Abstracts from (8/10-98)
are the negative studies?" Tunér J, Hode L.
It¹s all in the parameters: a critical analysis of some well-known
negative studies on low-level laser therapy. J Clinical Laser
Med & Surg. 1998; 16 (5): 245-248.
Studies failing to find any effect of LLLT are often used as support
for the alleged non-efficacy of LLLT. The authors have selected
some of the most quoted negative studies and analyzed them.
It turns out that the failure to find an effect too often depends
on mistakes in the design of the studies. Doses in the range 0.0007
- 0.1 J have been used for a variety of indications where therapeutic
doses are 100 times or more. Patients with psycosomatic pain have
been treated, HeNe laser has been used as a "placebo"
laser, treatment technique has been inadequate, powers density
extremely low, calculation of dosages incorrect, systemic effects
and tissue condition have been disregared etc. Meta-analyses disregarding
such pitfalls are also less useful. A combined knowledge of physics
and medicine seems to be an important factor in the design of
LLLT in male genital
Gasparyan L et al. Low level laser therapy of male genital tract
chronic inflammations. Proc. 2nd Congress World Association for
Laser Therapy, Kansas City, USA, September 2-5 1998; p. 82-83.
Male genital tract chronic inflammations were treated by combinations
of transdermal, transrectal (prostate gland) and intravenous HeNe
laser irradiation. The energy of a 2 mW HeNe laser was applied
via a light guide into a vein. The projections of the male genital
organ and the inguinal areas were irradiated with a 890 nm 5W
peak power cluster probe. For the transrectal prostate gland irradiation
a 890 nm 15W peak power laser was used. 36 patients were given
conventional medical therapy and another 36 were given LLLT in
combination with medical therapy. Clinical and laboratory findings
were statistically better in the LLLT group and relapse rate was
lower. It is suggested that LLLT increases the local circulation
and thus also improves the effect of antibiotics.
Bürgers disease improved
by laser therapy
Sasaki K et al. Low level laser therapy (LLLT) for thrombonagitis
obliterans. Proc. 2nd Congress World Association for Laser Therapy,
Kansas City, USA, September 2-5 1998; p 95-96 .
In this case report a patient with thrombonagitis obliterans (Bürgers
disease) was treated with a 60 mW 830 nm laser and a defocused
20 W Nd:YAG laser. Ulcers were remarkably improved. Agonizing
pain and ischemia were relieved. In the MRA findings, sudden arterial
obliteration disappeared. In the thermographical findings, skin
temperature increased to normal level.
LLLT in the dental
Pinheiro A et al. Low-level laser therapy is an important tool
to treat disorders in the maxillofacial region. J Clinical Laser
Med & Surg. 1998; 16 (4): 223-226.
241 patients with different disorders in the maxillofacial region
were treated with LLLT. Indications were temporomandibular disorders,
trigeminal neuralgia, muscular pain, aphtae etc. Lasers of 633,
670 and 830 nm were used. Most treatments consisted of a series
of 12 applications (twice a week). Average dose was 1.8 J/cm2.
At the end of treatment 154 patients were asymptomatic, 50 improved
considerably and 37 were symptomatic.
Laser is effective
for medial and lateral epicondylitis
Simunovic Z, Trobonjaca T et al. Treatment of medial and lateral
epicondylitis - tennis and golfer¹s elbow - with low level laser
therapy: a multicenter double blind, placebo controlled clinical
study of 324 patients. J Clinical Laser Med & Surg. 1998;
16 (3): 145-151.
In a two center study 324 patients with unilateral medial or lateral
epicondylitis were treated with LLLT. Trigger points were treated
with 830 nm. 633 and 904 nm in combination was used in the
scanning mode. Total pain relief was obtained in 82% of the acute
cases and 66% in the chronic cases. A combination of trigger points
(TP) and scanning was more effective than TP alone and TP alone
were more effective than scanning alone. One of the centers had
slightly less powerful lasers and the outcome was a bit lower,
although the dosage was the same in both centers.
HeNe laser reduces
a) Barasch B et al. Helium-neon laser effects on conditioning-induced
mucositis in bone marrow transplantation patients. Cancer. 1995;
76 (12): 2550-2556.
Oral mucositis is a common complication of bone marrow transplantation
conditioning therapy. Different drugs are given in order to reduce
rejection of the implant. These drugs induce an oral mucosits.
The mucositis is painful and complicates nutrition. Sometimes
the intake of the drug has to be stopped due to complications.
In the study above 20 patients received HeNe to their oral mucosa,
either right or left of midline. One side was sham irradiated.
Laser treatment was well-tolerated and reduced the severity of
b) Cowen D et al. Low energy helium-neon laser in the prevention
of oral mucositis in patients undergoing bone marrow transplant:
results of a double blind randomized trial. Int J Radiat Oncol
Biol Phys. 1997; 38 (4): 697-707. Significant reduction of oral
mucositis using a 60 mW HeNe laser
Medium Level Laser Therapy (MLLT)?
The advent of high power low-power laser tests the
validity of the term Low Level Laser Therapy. We have
seen a rather slow power output development from the early commercial
equipments, using sometimes only a couple of mW. With the advent
of the GaAlAs diode, the output powers of these lasers have increased
rapidly. 30 mW used to be a rather high power; then there were
lasers of 100 and even 200 mW. Now we have GaAlAs lasers of 500
and even 1 000 mW commercailly available. Is this still Low-power
laser? Yes and no. The fact that we are using 1 000 mW does not
necessarily mean that we use higher doses. 1-4 J/cm2 is still
a normal dose. But to reach that dose in seconds is quite something!
And since the energy density is considerably higher, we might
obtain better effects. And we are also able to reach deep lying
tissues, previously hardly within reach of the early lasers.
So, are we still using Low Level lasers? Or should
we coin the term Medium Level Laser Therapy (MLLT)?
There is so far scarse literature on these high powered lasers.
Hoteya et al (Report on the first IALSM Meeting. Laser Therapy.
9 (4): 185) reports on the use of a 1 W GaAlAs laser (670 mW/cm2)
in the field of orthopedics. When using it in a group of patients
with chronic pain, the efficacy rate was 75.5% and the no
change was 24.5%. Another earlier double-blind study for
the same indication, using a 150 mW GaAlAs laser resulted in an
efficacy rate of 70.6%. So the outcome is more or less the same.
But treatment time must have been considerably reduced. In conclusion
it can be said that the advent of MLLT seems very
promising and practical but there is a great need of controlled
New hope for patients with spinal
Rochkind S, Shahar A. Nevo Z. An innovative approach to
induce regeneration and the repair of spinal cord injury. Laser
Therapy.1997; 9 (4): 151. An Israeli research group has investigated
an innovative method of repairing injured spinal cords. In a rat
model the spinal cords were transected in 31 animals (between
T7/T8). In vitro constructed composite implants were used
in the transected area. These implants contained embryonal spinal
cord neuronal cells dissociated from rat fetuses, cultured on
biodegradable microcarriers. After being embedded in hyaluronic
acid the implants were ready to be placed into the injured area.
The whole lesion area was covered with a thin coagulated fibrin-based
membrane. Control animals underwent the same laminectomy but did
not receive any implant. In all animals the wound was closed normally.
Laser therapy was started immediately after surgery. It was continued
daily for two weeks using 780 nm, 200 mW, 30 minutes daily.
One group received the implant but no laser. During the 3-6 months
follow up, 14 of the 15 animals that received laser (A) showed
different degrees of active movements in one or both legs, compared
to 4 of 9 animals in the group who had received implants but no
laser (B). In the group receiving no implant and no laser (C),
1 out of 7 showed some motor movements in one leg. Somatosensory
evoked potentials were elicited in 10 of the 15 rats in group
A at three months, and on one side in one animal in group B. Axon
sprouting was observed as soon as three days post surgery, in
group A only.
Abstracts from (22/7-98)
LLLT improves nerve injuries
Dr. Shelley M Khullar of the Department of Oral Surgery, Faculty
of Dentistry, Oslo, Norway presented her dissertation in February
1997. The title of the dissertation is Reinnervation after
nerve injury: The effects of low level laser treatment.
The conclusion of the five published studies are: *A course of
20 LLL treatments using a GaAlAs laser (=820 nm) on an area of
long-standing paraesthesiae in the orofacial region induced an
objectively evaluated significant improvement in fine mechanosensory
perception and a decrease in the area of paraesthesiae. *The significant
improvement in mechanosensory perception was also perceived as
a subjective improvement by the patients. *A course of 20 LLL
treatment with a GaAlAs laser (=820 nm) induced no change in thermoperception
in an area of paraesthesiae. *Daily LLL treatment over a 28 day
period, with a GaAlAs laser accelerated motor nerve reinnervation
as assessed by return of motor function subsequent to a standardised
axonotmesis injury in the rat sciatic nerve. *LLL treatment with
a GaAlAs (=820 nm) laser enhanced sensory reinnervation of peripheral
target tissues subsequent to an IAN axotomy injury in the rat
model. The findings are demonstrated immunohistochemically by
the presence of CGRP positive neurones.
Biomodulation of normal and tumor
J Photochem Photobiol B: Biology. 1997; (40): 253-257 In a study
by Schaffer et al. various cells were irradiated by 805 nm laser
light. The cells were (1) murine skeletal myotubes, (2)
normal urothelial cells, (3) human squamous carcinoma cells of
the gingival mucosa and (4) urothelial carcinoma cells. Mitotic
index for 1, 2 and 4 increased at fluences of 4 J/cm2 while irradiation
at 20 J/cm2 resulted in a slight decrease. The no 3 cells showed
a decrease of the mitotic index with both fluences. The most interesting
observation is the different reaction of the two carcinoma cells.
Promising results using LLLT
for tinnitus and inner ear diseases Auris Nasus Larynx. 1997;
24 (1): 39-42.
Shiomi et al. used a 40 mW GaAlAs laser in a group of 38 patients
suffering from tinnitus, resistant to several medical therapies
for more than six months. 21.6 J was given each time through the
auditory meatus toward the cochlea. Ten treatments or more were
given. Only 26% of the patients reported improved duration, but
58% had reductiont of loudness and 55% reduced annoyance.
The authors conclude: Laser therapy seemed to be worth trying
on patients with intractable tinnitus. Editorial note: The
results can be improved if much higher doses are given. Dr. Lutz
Wilden of Bad Füssing, Germany reported on his 6 years of experience
at a recent lecture before the members of the Swedish Laser Medical
Society (Stockholm, May 1998). Dr. Wilden is using three different
lasers. One is directed through the meatus, two are positioned
over the mastoid. Total dosage 2000-4000 (sic) joules per treatment
(60 minutes per session, 30 minutes per ear). Doses may seem very
high, but the thick bone behind the ear absorbs about 95% of the
energy before reaching the inner ear. For more info, see http://home.t-online.de/gbl-hc/ez.
Laser therapy plays a role in
Lasers Surg Med. 1998; 22: 97-102.
Luger et al. studied the effect of HeNe laser on the healing of
tibial bone fractures in rats. 63 J (35 mW) was given
transcutaneously daily over the fracture area. After 4 weeks the
tibia was removed and tested at tension up to failure. The maximal
load at failure and the structural stiffness of the tibia were
found to be elevated significantly in the irradiated group, whereas
the extension maximal load was reduced. In addition, gross non-union
was found in four fractures in the contol group, compared to none
in the irradiated group.
GaAlAs laser treatment evaluated
for trigeminal neuralgia, paresthesia, atypical facial pain and
temporo-mandibular joint pain in a 5 year study. - Tandlægebladet.
1994; 98 (2): 526-529.
In Danish. - Eckerdal A, Lehmann Bastian H. Can low reactive-level
laser therapy be used in the treatment of neurogenic facial pain?
A double-blind, placebo controlled investigation of patients with
trigeminal neuralgia. Laser Therapy. 1996; 8: 247-252. At the
Odense University Hospital, Denmark, Arne Eckerdal has evaluated
the effect of 830 nm, 30 mW, laser treatment for a number of indications.
Patients suffering from trigeminal neuralgia (n = 36) had a positive
result in 81% at the end of treatment, 42% at 1-year control.
Patients having received previous alcohol blocks (n = 14) responded
less favourably to the treatment. 50% were pain free at the end
of the treatment period, 20% at 1 year control. Patients with
non-specific facial pain (n = 63) were pain free at the end of
treatment, 44% at follow up one year later. In a group of
22 patients with paresthesias (n = 22), only 5 were successful
at end of treatment , 4 were improved and 13 were not improved.
The result at 6 and 12 months were the same. Patients
with temporo-mandibular pain (n = 40) were improved in 73% and
at 1 year control still 70% were pain free.
Can HeNe laser improve fertility?
Abstracts LASERmed 97; p. 138, no 112 The fertilizing potential
of mouse spermatozoa was positively affected by HeNe laser in
vitro. Cohen et al at the Bar-Ilan University, Israel found that
the Ca2+ uptake, mainly in the mitochondria, was improved after
LLLT. The results suggest that the effect of 630 nm laser irradiation
id mediated through the generation of hydrogren peroxide by the
spermatozoa and that this effect plyas an important role in the
augmentation of the sperm cells capacity to fertilize in
Are there good
and bad free radicals?
Abstracts LASERmed 97; p. 138, no 110
There is considerable evidence that photobiostimulation proceeds
via enhanced production of reactive oxygen species (ROS) by the
photoexcited respiratory chain. Increased amounts of free radicals
are produced in the blood of patients with acute respiratory illness
or leukemi. However, irradiation with 633 or 830 nm reduces the
amount of free radicals produced in the anomalous blood cells.
Friedmarn and Lubart therefore suggest two categories of free
radicals: 1. the good ones, which may produce biostimulation
and which tentatively would be the superoxide anion radicals.
2. the bad ones, which collectively are designated
by R. The reduction of the quantity of free radicals by LLLT is
then ascribed to the reaction R + O2- = R- +O2 It is possible
that many of the therapeutic effects of low-power laser irradiation
are due to this reaction.
GaAs is effective in chronic low back
Two abstracxts from Lasers Surg Med. 1998; Suppl. 10, p. 6 1)Prof.
Soriano in Rosario, Argentina, performed a double blind trial
with elderly people suffering from chronic low back pain. After
a through medical examination the patients were divided into two
groups. One received GaAs 4J per point and one received sham irradiation.
Ten consecutive sessions were done, one every day. Pain was evaluated
through a VAS scale at the beginning and at the end of the treatment
period. Treatment was effective in 71% in the laser group and
36% in the sham gruop. The pain disappeared completely in 45%
in the laser group and 15% in the sham group. During the follow
up 35% of the patients in the laser group who had relieved their
pain more than 60% relapsed, compared to 70% in the control group.
There were no side effects. 2)Effects of low energy laser therapy
on herniated lumbar discs. Gruszka M et al. Gruszka (Buenos Aires)
treated 15 patients with one or more protruded lumbar disc herniations
with GaAs 904 nm, with a dose of 9J on each point, 20 to 25 points
on the lumbar spine and on referred radicular pain points, 3 to
5 times a week during 4 months. Pain was relieved in 100%, gait
and neurological signs improved in all patients, EMGs improved
and CAT scans showed less protrusion of the herniated discs.