Pain – Arthritis / Tendinitis

Pain is the chief reason people visit doctors.  As such, seeking to administer the best possible pain therapy has been our top priority at the Center for Cooperative Medicine since March 1999.

A growing body of science and clinical experience suggests that laser and bioelectromagnetic therapies at the outset of injury may prevent many, if not most, acute painful conditions from becoming chronic.  These treatments have also been shown to dramatically reduce pain and improve the lives of many diagnosed with chronic, painful conditions, even some thought to be untreatable.  Chronic pain affects as many as 100 million people (30% of the U.S. population) with a financial burden estimated roughly at $100 billion.

If you have been told that you just have to live with pain, think again.  While there are no panaceas, laser and other energy-based based treatments have been widely documented in the scientific literature to regenerate tissue (bone, tendon, ligament, muscle, nerve), promote normal biological function, reduce inflammation and alleviate pain in a wide variety of conditions.

At the Center for Cooperative Medicine we seek to deliver the best possible treatment in the shortest period of time.  We employ the World Association for Laser Therapy dosage guidelines and adjust treatment according to .  Many conditions may be resolved or improved significantly in 10 visits.

Following are case studies:

Chronic  Back, Hip & Sciatic Pain

• GB came with right-sided low back and hip pain radiating to the posterior thigh x 15 years and was scheduled for back surgery.
• By the fifth session, he reported a complete absence of pain.  He was seen for seven visits and cancelled surgery.

Back Pain / Sciatica / Neuropathy

• DJ was a 77 year old male whose chief complaint was severe right sided back and hip pain which radiated to the ankle as well as progressive numbness in both legs beginning at the knee, worse on the right.
• He also reported that he could not feel the accelerator pedal while driving because his right foot was completely numb.  Legs and feet were cold to touch.
• He was treated with acupuncture and laser and bioelectromagnetic therapies.
• By the 8th visit, back and hip pain had resolved, and we began to treat legs and feet.   “I can feel my toes,” he said immediately following the first treatment to his legs and feet.
• After the next visit, he reported, ”I feel my toes, and my legs are warmer.”  And they were.
• “I feel everything now.  I feel better than I did when I was 70,” he reported after the 12th session.

Chronic Back Pain

• JD was a thin, 86 year old male whose chief complaints were chronic low back pain for 15 years.  He scored his pain at 8 on a 10 point scale at his first visit.
• Pre-treatment pain scores declined to less than one by the 8th visit, and he was discharged but has returned for treatment to strengthen his legs.

Sciatica / Hip Pain

• NB was a 47 year old teacher whose chief complaints were sciatica and hip pain she scored at 10 pre treatment and 0-1 after the first session.  She then cleaned her entire house and returned in severe pain.
• Pre and post treatment pain scores declined progressively in her subsequent five sessions, and range of motion improved.

Tendonitis (Hamstring, Shoulder Pain)

• JL was a 62 year old retired high school coach with pain in his left hamstring, both shoulders (torn rotator cuff on the right) and both knees.
•  Hamstring and right shoulder pain scores were 4 pre-treatment and zero immediately afterward.  Pre-treatment pain scores declined progressively.  Pain in the right knee resolved without it being treated.
• JL was treated for 9 sessions and discharged, returning for “tune-ups” each year in 2005, 2006. 2007 and 2008.

“Shattered” Knee, Nerve Pain

• CC was a 68 year old female on oxycontin and gabpentin who had “shattered” her right knee and had replacement surgery in 2007.
• Her chief complaints were burning pain from the knee to the ankle laterally following the surgery which she described as “like fire ants crawling up the leg” if she was without medication.
• Pre-treatment pain scores were 4. She was seen for 4 visits.  Pain score prior to therapy at her last visit was zero.

Complex Regional Pain Syndrome (?) / Muscle Wasting / Pain

•  FO was a 68 year old female who came with severe, chronic pain in the neck, shoulders and numbness, tingling and pain in the arms and especially hands – which were hot to touch – as well as pain / weakness in low back, legs and knees.
•  Her chief complaints were inability to grip objects or write as well as pain, weakness and muscle wasting in arms and hands.
• She was discharged after 24 visits and credits laser therapy + increased activity / exercise with a complete turnaround in her health.  Pre-treatment pain scores at her last few visits were 1-2 vs 8-9 at the outset, and she has regained muscle mass and the use of her hands, even to sew and paint watercolors.

Heel Pain

• RS, a 52 year old female with chronic left heel pain, had broken many small bones in both feet in a motorcycle accident 10 years earlier.  Prior to the 1st treatment, pain score was 5 and 3 afterward.  Although pain score was subsequently only 2 after her two follow-up visits, a few months later she reported that it had completely resolved.

Plantar Fasciitis

• “Rose”, a  54 year old female who came with severe foot pain, writes in her own words: “My chief complaint was pain in both feet due to both severe plantar fasciitis and the results of a failed surgery. Symptoms included ongoing soreness, circulation irregularities, burning, pulling & aching during and after weight bearing. I am truly amazed (and joyful) over the significant reduction of all the above symptoms!  My pain level is minimal and my feet seem to be continuously getting stronger and more fully functional.   It has been four years since my surgery and there is simply no other explanation for this kind of improvement.  Laser acupuncture works!”

Neuroma

  • KJ was a 52 year old female whose primary complaint was pain and pressure at a nodule at the base of the third and fourth toes.
  • She was treated on 6 occasions and pain scores and the area of swelling became smaller and vanished prior to the last treatment.

Case Study – Shingles

  • JP was a 66 year old diabetic female who came in severe pain (“9-10”)with a red rash and herpetic lesions to the right sacral area / buttock and right inguinal area.
  • Over four treatments, post-treatment pain scores declined to 1.

Chronic Facial Pain – Case Study

• SD was a 58 year old female with a 15 year history of debilitating facial pain and headaches which had been diagnosed as “neuropathy in neck and ear, face, idiopathic facial pain, trigeminal neuralgia, neurological headaches.”
• “Laser therapy gave me back my life,” she said.
•  Pre-treatment pain scores which had been as high as 10 have declined progressively to 3 or less and have been 0 following treatment, and
the size of the affected area has been reduced.  Patient is now using a LED system for home treatment and has reported continued improvement.

Case Study – Knee Weakness / Instability

• DG was an athletic 61 year old former police officer with repeated injuries to his left knee which he described as ‘loose’ and for which surgical replacement had been recommended.
• He received 11 treatments with the goal of strengthening the knee and avoiding surgery.
• He reported his knee moved easier with increased ‘tightness’ after treatment and has resumed all athletic activities.  5 years later he is running and playing basketball.

Case Study – “Pulled Groin”

• LP was an athletic, 43 year old female who came two days after experience a “pulled groin” while resuming running after a long break.
• She was treated on three consecutive days and instructed to refrain from running or otherwise straining the area.
• Pain scored at 9 before treatment was 1-2 after the first session and 0 following the second and third sessions.

Case Study – Broken Leg

• RS, a 36 year old female, fractured her tibia snow skiing in February 2002 and returned home uncasted.
•  She was seen twice before surgery.  Pain scores were 10 in right leg/knee before her 1st treatment, 1 immediately thereafter, 6 prior to her 2nd treatment the next day and 0 immediately afterward.
• She was seen twice weekly after surgery to address pain / promote healing and for scar reduction which has improved progressively.

Case Study – Carpal Tunnel Syndrome

• RS – 35 year old female – was wearing braces on both wrists at her first visit. Carpal tunnel syndrome had been diagnosed a year and a half earlier, and surgery had been recommended.
• She reported normal sensation in her fingers and thumbs immediately after the first session.
• Some symptoms returned a day and a half after the 1st and 2nd treatments at progressively lower levels.  RS reported normal sensation in both hands following her third session.  Five years later she is asymptomatic.

Cervical Radiculopathy may mimic Carpal Tunnel Syndrome

• LS was a 56 year old male, automobile service technician who came because of numbness and tingling in the first four digits of his left hand.  He had been diagnosed with carpal tunnel syndrome based on slow nerve conduction as measured by EMG and by signs and symptoms.
• On the first visit he was treated with laser therapy over the medial wrist and palm – which produced no effect.
• At his second visit laser therapy was given over and along the cervical and upper thoracic vertebrae, neck and left shoulder.
• He reported that sensation in his fingers was immediately and completely restored.  He was seen for one follow-up visit three days later and reported only very slight numbness which was completely alleviated by laser treatment.

Chronic Shoulder Pain

• FS was an 84 year old male with right shoulder pain x 30 years, following a fractured clavicle which had healed asymmetrically in comparison to the left side.
• Initial pain scores were only 2-3, and patient’s chief complaint was limited range of motion and inability to work with his arm above his head.
• After 12 visits he reported that pain had vanished, and he has been able to help in painting his house, using a roller above his head, and his golf game has also improved.

Chronic Shoulder Pain

• EZ was a 73 year old retired male with chronic, intermittent pain between the shoulder blades on the right with certain movements of the arm.  He also was experiencing pain in the right bicep and occasional numbness and tingling extending from the elbow into the right forearm.
• He was treated with laser therapy, acupuncture and mobilization weekly.  Bioelectromagnetic therapy was given x 5 consecutive days then twice weekly for 10 weeks.  Pre treatment pain scores which had been as high as 8 were less than one or zero with the same arm movements.  Patient has resumed daily Tai Chi practice and regained range of motion.  Three years later, he is completely pain free.

Gout

MM was a 70 year old male with a 20 year history of hypertension whose chief complaint was acute inflammation and pain in the left big toe / foot diagnosed as gout with a pain score of 7.

Pain score was less than one after the initial treatment. Before the second and last treatment he rated the pain at 2 and 0 thereafter.

How effective is low intensity laser therapy in arthritis?

Bjordal et al 2003 reviewed 11 clinical trials in which the joint capsule was treated by laser therapy within an acceptable dosage range and methodological quality and concluded, ““Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders….”[1]

How much pain, suffering and money might be spared with the widespread implementation of laser and bioelectromagnetic therapies as first line treatment of pain?

Laser Therapy – Positive Double-Blind Studies

Arthritis

Antipa C. et al. Comparative effects of various IR low energy diodes in the treatment of the rheumatic diseases. 1997. In press (Monduzzi Editore, Bologna)

Barabas K. et al. Controlled clinical and experimental examinations on rheumatoid arthritis patients and synovial membranes performed with neodym phosphate glas laser irradiation. Proc. 7th Congr Internat Soc for Laser Surg and Med, Munich June 1987. Abstract no 216a.

Goldman J. A. et al. Laser therapy of rheumatoid arthritis.  Lasers Surg Med. 1980; 1: 93 102.

Gärtte S. et al. Doppelblindstudie zur Ueberpruefung der Wirksamkeit und Vertraeglichkeit einer niederenergetischen Lasertherapie bei Patienten mit aktiver Gonarthrose. Jaros Orthopaedie. 1995. 12: 3034.

Hoteya K. et al. Effects of a 1 W GaAlAs diode laser in the field of orthopedics. In: Meeting Report: The first Congress of the International Association for Laser and Sports Medicine. Tokyo, 1997. Laser Therapy 1997; 9 (4): 185

Lonauer G. Controlled double blind study on the efficacy of He-Ne-laser beams versus He-Ne- plus Infrared-laser beams in the therapy of activated osteoarthritis of finger joints. Clin Experim Rheuma. 1987; 5 (suppl 2) : 39

Mach E. S. et al. Helium-Neon (Red Light) Therapy of Arthritis. Rheumatologia, 1983; 3: 36.

Miyagi K. Double-blind comparative study of the effect of low-energy laser irradiation to rheumatoid arthritis. Current awareness of Excerpts Medica. Amsterdam. Elsevier Science Publishers BV. 1989; 25: 315.

Molina J. J. et al. La laserterapia como coadyuvante en el tratamiento de la A.R. (Artritis Reumatoidea). Boletin C.D.L., Barcelona. 1987; 14: 4-8.

Nivbrant Bo et al. Therapeutic laser treatment in gonarthrosis. Acta Orthop Scand. 1989; 60: 231.

Ortutay J et al. Psoriatic Arthritis Treatment with low power laser irradiation. A double blind clinical study. Lasermedizin – Laser in Med Surg. 1998; 13 (3-4): 140.

Oyamada Y. et al. A double blind study of low power He-Ne laser theraphy in rheumatioid arthritis. Optoelectronics in Medicine. 1987; p 747-750. Springer Verlag, Berlin (abstract). Complete study in Boleton de CDL. 1988; 17: 8-12.

Palmgren N. et al. Low-Power Laser Therapy in Rheumatoid Arthritis. Lasers in Medical Science. 1989; 4: 193.

Willner R. et al. Low power infrared laser biostimulation of chronic osteoarthritis in hand. Lasers Surg Med. 1985; 5: 149.

Epicondylitis

Gudmundsen J. et al. Laserbehandling av epicondylitis humeri og rotatorcuff-syndrom. Dobbelt blindstudie – 200 pasienter. (Laser treatment of epicondylitis humeri and rotator cuff syndrome. Double blind study – 200 patients. In Norwegian) Norsk tidsskrift for idrettsmedisin. 1987; 2: 6.

Haker E. et al.  Is low-energy laser treatment effective in lateral epicondylalgia? J of Pain and Symptom Management. 1991; 6(4): 241.

Hopkins G. O. et al. Double blind cross over study of laser versus placebo in the treatment of tennis elbow. Proc International. Congress on Lasers, “Laser Bologna”. 1985: 210. Monduzzi Editore S.p.A., Bologna.

Palmieri B. A double blind stratified cross over study of amateur tennis players suffering from tennis elbow using infrared laser therapy. Medical Laser Report. 1984; 1: 3-14

Simunovic Z., Trobonjaca T. et al. Treatment of medial and lateral epicondylitis – tennis and golfer elbow – with low level laser therapy: a multicenter double blind, placebo controlled clinical study on 324 patients. J Clin Laser Med & Surg. 1998; 16 (3): 145-151.

Vasseljen O. et al. Low level laser versus placebo in the treatment of tennis elbow. Scand Scand J Rehab Med. 1992; 24: 37. Also in Physiotherapy. 1992; 5: 329.

Fibrositis/Fibromyalgia

Scudds R. A. et al: A double-blind crossover study of the effects of low-power gallium arsenide laser on the symptoms of fibrositis. Physiotherapy Canada. 1989; 41: (suppl 3): 2.

Pain

Armino L. et al. Laser therapy in post-episiotomic neuralgie. LASER. Journ Eur Med Laser Ass. 1988; 1(1):7.

Atsumi K. et al. Biostimulation effect of low-power energy diode laser for pain relief. Lasers Surg Med. 1987; 7: 77.

Carillo J. et al. A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars. Int Dent Journ. 1990; 40: 31.3

Ceccherelli F. Diode laser in cervical myofascial pain. A double-blind study versus placebo. The Clin J Pain. 1989; 4: 301-304.

Cheng R. Combined treatments of electrotherapy plus soft laser therapy has synergistic effect in pain relief and disease healing. Surgical and Medical Lasers. 1990; 3 (3): 135 (abstract).

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.

Emmanoulidis O. et al. CW IR low-power laser application significantly accelerates chronic pain relief rehabilitation of professional athletes. A double blind study. Lasers Surg Med. 1986; 6: 173.

De Bie R. A. Effect of laser therapy on ankle sprains Ned. T. Fysiotherapie. 1988; 95: 108-112. (in Dutch)

Flöter T., Refisch H. P. Pain treatment with laser. A double blind study. Proc. of the 4th Internat Symposium.Acupunct & Electro-Therap Res. 1988; 13(4): 236-237. Also: Schmerzbehandlung mit Laser. Eine Dopppelblinde Studie. Top Medizin. 1990; 4(4): 52-56.

Gertner C. Analgesy by low power laser (LPL): a controlled double blind study in ankylosing spondarthritis (SPA).  Lasers Surg Med. 1989; Suppl 1:55.

Hashimoto T. et al. Efficacy of laser irradiation on the area near the stellate ganglion is dose-dependent: a double-blind crossover placebo-controlled study. Laser Therapy. 1997; 1(9): 7-11.

Kemmotsu M. D. et al. LLLT for pain attenuation – the current experience in the pain clinic. In: Progress in Laser Therapy. Eds Oshiro T, Calderhead R G. 1991: 197-200. John Wiley & Sons, Chichester, Engl. ISBN 0-471-93154-3.

Kemmotsu M. D. et al. LLLT for pain attenuation – the current experience in the pain clinic. In: Progress in Laser Therapy. Eds Oshiro T, Calderhead R G. 1991: 197-200. John Wiley & Sons, Chichester, Engl. ISBN 0-471-93154-3.

Longo L. et al. Treatment with 904 nm and 10600 nm laser of acute lumbago – double blind control. LASER. Journ Eur Med Laser Ass. 1988; 1(3):16.

Mokhtar B. et al. A double blind placebo controlled investigation of the hypoalgesic effects of low intensity laser irradiation of the cervical roots using experimental ischaemic pain. Proc. Second Meeting of the International Laser Therapy Assn., ôLondon Laserö, Sept 1992, p 61.

Moore K. et al The effect of infra-red diode laser irradiation on the duration and severity of postoperative pain. A double-blind trial. Laser Therapy. 1992; 4: 145.

Moore K. et al. LLLT treatment of post herpetic neuralgia. Laser Therapy. 1988; 1: 7.

Roumeliotis D. et al. 820nm 15mW 4J/cm2, laser diode application in sports injuries. A double blind study. Proc. Fifth Annual Congress British Medical Laser Association. 1987.

Saeki N. et al. Double blind test for biostimulation effects on pain relief by diode laser. 1989. Laser Surgery; 1066: 93-100.

Sato K. et al. A double blind assessment of low power laser therapy in the treatment of postherpetic neuralgia. Surgical and Medical Lasers. 1990; 3 (3): 134 (abstract)

Simunovic Z., Trobonjaca T. Soft tissue injury during sport activities and traffic accidents – treatment with low level laser therapy. A multicenter double blind, placebo controlled clinical study on 132 patients. Proc. IXX ASLMS Congress, Orlando, Florida, April 1999.

Soriano F. A. et al Acute cervical pain is relieved with gallium-arsenida (GaAs) laser irradiation. A double-blind preliminary study. Laser Therapy. 1996; 8: 149-154.

Soriano F. A. et al. Low level laser therapy response in patients with chronic low back pain. A double blind study. Lasers Surg Med. 1998, Suppl. 10, p. 6.

Toya S. et al. Report on a computer-randomized double blind clinical trial to determine the effectiveness of the GaAlAs (830 nm) diode laser for pain attenuation in selected pain. Laser Therapy 1994; 6:143.

Taguchi T. et al. Thermographic changes following laser irradiation for pain. Clinical Laser Med Surg. 1991; 2(9): 143.

Tsurko V. et al. Laser therapy of rheumatoid arthritis. A clinical and morphological study. Terap Arkh. 1983; 97. (Russian).

Walker J. Relief from Chronic Pain by Low Power Laser Irradiation. Neuroscience Letters. 1983; 43: 339

Wylie L. et al. The hypoalgesic effects of low intensity infrared laser therapy upon mechanical pain threshold. Lasers Surg Med. 1995; Suppl 7:9.

Tendonitis

Loegdberg-Andersson M. et al. Low level laser therapy (LLLT) of tendinitis and myofascial pains – a randomized, double-blind, controlled study. Laser Therapy. 1997; 2 (9): 79-86.

Meier J. L, Kerkour K. Traitement laser de la tendinite. Med. et Hyg. 1989; 46: 907-911.

Saunders L. The efficiacy of low-level laser therapy in supraspinatus tendinitis.  Clin Rehab. 1995; 9: 126-134

Trigger Points

Airaksinen O., et al. Effects of infra-red laser irradiation at the trigger points. Scand J of Acu & El Therapy. 1988; 3: 56-61

Laakso E. L. et al. Pain scores and side effects in response to low level laser therapy (LLLT) for myofascial trigger points. Laser Therapy. 1997; 2 (9): 67-72.

Snyder-Mackler L. et al. Effect of helium-neon laser on musculoskeletal trigger points. Physical Therapy. 1986; 66: 1087.

Snyder-Mackler L. et al. Effect of helium-neon laser irradiation on skin resistance and pain in patients with trigger points in the neck or back.  Physical Therapy. 1989; 69: 336.


[1] Bjordal JM, Couppe C, Chow RT, Tuner J, Ljunggren EA, A Systematic Review of Low Level Laser Therapy with Location-Specific Doses for Pain from Chronic Joint Disorders, J Physiother. 2003;49(2):107-16.