Query: Laser in neck pain 2014

title: Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis
abstract: This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2% Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88% Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28% NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77% Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF a was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNFa and beta endorphin.

title: Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain.
abstract: Randomized controlled trial.  To determine if force magnitude during posterior to anterior mobilization affects immediate and short term outcomes in patients with chronic, nonspecific neck pain.  The optimal dose of mobilization to effectively treat patients with neck pain is not known.  Patients with neck pain of at least 3 months in duration (n 64) were randomized to receive a single treatment of posterior to anterior mobilization applied with 30 N or 90 N of mean peak force (3 sets of 30 seconds) or a placebo (detuned laser) on the spinous process at the painful spinal level. Pressure pain threshold, pain measured with a visual analog scale (range, 0 100 mm) cervical range of motion, and spinal stiffness at the painful spinal level (measured with a custom device and normalized as a percentage of C7 stiffness) were assessed before, immediately after, and at a mean SD follow up of 4.0 1.8 days following treatment. Repeated measures analysis of covariance and Bonferroni adjusted post hoc tests determined group differences for each outcome measure after treatment and at follow up.  At follow up, the 90 N group had less pain than the 30 N group (mean difference, 11.3 mm; 95% confidence interval: 0.1, 22.6 mm; P .048) and lower stiffness than the placebo group (mean difference, 17.5% 95% confidence interval: 4.2% 30.9% P .006) These differences were not present immediately after treatment. There were no significant between group differences in pressure pain threshold or range of motion after treatment or at follow up.  A specific dose of mobilization, in terms of applied force, appears necessary for reducing stiffness and potentially pain in patients with chronic neck pain. Changes were not observed immediately after mobilization, suggesting that its effects are not directly mechanical.

title: Short term effects of acupuncture and stretching on myofascial trigger point pain of the neck: a blinded, placebo controlled RCT.
abstract: This trial aimed to evaluate the short term effectiveness of acupuncture plus stretching to reduce pain and improve range of motion in patients afflicted by cervical myofascial pain syndrome.  Randomized, blinded, placebo controlled crossover study.  Nineteen patients (11 females, eight males, 33 14 years) with myofascial neck pain in randomized order received the following treatments with one week washout between: acupuncture, acupuncture plus stretching, and placebo laser acupuncture.  Mechanical pain threshold (MPT, measured with a pressure algometer) represented the primary outcome. Secondary outcomes were motion related pain (Visual Analogue Scale, VAS) and cervical range of motion (ROM, recorded by means of an ultrasonic 3D movement analysis system) Outcomes were assessed immediately prior as well as 5, 15 and 30 min post treatment. Friedman tests with post hoc Bonferroni Holm correction were applied to compare differences between treatments.  Both acupuncture as well as acupuncture plus stretching increased MPT by five, respectively, 11 percent post treatment. However, only acupuncture in combination with stretching was superior to placebo (p<0.05) There were no significant differences between interventions at 15 and 30 min post treatment. VAS did not differ between treatments at any measurement. Five minutes after application of acupuncture plus stretching, ROM was significantly increased in the frontal and the transversal plane compared to placebo (p<0.05)  The combination of acupuncture and stretching could represent a suitable treatment option to improve cervical movement behavior and reduce trigger point pain in the short term. However, additional studies further discriminating the placebo effects are still warranted.

title: Effect of high intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double blind, placebo controlled study
abstract: Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double blind study, we evaluated the effects of high intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12) Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short form 36 health survey (SF 36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.

title: TO COMPARE THE EFFECTIVENESS OF MYOFASCIAL RELEASE TECHNIQUE VERSUS POSITIONAL RELEASE TECHNIQUE WITH LASER IN PATIENTS WITH UNILATERAL TRAPEZITIS
abstract: Trapezius pain is the classic stress pain and it is the most common musculoskeletal disorder. It is usually caused by placing too much stress or strain over the trapezius muscle. The upper trapezius muscle is designated as postural muscle and it is highly susceptible to overuse. Trapezius muscles help with the function of neck rotation, side bending and extension. Tightness in the muscles can decrease the range of motion of the neck. The decrease in motion can negatively affect the mobility of the cervical joints. Limited range of motion creates an increase in soft tissue tightness, with an ensuing pain spasm cycle which can be difficult to break. Physiotherapy techniques like myofascial release technique and Positional release therapy has been proposed as an adjunct to conventional therapy to treat trapezitis. Giving myofascial release technique and positional release therapy along with LASER and exercises improves the cervical range of motion and relieves pain and enhances quality of life in the patient with trapezitis. Hence this study is aimed to determine the effect of myofascial release technique and positional release therapy in trapezitis.  Comparative  Out Patient Department of Orthopedics, Kempegowda Institute of Medical Science Hospital and Research Center, Bangalore. Out Patient Department of Physiotherapy, Kempegowda Institute of Physiotherapy, Bangalore.  Visual analog scale (VAS) for pain, Cervical ROM, Neck disability index.  Comparative Study design was used for this study.  20 50 year, Patients with unilateral trapezitis. Exclusion criteria Traumatic Neck Injury, Fracture of cervical vertebras, Cervical Spinal Cord Compromise, Cervical Radiculopathy, Spondylolysthesis of the cervical spine, A history of heart disease or the presence of a pacemaker, epilepsy, a psychological disorder or pregnancy .Sixty subjects with unilateral upper trapezius spasm were randomly allocated into two groups namely Group A and Group B and treated with LASER which was common to both the groups Myofacial release technique was given to group A and Positional Release Therapy was given to the Group B respectively for Alternatively 3 days for four weeks after obtaining informed consent.  This study showed statistically significant improvement in lateral flexion (p=0.001) reduction in Pain intensity (p=0.001) and improvement in functional ability (p=0.001) in both the

title: Tonsillitis and sore throat in children
abstract: Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcomes after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy have slowly changed in Germany. However, no national guidelines exist and the frequency of tonsil surgery varies across the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under six years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i.e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy =tonsillotomy) No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more of such episodes occur in each of the 2 preceding years (according to the paradise criteria) Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of healthy children even bear strepptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens) The acute tonsillitis should be treated with steroids (e.g. dexamethasone) NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime) With respect to the symptom reduction and primary healing the short term late generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for three to five days) is comparable to the long term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short term penicilline therapy and the standard ten days therapy. On the other hand, only the ten days antibiotic therapy has proven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100,000 children of school age. The main morbidity after tonsillectomy is pain and the late haemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after three weeks. Life threatening haemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every haemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behaviour in case of haemorrhage with a written consent before the surgery. The handout should contain important addresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of haemorrhage. Haemorrhage in small children can be especially life threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive haemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate inflexible suction tubes. All different surgical techniques have the risk of haemorrhage and even the best surgeon will experience a postoperative haemorrhage. The lowest risk of haemorrhage is after cold dissection with ligature or suturing. All "hot" techniques with laser, radiofrequency, coblation, mono or bipolar forceps have a higher risk of late haemorrhage. Children with a hereditary coagulopathy have a higher risk of haemorrhage. It is possible, that these children were not identified before surgery. Therefore it is recommended by the Society of paediatrics, anaesthesia and ENT, that a standardised questionnaire should be answered by the parents before tonsillectomy and adenoidectomy. This 17 point checklist questionnaire is more sensitive and easier to perform than a screening with blood tests (e.g. INR and PTT) Unfortunately, a lot of surgeons still screen the children preoperatively by coagulative blood tests, although these tests are inappropriate and incapable of detecting the von Willebrand disease, which is the most frequent coagulopathy in Europe. The preoperative information about the surgery should be done with the child and the parents in a calm and objective atmosphere with a written consent. A copy of the consent with the signature of the surgeon and both custodial parents has to be handed out to the parents.

title: Effects of phototherapy on muscle activity and pain in individuals with temporomandibular disorder: a study protocol for a randomized controlled trial
abstract: BackgroundAccording to the International Association for the Study of Pain (IASP) the term temporomandibular disorder (TMD) regards a subgroup of orofacial pain, the symptoms of which include pain or discomfort in the temporomandibular joint, ears, masticatory muscles and neck on one or both sides, as well as joint sounds, limited mandibular movements or mandibular deviation and difficulties chewing. Phototherapy, such as low level laser therapy (LLLT) and light emitting diode (LED) therapy, is one of the resources used to treatment muscle pain. Thus, there is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (LLLT and LED) in the same apparatus.The aim of the proposed study is to evaluate the effects of four different doses of phototherapy on pain, activity of the masticatory muscles (masseter and bilateral anterior temporal) and joint mobility in individuals with temporomandibular disorder. A further aim is to determine the cumulative effect 24 and 48 hours after a single session.DesignA placebo controlled, double blind, randomized, clinical trial will be carried out involving 72 women between 18 and 40 years of age with a diagnosis of myogenous TMD. The participants will then be randomly allocated to four groups totaling 18 individuals per group. Three groups will be submitted to a single session of phototherapy with different light sources, and one group will receive placebo therapy: Group A (2.62 Joules) Group B (5.24 Joules) Group C (7.86 Joules) and Group D (0 Joules) The following assessment tools will be administered on four separate occasions (baseline and immediately after, 24 h after and 48 h after phototherapy) Pain intensity will be assessed using the visual analog scale for pain, while pain thresholds will be determined using algometer, and electromyographic (EMG) analysis on the masseter and anterior temporal muscles.DiscussionThe study will contribute to the practice of the evidence based use of phototherapy in individuals with a myogenous TMD. Data will be published after the study is completed.

title: Oral mucositis prevention and management by therapeutic laser in head and neck cancers.
abstract: Oral mucositis is considered a severe complication in cancer patients receiving radiotherapy or chemotherapy for head and neck cancer. The aim of this review study was to assess the effect of low level laser therapy for prevention and management of oral mucositis in cancer patients.  The electronic databases searched included Pubmed, ISI Web of Knowledge and Google scholar with keywords as "oral mucositis" "low level laser therapy" from 2000 to 2013.  The results of most studies showed that photobiomodulation (PBM) reduced the severity of mucositis. Also, it can delay the appearance of severe mucositis.  Low level laser therapy is a safe approach for management and prevention of oral mucositis.

title: Effect of diode laser in the treatment of patients with nonspecific chronic low back pain: a randomized controlled trial.
abstract: DATA Low back pain is a common, highly debilitating condition, whose severity is variable. This study evaluated the efficacy of treatment with Ga Al As diode laser (980 nm) with a large diameter spot (32 cm(2) in association with exercise therapy, in reducing pain.  The present study aimed to evaluate the pain reduction efficacy of treatment with the Ga Al As diode laser (980 nm) in combination with exercise therapy, in patients with chronic low back pain (CLBP)  This study evaluated 100 patients with CLBP (mean age 60 years) who were randomly assigned to two groups. The laser plus exercises group (Laser+EX: 50 patients) received low level laser therapy (LLLT) with a diode laser, 980 nm, with a specific handpiece [32 cm(2) irradiation spot size, power 20 W in continuous wave (CW) fluence 37.5J/cm(2) total energy per point 1200 J] thrice weekly, and followed a daily exercise schedule for 3 weeks (5 days/week) The exercises group (EX: 50 patients) received placebo laser therapy plus daily exercises. The outcome was evaluated on the visual analogue pain scale (VAS) before and after treatment.  At the end of the 3 week period, the Laser+EX group showed a significantly greater decrease in pain than did the EX group. There was a significant difference between the two groups, with average D VAS scores of 3.96 (Laser+EX group) and 2.23 (EX group) The Student's t test demonstrated a statistically significant difference between the two groups, at p<0.001.  This study demonstrated that the use of diode laser (980 nm) with large diameter spot size, in association with exercise therapy, appears to be effective. Such treatment might be considered a valid therapeutic option within rehabilitation programs for nonspecific CLBP.

title: Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle.
abstract: To identify the most effective components in an active exercise physiotherapy treatment intervention for chronic neck pain based on the frequency, intensity, time, and type (FITT) exercise method of tailoring physical activity recommendations to the individual needs and goals of patients.  Databases, including the Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, SPORTDiscus, Biomedical Reference Collection, and Academic Search Premier, were searched for relevant articles.  Quantitative design studies that included active exercise as part of a multimodal or stand alone approach were selected. Only studies scoring =6 on the Physiotherapy Evidence Database Scale were included in the review because this reflected a good level of evidence.  Study methodologies and relevant outcome measures, including isometric strength, Neck Disability Index scores, and pain scores, were extracted from relevant articles and grouped together for appraisal and synthesis.  Evidence from selected articles was synthesized according to the FITT exercise principal to determine the most effective exercise type, frequency, and intensity in the treatment of chronic neck pain.  Physiotherapy interventions using a multimodal approach appear to produce more beneficial outcomes in terms of increased strength, improved function, and health related quality of life and reduced pain scores. Active strengthening exercises appear to be beneficial for all of these outcomes; the inclusion of additional stretching and aerobic exercise components appear to enhance the benefits of an exercise intervention.