Malignant ulceration due to a neoplastic process presents difficulty both to the clinician and more importantly to the patient. Laser therapy has been shown to have a beneficial effect on chronic ulcers in patients with non-neoplastic processes. In the present study we present cases of neoplastic ulceration which showed some response to laser therapy.
We evaluated the efficacy of polarized light therapy for pain attenuation in outpatients with various types of musculoskeletal pain. The patients consisted of 100 with herniated intervertebral disc, 48 cases of myofascial pain syndrome, 36 with sprain and strain, 26 with frozen shoulder, 23 with arthritis, 15 with Raynaud’s syndrome, and 15 cases of tendinitis or epicondylitis. Degree of pain was assessed by a visual analogue scale: VAS (0 to 10) before and after polarized light therapy. The polarized light therapy system used had 1800 mW power output and a wavelength range of 600 to 1600 nm. Along with irradiation of trigger and tender points, irradiation was carried out near the stellate ganglion for 5 to 10 min for the upper limbs and near the lumbar sympathetic ganglion for 10 min, The mean VAS before treatment was 8.3 ± 1.7, whereas that after treatment was 3.1 ± 1.9. The difference was significant (P<0.01). Excellent results (full recovery of movement and strength with more than 75% of the VAS improvement rate) were seen in 135 patients (51.3%), and good results (significant improvement of movement and strength with an improvement in the VAS score between 50% and 75%) were obtained in 69 patients (26.2%). Thermographic evaluation revealed increases of regional temperature when the temperature was relatively hypothermic, and decreases when it was relatively hyperthermic. Although some first and second degree burns at the probe site were observed, they were transient and no specific treatment was needed. Our results indicate that polarized light therapy is effective in the attenuation of musculoskeletal pain of various origins, as is low reactive-level laser therapy (LLLT).
The clinical application of low incident levels of laser energy, known as low reactive level laser therapy, or LLLT, is appearing more frequently in the literature. One application which has been researched with animal models, followed by clinical applications in man, is for the enhanced healing of flaps. The enhanced blood flow following LLLT has been reported by a number of researchers including the authors, but precise evaluation following multiple treatment sessions has not yet been presented. The authors have evaluated a series of irradiations in a preliminary group of four patients in whom musculocutaneous flaps were indicated following surgery related to circulatory disorders. The diode laser (830 nm, 60 mW, 16 J/cm2, continuous wave) was applied in the non-contact method to the pedicle or feeder artery of the flap, and to the distal portion of the flap for 10 min each. Laser Doppler readings were taken before and immediately after each irradiation session, Both blood flow and mass showed a significant increase following LLLT, not only for the first treatment session, but in subsequent sessions. This was accompanied by a subjective patient self-evaluation where a feeling of warmth was reported which in one case increased to the point that the patient perspired following LLLT. The results are examined especially from the point of view of the possible cumulative effect of successive treatment sessions. The authors conclude that, allowing for the fact that further detailed controlled studies are necessary, there is a significant rise in blood flow and mass following LLLT, and that this increased volume of blood must aid in the faster and better take of the musculocutaneous flap.
The relationship between pain attenuation and serotonergic mechanism by low powered laser have been studied. The subjects of 63 cases, having chronic pain and good pain relief were investigated and the change ratio of plasma serotonin was analysed. On first time laser therapy, the change ratio of plasma serotonin had a stable tendency to give a statistically positive ratio (P<0.001), by the tenth time the ratio had decreased and tended to give a negative ratio (P<0.05) as a result of every other day irradiation. Furthermore, by every day repeated irradiation, the change ratio in plasma serotonin had altered to a negative ratio. In this respect, the change ratio of plasma serotonin may be a good clinical indication for LLLT in the assessment of pain attenuation.
In the past 30 years the interest in problems of wound-healing has dramatically increased. Partly this is due to the fact that clinicians would like to understand the nature of the disease they treat. But also this is because the experimental model of wound repair gives the opportunity to study the involved cell system in a better way. My own research on wound healing concerning laser biostimulation has been confined to epithelial surfaces of the body. I would like to restrict my remarks largely to results obtained from investigating repair of the skin.
LLLT has made great advances, especially over the past decade. However, little attention has been paid to standardizing laser therapist training, and motivation. In Spring of 1990 the author opened a new annexe to his main Goshogawara clinic in a nearby agricultural town, The clinic was staffed with therapists trained in the main clinic. At the end of 18 months, the results from the two clinics were compared over an identical range of pain entities. Both clinics were using the Luketron GaAIAs diode laser (830 nm, 60 mW, c/w). The male:female ratio was 1:1.5 both for the annexe and for the main clinic. The average age for the annexe patients was 55.1 y.o., (M:54.1, F:56.9) and for the main clinic 54.9 (M:53.8, F:55.7). There were no major statistical differences between the two clinics as far as treatment sessions per symptom, and the average number of sessions per patient. However, the overall efficacy rate for the annexe was 63.7%, compared with 81.3% for the main clinic. This could not be explained by a major difference in any of the age, disease or treatment statistics, It was finally discovered that the attitude of the therapists in the annexe to their treatment was very different, mainly because they felt they had been `exiled' to the smaller and much more agricultural town. Despite having received the same training, and using the same equipment as the therapists in the main clinic, their enthusiasm and attitude to the treatment and the patients was much less positive than in the main clinic. This shows that the training, including the mental attitude of the therapists should be of equal importance to a clinic director as the actual treatment of the patients.