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Laser Therapy Research for Back Pain

Low Level Laser Therapy (LLLT) for Patients with Sacroiliac Joint Pain

Ikuko Ohkuni, Nobuyuki Ushigome, Takashi Harada, Toshio Ohshiro, Kazuhiro Mizutani, Yoshiro Musya, Yukihiko Okada, Hiroshi Takahashi
Dept. of Rehabilitation Medicine, Toho University School of Medicine
Japan Medical Laser Laboratory
Dept. of Second Orthopaedic Surgery, Toho University School of Medicine
Okada Orthopaedic Clinic, Yokohama, Japan
Dept. of Orthopaedic Surgery Toho University School of Medicine

Background and Aims: Sacroiliac Joint pain not associated with a major etiological factor is a common problem seen in the orthopedic clinical setting, but diagnosis is difficult because of the anatomical area and thus it is sometimes difficult to effect a complete cure. Low Level Laser Therapy (LLLT) has been well-reported as having efficacy in difficult pain types, so the following preliminary study was designed to assess the efficacy of LLLT for sacroiliac pain.
Materials and Methods: Nine patients participated, 4 males and 5 females, average age of 50.4 yrs, who attended the outpatient department with sacroiliac pain. The usual major disorders were ruled out. Pain was assessed subjectively pre and post-LLLT on a visual analog scale, and trunk range of motion was examined with the flexion test to obtain the pre and post-treatment finger to floor distance (FFD). The LLLT system used was an 830nm CW diiode laser, 1000 mW, 30 sec/point (20 J/cm2) applied on the bilateral tender points twice/week for 5 weeks. Baseline and final assessment values (after the final treatment session) were compared with the Wilcoxon signed rank test (nonparametric score).
Results: All patients completed the study. Eight of the 9 patients showed significant pain improvement and 6 demonstrated significantly increased trunk mobility (P <0.05 for both).
Conclusions: LLLT was effective for sacroiliac pain, and this may be due to improvement of the blood circulation of the strong ligaments which support the sacroiliac joint, activation of the descending inhibitory pathway, and the additional removal of irregularities of the sacroiliac joint articular surfaces. Further larger-scale studies are warranted.

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Retrospective study of adjunctive diode laser therapy for pain attenuation in 662 patients: detailed analysis by questionnaire.

Nakaji S, Shiroto C, Yodono M, Umeda T, Liu Q.
Department of Hygiene, Hirosaki University School of Medicine, Aomori, Japan

Photomed Laser Surg. 2005 Feb;23(1):60-5. [PMID: 15782035]

OBJECTIVE: The aim of this study was to assess the long-term effects of low-level laser therapy (LLLT) through a retrospective survey using questionnaires.

BACKGROUND DATA: The use of LLLT for chronic pain attenuation has been reported in the international literature for over 20 years.

METHODS: We used a series of diode laser systems in which the most effective wavelength was consistently found to be 830 nm with an output power in continuous-wave of 60 mW. Subjects were 1,087 patients treated by LLLT at the Shiroto Clinic from April 1992 to August 1995. Questionnaires were sent to subjects in September and October 1996.

RESULTS: The reply rate was 60.9%, comprising 662 questionnaires (265 males, 397 females, mean age of 53.4 years). The total efficacy rating (excellent plus good) immediately after LLLT was 46.8% in men and 47% in women. At the time of the survey, this rose to 73.3% in men and 76.8% in women, with positive effects also recorded on psychosomatic factors such as well-being, physical energy, general fatigue, mental vigor, and emotional stability. LLLT effects continued for 1-3 days. No statistically significant difference in efficacy was seen between males and females. LLLT as used in the study is therefore considered safe, effective, and side-effect-free, making it an ideal adjunctive therapeutic modality for intractable chronic and other pain.

CONCLUSION: Infrared diode LLLT is therefore considered safe, effective, and side-effect-free, making it an ideal adjunctive therapeutic modality for intractable chronic pain.

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Combination Therapy Comprising Low Level Laser Therapy (LLLT) and Brace Therapy for Chronic Lower Back Pain Patients

1) Ikuko Ohkuni, 1) Nobuyuki Ushigome, 1) Takashi Harada, 2) Toshio Oshiro, 3) Yoshiro Musya, 3) Kazuhiro Mizutani, 4) Hiroshi Takahashi, 4) Toru Suguro, 4) Kazuaki Tsuchiya
1) Dept. of Rehabilitation Medicine, Toho University 2) Japan Medical Laser Laboratory 3) Dept. of Orthopaedic Surgery, Toho University Ohashi Hospital 4) Dept. of Orthopaedic Surgery, Toho University

Summary: Low Level Laser Therapy (LLLT) in combination with a sacroiliac brace was used on 33 patients with chronic lower back pain to examin the effectiveness of this combination therapy. A semiconductor laser (1000mW, CW, 830nm) was used. Due to the short duration effect of LLLT previously reported, we tested the effect of combination therapy using LLLT and a sacroliliac brace. Our results showed that the number of patients who had lower back pain in their activities of daily living (ADL) or work decreased, and this combination therapy improved both their ADL and quality of life (QOL). Chronic lower back pain patients who had just started visiting our hospital obtained satisfactory results with LLLT but the latency period was short. In order to maintain the effects of LLLT, we controlled the patients' posture with a sacroiliac brace, which was able to prevent chronic pain for a longer period. The combination treatment was well-tolerated, side-effect free and offered good efficacy in improving pain and range of motion of the lumbar spine.

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Retroactive study 524 patients function 830 nm GaAlAs diode laser reactive-level laser therapy lumbago

T. Ohshiro and Y. Shirono
Japan Medical Laser Laboratory and Ohshiro Clinic, Kojimachi, Tokyo, Japan

Summary: From 1983, out of 4500 pain patients treated at the Ohshiro clinic, 1500 had lumbago-related disease entities. From 1987 until the present, a period of 61 months, 524 patients with a variety of lumbar diseases received low reactive-level laser therapy, LLLT, using the GaAlAs diode laser (830 nm, 60 mW, continuous wave). There were 364 males and 160 females (M:F-2.3:1), with an average age of 53.7 years (M: 5.37, F: 47.5). The laser was applied in the pressure contact technique at a variety of treatment times, using Ohshiro's proximal priority method. The patients graded the effectiveness of their therapy into four grades, from excellent to poor; the sum of the first two grades was used to assess the overall efficacy rate. Patients were interviewed immediately before and after the first therapy session, to give the immediate effect, and at one week after the final session, to elucidate the delayed LLLT effect. Some of the patients (81.6%) reported excellent or good immediate results, and 82% gave the same assessment for the delayed effect. No side-effects at all were reported, and patients have maintained the effective results during the follow-up period. The authors conclude that LLLT with the GaAlAs diode laser at the parameters as reported affords an easily applied, noninvasive, effective and safe therapeutic method for the treatment of pain entities in the lumbago group. Further controlled studies are needed to research in detail the possible mechanisms and pathways, although some are already known.

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Low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica.

Bertolini GR, Artifon EL, Silva TS, Cunha DM, Vigo PR.
Injury and Physiotherapeutic Resource Study Laboratory, Western Paraná State University, Cascavel, PR, Brazil.

Arq Neuropsiquiatr. 2011;69(2B):356-9. [PMID: 21625765]

Abstract: Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.

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