Query: Laser in neck pain 2010

title: Low level laser therapy for acute neck pain with radiculopathy: a double blind placebo controlled randomized study.
abstract: The objective of the study was to investigate clinical effects of low level laser therapy (LLLT) in patients with acute neck pain with radiculopathy.  Double blind, randomized, placebo controlled study.  The study was carried out between January 2005 and September 2007 at the Clinic for Rehabilitation at the Medical School, University of Belgrade, Serbia.  Sixty subjects received a course of 15 treatments over 3 weeks with active or an inactivated laser as a placebo procedure. LLLT was applied to the skin projection at the anatomical site of the spinal segment involved with the following parameters: wavelength 905 nm, frequency 5,000 Hz, power density of 12 mW/cm(2) and dose of 2 J/cm(2) treatment time 120 seconds, at whole doses 12 J/cm(2) OUTCOME MEASURES The primary outcome measure was pain intensity as measured by a visual analog scale. Secondary outcome measures were neck movement, neck disability index, and quality of life. Measurements were taken before treatment and at the end of the 3 week treatment period.  Statistically significant differences between groups were found for intensity of arm pain (P 0.003, with high effect size d 0.92) and for neck extension (P 0.003 with high effect size d 0.94) CONCLUSION LLLT gave more effective short term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure.

title: Low level laser therapy for neck pain
abstract: Dear Sir A recent article (1) published in The Lancet entitled 'Efficacy of low level laser therapy in the management of neck pain: A systematic review and meta analysis of randomized placebo or active treatment controlled trials' has come to my attention. The authors studied 16 randomised controlled trials including a total of 820 patients with acute and chronic neck pain, treated with low level laser therapy (LLLT) A significant reduction in pain intensity immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain was found. Side effects from LLLT were mild and no different from those of placebo. Unfortunately, the study does not categorise any specific neck pain diagnosis but, nevertheless, is still relevant for the headache practice. Neck pain is faced every day by the headache specialist; in addition, neck pain is mentioned by two thirds of migraine patients during their attacks. Laser therapy is a modality that can be viewed with scepticism by physicians or healthcare providers, in part because unwarranted claims are sometimes made in the lay press and in advertising. The mechanism behind laser therapy action also remains unknown, but many drugs that are prescribed every day for neck pain (and headache disorders) have unclear mechanisms of action, sometimes with significant side effects. LLLT has a potential for efficacy in headache disorders and a very benign side effect profile, suitable for several patient profiles including its use in pregnancy, the elderly, patients with allergies to medications, and the paediatric population. LLLT is also an option worthy of consideration for a trial in the patient who did not respond to usual therapy. Unlike other lasers in medicine, LLLT devices should not be expensive; treatments can also be cost effective. This letter is a call for the headache research community to look with more emphasis not only in LLLT use for primary headache disorders but also other non pharmacological treatments for headaches, since today's medicine is heavily biased towards pharmacological approaches to therapies because of massive investment by pharmaceutical companies, as opposed to a minimal government or public investment in non commercial oriented therapies. Further trials of LLLT in migraine, tension type headache, and neck related headaches are warranted, the funding source is critical since device companies may bias methodology and interfere with evidence. Trials relevant to headache therapy with unbiased funding should be reinforced by society.

title: Low level laser therapy for neck pain
abstract: Roberta Chow and colleagues (Dec 5, p 1897) conclude that regular lowlevel laser therapy is eff ective in the management of neck pain. Theirs is a well designed systematic review, but our experience with such reviews in the specialty of musculoskeletal disorders makes us suspicious about the validity of the data used for the statistical pooling, and therefore the conclusions. We were able to retrieve most articles published in English. Assessment of these studies resulted in the following possible sources of bias: Two studies had signifi cant baseline diff erences in pain in favour of the active treatment group, which probably resulted in overestimation of the mean diff erence. There is a typing error in Chow and colleagues' fi gure 4, which suggests a signifi cant mean diff erence in the trial by Chow et al (2004) However, the diff erence is non signifi cant in the original study. Since these studies provide three of the largest reported mean diff erences, we think that the overall mean diff erence is too optimistic. We also think that the reported heterogeneity was mainly due to clinical heterogeneity. Pooling of data from patients with non specifi c neck pain, myofascial pain syndrome, and cervical osteoarthritis is in our view inap propriate. This notion is illustrated by the fact that the largest mean diff erence was found in the patients with cervical osteoarthritis (fi gure 4 in Chow and colleagues' paper) Therefore, although low level laser therapy might be an eff ective treatment strategy, we think that Chow and colleagues' conclusion is based on an overestimation of the actual treatment eff ect and that their interpretation of the generalisability is unjust because of clinical heterogeneity. We declare that we have no confl icts of interest.

title: Conservative interventions provide short term relief for non specific neck pain: a systematic review.
abstract: Which interventions for non specific neck pain are effective in reducing pain or disability? DESIGN Systematic review with meta analysis of randomised controlled trials.  Adults with non specific neck pain.  All interventions for neck pain that were evaluated in trials with a placebo, minimal or no intervention control.  Pain and disability outcomes (0 100 scale) at the conclusion of a course of treatment (short term) and in the medium (3 to 9 months) and long 9 months) term.  33 trials were identified. The interventions with significant short term effects on pain were manipulation (MD 22, 95% CI 32 to 11) multimodal intervention (MD 21, 95% CI 34 to 7) specific exercise (MD 12, 95% CI 22 to 2) combination orphenadrine/paracetamol (MD 17, 95% CI 32 to 2) and manual therapy (MD 12, 95% CI 16 to 7) There was a significant short term effect on disability for acupuncture (MD 8, 95% CI 13 to 2) and manual therapy (MD 6, 95% CI 11 to 2) Treatment with laser therapy resulted in better pain outcomes at medium term follow up but not at short term follow up. No other intervention demonstrated medium or long term effects.  Some conservative interventions for neck pain are effective in the short term. Few interventions that have been investigated have shown longer term effects that are better than placebo or minimal intervention.

title: Use of 660 nm diode laser in the prevention and treatment of human oral mucositis induced by radiotherapy and chemotherapy.
abstract: The aim of this multidisciplinary study was to evaluate quantitatively and qualitatively the effect of a 660 nm diode laser in the prevention and treatment of human oral mucositis (OM) in patients suffering from head and neck cancer who had undergone radiotherapy and chemotherapy.  DATA OM is a severe oral lesion resulting from the toxic effects of treatment for cancer in the head and neck region. Low level laser therapy is indicated to prevent and treat this oral complication and may be used alone or in association with conventional drug treatment, producing pain relief and wound repair.  This study included 72 patients with head and neck cancer treated at the Cancer Hospital of Mato Grosso, Brazil, and divided into a control group (C; n 36) and a laser group (L; n 36) Laser therapy was performed in combination with radiotherapy and chemotherapy twice a week using a diode laser (lambda 660 nm, power 30 mW, spot size 2 mm, energy 2 J per point)  Statistically significant differences were observed between the two groups. Patients in group L usually did not present with OM or pain, but all patients in group C presented with OM ranging from Level I to III associated with pain. This difference was significant from week 1 on, increased until week 4 and remained stable up to week 7.  Laser therapy was effective in preventing and treating oral effects induced by radiotherapy and chemotherapy, thus improving the patient's quality of life.

title: Efficacy of low level laser therapy and aluminum hydroxide in patients with chemotherapy and radiotherapy induced oral mucositis.
abstract: This study evaluated the efficacy of low level laser therapy (LLLT) and aluminum hydroxide (AH) in the prevention of oral mucositis (OM) A prospective, comparative and non randomized study was conducted with 25 patients with head and neck cancer subjected to radiotherapy (RT) or radiochemotherapy (RCT) Twelve patients received LLLT (830 nm, 15 mW, 12 J/cm2) daily from the 1st day until the end of RT before each sessions during 5 consecutive days, and the other 13 patients received AH 310 mg/5 mL, 4 times/day, also throughout the duration of RT, including weekends. OM was measured using an oral toxicity scale (OTS) and pain was measured using the visual analogue scale (VAS) EORTC questionnaires were administered to the evaluate impact of OM on quality of life. The LLLT group showed lower mean OTS and VAS scores during the course of RT. A significant difference was observed in pain evaluation in the 13th RT session (p=0.036) In both groups, no interruption of RT was needed. The prophylactic use of both treatments proposed in this study seems to reduce the incidence of severe OM lesions. However, the LLLT was more effective in delaying the appearance of severe OM.

title: Findings From The Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders
abstract: To summarize the key findings of a best evidence synthesis on neck pain.  A systematic search, critical review, and best evidence synthesis of the literature on the burden and determinants of neck pain, its assessment and intervention, and its course and prognostic factors.  There were 552 studies judged to have adequate internal validity to form the basis of the best evidence synthesis. Neck pain is common across populations and age groups. Most do not experience a complete resolution of symptoms, and its course of recovery is similar across populations. In the absence of trauma and "red flags," routine imaging is not needed. Treatments emphasizing activity and return to normal function are more beneficial than those without such a focus.  Neck pain is common, and its determinants and prognosis are multifactorial.

title: The epidemiology of neck pain.
abstract: Neck pain is becoming increasingly common throughout the world. It has a considerable impact on individuals and their families, communities, health care systems, and businesses. There is substantial heterogeneity between neck pain epidemiological studies, which makes it difficult to compare or pool data from different studies. The estimated 1 year incidence of neck pain from available studies ranges between 10.4% and 21.3% with a higher incidence noted in office and computer workers. While some studies report that between 33% and 65% of people have recovered from an episode of neck pain at 1 year, most cases run an episodic course over a person's lifetime and, thus, relapses are common. The overall prevalence of neck pain in the general population ranges between 0.4% and 86.8% (mean: 23.1% point prevalence ranges from 0.4% to 41.5% (mean: 14.4% and 1 year prevalence ranges from 4.8% to 79.5% (mean: 25.8% Prevalence is generally higher in women, higher in high income countries compared with low and middle income countries and higher in urban areas compared with rural areas. Many environmental and personal factors influence the onset and course of neck pain. Most studies indicate a higher incidence of neck pain among women and an increased risk of developing neck pain until the 35 49 year age group, after which the risk begins to decline. The Global Burden of Disease 2005 Study is currently making estimates of the global burden of neck pain in relation to impairment and activity limitation, and results will be available in 2011.

title: Manipulation or mobilisation for neck pain: a Cochrane Review.
abstract: Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain. This review assesses if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life (QoL) and global perceived effect (GPE) in adults experiencing neck pain with or without cervicogenic headache or radicular findings. A computerised search was performed in July 2009. Randomised trials investigating manipulation or mobilisation for neck pain were included. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardised mean differences (pSMD) were calculated. 33% of 27 trials had a low risk of bias. Moderate quality evidence showed cervical manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate term follow up. Low quality evidence suggested cervical manipulation may provide greater short term pain relief than a control (pSMD 0.90 (95%CI: 1.78 to 0.02) Low quality evidence also supported thoracic manipulation for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and immediate pain reduction in chronic neck pain (NNT 5; 29% treatment advantage) Optimal technique and dose need to be determined.

title: Kinematics of fast cervical rotations in persons with chronic neck pain: a cross sectional and reliability study
abstract: BackgroundAssessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before.MethodsCervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS) and compared to 49 healthy controls (CON) The relationship between cervical kinematics and symptoms, self rated functioning and fear of movement was evaluated in the NS group. A sub sample of 16 NS and 16 CON was re tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile.ResultsTogether, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 88 deg/s and CON: 348 92 deg/s, p 0.01) Peak speed was slower in NS compared to healthy controls and even slower in NS with comorbidity of low back pain. Associations were found between reduced peak speed and self rated difficulties with running, performing head movements, car driving, sleeping and pain. Peak speed showed reasonably high reliability, while the reliability for conjunct movements was poor.ConclusionsPeak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.