Cold Laser Therapy, Shingles Post Herpatic Neuralgia

Laser Therapy and Pain Relief

Laser Therapy and Pain Relief
By James White, DC and Kendra Kaesberg-White, DC

Light amplification of stimulated emission of radiation (laser) is a light beam from the electromagnetic spectrum. Unlike conventional light sources a laser beam travels in only one direction and is monochromatic with its photons (little packets of energy) which are all identical in size, traveling equidistant in time and space.
Low-level laser therapy (LLLT) has been investigated and used clinically for over 30 years, mostly in Eastern Europe and Asia. The ability of lasers to cut, cauterize and destroy tissue is well known. These same or similar lasers at lower powers can nonthermally and nondestructively alter cellular function. This phenomenon, known as laser biostimulation, is the basis for the current use of lasers to treat a variety of articular, neural and soft tissue conditions.1
A variety of names have been used to describe the same type of low-level laser: biostimulation, low energy, low reactive, low intensity, soft and or cold laser. In current practice, LLLT uses low output levels (15100 mW), short treatment times (10-240 seconds), and low energy levels (1-4 J/cm2).1

The mechanism and effectiveness of LLLT has been compared with ultrasound therapy,2 and should be considered as an extension to the accepted physiotherapy modalities that currently utilize parts of the electromagnetic spectrum, such as shortwaves, microwaves, infrared, and ultraviolet therapy.1

Lasers produce nonionizing, electromagnetic radiation that is extremely monochromatic, polarized and coherent.3 Laser light has been reported to penetrate human tissue in the ranges of .8-15mm,4,5 but the majority of the light will be absorbed within the first 4mm.6,7 Although this may seem superficial, it should be noted that chemical processes may be initiated and mediate physiological effects at a deeper level.8

The initial studies utilizing LLLT on nerve tissue produced mixed results regarding nerve conduction velocity and distal latency. These earlier studies utilized low powered HeNe lasers (<=1mW) and resultant low energy densities (<=.012 J/cm2).1 More recent studies utilizing higher energy densities and deeper penetrating lasers have found alterations in distal nerve latency and conduction velocity by a few to many percent, and which can last for periods of 30 minutes or greater.1,9-11

It appears that nerve tissue has a photosensitive component, which results in a biostimulation blockade response following laser exposure.12 It is felt that LLLT reduces the excitability of the nerve cells by an interruption of the fast pain fibers with a resultant reduction in pain.12-15 LLLT has also been shown to accelerate the repair process of crush damaged nerves and improve function in both the CNS and peripheral nerves after injury.1,16-18 Laser Safety LLLT is a relatively safe procedure. Due to the low level, nonthermal nature of the laser, there is no tissue destruction or other hazards that you would find associated with the higher powered lasers. The FDA has classified the most commonly used low level lasers as a class III, nonsignificant risk, medical device for investigations use only.19 Because of the coherent nature of the laser beam, ocular damage is the main concern for the LLLT user. The operator should not attempt to stare directly into the beam. Suitable goggles to attenuate the wavelengths would be used by both the operator and patient.20 Other suggested contraindications would be to avoid exposure to sensitive tissue such as fetus, gonads and malignancy.20 Clinical Studies A number of papers have shown a reduction of pain with laser treatments directed over acupuncture points.21-24 Altered skin resistance with a reduction of pain were also noted in subjects who receive LLLT over muscular trigger points.25-26 A group of subjects with chronic tendinopathies, that had been previously treated unsuccessfully with physical therapy, NSAIDS, local injections, and or surgery, had an 87 percent success rate in pain reduction following the application of LLLT.27 In a study involving over 4,000 subjects who had suffered from conditions such as degenerative arthritis; muscle pain; tendinitis and tension myalgia. More than 80 percent of the subjects found a marked lessening of their symptoms following irradiation with an IR laser.28-30 In a study involving a total of 69 subjects and 302 total laser treatment sessions, more that 80 percent of the subjects with chronic radiculopathies and over 90 percent of the subjects with chronic neuropathies experienced a greater than 50 percent total relief of pain following LLLT.14

In a similar study involving 60 total patients and 111 total laser treatments, it was shown that LLLT produced an immediate reduction of pain in 79 percent of the subjects.15 In a study involving over 100 subjects and over 500 laser treatments, it was observed that acute soft tissue pain syndromes showed a dramatic response following the initial laser treatment with a marked reduction in tissue swelling, bruising and good pain relief.31 Subsequent treatments (2-3) produced further improvement.31 It was also noted that chronic pain syndromes were slower to respond to LLLT (average of eight treatments), although 75 percent of the subjects noted significant pain relief.31 A two-stage survey of 116 chartered physiotherapists in Northern Ireland, who utilize LLLT as part of their clinical practice, ranked LLLT effective for the treatment of myofascial and postoperative pain syndromes; rheumatoid arthritis; muscle tears; hematomas; tendinitis; shingles; herpes simplex; scarring; burn and would healing.32 In this same survey, LLLT was ranked first, on the basis of relative effectiveness, when compared with four other modalities (interferential therapy, shortwave diathermy, ultrasound, and pulsed electromagnetic therapy), for use in pain relief and wound healing.32

Suggested Mercy Conference Review Low Level Laser Therapy: Low level laser therapy (LLLT) is a conservative procedure that utilized visible red and/or infrared regions of the electromagnetic spectrum. It is used as a physiotherapy modality for a variety of articular, neural and soft tissue conditions. Rating: Investigational to promising, awaiting FDA approval.

Evidence: Class I, II, III. Conclusions Laser therapy is gaining laboratory and clinical data to prove its effectiveness. LLLT has gained acceptance for treating a variety of osseous, neural and soft tissue conditions in many parts of the world. The acceptance in the U.S. has been limited because of the rigors of the FDA approval process. Many of the earlier studies involving laser use lacked proper scientific controls. Today there are many controlled studies that are well-designed and multicentered. These studies include the use of modern electrodiagnostic and magnetic resonance imaging to monitor the subjects response in an effort to objectively study the role of LLLT in treating neuromusculoskeletal pain. There is a current need for clinical investigators to research these new laser medical devices. Additional research is required to obtain data concerning success rates in treating specific conditions, length of exposure, frequency of treatments, and related therapeutic protocols. James J. White, DC Kendra Kaesberg-White, DC Belleville, Illinois
Chiropractor Fairfax VA 22031
Cold Laser Therapy
Shingles, Post Herpatic Neuralgia

10 Surprising Facts About Headaches

10 Surprising Facts About Headaches

Did you know that sex can give you a bad headache? How about that three gene variations linked to migraines have been discovered? And that most sinus headaches are really migraines?

Research is zeroing in on a source of pain we’ve all felt at one time or another, whether it’s a dull aching pain or a tension headache, the throbbing of a migraine or a pounding hangover headache after a big night out. Here’s the rundown of 10 things you may not know about headaches - and how to avoid them:

Explore the head in 3D and learn where headaches affect you.

1. Sinus Headaches Are Rare: Nasal and sinus congestion, facial pain and pressure, and a headache usually don’t add up to a sinus headache. Headache specialists say that “true” sinus headaches are rare. In a study with almost 3,000 patients who had at least six “sinus headaches” in the previous six months, medical evaluations showed that 88 percent actually had migraines. In another study, 45 percent of migraine patients had either nasal congestion or watery eyes. Tipoff: it’s probably migraine if in addition to “sinus” symptoms, you’re nauseous, sensitive to light or noise and if the headache throbs and worsens with activity.

2. Processing 3D Images Causes Brain Strain: A Northwestern University ophthalmology professor warns that a large segment of the population may develop a headache and nausea while watching 3D movies. This is due to the brain strain involved with processing the three dimensional images - the more an image jumps out at you, the more effort your brain must make to fuse the pictures together, says Northwestern University's Michael A. Rosenberg, MD.

3. Take-Off and Landing Lead to Headaches: No, this has nothing to do with the aggravation of cancelled flights or long delays. Instead, sudden, severe, stabbing headaches during a plane’s ascent or descent are being reported. Doctors haven’t figured out yet what causes them. Luckily, the pain lasts only about 20 minutes.

4. Bug Spray Prompts Headaches: It’s not the bugs but exposure to insecticides used to kill them that causes these headaches (plus dizziness, trouble breathing, nausea and vomiting). According to the U.S. Centers for Disease Control and Prevention, most cases required no medical treatment, but one death has been reported and 18 percent of those exposed to the insecticides required medical attention.

5. High Cholesterol Causes Headaches: You may not have to worry unless you’re in your late 60s or older and have migraines with aura (the flashing lights, tingling and other signs of a headache’s approach that about one-third of migraine patients report). A recent study found a link between migraine with aura and high cholesterol in seniors. Migraine with aura has also been linked to a higher risk of heart disease and stroke.

Need to lower your cholesterol? Let's start with what's on your plate.


6. Headaches Might Be Genetic: Researchers have pinpointed three genetic variations linked to an increased risk of migraines. One is involved in sensing cold and pain, another is linked to several processes including signaling in nerve cells (neurons). The role of the third isn’t yet known. Each of the gene variations identified alters the risk for migraines by 10 to 15 percent.

7. Alcohol, As a Trigger, Is Overstated: Research from Italy suggests that the role of alcohol and some foods in triggering migraines has been overstated. Instead, the investigators found that stress, fatigue and in women, menstruation are most often the culprits. They suggested that migraine patients who want to drink alcohol could try small amounts of specific types to see what they can tolerate.

8. Botox Can Treat Headaches: Best known as a wrinkle remover, Botox also can put the brakes on chronic migraines (those that occur 15 days per month or more). The U.S. Food and Drug Administration has approved the use of Botox for migraine prevention. Injections seem to cut down on headaches, although studies suggest that Botox doesn’t work as well as some prescription drugs. Researchers still haven’t figured out how Botox staves off the headaches, but they do know that effects last only about three months before patients have to be re-injected.

9. The Battlefield Has Created a New Type of Headache: About one third of the soldiers returning from Iraq are bringing with them a new type of chronic migraine caused by nerve damage or the pressure from bomb blast waves. While these headaches are still being studied, treatments include rest, avoiding migraine triggers, stress management and changes of diet.

10. Sex Causes Headaches: Here’s a surprise: men are more likely to get these types of headaches than women. According to the American Headache Society, two types of headaches are related to sexual activity: a dull ache that develops as the sex act increases or a severe one that strikes as orgasm nears. Experts say it’s best to check with your doctor the first time you get one of these headaches. Hint: performance-enhancing drugs can bring on headaches in men who have migraines



Headache Treatment, Fairfax VA 22031

Can Exercise Assist with Low Back Pain during Pregnancy?

VHI Evidence Based Newsletter

Can exercise improve pain and function in pregnant women with pelvic girdle or low back pain?

A: To answer this question, we performed a comprehensive search of the PubMed database (June 2011) for randomized, controlled trials and systematic reviews from the past 10yrs that addressed this specific research question. 1

Four studies met the criteria for inclusion in this review, comparing education to education plus exercise (1), exercise and education to no treatment (2), education plus home exercise or supervised exercise (3), and standard treatment plus acupuncture or stabilization exercise (4).

Two studies showed a significant effect of exercise (1, 4). Kluge et al evaluated education or education with 10 wks of lumbopelvic exercise among 50 pregnant women with lumbar and/or pelvic girdle pain (1). Immediately after the intervention, significant improvements in pain and function were shown with exercise. Of note, a majority of women reported lumbar pain. Elden et al evaluated 6 wks of standard treatment plus acupuncture or pelvic stabilization exercise among 386 pregnant women with pelvic girdle pain (4). One week after the intervention, acupuncture and stabilization exercise significantly reduced pain compared to standard treatment.

In contrast, two studies found no effect of exercise (2, 3). Haugland et al compared 4 wks of education and exercise to no treatment among 569 women with pelvic girdle pain during pregnancy (2). At 12 mos postpartum, pain had decreased in both groups. Study limitations included a high drop-out rate, and 60% of control subjects seeking outside treatment. Nilsson-Wikmar et al compared education to education plus 10-16 wks of pelvic stabilization exercise performed either at home or in a clinic setting among 118 women with pelvic girdle pain during pregnancy (3). By 12 mos postpartum, all subjects showed significant improvements in pain and function. In both of these studies, the type of exercises used do not appear to be classified as stabilization exercises.

Based on this review, specific lumbopelvic stabilization exercises appear useful on reducing pain and increasing function in pregnant women with lumbopelvic pain; however, additional research is needed. Sample exercises from VHI PC-Kits have been provided based on examples from the two studies finding a beneficial effect.

Dr. Joshua Brooks
Chiropractor Fairfax, VA 22031