Advertisement

Lasers in Medical Science

, Volume 29, Issue 6, pp 1839–1847 | Cite as

Adjunctive use of combination of super-pulsed laser and light-emitting diodes phototherapy on nonspecific knee pain: double-blinded randomized placebo-controlled trial

  • Ernesto Cesar Pinto Leal-Junior
  • Douglas Scott Johnson
  • Anita Saltmarche
  • Timothy Demchak
Original Article

Abstract

Phototherapy with low-level laser therapy (LLLT) and light-emitting diode therapy (LEDT) has arisen as an interesting alternative to drugs in treatments of musculoskeletal disorders. However, there is a lack of studies investigating the effects of combined use of different wavelengths from different light sources like lasers and light-emitting diodes (LEDs) in skeletal muscle disorders. With this perspective in mind, this study aimed to investigate the effects of phototherapy with combination of different light sources on nonspecific knee pain. It was performed a randomized, placebo-controlled, double-blinded clinical trial. Eighty-six patients rated 30 or greater on the pain visual analogue scale (VAS) were recruited and included in study. Patients of LLLT group received 12 treatments with active phototherapy (with 905 nm super-pulsed laser and 875 and 640 nm LEDs, Manufactured by Multi Radiance Medical, Solon, OH, USA) and conventional treatment (physical therapy or chiropractic care), and patients of placebo group were treated at same way but with placebo phototherapy device. Pain assessments (VAS) were performed at baseline, 4th, 7th, and 10th treatments, after the completion of treatments and at 1-month follow-up visit. Quality of life assessments (SF-36®) were performed at baseline, after the completion of treatments and at 1-month follow-up visit. Our results demonstrate that phototherapy significantly decreased pain (p < 0.05) from 10th treatment to follow-up assessments and significantly improved (p < 0.05) SF-36® physical component summary at posttreatments and follow-up assessments compared to placebo. We conclude that combination of super-pulsed laser, red and infrared LEDs is effective to decrease pain and improve quality of life in patients with knee pain.

Keywords

Knee pain Super-pulsed laser Light-emitting diodes Musculoskeletal disorders 

Notes

Competing interests

Professor Ernesto Cesar Pinto Leal-Junior receives research support from Multi Radiance Medical (Solon, OH, USA), a laser device manufacturer. Douglas Scott Johnson is an employee and shareholder of Multi Radiance Medical (Solon, OH, USA). Anita Saltmarche and Dr. Timothy Demchak are educational consultants for Multi Radiance Medical (Solon, OH, USA).

References

  1. 1.
    Tsai WC, Hsu CC, Chang HN, Lin YC, Lin MS, Pang JH (2010) Ibuprofen upregulates expressions of matrix metalloproteinase-1, -8, -9, and -13 without affecting expressions of types I and III collagen in tendon cells. J Orthop Res 28:487–491PubMedGoogle Scholar
  2. 2.
    Thampatty BP, Li H, Im HJ, Wang JH (2007) EP4 receptor regulates collagen type-I, MMP-1, and MMP-3 gene expression in human tendon fibroblasts in response to IL-1 beta treatment. Gene 386:154–161PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Wang JH, Iosifidis MI, Fu FH (2006) Biomechanical basis for tendinopathy. Clin Orthop Relat Res 446:320–332CrossRefGoogle Scholar
  4. 4.
    Smith AS, Kosygan K, Williams H, Newman RJ (1999) Common extensor tendon rupture following corticosteroid injection for lateral tendinosis of the elbow. Br J Sports Med 33:423–424PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Sendzik J, Lode H, Stahlmann R (2008) Quinolone-induced arthropathy: an update focusing on new mechanistic and clinical data. Int J Antimicrob Agents 33:194–200PubMedCrossRefGoogle Scholar
  6. 6.
    Chow R, Armati P, Laakso EL, Bjordal JM, Baxter GD (2011) Inhibitory effects of laser irradiation on peripheral mammalian nerves and relevance to analgesic effects: a systematic review. Photomed Laser Surg 29:365–381PubMedCrossRefGoogle Scholar
  7. 7.
    Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RA (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg 24:158–168PubMedCrossRefGoogle Scholar
  8. 8.
    Hegedus B, Viharos L, Gervain M, Gálfi M (2009) The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg 27:577–584PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Bjordal JM, Lopes-Martins RA, Iversen VV (2006) A randomised, placebo controlled trial of low level laser therapy for activated achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med 40:76–80PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM (2008) Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. Am J Sports Med 36:881–887PubMedCrossRefGoogle Scholar
  11. 11.
    Basford JR, Sheffield CG, Harmsen WS (1999) Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil 80:647–652PubMedCrossRefGoogle Scholar
  12. 12.
    Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND (2010) Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study. Photomed Laser Surg 28:553–560PubMedCrossRefGoogle Scholar
  13. 13.
    Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S (2004) Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med 35:229–235PubMedCrossRefGoogle Scholar
  14. 14.
    Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009) Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 374:1897–1908PubMedCrossRefGoogle Scholar
  15. 15.
    Leal Junior EC, Lopes-Martins RA, Dalan F, Ferrari M, Sbabo FM, Generosi RA, Baroni BM, Penna SC, Iversen VV, Bjordal JM (2008) Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans. Photomed Laser Surg 26:419–424PubMedCrossRefGoogle Scholar
  16. 16.
    Leal Junior EC, Lopes-Martins RA, Vanin AA, Baroni BM, Grosselli D, De Marchi T, Iversen VV, Bjordal JM (2009) Effect of 830 nm low-level laser therapy in exercise-induced skeletal muscle fatigue in humans. Lasers Med Sci 24:425–431PubMedCrossRefGoogle Scholar
  17. 17.
    Leal Junior EC, Lopes-Martins RA, Baroni BM, De Marchi T, Rossi RP, Grosselli D, Generosi RA, de Godoi V, Basso M, Mancalossi JL, Bjordal JM (2009) Comparison between single-diode low-level laser therapy (LLLT) and LED multi-diode (cluster) therapy (LEDT) applications before high-intensity exercise. Photomed Laser Surg 27:617–623PubMedCrossRefGoogle Scholar
  18. 18.
    Leal Junior EC, Lopes-Martins RA, Rossi RP, De Marchi T, Baroni BM, de Godoi V, Marcos RL, Ramos L, Bjordal JM (2009) Effect of cluster multi-diode light emitting diode therapy (LEDT) on exercise-induced skeletal muscle fatigue and skeletal muscle recovery in humans. Lasers Surg Med 41:572–577PubMedCrossRefGoogle Scholar
  19. 19.
    Leal Junior EC, Lopes-Martins RA, Frigo L, De Marchi T, Rossi RP, de Godoi V, Tomazoni SS, da Silva DP, Basso M, Lotti Filho P, Corsetti FV, Iversen VV, Bjordal JM (2010) Effects of low-level laser therapy (LLLT) in the development of exercise-induced skeletal muscle fatigue and changes in biochemical markers related to post-exercise recovery. J Orthop Sports Phys Ther 40:524–532PubMedCrossRefGoogle Scholar
  20. 20.
    de Almeida P, Lopes-Martins RA, De Marchi T, Tomazoni SS, Albertini R, Corrêa JC, Rossi RP, Machado GP, da Silva DP, Bjordal JM, Leal Junior EC (2012) Red (660 nm) and infrared (830 nm) low-level laser therapy in skeletal muscle fatigue in humans: what is better? Lasers Med Sci 27:453–458PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    De Marchi T, Leal Junior EC, Bortoli C, Tomazoni SS, Lopes-Martins RA, Salvador M (2012) Low-level laser therapy (LLLT) in human progressive-intensity running: effects on exercise performance, skeletal muscle status, and oxidative stress. Lasers Med Sci 27:231–236PubMedCrossRefGoogle Scholar
  22. 22.
    Leal-Junior EC, Vanin AA, Miranda EF, de Carvalho PdeT, Dal Corso S, Bjordal JM (2013) Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis. Lasers Med Sci [Epub ahead of print].Google Scholar
  23. 23.
    Ware JE Jr, Gandek B (1998) Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol 51:903–912PubMedCrossRefGoogle Scholar
  24. 24.
    Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA (2003) A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. The Australian J Physiother 49:107–116CrossRefGoogle Scholar
  25. 25.
    Vernon H, Schneider M (2009) Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manip Physiol Ther 32:14–24CrossRefGoogle Scholar
  26. 26.
    Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI (2008) A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord 29:75CrossRefGoogle Scholar
  27. 27.
    Rodrigo SM, Cunha A, Pozza DH, Blaya DS, Moraes JF, Weber JB, de Oliveira MG (2009) Analysis of the systemic effect of red and infrared laser therapy on wound repair. Photomed Laser Surg 27:929–935PubMedCrossRefGoogle Scholar
  28. 28.
    Mendez TM, Pinheiro AL, Pacheco MT, Nascimento PM, Ramalho LM (2004) Dose and wavelength of laser light have influence on the repair of cutaneous wounds. J Clin Laser Med Surg 22:19–25PubMedCrossRefGoogle Scholar
  29. 29.
    Friedmann H, Lipovsky A, Nitzan Y, Lubart R (2009) Combined magnetic and pulsed laser field produce synergistic acceleration of cellular electron transfer. Laser Ther 18:137–141CrossRefGoogle Scholar
  30. 30.
    Bjordal JM (2012) Low level laser therapy (LLLT) and World Association for Laser Therapy (WALT) dosage recommendations. Photomed Laser Surg 30:61–62PubMedCrossRefGoogle Scholar
  31. 31.
    Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RA (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg 24:158–168PubMedCrossRefGoogle Scholar
  32. 32.
    de Almeida P, Lopes-Martins RÁ, Tomazoni SS, Albuquerque-Pontes GM, Santos LA, Vanin AA, Frigo L, Vieira RP, Albertini R, de Carvalho PT, Leal-Junior EC (2013) Low-level laser therapy and sodium diclofenac in acute inflammatory response induced by skeletal muscle trauma: effects in muscle morphology and mRNA gene expression of inflammatory markers. Photochem Photobiol 89:501–507PubMedCrossRefGoogle Scholar
  33. 33.
    de Almeida P, Tomazoni SS, Frigo L, de Carvalho PD, Vanin AA, Santos LA, Albuquerque-Pontes GM, De Marchi T, Tairova O, Marcos RL, Lopes-Martins RA, Leal-Junior EC (2014) What is the best treatment to decrease pro-inflammatory cytokine release in acute skeletal muscle injury induced by trauma in rats: low-level laser therapy, diclofenac, or cryotherapy? Lasers Med Sci 29:653–658PubMedCrossRefGoogle Scholar
  34. 34.
    Ohshiro T (2005) The proximal priority technique: how to maximize the efficacy of laser therapy. Laser Ther 14:121–128CrossRefGoogle Scholar
  35. 35.
    Basford JR, Hallman HO, Matsumoto JY, Moyer SK, Buss JM, Baxter GD (1993) Effects of 830 nm continuous wave laser diode irradiation on median nerve function in normal subjects. Lasers Surg Med 13:597–604PubMedCrossRefGoogle Scholar
  36. 36.
    Lievens PC (1991) The effect of combined HeNe and IR laser treatment on the regeneration of the lymphatic system during the process of wound healing. Lasers Med Sci 6:193–199CrossRefGoogle Scholar
  37. 37.
    Lievens PC (1985) The influence of laser-irradiation on the motoricity of the lymphatic system and on the wound healing process. In: Proceedings from the International Congress on Laser in Medicine and Surgery, 171–174Google Scholar
  38. 38.
    Asimov A, Asimov R, Rubinov A, Gisbrecht A (2012) The physics of biomedical effect of blood oxyhemoglobin photodissociation. JBAP 1:33–38Google Scholar
  39. 39.
    Mak MC, Cheing GL (2012) Immediate effects of monochromatic infrared energy on microcirculation in healthy subjects. Photomed Laser Surg 30:193–199PubMedCrossRefGoogle Scholar
  40. 40.
    Moriyama Y, Nguyen J, Akens M, Moriyama EH, Lilge L (2009) In vivo effects of low level laser therapy on inducible nitric oxide synthase. Lasers Surg Med 41:227–231PubMedCrossRefGoogle Scholar
  41. 41.
    Mester A (2013) Laser biostimulation. Photomed Laser Surg 31:237–239PubMedCrossRefGoogle Scholar
  42. 42.
    Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The J Pain 4:407–414CrossRefGoogle Scholar
  43. 43.
    England S, Farrell AJ, Coppock JS, Struthers G, Bacon PA (1989) Low power laser therapy of shoulder tendonitis. Scand J Rheumatol 18:427–431PubMedCrossRefGoogle Scholar
  44. 44.
    Gur A, Cosut A, Sarac AJ, Cevik R, Nas K, Uyar A (2003) Efficacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee: a double-blind and randomized-controlled trial. Lasers Surg Med 33:330–338PubMedCrossRefGoogle Scholar
  45. 45.
    Alfredo PP, Bjordal JM, Dreyer SH, Meneses SR, Zaguetti G, Ovanessian V, Fukuda TY, Junior WS, Lopes Martins RÁ, Casarotto RA, Marques AP (2012) Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study. Clin Rehabil 26:523–533PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Ernesto Cesar Pinto Leal-Junior
    • 1
    • 2
  • Douglas Scott Johnson
    • 3
  • Anita Saltmarche
    • 4
  • Timothy Demchak
    • 5
  1. 1.Postgraduate Program in Rehabilitation SciencesUniversidade Nove de Julho (UNINOVE)São PauloBrazil
  2. 2.Postgraduate Program in Biophotonics Applied to Health SciencesUniversidade Nove de Julho (UNINOVE)São PauloBrazil
  3. 3.Multi Radiance MedicalSolonUSA
  4. 4.Laser Therapy UAtlantaUSA
  5. 5.Department Applied Medicine and RehabilitationIndiana State UniversityTerre HauteUSA

Personalised recommendations