1), rheumatological pain associated with musculoskeletal conditions (2, 37, 38), carpal tunnel and chronic pain syndromes (5, 39, 40) and geriatric osteoarticular diseases (12).

Reproduction, endometrosis: One paper reported good results of LLLT endometrosis with uterine varices in women. Treatment was at LV03, CV06, SP08 for 5-10 min/point/d, for 7 sessions/course, for 1-2 courses (51).

Skin, dermatology: One paper reported that LLLT helped in atopic dermatitis (47).

Vomiting: One paper reported that LLLT reduced postoperative vomiting in children undergoing strabismus surgery. Treatment was given at PC06 (34).

Cancer: Of 2 articles, both suggest that LLLT can help in human cancer management - in radiation-induced mucositis (3) & in controlling postoperative complications & duration of lymphorrhoea in breast cancer (22).

Summary

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Tuner & Hode studied 1200 papers on LLLT & found 85 positive & 35 negative double-blind studies. The negative studies were scrutinized carefully to pinpoint possible reasons for the failures (43). As in most areas of biology, there is evidence for & against the efficacy of LLLT, but the balance seems to be positive. Further research is needed on the uses & limitations of LLLT.

Abstracts

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1. Akai M, Usuba M, Maeshima T, Shirasaki Y, Yasuoka S (1997) Laser's effect on bone & cartilage change induced by joint immobilization: an experiment with animal model. Lasers Surg Med 21(5):480-4. akai-reh@h.u-tokyo.ac.jp Dept of Physical Therapy, Tsukuba College of Technology, Ibaraki, Japan. Influence of low-level (810 nm, Ga-Al-As semiconductor) laser on bone & cartilage during joint immobilization was examined with rats' knee model. The hind limbs of 42 young Wistar rats were operated on in order to immobilize the knee joint. They were assigned to three groups 1 wk after operation; irradiance 3.9 W/cm2, 5.8 W/cm2, & sham treatment. After 6 times of treatment for another 2 wk both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness & loss tangent), & for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions. The indentation test revealed preservation of articular cartilage stiffness with 3.9 & 5.8 W/cm2 therapy. Soft laser treatment may possibly prevent biomechanical changes by immobilization. PMID: 9365959, UI: 98032663
2. Basford JR, Sheffield CG, Harmsen WS (1999) Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil Jun;80(6):647-52. Dept of Physical Medicine & Rehabilitation, Mayo Clinic & Foundation, Rochester, MN 55902, USA. They assessed the effectiveness of low-intensity laser therapy in the treatment of musculoskeletal low back pain in a double-masked, placebo-controlled, randomized clinical trial in a physical medicine & rehabilitation clinic. 63 ambulatory men & women, 18-70 yr old, with symptomatic nonradiating low back pain of >30 d duration and normal neurologic examination results were block randomized into two groups with a computer-generated schedule. All underwent irradiation for 90 sec at eight symmetric points along the lumbosacral spine 3 times/wk for 4 wk by a masked therapist. The sole difference between the groups was that the probes of a 1.06 um neodymium:yttrium-aluminum-garnet laser emitted 542mW/cm2 for the treated subjects & were inactive for the control subjects. Subject's perception of benefit, level of function as assessed by the Oswestry Disability Questionnaire, & lumbar mobility. The treated group had a time-dependent improvement in 2/3 outcome measures: perception of benefit & level of function. These results were most marked at the midpoint evaluation (p<.005, p<.01) & end of treatment (p<.017, p<.001) but tended to lessen at the 1-mo follow-up (p<.10, p<.004). Lumbar mobility did not differ between the groups at any time. All tests were two-sample t tests with unequal variances. Treatment with low-intensity 1.06 um laser irradiation gave a moderate reduction in pain and improvement in function in patients with musculoskeletal low back pain. Benefits, however, were limited and decreased with time. Further research is warranted. Publication Types: Clinical trial Randomized controlled trial PMID: 10378490, UI: 99304835
3. Bensadoun RJ, Franquin JC, Ciais G, Darcourt V, Schubert MM, Viot M, Dejou J, Tardieu C, Benezery K, Nguyen TD, Laudoyer Y, Dassonville O, Poissonnet G, Vallicioni J, Thyss A, Hamdi M, Chauvel P, Demard F (1999) Low-energy He/Ne laser in the prevention of radiation-induced mucositis: A multicenter phase III randomized study in patients with head & neck cancer. Support Care Cancer Jul;7(4):244-52. External Radiotherapy Unit, Centre Antoine-Lacassagne, Nice, France. rene-jean.bensadoun@cal.nice.fnclcc.fr Use of low-energy He-Ne laser (LEL) appears to be a simple atraumatic technique for the prevention and treatment of mucositis of various origins. Preliminary findings, & significant results obtained for chemotherapy-induced mucositis in a previous phase III study, prompted a randomized multicenter double-blind trial to evaluate LEL in the prevention of acute radiation-induced stomatitis. Irradiation by LEL corresponds to local application of a high-photon-density monochromatic light source. Activation of epithelial healing for LEL-treated surfaces, the most commonly recognized effect, has been confirmed by numerous in vitro studies. The mechanism of action at a molecular and enzymatic level is presently being studied. From September 1994 to March 1998, 30 patients were randomized. Technical specification: 60 mW (25 mW at Reims, 1 patient), He-Ne, wavelength 632.8 nm. The trial was open to patients with carcinoma of the oropharynx, hypopharynx & oral cavity, treated by radiotherapy alone (65 Gy at a rate of 2 Gy/fraction, 5 fractions/wk) without prior surgery or concomitant chemotherapy. The malignant tumor had to be located outside the tested laser application areas (9 points): posterior third of the internal surfaces of the cheeks, soft palate & anterior tonsillar pillars. Patients were randomized to LEL or placebo light treatment, starting on the first day of radiotherapy & before each session. The treatment time (t) for each application point was given by the equation : t(s)= energy (J/cm2) x surface (cm2)/Power (W). Objective assessment of the degree of mucositis was recorded weekly by a physician blinded to the type of treatment, using the WHO scale for grading of mucositis & a segmented visual analogue scale for pain evaluation. Protocol feasibility & compliance were excellent. Grade 3 mucositis occured with a frequency of 35.2% without LEL & of 7.6% with LEL (p<.01). The frequency of "severe pain" (grade 3) was 23.8% without LEL, falling to 1.9% with LEL (p<.05). Pain relief was significantly reduced throughout the treatment period (wk 2-7). LEL therapy can reduce the severity & duration of oral mucositis associated with radiation therapy. Also, there is great potential for use of LEL in combined treatment protocols with concomitant chemotherapy & radiotherapy. PMID: 10423050, UI: 99349913
4. Bissell JH (1999) Therapeutic modalities in hand surgery. J Hand Surg [Am] May;24(3):435-48. Dept of Physical Medicine & Rehabilitation, Centura Rehabilitation, St Mary Corwin Medical Center, Pueblo, CO 81004, USA. Therapeutic modalities are useful adjuncts in the rehabilitation of many patients commonly seen by hand surgeons. Therapeutic heat, cold, ES- & laser- and magnetic field- treatments are evaluated for their respective mechanisms of action, indications, contraindications, & clinical results. The most therapeutic modalities have been extensively investigated & relevant basic science & randomized well-controlled clinical studies addressing the efficacy of therapeutic modalities are emphasized. Publication Types: Review Review, academic PMID: 10357520, UI: 99284412
5. Branco K, Naeser MA (1999) Carpal tunnel syndrome: clinical outcome after LLLT-acupuncture, microamps TENS, & other alternative therapies: an open protocol study. J Altern Complement Med Feb;5(1):5-26. Acupuncture Healthcare Services, Westport, Massachusetts, USA. They measured outcome for carpal tunnel syndrome (CTS) patients (who previously failed standard medical/surgical treatments) treated primarily with a red-beam, LLLT-AP & microamps TENS on the affected hand; secondarily, with other alternative therapies. DESIGN: Open treatment protocol, patients diagnosed with CTS by their physicians. Treatment was given by licensed acupuncturist in a private practice office. 36 hands were treated (from 22 women, 9 men), ages 24-84 yr, median pain duration, 24 mo. 14 hands had failed 1-2 surgical release procedures. Primary treatment: red-beam, 670 nm, continuous wave, 5 mW, diode LLLT pointer (1-7 J per point), & microamps TENS (<900 uA) on affected hands. Secondary treatment: infrared LLLT (904 nm, pulsed, 10 W) and/or needle AP on deeper acupoints; Chinese herbal medicine & supplements, on a case-by-case basis (3 treatments/wk for 4-5 wk). Pre- & posttreatment Melzack pain scores & profession and employment status were recorded. Posttreatment, pain significantly reduced (p<.0001), & 33/36 hands (91.6%) no pain, or pain reduced by >50%. 14 hands that failed surgical release were successfully treated. Patients remained employed, if not retired. Follow-up after 1-2 yr with cases aged <60, only 2/23 hands (8.3%) had return of pain, but were successfully re-treated within a few weeks. Possible mechanisms for effectiveness include increased adenosine triphosphate (ATP) on cellular level, decreased inflammation, temporary increase in serotonin. Combined treatment with LLLT-AP + microamp TENS + Chinese herbs has potential cost-savings (current estimated cost per case, $12,000; this treatment, $1,000). It is safe when applied by licensed acupuncturist trained in laser-AP; supplemental home treatments may be performed by patient under supervision of acupuncturist. Publication Types: Clinical trial PMID: 10100028, UI: 99199801
6. Brugnera A, Cruz FM, Zanin FA & Pecora JD (1999) Clinical results evaluation of dentinary hypersensitivity patients treated with laser therapy. Proc. SPIE Vol. 3593, p. 66-68, Lasers in Dentistry V, John D. Featherstone; Peter Rechmann; Daniel Fried; Eds. Camilo Castelo Branco Univ.;Univ. of Sao Paulo School of Dentistry. The aim was to show the % of cured patients treated with LLLT clinically diagnosed dentinary hypersensitivity. They report on >300 human teeth treated at the Laser Center of Camilo Castelo Branco Univ during 1995-1997. Pulpal vitality was verified using thermal tests, & only reversible process was treated. The teeth were dried with cotton pellets and laser beam was applied, using He-Ne laser, & ArGaAl Lasers. All teeth received 4 joules/session, up to 5 sessions. 79% of patients were treated in 3 sessions with success; 8.6% were cured in 4 sessions; & 4.3% were successfully treated in 5 sessions, obtaining 92% success. LLLT is an effective & useful treatment to dentinary hypersensibility. (c)1999 SPIE
7. Conti PC (1997) LLLT in the treatment of temporomandibular disorders (TMD): a double-blind pilot study. Cranio Apr;15(2):144-9. Bauru School of Dentistry, Univ of Sao Paulo, Brazil. The aim was to evaluate the efficacy of LLLT in patients with Temporomandibular Disorders (TMD) in a double-blind design. 20 patients with a chief complaint of pain were divided into myogenous and arthrogenous groups. They were also divided on the basis of the treatment rendered: real versus placebo treatment. An 830 nm Ga-Al-As Laser device with a energy power of 4 joules was used (OMNILASE, LASERDYNE PTY LTD) in three treatment sessions. To evaluate the effect of laser treatment, a Visual Analogue Scale (VAS) was used for pain & active range of motion (AROM) was used to measure changes in mandibular function. After real LLLT, there was a reported improvement in pain only for the myogenous pain patients (p</=.02). For arthrogenous pain patients, real LLLT gave an improvement in Total Vertical Opening (TVO) (p<.05), Protrusive excursion (PROT) (p<.02) & Left lateral excursion (LATLEF) (p<.02). The placebo control group showed improvement in TVO and PROT for those patients with myogenous pain & LATLEF for those patients with arthrogenous pain. A repeated measurement one-way ANOVA showed no significant differences between real & placebo groups. Considering the non-invasive & harmless characteristics of this modality, more research is recommended, using higher power & increased frequency of laser applications. Publication Types: Clinical trial Randomized controlled trial PMID: 9586517, UI: 98247664
8. Craig JA, Barlas P, Baxter GD, Walsh DM, Allen JM (1996) Delayed-onset muscle soreness: lack of effect of combined phototherapy/LLLT at low pulse repetition rates. J Clin Laser Med Surg Dec;14(6):375-80. Rehabilitation Sciences Research Group, School of Health Sciences, Univ of Ulster, Jordanstown, N. Ireland. A double-blind, placebo-controlled study using male subjects (n=60), was conducted to investigate the efficacy of three different frequencies of combined phototherapy/low-intensity laser therapy (CLILT) in alleviating the signs & symptoms of delayed-onset muscle soreness (DOMS). The study was approved by the Univ's ethical committee. After screening for relevant pathologies, recent analgesic or steroid drug usage, current pain, diabetes, or current involvement in regular weight-training activities, subjects were randomly allocated to one of five experimental groups: Control, Placebo, or 2.5-Hz, 5-Hz, or 20-Hz CLILT groups (660-950 nm; 31.7 J/cm2; pulsed at the given frequencies for a duration of 12 min; n=12 all groups). Once baseline measurements were obtained, DOMS was induced in the nondominant arm, which was exercised in a standardized fashion until exhaustion, using repeated eccentric contractions of the elbow flexors. The procedure was repeated twice more to ensure exhaustion was achieved, after which subjects were treated according to group allocation. In the CLILT/placebo groups, the treatment head was applied directly to the affected arm at the level of the musculotendinous junction. Subjects returned on 2 consecutive days for further treatment and assessment. The range of variables used to assess DOMS included range of movement (universal goniometer), mechanical pain threshold/tenderness (algometer) & pain (visual analogue scale & McGill Pain Questionnaire). Measurements were taken before & after treatment on each day, except for the McGill Pain questionnaire, which was completed at the end of the study. Analysis of results using repeated measures & one-factor analysis of variance with relevant post hoc tests showed significant changes in ranges of movement accompanied by increases in subjective pain & tenderness for all groups over time (p=0.0001); however, such analysis failed to show any significant differences between groups on any of the days. The data give no convincing evidence for any putative hypoalgesic effect of CLILT upon DOMS at the parameters used here. Publication Types: Clinical trial Randomized controlled trial PMID: 9467328, UI: 98128434
9. de Bie RA, de Vet HC, Lenssen TF, van den Wildenberg FA, Kootstra G, Knipschild PG (1998) LLLT in ankle sprains: a randomized clinical trial. Arch Phys Med Rehabil Nov;79(11):1415-20. Dept of Epidemiology, Maastricht Univ, The Netherlands. To test the efficacy of LLLT on lateral ankle sprains as an addition to a standardized treatment regimen, a trial was conducted in an ambulatory care setting in which high-dose laser (5J/cm2), low-dose laser (0.5J/cm2), & placebo laser therapy (0J/cm2) at skin level were compared in a randomized, double-blind, controlled clinical trial with a follow-up of 1 yr. Patients, therapists, assessors, and analysts were blinded to the assigned treatment. After informed consent & verification of exclusion criteria, 217 patients with acute lateral ankle sprains were randomized to three groups. 12 treatments of 904nm laser therapy in 4 wk were used with a standardized treatment regimen of 4 wk of brace therapy combined with standardized home exercises & advice. The laser therapy device used was a 904nm Ga-As laser, with 25-W peak power & 5,000 or 500Hz frequency, a pulse duration of 200nsec, & an irradiated area of 1cm2. Pain & function were reported by the patient. Intention-to-treat analysis of the short-term results showed no statistically significant difference on the primary outcome measure, pain (p=.41), although the placebo group showed slightly less pain. Function was significantly better in the placebo group at 10 d (p=.01) & 14 d (p=.03) after randomization. The placebo group also performed significantly better on days of sick leave (p=.02) & at some points for hindrance in activities in daily life and pressure pain, as well as subjective recovery (p=.05). Intention-to-treat analysis showed that total days of absenteeism from work & sports were remarkably lower in the placebo group than in the laser groups, ranging from 3.7-5.3 & 6-8 d, respectively. The total number of relapses at 1 yr in the LLLT group (n=22) was significantly higher (p=.04) than in the other two groups (HLLT, n=13; placebo, n=13). Subgroup analysis to correct for possible confounders did not alter these findings. Neither high- nor low-dose laser therapy was effective in the treatment of lateral ankle sprains. Publication Types: Clinical trial Randomized controlled trial PMID: 9821903, UI: 99037665
10. Flemming KA, Cullum NA, Nelson EA (1999) A systematic review of laser therapy for venous leg ulcers. J Wound Care Mar;8(3):111-4. Centre for Evidence Based Nursing, Univ of York, UK. A systematic review of randomised controlled trials (RCTs) was conducted to establish the effectiveness of LLLT as a treatment for venous leg ulcers. Wound-care journals, conference proceedings & electronic databases (including Medline & Cinahl) were searched up to October 1997 for RCTs comparing LLLT with sham laser, no laser, or non-coherent light of other wavelengths. In addition, companies who manufacture or distribute therapeutic lasers were contacted for any unpublished or ongoing studies. Results from searches were scrutinised by one reviewer to identify possible RCTs & full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. A second reviewer checked the data extraction. Meta-analysis was used to combine the results of trials where the interventions & outcome measures were sufficiently similar. A total of 4 eligible RCTs were identified. Two compared treatment with laser therapy to sham or placebo laser treatment. One study compared laser therapy with ultraviolet therapy. The fourth was a three-armed study which compared the effects of laser therapy alone, laser therapy plus infrared light, & non-coherent unpolarised red light. The comparisons of laser therapy with placebo, & laser therapy with ultraviolet therapy, showed no significant difference between treatments with regard to ulcer healing rates. The comparison of laser with red light showed a significant increase in complete healing at 9 mo for the combination of laser & infrared light compared to non-coherent unpolarised red light. There was no evidence that LLLT per se helped to heal venous leg ulcers but a combination of He-Ne laser & infrared light may promote their healing. However, more research is needed. PMID: 10362987, UI: 99291166
11. Gao YQ, Liu TC & Tang XJ (1998) Intravascular low-intensity He-Ne laser irradiation therapy on idiopathic edema. Proc. SPIE Vol. 3344, p. 167-170, 1997 Shanghai International Conference on Laser Medicine & Surgery, Jing Zhu; Ed. Huanan Normal Univ.; Post of Five Hospital. 194 patients with psoriasis were treated by i/v LLLT combined with i/v Vit C 2.0g & inhaled oxygen, 1 hour, once/d, for 5-40 times, & 13 times in average, 10 times with 4-7 d intervals. 23 cases were cured, 61 had good effect, 110 cases improved & 10 relapsed. Curative effect was related to treatment times - cured & good effect: 5 times 12.5%; 10 times 31%; 15 times 94%. A matched control group in 17 patients was treated by drug; 1 had good effect, 13 improved & 3 had no effect. (c)1999 SPIE
12. Giavelli S, Fava G, Castronuovo G, Spinoglio L, Galanti A (1998) [LLLT in osteoarticular diseases in geriatric patients - Article in Italian]. Radiol Med (Torino) Apr;95(4):303-9. Dipartimento di Radiologia e Laserterapia, Istituto Gerontologico Pio Albergo Trivulzio, Milano. Laser light absorption through the skin causes tissue changes, targeting the nervous, the lymphatic, the circulatory & the immune systems with an antalgic, anti-inflammatory, anti-edemic effect and stimulating tissue repair. Therefore LLLT is now commonly used in many rehabilitation centers, including the "Istituto Gerontologico Pio Albergo Trivulzio", Milan, Italy. However, to activate the treatment program, the basic medical research results must always be considered to choose the best optical wavelength spectrum, technique & dose, for rehabilitative laser therapy. We analyzed the therapeutic effects of different wavelengths and powers in various treatment schedules. In particular, a protocol was designed to test such physical parameters as laser type, doses & individual schedule in different pathologic conditions. We report the results obtained with LLLT in the rehabilitation of geriatric patients, considering the various physical & technical parameters used in our protocol. We used the following laser equipment: an He-Ne laser with 632.8 nm wavelength (Mectronic), a GaAs Laser with 904 nm wavelength (Mectronic) & a CO2 Laser with 10,600 nm wavelength (Etoile). To evaluate the patient clinical status, we use a different form for each involved joint; the laser beam is targeted on the region of interest & irradiation is carried out with the sweeping method or the points technique. Irradiation technique, doses & physical parameters (laser type, wavelength, session dose & number) are indicated on the form. The complete treatment cycle was 5 sessions/wk for 20 sessions in all. At the end of the treatment cycle, the results were scored on a 5-grade semiquantitative scale--excellent, good, fair, poor & no results. We examined 3 groups of patients affected with gonarthrosis (149 patients), lumbar arthrosis (117 patients), and algodystrophy (140 patients) respectively. In gonarthrosis patients, the statistical analysis of the results showed no significant differences between CO2 laser & GaAs laser treatments (p=.975), but significant differences between CO2 laser & He-Ne laser treatments (p=.02) & between GaAs laser & He-Ne laser treatments (p=.003). In lumbar arthrosis patients treated with GaAs or He-Ne laser, significant differences were found between the two laser treatments & the combined sweeping-points techniques appeared to have a positive trend relative to the sweeping method alone, especially in sciatic suffering. In the algodystrophy syndrome, in hemiplegic patients, significant differences were found between CO2 & He-Ne laser treatments (p=.026), between high & low CO2 laser doses (p=.024), & between low CO2 laser dose & high He-Ne laser dose (p=.006). LLLT can be used to treat osteoarticular pain in geriatric patients. For best results, the diagnostic picture must be correct & a treatment program defining the physical parameters used (wavelength, dose & irradiation technique) must also be designed. PMID: 9676207, UI: 98340896
13. Gladkova ND, Karachistov AB, Komarova LG, Alekseeva OP & Grunina EA (1996) Clinical effectiveness of low-power laser radiation & functioning of hemosalivatory barrier in patients with rheumatic diseases. Proc. SPIE Vol. 2929, p. 124-131, Effects of Low-Power Light on Biological Systems II, Giulio Jori; Tina I. Karu; Eds. Institute of Applied Physics; Nizhny Novgorod Medical Academy. We estimated the clinical effectiveness of several regimes & ways of LLLT on the basis of a double-blind, placebo-controlling randomizing comparative test in 454 patients with rheumatic diseases (RD). LLLT for RD has a well-expressed placebo effect. The level of clinical effect of LLLT for RD was not so high. We could achieve no "considerable improvement" in any case and only 18% showed "an improvement". Only in 15% of patients with RD, a sufficient functioning of hemo-salivary barrier was observed, the latter providing a reserve for adaption mechanism, which leads under the influence of stressor agents of medium strength not only to anesthetic, but also to moderately expressed anti- inflammatory effect. LLLT should be viewed as a symptomatic means, with a primary anesthetic & feeble anti-inflammatory effect, which can not influence the course of the rheumatoid process. (c)1999 SPIE
14. Harazaki M, Isshiki Y (1997) Soft laser irradiation effects on pain reduction in orthodontic treatment. Bull Tokyo Dent Coll Nov;38(4):291-5. Dept of Orthodontics, Tokyo Dental College, Chiba, Japan. The effects of LLLT on reduction of pain while undergoing orthodontic treatment was examined in this study. These patients were randomly separated into 3 groups: non-treated control group (CG), blind irradiation group (BG), and laser irradiated group (LG). The effect of laser irradiation on reduction in pain was analyzed by a questionnaire given to patients who had been wired with an edgewise appliance of a multi-bracket system for orthodontic therapy. Just after application of the initial wire, LG patients were irradiated with the soft laser from the labial & lingual sites for a total of one minute. Reduction in pain was found in some patients who had been irradiated. In particular, delay in the pain appearance was noted as compared to the other two control groups. Publication Types: Clinical trial Randomized controlled trial PMID: 9566142, UI: 98227264
15. Jacobsen FM, Couppe C, Hilden J (1997) Comments on the use of LLLT in painful musculo-skeletal disorders. Pain Oct;73(1):110-1. Publication Types: Comment Letter Comments: Comment on: Pain 1993 Jan;52(1):63-6 PMID: 9414066, UI: 98074877
16. Khotiaintsev KS, Doger-Guerrero E, Glebova L, Svirid V & Sirenko Y (1996) Laser blood irradiation effect on electrophysiological characteristics of acute coronary syndrome patients. Proc. SPIE Vol. 2929, p. 132-137, Effects of Low-Power Light on Biological Systems II, Giulio Jori; Tina I. Karu; Eds. Instituto de Fisiologia/Univ. Autonoma de Puebla; Kiev Mohlya Academy Univ.; Univ. Nacional Autonoma de Mexico; Institute of Cardiology. This paper treats electro-physiological effects of the low-level laser irradiation of blood (LBI). The data presented here are based on the observation of almost 200 patients suffering from the acute disruption of coronary blood circulation, unstable angina pectoris and myocardial infarction. Statistically significant changes of the electro-physiological characteristics were observed in the group of 65 patients, treated by the LBI. In particular, the significant 6% extension of the effective refractory period was observed. The electrical situation threshold has increased by 20.6%. The significant changes of some other important electro-physiological characteristics were within the range of 5-15%. In this paper, the data obtained on the LBI effectiveness are compared also with the results obtained on 94 patients who in addition to the standard anti-angina therapy were treated by the autohaemo- transfusion performed simultaneously with the UV-light irradiation of the transfused blood. There was a significant positive effect of the low energy LBI. Electrophysiological data gave good correlation with observed anti-arrhythmic effect of the LBI. This is proved by the data obtained on the electrophysiological characteristics of the cardiovascular system & by other clinical data on the experimental & control group of patients. The research established the exact effect of the low level LBI. LBI gave marked positive changes in electro-physiological characteristics of the cardiovascular system of the patients, it also led to the pronounced anti-arrhythmic effect. (c)1999 SPIE
17. Kipshidze N, Sahota H, Komorowski R, Nikolaychik V, Keelan MH Jr (1998) Photoremodeling of arterial wall reduces restenosis after balloon angioplasty in an atherosclerotic rabbit model. J Am Coll Cardiol Apr;31(5):1152-7. Medical College of Wisconsin, Milwaukee 53226, USA. Kipshidz@post.its.mew.edu OBJECTIVES: This study evaluated the long-term impact of endoluminal low power red laser light (LPRLL) on restenosis in an atherosclerotic rabbit model. BACKGROUND: Despite widespread application of balloon angioplasty for treatment of coronary artery disease, restenosis limits its clinical benefits. Restenosis is a complex process & may be partly attributed to the inability of the vascular endothelium to regenerate & cover the denuded area at the site of arterial injury. We found earlier that LPRLL stimulates endothelial cell proliferation in vitro & contributes to rapid endothelial regeneration after balloon injury in nonatherosclerotic rabbits. METHODS: Rabbit abdominal aortas (n=12) were treated in separate zones with balloon dilation & balloon dilation plus laser illumination. Endoluminal laser therapy was performed using a laser-balloon catheter delivering a single dose of 10 mW for 3 min from a He-Ne laser (632 nm). Angiography was performed before & after treatment and was repeated 8 wk before harvesting the aortas. Quantitative angiographic analysis showed no differences in the minimal lumen diameter (MLD) between the two zones before treatment; an increase in the MLD in both zones after balloon angioplasty & a significant versus slight reduction of the MLD in the balloon treatment versus balloon plus laser zones at 8 wk. Histologic examination showed a very high level of myointimal hyperplasia in the balloon treatment zones but a minimal level in the LPRLL-treated zones. Morphometric analysis revealed a statistically significant difference in the lumen area, intimal area & intima/media ratio between the balloon versus balloon plus laser treatment sites. Endoluminal irradiation with LPRLL prevents restenosis after balloon angioplasty in an atherosclerotic rabbit model. PMID: 9562022, UI: 98220489
18. Kniazeva TA, Nosova AV, Zubkova SM (1997) [The development of systems for the early rehabilitation of patients with ischemic heart disease following aortocoronary bypass - Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Jul-Aug;(4):7-10. Two rehabilitation complexes are described for CHD patients early after aortocoronary shunting. The first complex includes "dry" effervescent baths, magnetolaser therapy applied to the heart area, cryomassage of the abdomen. The second complex consisted of the above modalities plus dry air baths. Indications and contraindications to these complexes are specified. Publication Types: Clinical trial Randomized controlled trial PMID: 9424839, UI: 97451924
19. Koultcavenia, EV (1998) Influence of LLLT on kidney functions. Proc. SPIE Vol. 3569, p. 70-74, Effects of Low-Power Light on Biological Systems IV, Giovanni F. Bottiroli; Tiina I. Karu; Rachel Lubart; Eds. Novosibirsk Research Institute of Tuberculosis. Most renal diseases are accompanied by lowering of kidney functions. That makes the quality of the treatment worse. On an example 69 patients receiving LLLT, the influence of the laser radiation on a contracting system of blood, on current of an active & inactive tubercular inflammation & on partial functions of kidneys were investigated. LLLT did not influence the contracting system; it promoted stopping of unspecific & moderate peaking of specific inflammation of kidneys. After LLLT blood microcirculation in kidney improved in 58% of patients; secretion in 63.1%; stimulation of urodynamic stable in 79%. Increased diuresis, improved filtration and concentration functions of kidneys also were marked. (c)1999 SPIE
20. Lizarelli RF, Ciconelli KP, Braga CA & Berro RJ (1999) Low-powered laser therapy associated with oral implantology. Proc. SPIE Vol. 3593, p. 69-73, Lasers in Dentistry V, John D. Featherstone; Peter Rechmann; Daniel Fried; Eds. Univ. of Sao Paulo; Odontology Association of Ribeirao Preto. The objective of this present work to evaluate in the level of pain & tumor the effect of the low-power density laser irradiation of GaAlAs 790 nm in implanted patients during the postoperative period. Forty five clinic situations were selected & divided in three different groups: Group I, control, without laser application, but with analgesic & anti-inflammatory medication; Group II, patients were irradiated on the day of the surgery, after surgery, & on the two subsequent days; & Group III, patients were irradiated on the day of the surgery, on the day of the surgery, before & after the end of the same, & in the two subsequent days after. All the applications were accomplished using the same energy parameters & by the same operator. The measures, with relationship to the pain & the tumor, they were accomplished in the immediate postoperative, in the postoperative always by the same examiner. The statistical analysis sustained the clinic observations. The low power density laser of GaAlAs 790 nm suggested the same clinical results when pain & tumor formation were controlled by analgesic & anti- inflammatory medication. (c)1999 SPIE
21. Mikhailov VA, Aleksandrova OIu, Gol'dina EM (1998) [The immunomodulating action of low-energy laser radiation in the treatment of bronchial asthma - Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Jul-Aug;(4):23-5. PMID: 9855770, UI: 99073001
22. Mikhailov VA, Skobelkin OK, Denisov IN, Frank GA & Voltchenko NN (1996) Results of treatment in patients with IIa - IIIast. breast cancer treated by combination of LLLT and surgery (5-year experience). Proc. SPIE Vol. 2728, p. 83-91, CIS Selected Papers: Laser Use in Oncology, Andrey V. Ivanov; Mishik A. Kazaryan; Eds. Ctr. of Laser Medicine, M.I. Setchenov Moscow Medical Academy, P.A. Hertzen Moscow Research Oncology Institute. Laser therapy with semiconductor laser (wavelength 890 nm) was performed in 41 patients with stage IIa-IIIa breast cancer. LLLT was used before surgery & postoperative period for 2 yr. LLLT decreased postoperative complications by 15.3% & decreased duration of lymphorrhea. In LLLT- & control- patients with stage IIa breast cancer, respectively, 5 yr survival was 100 & 86%, & 5 yr non-recurrence was 91.3 & 77.7%. In stage IIIa patients, survival was 94 & 79%, & non-recurrence was 82 & 60%. (c)1999 SPIE
23. Minor MA, Sanford MK (1998) The role of physical therapy & physical modalities in pain management. Rheum Dis Clin North Am Feb;25(1):233-48, viii. Dept of Physical Therapy, School of Health Related Professions, Univ of Missouri School of Medicine, Columbia, USA. This article provides an overview to arthritis care of the common physical modalities (heat, cold, TENS, LLLT, topical applications, & external devices). The rationale for use and effectiveness of the various physical modalities are discussed. Exercise is presented in terms of mode and effect of range of motion, muscle conditioning, and aerobic exercise. Publication Types: Review Review, tutorial PMID: 10083966, UI: 99183712
24. Ohshiro T, Calderhead RG (1991) Development of low reactive-level laser therapy & its present status. J Clin Laser Med Surg Aug;9(4):267-75. Japan Medical Laser Laboratory, Tokyo. A new subspecialty in the medical application of the laser has developed, especially over the last decade, depending on the therapeutic rather than the surgical applications of the laser. LLLT is now being recognized as a valid medical tool. Two types of LLLT are presented, simultaneous & pure. In surgical laser applications, ranges of heat are generated in the target tissue, destroying or altering its architecture. This is referred to as high reactive-level laser treatment, or HLLT. In addition, nonphotothermally destructive reactions may also occur, such as photo-osmosis. These are also part of HLLT. Simultaneously, nondestructive thermal and nonthermal bioactivation occur at the periphery of the target tissue: this is "simultaneous LLLT" and occurs along with HLLT, explaining some of the advantages of laser surgery. Laser systems have been developed which deliver power & energy densities below the destructive level, only to activate the irradiated tissue. This is "pure LLLT." The history & background of LLLT are presented, the terminology discussed, & practical applications of LLLT are presented. Publication Types: Historical article Review Review, tutorial PMID: 10149466, UI: 92900937
25. Petersen SL, Botes C, Olivier A, Guthrie AJ (1999) The effect of LLLT on wound healing in horses. Equine Vet J May;31(3):228-31. Equine Research Centre, Faculty of Veterinary Science, Univ of Pretoria, Onderstepoort, Republic of South Africa. Laser therapy is used in many countries, including South Africa, for the treatment of skin wounds. Low level GaAlAs laser was administered to full thickness skin wounds (3 x 3 cm) induced surgically on the dorsal aspect of the metacarpophalangeal joints of 6 crossbred horses in a randomised, blind, controlled study. Treated wounds that received a daily laser dosage of 2 J/cm2 were compared with nontreated control wounds on the opposite leg. There were no wound complications. Both groups of wounds were cleaned daily using tap water. Wound contraction & epithelialisation were evaluated using photoplanimetry. There were no significant differences in wound contraction or epithelialisation between the laser treated & the control wounds. LLLT had no clinically significant effect on second intention wound healing. PMID: 10402136, UI: 99328586
26. Pidaev AV (1997) [A mathematical assessment of the efficacy of the methods for treating patients with chronic nonspecific lung diseases at a health resort - Article in Russian]. Lik Sprava Nov-Dec;(6):168-72. A total of 866 patients with chronic unspecific lung diseases were examined. Medical data collection, storage and acquisition involved making use of the operational system UNIX as well as data base control systems UBASE and INFORMIX. Usage of bronchodilators, antibacterial drugs & corticosteroids were related to the results of treatment. Patients with chronic nonspecific lung diseases can also derive benefit from such nonpharmacologic modes of treatment as apparatus-aided training of breathing, hypoxia & hypercapnia training, AP-laser therapy treatments, herbal aromatic substances. PMID: 9589970, UI: 98251881
27. Piller NB, Thelander A (1998) Treatment of chronic postmastectomy lymphedema with LLLT: a 2.5 year follow-up. Lymphology Jun;31(2):74-86. Dept of Public Health, School of Medicine, Flinders Medical Centre, Bedford Park, South Australia. binbp@flinders.edu.au Ten women with unilateral arm lymphedema after axillary clearance (radical mastectomy) & radiotherapy for breast cancer received 16 treatment sessions with LLLT over 10 wk & seven patients were followed for 36 mo. The effect of LLLT was monitored by arm circumference, plethysmography, tonometry, bioimpedance & a questionnaire dealing with subjective symptoms. After treatment, edema volume (both extracellular & intracellular) was decreased, the tissue (except for the upper arm) progressively softened or approached a normal texture, & the patients reported improvement in aches/pains, tightness, heaviness, cramps, pins/needles, & mobility of the arm. Skin integrity was also improved & the index for risk of infection decreased. Follow-up assessment at 1, 3, 6, & 30-36 mo showed varying trends although at 30-36 mo most subjective parameters & bioimpedance derived data on ECF & ICF tended to return toward pre-treatment levels. Arm circumference continued to show overall improvement, however, with a volume reduction of the affected arm reaching 29%. Tonometry also showed maintenance of near normal values for the involved forearm & anterior and posterior chest; however, the upper arm showed progressive induration. LLLT, at least initially, improved most objective & subjective parameters of post-mastectomy arm lymphedema. PMID: 9664272, UI: 98328974
28. Pinheiro AL, Cavalcanti ET, Pinheiro TI, Alves MJ, Manzi CT (1997) LLLT in the management of disorders of the maxillofacial region. J Clin Laser Med Surg 15(4):181-3. School of Dentistry, Universidade Federal de Pernambuco, Recife, Brazil. They analysed the effects of LLLT on the treatment of maxillofacial disorders. Pioneer work published by Mester et al. opened a new frontier in the clinical treatment of many disorders with the use of LLLT. Although LLLT is not well accepted in many places, its use is growing steadily in others, including Europe and more recently in Brazil. 141 female & 24 male patients, between 7 & 81 yr olde (mean=39.2 yr old), suffering from disorders of the maxillofacial region were treated with 632.8-nm, 670-nm, & 830-nm diode lasers at the Laser Center of the Universidade Federal de Pernambuco. The disorders included temperomandibular joint pain, trigeminal neuralgia, muscular pain, aphatae, inflammation, & tooth hypersensitivity both postoperatively & in small hemangiomas. Most treatment consisted of a series of 12 applications (twice/wk), and in eight cases a second series was applied. Patients were treated with an average dose of 2.5 J/cm2. 120/165 patients were asymptomatic at the end of the treatment, 25 improved considerably, & 20 were symptomatic. LLLT had many benefits in treating many disorders of the maxillofacial region. PMID: 9612167, UI: 98275114
29. Pinheiro AL, Cavalcanti ET, Pinheiro TI, Alves MJ, Miranda ER, De Quevedo AS, Manzi CT, Vieira AL, Rolim AB (1998) LLLT is an important tool to treat disorders of the maxillofacial region. J Clin Laser Med Surg Aug;16(4):223-6. Laser Center, School of Dentistry, Universidade Federal de Pernambuco, Brazil. They report on the effects of LLLT in the treatment of maxillofacial disorders. Further to our previous work, this paper reports the results of the use of LLLT on the treatment of several disorders of the oral & maxillofacial region. This paper presents LLLT as an effective method of treating such disorders. 205 female & 36 male patients ages between 7 & 81 yr old (mean 38.9 yr old), suffering from disorders of the maxillofacial region, were treated with 632.8, 670, and 830 nm diode lasers at the Laser Center of the Universidade Federal de Pernambuco, Recife, Brazil (UFPE). The disorders included temporomandibular joint (TMJ) pain, trigeminal neuralgia, muscular pain, aphatae, inflammation, & tooth hypersensitivity postoperatively & in small hemangiomas. Most treatment consisted of a series of 12 applications (twice/wk) & in 15 cases a second series was applied. Patients were treated with an average dose of 1.8 J/cm2. RESULTS: One hundred fifty four out of 241 patients were asymptomatic at the end of the treatment, 50 improved considerably, & 37 were symptomatic. LLLT was effective & beneficial in treating many disorders of the maxillofacial region. PMID: 9796491, UI: 99012583
30. Polosukhin VV (1997) Dynamics of the ultrastructural changes in blood & lymphatic capillaries of bronchi in inflammation & following endobronchial laser therapy. Virchows Arch Oct;431(4):283-90. Laboratory of Laser Researches of Lymphatic System, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk, Russia. An ultrastructural & autoradiographic analysis of changes in 188 biopsy specimens of bronchial mucosa of the large bronchi from 76 patients with chronic inflammatory lung diseases was carried out. Fibrosis results in an apparent reduction of metabolic activity in endothelial cells, affecting the proliferation of basal cells with changes in cell differentiation. Endobronchial laser therapy with an He-Ne laser induced proliferative & metabolic processes in the lamina propria of the bronchial mucosa with hyperaemia, intensive diapedesis of leucocytes and formation of leucocytic infiltrations & granulation tissue. The proliferative & metabolic activity of endothelial & stromal cells increased, & delicate fibrous connective tissue was formed. PMID: 9368666, UI: 98035071
31. Prozorova GG, Sil'vestrov VP, Simvolokov SI, Nikitin AV (1997) [The efficacy of membrane-stabilizing therapy in patients with chronic obstructive bronchitis - Article in Russian]. Ter Arkh 69(10):34-6. A membrane stabilizing effect of endobronchial laser therapy and antioxidative drugs piracetam & solcoseril was studied in 83 patients with chronic bronchitis. Malonic dialdehyde was measured to evaluate effects of this treatment on cellular & humoral immunity, blood coagulation & lipid peroxidation. Addition of membrane stabilizers to standard therapy of chronic bronchitis lowered malonic dialdehyde concentrations while the addition of the stabilizers & endobronchial laser therapy relieved clinical symptoms earlier, improved parameters of immunity, hemostasis & lipid peroxidation. PMID: 9471786, UI: 98083659
32. Rakitina DR, Urias'ev OM, Garmash VIa, Ivanova MV, Krasnovid NI, Lebedev AV (1997) [Effects of laser therapy on lipids and antioxidants in blood of patients with bronchial asthma - Article in Russian]. Ter Arkh 69(12):49-50. Laser therapy was assessed for effects on lipoperoxides and free radical catchers in blood lipids of patients with bronchial asthma (BA). When a group of 52 BA patients was compared to healthy donors by dienic conjugates, vitamin E & overall lipid-soluble antioxidants levels in the whole blood & plasma, were higher in asthmatics. Combination of laser therapy with conventional treatment returned these parameters close to normal. PMID: 9503535, UI: 98164276
33. Rigau J, Sun CH, Trelles MA & Berns MW (1996) Effects of the 633-nm laser on the behavior & morphology of primary fibroblast culture. Proc. SPIE Vol. 2630, p. 38-42, Effects of Low-Power Light on Biological Systems, Tiina I. Karu; Anthony R. Young; Eds. Instituto Medico Vilafortuny, Beckman Laser Institute & Medical Clinic, Instituto Medico Vilafortuny, Beckman Laser Institute and Medical Clinic. We previously described the influence of LLLT on the primary fibroblast ATCC CRL1471 CCD-19SK passage 7 in culture, metabolic changes & statistical significance absorption of (superscript 3)[H]Hydroxyproline after 2 irradiations (12 hour intervals) with Ar:DYE Laser, 633 nm wavelength, output power 38 mw, spot size 3.5 cm, power density 4 mw/cm(superscript 2), energy density plus or minus 2 J/cm(superscript 2). The aim of this work was to investigate, by using the same procedure, the behavior of the confluence monolayer fibroblasts culture when a central scratch of 0.4-1 mm & 2 irradiations were performed. Colony formation, haptotaxis (direction) & chemotaxis- chemokinesis (movement) appeared sooner in the LLLT cultures than in non-treated cultures. LLLT induced fibroblast biological effects. (c)1999 SPIE
34. Schlager A, Offer T, Baldissera I (1998) Laser stimulation of acupoint PC06 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anaesth Oct;81(4):529-32. Dept of Anaesthesia and Intensive Care Medicine, Leopold Franzens Univ of Innsbruck, Austria. We conducted a double-blind, randomized, placebo-controlled study to investigate the effectiveness of AP at PC06 on postoperative vomiting in children undergoing strabismus surgery. LLLT-AP was performed at PC06 15 min before induction of anaesthesia & 15 min after arriving in the recovery room. In the laser-AP group, the incidence of vomiting was significantly lower (25%) than that in the placebo group (85%). Publication Types: Clinical trial Randomized controlled trial PMID: 9924226, UI: 99123301
35. Sergeeva LV, Dobkin VG, Baenskii AV, Kulikovskaia NV, Litvinov VI (1997) [Use of immunochemical studies to predict the course of fibrous cavernous tuberculosis of lung and postoperative complications in patients on chemo and laser therapy - Article in Russian]. Probl Tuberk (4):23-6. Central NII of Tuberculosis RAMN, Moscow. 103 patients with fibrocavernous tuberculosis of the lung were examined. All had chemotherapy, including 3-4 antituberculous agents. Laser therapy was performed with a UZOR-2K low-energy semiconductor laser. The course of the disease was poor in patients with profound changes in the serum level of protein, with high antigenemia and antibody production; X-ray positive changes were achieved to a lesser extent, bacterial expellation stopped less frequently & more slowly. The decreases in the serum content of the proteins tested, in the level of antigenemia & antibody production that occur with drug & laser therapies are also an important factor in preoperative preparation, which is highly effective in preventing postoperative complications. PMID: 9333810, UI: 97444869
36. Shuvalova IN, Klimenko IT, Zhukova LP, Oborin IuI (1998) [The effect of low-intensity laser radiation in the infrared & red ranges on arterial pressure regulation in patients with borderline hypertension - Article in Russian]. Lik Sprava Oct-Nov;(7):141-3. Effectiveness was studied of LLLT on regulation of arterial blood pressure (BP) in 185 patients (51 men, 134 women). The above patients were prescribed four therapeutic complexes: group I was exposed to infra-red irradiation by zones; group II--to scanning He-Ne laser across the portal zone & paravertebrally CIII-Th5; group III--to He-Ne laser in the area of right sinocarotid zone; group IV underwent hydrolaser shower (in red & intra-red range). Complaints were studied as were data from lab investigations, the condition of different bodily systems, BP level, the functional state of the cardiovascular system as per ECG & rheography findings. A positive clinical effect was achieved in all the groups studied. In the rehabilitation of patients with borderline hypertension during the sanatorium stage, LLLT markedly enhanced the efficiency of the therapy administered. LLLT can be prescribed to patients irrespective of their hemodynamic types. Irradiation of the right sinocarotid zone & hydrolaser therapy are indicated to patients presenting with hypo- & eukinetic types of hemodynamics & baseline sympatheticotonia. PMID: 10050485, UI: 99159392
37. Simunovic Z (1996) LLLT with trigger points technique: a clinical study on 243 patients. J Clin Laser Med Surg Aug;14(4):163-7. Laser Center, Locarno, Switzerland. Among the various methods of application techniques in LLLT (He-Ne 632.8 nm visible red or infrared 820-830 nm continuous wave & 904 nm pulsed emission) there are very promising "trigger points" (TPs), i.e., myofascial zones of particular sensibility & of highest projection of focal pain points, due to ischemic conditions. The effect of LLLT & the results obtained after clinical treatment of >200 patients (headaches & facial pain, skeletomuscular ailments, myogenic neck pain, shoulder & arm pain, epicondylitis humery, tenosynovitis, low back & radicular pain, Achilles tendinitis) to whom the "trigger points" were applied were better than we had ever expected. According to clinical parameters, it has been observed that the rigidity decreases, the mobility is restored (functional recovery), & the spontaneous or induced pain decreases or even disappears, by movement, too. LLLT improves local microcirculation & it can also improve oxygen supply to hypoxic cells in the TP areas & at the same time it can remove the collected waste products. The normalization of the microcirculation, obtained due to laser applications, interrupts the "circulus vitiosus" of the origin of the pain & its development (Melzak: muscular tension > pain > increased tension > increased pain, etc.). Results measured according to VAS/VRS/PTM: in acute pain, diminished >70%; in chronic pain >60%. Clinical effectiveness (success or failure) depends on the correctly applied energy dose; over/underdosage produces opposite, negative effects on cellular metabolism. We noted no negative effects & the use of analgesic drugs could be reduced or completely excluded. LLLT 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, UI: 98117748
38. Simunovic Z, Trobonjaca T, Trobonjaca Z (1998) Treatment of medial & lateral epicondylitis - tennis & golfer's elbow - with LLLT: a multicenter double blind, placebo-controlled clinical study on 324 patients. J Clin Laser Med Surg Jun;16(3):145-51. Laser Center, Locarno, Switzerland. tzlatko@mamed.medri.hr Among the other treatment modalities of medial & lateral epicondylitis, LLLT has been promoted as a highly successful method. The aim of this clinical study was to assess the efficacy of LLLT using trigger points (TPs) & scanner application techniques under placebo-controlled conditions. The current clinical study was completed at two Laser Centers (Locarno, Switzerland & Opatija, Croatia) as a double-blind, placebo controlled, crossover clinical study. The patient population (n=324), with either medial epicondylitis (Golfer's elbow; n=50) or lateral epicondylitis (Tennis elbow; n=274), was recruited. Unilateral cases of either type of epicondylitis (n=283) were randomly allocated to one of three treatment groups according to the LLLT technique applied: (1) Trigger points; (2) Scanner; (3) Combination Treatment (i.e., TPs & scanner technique). Bilateral cases of either type of epicondylitis (n=41) were subject to crossover, placebo-controlled conditions. Laser devices used to perform these treatments were infrared (IR) diode laser (GaAlAs) 830 nm continuous wave for treatment of TPs & He-Ne 632.8 nm combined with IR diode laser 904 nm, pulsed wave for scanner technique. Energy doses were equally controlled & measured in Joules/cm2 either during TPs or scanner technique sessions in all groups of patients. The treatment outcome (pain relief and functional ability) was observed & measured according to the following methods: (1) short form of McGill's Pain Questionnaire (SF-MPQ); (2) visual analogue scales (VAS); (3) verbal rating scales (VRS); (4) patient's pain diary; & (5) hand dynamometer. Total relief of the pain with consequently improved functional ability was achieved in 82% of acute & 66% of chronic cases, all of which were treated by combination of TPs & scanner technique. The best results were obtained using combination treatment (i.e., TPs & scanner technique). Good results are obtained from adequate treatment technique correctly applied, individual energy doses, adequate medical education, clinical experience, & correct approach of laser therapists. Under- & overirradiation dosage can result in the absence of positive therapy effects or even opposite, negative (e.g., inhibitory) effects. The data gave further evidence of the efficacy of LLLT in the management of lateral & medial epicondylitis. Publication Types: Clinical trial Multicenter study Randomized controlled trial PMID: 9743652, UI: 98416293
39. Smith CF & Vangsness CT (1992) Future of laser biostimulation in America today: microlight 830. Proc. SPIE Vol. 1643, p. 275-276, Laser Surgery: Advanced Characterization, Therapeutics, & Systems III, R. Rox Anderson; Ed. Univ. of Southern California School of Medicine. For the last 2 yr we have been investigating the use of a 830 nm laser for LLLT in chronic pain syndromes. The laser output does not exceed 100 mW. This wave length has been carefully selected to be in the 'window' of wavelengths between 650 & 900 nm. At this level, the laser energy will penetrate the epidermis, the dermis and the subcutaneous layers to the deep tissue. The tissue effect of this laser energy is not thermal but rather a stimulation of micro-circulation with a secondary effect of blocking pain enzymes & activation of the synthesis of endorphin enzymes. We have experience with approximately 75 patients who have been treated with LLLT. We used a double-blind study at several General Motors facilities in Michigan to determine the effectiveness of LLLT in inflammatory conditions. Repetitive injuries in the work place have moved from 18% of industrial accidents in 1981 to 52% in 1989. Carpal Tunnel Syndrome is the number one economic problem in occupational medicine; 15% of employees of American automotive plants have Carpal Tunnel Syndrome. This large number of patients have been treated in the past by standard physiotherapy treatment modalities & ultimately by surgery for failure of conservative therapy. Incidence of 'return to work activities' has been low. LLLT affords a positive solution to this problem not only therapeutically but prophylactically. Indications for treatment are Chronic Pain Syndrome & Carpal Tunnel Syndrome of mild to moderate degree. (c)1999 SPIE.
40. Smith CF, Vangsness CT, Anderson T & Good W (1995) Treatment of repetitive use carpal tunnel syndrome. Proc. SPIE Vol. 2395, p. 658-661, Lasers in Surgery: Advanced Characterization, Therapeutics, & Systems V, R. Rox Anderson; Ed. Univ. of Southern California School of Medicine) AC(General Motors). In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit LLLT unit was used in Group A, while an actual LLLT unit was used in Group B. Groups A & B were statistically significantly different in terms of return to work, conduction study improvement, & certain range of motion & strength studies. (c)1999 SPIE
41. Takac S, Stojanovic S (1998) [Diagnostic and biostimulating lasers - Article in Serbo-Croatian (Roman)]. Med Pregl May-Jun;51(5-6):245-9. Zavod za sudsku medicinu, Medicinski fakultet, Novi Sad. They present data on the application of diagnostic & biostimulating laser instruments in medicine. For diagnostic purposes there are several types of laser instruments & procedures available: Laser Microscopic Masonic Analyzer (LAMMA), Flow cytometry. Doppler effects of laser rays (Laser Doppler velocytometry, Laser Doppler spermokhinezymetry, Laser Doppler spectrometry), Laser fluorescent microscopy, Laser nephelometry, Transilumination by lasers (diaphanography), Laser spectroscopy, Laser holography, Laser rethinoscopy, Microirradiation by lasers. Literary data concerning favorable effects of low power laser radiation on series of diseases covering different medical specialties are cited, pointing to possibility of significant enrichment of already available arsenal of physical methods, thera-pies & rehabilitation procedures. Mechanisms of biostimulation of human tissues & organs under low power laser radiation are also presented. All these stimulatory & regulatory mechanisms of the cell metabolism are involved in the wound epitelization, reduction of edema & inflammation & reestablishement of arterial, venous & lymph microcirculation and consequently inducing better tissue nutrition. The use of laser spectroscopy for quantitative analysis of cations from a single drop of dried blood on a piece of filter paper was not realized, although individual analyses of frozen skin biopsies for calcium, arsenic & gold were accomplished. In Europe, this technique has also found its application in forensic medicine. Furthermore, laser-based methods have been used to study air pollution with carcinogens in occupational exposures & also for the detection of narcotic drugs. Laser cytofluorometry utilizes the argon laser for scanning of single stained cells & has achieved utilization in mass examination programs for Pap-smear determinations. The same technique is used in cell sorting system that is now important in monoclonal antibody determination in hybridoma technology. Other possible diagnostic applications include laser particle size measurement techniques, & laser nephelometry for determination of immunoglobulins classes & autoantibodies such as rheumatoid factors. Laser Doppler velocimetry is used to measure blood flow by means of a simple probe that rests on the lip. Biostumulating laser instruments. World famous scientist Endre Mester, from Budapest, is one of the pioneers with great experimental & clinical experience in the use of biostimulating effects of lasers. His former student, O. Ribari first used biostimulating effects of He-Na laser (390 mJ power) for the epitelization of perforated tympanic membrane & treatment of postoperative fistulas of the neck & of the mastoid. Generally speaking, biostimulating effect of LLLT is in its anti-inflammatory, analgesic & anti-edematous effect on tissues. There is absolute increase in microcirculation, higher rates of ATP, RNA & DNA synthesis, & thus better tissue oxygenation & nutrition. There is also increase in the absorption of interstitial fluid, better tissue regeneration & stimulation of the analgesic effect. The past three decades of laser medicine & surgery have shown great progress & promise for the future. PMID: 9720352, UI: 98386821
42. Tkachishin VS (1999) [Effectiveness of nondrug treatment of chronic bronchitis in persons exposed to radiation due to Chernobyl AES accident - Article in Russian]. Ter Arkh 71(3):24-8. AIM: Assessment of efficacy of combined treatment of chronic bronchitis (CB) in subjects exposed to radiation after the Chernobyl accident including nonpharmacological (NP) modalities vs conventional chemotherapy (CT). 149 patients with different forms of CB in exacerbation were divided into 2 groups. The study group of 62 patients received NP + CT. Control group of 87 patients received CT alone. The response was judged by achievement of partial or complete remission, general condition score, external respiration function. The combined treatment significantly more frequently (p<.05) led to CB remission & more marked improvement of the patient's condition. External respiration improved insignificantly. Combined treatment by nonpharmacological methods improved the treatment results in exacerbation of chronic bronchitis. PMID: 10234759, UI: 99251067
43. Tuner J, Hode L (1998) It's all in the parameters: a critical analysis of some well-known negative studies on LLLT. J Clin Laser Med Surg Oct;16(5):245-8. Swedish Laser Medical Society, Stockholm, Sweden. Scientific studies include references to historical studies on LLLT in general & to old studies on the specific subject in particular. Some studies are quoted often. It is fair to take a second look at these, since few people seem to have read them carefully, & others have read them only in the abstract form. This paper critically reviews the parameter pitfalls found in many of the classic "negative" studies. A study of 1,200 papers on LLLT has resulted in 85 positive & 35 negative double-blind studies. The negative studies have been scrutinized carefully in an effort to pinpoint possible reasons for the failures. In the following, most are double-blind studies, but some non-blinded & animal studies have been included to give typical examples of pitfalls. Publication Types: Review Review, tutorial Comments: Comment in: J Clin Laser Med Surg 1998 Oct;16(5):243 PMID: 9893504, UI: 99109382
44. Urioste SS, Arndt KA, Dover JS (1999) Keloids and hypertrophic scars: review & treatment strategies. Semin Cutan Med Surg Jun;18(2):159-71. Beth Israel Deaconess Medical Center, Chestnut Hill, MA 02467, USA. Keloids & hypertrophic scars represent exuberant forms of scar formation that frequently are pruritic, painful, & occasionally form strictures. As well, they may result in significant cosmetic disfigurement. Recent years have seen an increased understanding in the molecular & biological mechanisms of keloidal scar formation, allowing for the development of more specific therapeutic options for these lesions. Despite these developments, keloids & hypertrophic scars remain difficult to manage. Clinical, histopathological, and biochemical features of keloids & hypertrophic scars, as well as treatment guidelines, are discussed. Publication Types: Review Review, tutorial PMID: 10385284, UI: 99312010
45. Usuba M, Akai M, Shirasaki Y (1998) Effect of LLLT on viscoelasticity of the contracted knee joint: comparison with whirlpool treatment in rats. Lasers Surg Med 22(2):81-5. Dept of Physical Therapy, Tsukuba College of Technology, Ibaraki, Japan. usuba@k.tsukubatech.ac.jp The purpose of this study was to compare the effect of LLLT with sham & whirlpool treatment on the contracted knee joint in rat. 48 Wistar rats were operated on to immobilize knee joint, & 1 wk after operation they were randomly assigned to 4 treatment groups: laser 40 mW (3.9 W/cm2), laser 60 mW (5.8 W/cm2), whirlpool (42 degrees C), and sham laser. Tunable Ga-Al-As semiconductor (810 nm) laser was used for another 2 wk of treatment. Removing and preparing bilateral hind legs, degree of knee contracture was assessed by measuring the knee flexion angle, weight of the gastrocnemius muscle, & periarticular connective tissue viscoelasticity measuring phase-lag & stiffness. LLLT had no significant effect except the phase-lag of laser 60 mW. It did not provide a significant effect for minimizing the degree of experimental joint contracture over whirlpool treatment. PMID: 9484700, UI: 98145732
46. Vasil'ev AP, Strel'tsova NN, Kiianiuk NS (1997) [The stress-limiting action of low-intensity laser radiation in patients with ischemic heart disease - Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Nov-Dec;(6):3-5. In 20 patients with exercise-induced angina, the cold test brought about activated lipid peroxidation, modified the lipid phase of a red cell membrane, which correlated with systolic changes. After LLLT for 1 mo, the cold test caused no activation of lipid peroxidative processes, no significant changes in the organization of a cell membrane lipid bilayer, or any profound cardiac performance abnormalities. LLLT has membrane-stabilizing & antistress effects. LLLT should be used in coronary heart disease patients having a functional component of coronary insufficiency. PMID: 9484017, UI: 98145011
47. von Kobyletzki G, Freitag M, Herde M, Hoxtermann S, Stucker M, Hoffmann K, Altmeyer P (1999) [Phototherapy in severe atopic dermatitis: Comparison between current UVA1 therapy, UVA1 cold light & combined UVA-UVB therapy - Article in German]. Hautarzt Jan;50(1):27-33. Dermatologische Klinik, Ruhr-Universitat Bochum. Severe atopic dermatitis, especially when involving the face, does not respond well to conventional therapy. In the present prospective randomized trial, we compared therapeutic efficiency of medium-dose UVA1, medium-dose cold light UVA1 (15 treatment courses with 50 J/cm2 each) & combined UVA-UVB phototherapy. Four (13.3%) of 30 UVA1 treated patients, one (3.4%) of 30 UVA1 cold light treated patients and three (30%) of 10 patients treated with combined UVA-UVB discontinued therapy course before finishing treatment protocol because skin status did not improve or even deteriorated. In the other patients treated over a period of 3 wk, skin status improved significantly or even cleared completely in 80.8% of UVA1 treated & in 89.7% of UVA1 cold light treated patients resulting in a significant decrease of the SCORAD-Score (UVA1 group from 68.6+10.9 SD to 29.8+7.1 SD & UVA1 cold light group from 72.5+13.4 SD to 23.8+11.6 SD; p<.05 each). In the UVA-UVB treated group, the SCORAD-Score also decreased (from 71.0+9.4 SD to 41.6+10.5 SD), but significantly less than in both UVA1 treated groups (p<.05 each). 4 wk after completing therapy UVA1 treated patients showed a prolonged therapy benefit as compared to UVA-UVB treated patients. Plasma levels of eosinophil cationic protein & soluble interleukin-2 receptor significantly decreased under UVA1 phototherapy but not under UVA-UVB therapy. Compared to conventional UVA1 phototherapy, UVA1 cold light phototherapy showed advantages due to the absence of potentially proinflammatory effects based on temperature-induced increase of skin blood flow (quantified by Laser doppler scanning) & increased sweat production (determined by the patient using a visual analog scale). Publication Types: Clinical trial Randomized controlled trial PMID: 10068928, UI: 99168053
48. Walsh LJ (1997) The current status of LLLT in dentistry. Part 1: Soft tissue applications. Aust Dent J Aug;42(4):247-54. Dept of Dentistry, Univ of Queensland. Despite >30 yr experience with LLLT or 'biostimulation' in dentistry, concerns remain as to its effectiveness as a treatment modality. Controlled clinical studies have shown that while LLLT is effective for some specific applications, it is not a panacea. This paper provides an outline of the biological basis of LLLT & summarizes the findings of controlled clinical studies of the use of LLLT for specific soft tissue applications in dentistry. Areas of controversy where there is a pressing need for further research are identified. Publication Types: Review Review, tutorial Comments: Comment in: Aust Dent J 1997 Dec;42(6):414 PMID: 9316312, UI: 97462037
49. Walsh LJ (1997) The current status of LLLT in dentistry. Part 2: Hard tissue applications. Aust Dent J Oct;42(5):302-6. Dept of Dentistry, Univ of Queensland. While most applications of LLLT in dentistry are directed toward soft tissues, in recent years there has been increasing interest in tooth-related or hard tissue applications of LLLT. He reviews the applications of LLLT in the treatment of dentine hypersensitivity & pain arising from the periodontal ligament, & describes the phenomenon of lethal laser photosensitization & its applications in the treatment of dental caries. Technical aspects of LLLT equipment & safety concerns are also discussed. Publication Types: Review Review, tutorial PMID: 9409045, UI: 98073439
50. Webb C, Dyson M, Lewis WH (1998) Stimulatory effect of 660 nm low level laser energy on hypertrophic scar-derived fibroblasts: possible mechanisms for increase in cell counts. Lasers Surg Med 22(5):294-301. Dept of Rehabilitation Sciences, The Hong Kong Polytechnic Univ, Hong Kong. Varying effects of red light wavelengths on in vitro cells have been reported. LLLT is used to assist wound healing especially for indolent ulcers. On healing, burn wounds may become hypertrophic, resulting in excessive wound contraction, poor cosmesis, and functional impairment. This study enquired whether 660 nm LLLT affected hypertrophic scar-derived fibroblasts. The experiments investigated the effect of a 660 nm, 17 mW laser diode at dosages of 2.4 J/cm2 & 4 J/cm2 on cell counts of two human fibroblast cell lines, derived from hypertrophic scar tissue (HSF) & normal dermal (NDF) tissue explants, respectively. The protocol avoided transfer of postirradiated cells. Estimation of fibroblasts utilized the methylene blue bioassay. Post-660 nm-irradiated HSFs had very significantly higher cell counts than controls p<.01 on d1-4 (Mann-Whitney U-test), & p<.01 on d1-3 for similarly irradiated NDFs. PMID: 9671996, UI: 98335717
51. Ye HZ (1993) Views on treatment of endometriosis by using laser acupuncture & moxibustion. Proc. SPIE Vol. 1616, p. 497-500, International Conference on Photodynamic Therapy & Laser Medicine, Jun-Heng Li; Ed. Hospital of Yangzi Petrochemical Corp. This article emphasizes the treatment of endometriosis by using laser-AP & moxibustion which belongs to Shi Zhen. The major pathophysiology is that the circulation of the Qi and blood is obstructed. The obstruction of Qi leads to a block of blood & poor circulation that causes pain. The treatment should be introduced mainly by adjusting Qi and blood. We used an He-Ne LLLT unit. Its output was >/= 20 mw, wavelength 632.8 nm with a single-red light. Using a double tube fiber bundle it was applied at LV03, CV06, SP08 for 5-10 min/point/d, for 7 sessions/course. LLLT results in cleaning the liver, adjusting the oxygen, and disencumbering the varices & the pain. When it makes the circulation of Qi free, the blood is normally transported & the pain disappears. After 1-2 courses of therapy, clinical re-examination indicated the disappearance of scleromata in the uterus. 5 patients treated & continually re-checked recovered. Finally, their menses turned normal & clinical symptoms vanished within 6 mo. (c)1999 SPIE