Efficacy of Low-Level Laser Therapy for the Treatment of Nonspecific Chronic Neck Pain: Low-Level Laser Therapy vs. Sham Laser.

Introduction: The most common type of neck pain is chronic nonspecific pain. There are conflicting opinions about the beneficial effects of a low-level laser in reducing chronic nonspecific neck pain. The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) for the treatment of non-specific chronic neck pain. Methods: This study was conducted as a prospective randomized clinical trial. Forty-four patients were randomly divided into two groups: (1) Intervention group (n=22): LLLT in the red spectra range with a wavelength of 980 (nm) and a power of 16 (J/cm2 ) was irradiated in the affected areas of the neck, the muscles along the spine, and the upper trapezius; (2) sham group (n=22): A low-level laser was irradiated with a passive probe (non-laser red light) in the affected areas of the neck, the muscles along the spine, and the upper trapezius. The treatment protocol consisted of 12 sessions (15 minutes, three times a week, for four weeks). These patients were evaluated for pain using the visual analog scale (VAS) (0-10). The patients were followed up for four weeks. Results: This study showed a statistically significant reduction in chronic nonspecific neck pain in the LLLT group (P<0.05). Conclusion: It is concluded that LLLT was effective in reducing chronic nonspecific neck pain. LLLT is a non-invasive, safe and effective method that can improve chronic nonspecific neck pain in patients in the short term.

The Effect of Percutaneous Laser Disc Decompression on Reducing Pain and Disability in Patients With Lumbar Disc Herniation.

Introduction: As low back pain incidence is increasing, noninvasive modalities are gaining attention for their ability to achieve the best possible outcome with the least complications. Percutaneous laser disc decompression (PLDD) is currently popular for this purpose. This study aims to evaluate the effect of PLDD on disability and pain reduction in patients with lumbar disc herniation. Methods: Thirty patients were enrolled in this study. Spinal nerve blocks were conducted by laser discectomy single stage injection of a needle into the disc space. The nucleus pulposus of herniated discs were irradiated with laser in order to vaporize a small part of the nucleus pulposus of the intervertebral discs and reduce the voluminosity of diseased discs. Patients were treated with 1000 J of 980 nm diode laser with 5 W energy. In order to measure the severity of pain, visual analog scale (VAS) and also ODI (Oswestry Disability Index) were used. Data were analyzed using SPSS version 12. Results: Thirty patients participated in this trial including 11 men and 19 women with a mean age (SD) of 40.8 (10.8) years. The mean patients VAS score and ODI level before and after discectomy showed statistically significant differences. The mean VAS and ODI scores showed no statistical difference between males and females (P<0.05) and percutaneous laser discectomy decreased the VAS and ODI at both groups of patients similarly. Conclusion: We found the use of PLDD reduces pain and disability in patients as a noninvasive procedure.

Unilateral Epidural Blockade for Lower Limb Fracture Surgery: Parasagittal Epidural Versus Midline Epidural Anesthesia.

OBJECTIVE: To compare the efficacy of parasagittal interlaminar (PIL) and midline interlaminar (MIL) approaches for epidural block in patients with lower limb orthopedic surgery. METHODS: This double-blind randomized clinical trial was performed on 40 patients undergoing tibial shaft fracture surgery. In PIL group, an 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L2-3 or L3-4 intervertebral spaces and pushed forward in a posteroanterior (PA) direction vertical to the body surface. After determining the most lateral place for needle arrival in an anteroposterior (AP) view, needle was pushed forward into the epidural space. For the MIL group, needle was pushed forward from the midline interspinous space with the same method. After confirmation of needle position, 1 mL of contrast was injected to confirm the epidural space distribution and then 15 ml lidocaine 2% was injected. The sensory and motor block level, onset, duration, heart rate (HR), mean arterial pressure (MAP), and arterial oxygen saturation (SPO2), and success rate were recorded. RESULTS: Mean patients' baseline characteristics showed no statistically significant difference between the two groups.p>0.05). Outcome measures were statistically different and significantly higher in PIL group (p-values for sensory block level <0.001, motor block level <0.001, duration of sensory block: <0.001 and duration of motor block <0.001 and success rate: <0.001). Hemodynamic variables didn't show statistically significant difference between the two groups (p-values for Systolic pressure: 0.997, diastolic pressure:0.579, MAP:0.585, HR:0.710). CONCLUSION: Epidural anesthesia with parasagittal interlaminar approach provide deep motor block, high sensory level block, and hemodynamic stability. CLINICAL TRIAL REGISTRY: IRCT2017041615515N2.

Automatic anesthesia depth staging using entropy measures and relative power of electroencephalogram frequency bands.

Many of the surgeries performed under general anesthesia are aided by electroencephalogram (EEG) monitoring. With increased focus on detecting the anesthesia states of patients in the course of surgery, more attention has been paid to analyzing the power spectra and entropy measures of EEG signal during anesthesia. In this paper, by using the relative power of EEG frequency bands and the EEG entropy measures, a new method for detecting the depth of anesthesia states has been presented based on the least squares support vector machine (LS-SVM) classifiers. EEG signals were recorded from 20 patients before, during and after general anesthesia in the operating room at a sampling rate of 200 Hz. Then, 12 features were extracted from each EEG segment, 10 s in length, which are used for anesthesia state monitoring. No significant difference was observed (p > 0.05) between these features and the bispectral index (BIS), which is the commonly used measure of anesthetic effect. The used LS-SVM classifier based method is able to identify the anesthesia states with an accuracy of 80% with reference to the BIS index. Since the underlying equation of the utilized LS-SVM is linear, the computational time of the algorithm is not significant and therefore it can be used for online application in operation rooms.

Evaluation of the Effects of Intravenous and Percutaneous Low Level Laser Therapy in the Management of Shoulder Myofascial Pain Syndrome.

INTRODUCTION: Myofascial pain syndrome (MPS) treatment is challenging with a high recurrence rate and still lacks a clear treatment frame. Therefore research on new, more efficient and long lasting effect treatment modalities is necessary. This study looked at the effects of intravenous laser therapy (IVL) and percutaneous low level laser (PLLL) in the management of shoulder MPS. METHODS: In this randomized controlled trial, 30 patients fulfilling inclusion criteria were randomly equally allocated to 3 groups, control, IVL and PLLL. Control group received 12 sessions of placebo low level laser, IVL group received 12 sessions of IVL therapy, and PLLL group received 12 sessions of PLLL therapy. All patients were trained for better body posture, body mechanics, gentle massage of trigger points, stretching exercises of affected muscle (trapezius), and received 10 mg of oral nortriptyline regimen every night for 3 months. Outcomes included pain severity, functional disability, and quality of life. Patients were assessed using Numeric Rating Scale (NRS), Pain Disability Index (PDI), and Short Form Health Survey (SF-12). Data collected were analyzed using analysis of variance (ANOVA), Mann-Whitney and t tests. RESULTS: The mean of PDI and maximum pain intensity during day and night significantly reduced in both PLLL and IVL groups compared to control group. Although pain severity and PDI reduction was more pronounced in IVL group compared to PLLL group, the differences were not statistically significant. Also, quality of life statistically significantly improved in both IVL and PLLL groups compared to control group was more, and although higher in IVL group, the difference was not statistically significant when compared to PLLL group. No side effects were observed in the intervention groups. CONCLUSION: Intravenous laser and PLLL therapy had a positive effect on pain severity and PDI reduction, and quality of life in this study. Also no adverse event was recorded. Thus, intravenous lasers and PLLL therapy seem to be effective complementary modalities in managing patients with shoulder MPS.

A Comparison of the Sociodemographic and Clinical Characteristics of Patients Referring to a Pain Clinic with Subacute and Chronic Pain.

OBJECTIVES: The aim of the present study was to assess and compare the sociodemographic characteristics and clinical features of patients referring to a university hospital's pain clinic with chronic ( ≥ 12 weeks) and subacute pain ( < 12 weeks). METHODS: In this cross-sectional study, 426 patients were included. Demographic variables including education level, marital and employment status, and risk factors such as obesity, diabetes mellitus, hypertension, cigarette smoking, and opium addiction were recorded. Also, sites of pain, pain quality and associated symptoms, and pain severity were assessed using a numerical rating scale. Each one of these variables was compared between the chronic and subacute pain groups. RESULTS: Of the 426 studied patients, 292 (69%) had chronic pain and 134 (31%) reported subacute pain. Patients with chronic pain were older and had higher body mass indices. Additionally, self-employment was less frequent among the chronic pain group. The patients with chronic pain had a higher prevalence of addiction. The most commonly reported site of pain in all patients was the lower back (62.4%), followed by pain in the leg and foot (39.9%), knee (24.4%), and hip (18.8%). There were no statistically significant differences in pain sites between the two groups, except for knee pain, which was more common among the chronic pain group. The patients with chronic pain had a higher incidence of obscure and persistent pain, while those with subacute pain experienced more night pain. CONCLUSIONS: About one-third of the patients referring to the pain clinic had subacute pain. The patients with chronic pain were older and more obese, had a higher prevalence of addiction, had more cases of knee pain, and reported more instances of obscure and persistent pain than those with subacute pain.

The intravenous laser blood irradiation in chronic pain and fibromyalgia.

Intravenous laser blood irradiation was first introduced into therapy by the Soviet scientists EN.Meschalkin and VS.Sergiewski in 1981. Originally this method was developed for the treatment of cardiovascular diseases. Improvement of rheologic properties of the blood as well as improvement of microcirculation and reduction of the area of infarction has been proved. Further, reduction of dysrhythmia and sudden cardiac death was achieved. At first, only the Helium-Neon laser (632.8 nm) was used in this therapy. For that, a power of 1-3mW and a period of exposure of 20-60 minutes were applied. The treatments were carried out once or twice a day up to ten appointments in all1. In the years after, many, and for the most part Russian studies showed that helium-neon laser had various effects on many organs and on the hematologic and immunologic system. The studies were published mainly in Russian which were little known in the West because of decades of political separation, and were regarded with disapproval. Besides clinical research and application for patients, the cell biological basis was developed by the Estonian cell biologist Tiina Karu at the same time. An abstract is to be found in her work "The Science of Low-Power Laser-Therapy"

Low level laser therapy for painful joints.

Low Level Laser Therapy (LLLT) uses a light source that generates extremely pure light, of a single wavelength(1). The effect is not thermal, but rather related to photochemical reactions in the cells. LLLT was introduced as an alternative non-invasive treatment for OA about 10 years ago, but its effectiveness is still controversial(2). A Cochrane review of LLLT in osteoarthritis included five trials, and concluded that despite some positive findings, the meta-analysis lacked data on how LLLT effectiveness was affected by the important factors of wavelength, treatment duration of LLLT, dosage, and site of application over nerves instead of joints(1,3,4,5,6,7). A different review(2) addresses some of these issues in a wider range of trials, and is broadly positive, if limited by numbers.

A Comparison between Sedative Effect of Propofol-Fentanyl and Propofol-Midazolam Combinations in Microlaryngeal Surgeries.

Considering the growing trend of laryngeal surgeries and the need to protect the airway during and after surgery, among several therapeutic regimens to induce sedation, two regimens of propofol-fentanyl and propofol-midazolam were compared in microlaryngeal surgeries. Forty ASA I-II class patients undergoing microlaryngeal surgeries and referring routinely for postoperative visits were randomly recruited into two groups. For all the patients, 0.5 mg/Kg of propofol was used as bolus and then, 50 mcg/Kg/min of the drug was infused intravenously. For one group, 0.03 mg/Kg bolus of midazolam and for the other group, 2 mcg/Kg bolus of fentanyl was administered in combination with propofol. Ramsay system was used in order to evaluate the effect of the two drugs in inducing sedation. The need for additional dose, blood pressure, heart rate, arterial blood oxygen saturation, and also recovery time and adverse effects such as nausea/vomiting and recalling intra-operative memories, were assessed. The patients in the two groups were not statistically different regarding the number of patients, age, sex, preoperative vital signs, the need for additional doses of propofol, systolic blood pressure and mean systolic blood pressure during laryngoscopy. However, mean systolic blood pressure 1 min after removal of laryngoscope returned faster to the baseline in midazolam group (p < 0.01). Mean heart rate returned sooner to the baseline in fentanyl group following removal of stimulation. Besides, heart rate showed a more reduction following administration of fentanyl (p < 0.02). Mean arterial blood oxygen saturation during laryngoscopy significantly decreased in fentanyl group (p < 0.05) compared to the other group. The time it took to achieve a full consciousness was shorter in midazolam group (p < 0.01). Nausea/vomiting was significantly more prevalent in fentanyl group while the patients in midazolam group apparently experienced more of amnesia, comparatively (p < 0.01). Inducing laryngeal block and local anesthesia using propofol-midazolam regimen is not only associated with a more rapid recovery and less recalling of unpleasant memories, but also better in preventing reduction of arterial oxygen saturation during laryngoscopy compared with propofol-fentanyl regimen.

Intravenous regional block with phentolamine in the treatment of complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a variety of painful conditions following injury which appears regionally having a distal predominance of abnormal findings. This study, evaluate the use of phentolamine for sympathetic block and regional anesthesia in treatment of CRPS related pain. In this study, 68 patients with CRPS who were referred to pain clinics of Imam Hossein and Akhtar Hospitals and Gandy Center of Surgery between 2003-2008 were evaluated. Forty three of 87 patients finally undertaken intravenous regional sympatholytic block according to therapeutic protocol. 37 patients (86%) received one block, 2 of them (4.75%) received 2 repetitions of blocks and finally repeated block for three times occurred in 4 patients (9.3%). A week after block pain relief outcomes was recorded as following; excellent in 7 patients (16.3%), good in the 32 patients (74.4%) and moderate in the 4 patients (9.3%). After a month, 8 patients (18.5%) showed excellent relief and it was good and moderate in 32 (78%) and one case (2.4%), respectively. Pain relief after three months was excellent, good and moderate in the 13 patients (31.7%), 25 patients (61%) and 3 patients (7.3%), respectively. In this study level of pain relief was significant in various intervals and it showed significant difference in relief three months after block (P=0.04). CRPS due to SMP(sympathetically maintained pain) is thought to be alleviated by phentolamine. Intravenous phentolamine infusion is potentially a new significant option for the therapy of CRPS.

Effect of cryoanalgesia on post-thoracotomy pain.

We prepared this study to determine the effect of cryoanalgesia on post-thoracotomy pain. In this double-blinded randomized clinical trial, 60 patients who underwent thoracotomy were divided into two groups (control and cryoanalgesia). Visual Analogue Scale (VAS, 0-10) was used for the measurement of severity of post-thoracotomy pain. It was classified into three categories: 0-1 (mild), 2-3 (moderate), and 4-10 (severe). Pethidine (0.5-1 mg/kg) was administered in case of need for both groups. Patients were visited at the hospital a week later, and were contacted by phone at the first, second, and third months post-operatively. Intensity of pain in the control group was higher than the cryoanalgesia group in all visits the follow-up period. On the second day, the frequencies of severe pain (4-10) were 33.3% and 0 in the control and cryoanalgesia groups, respectively. The mild pain on the seventh day was 13.3% and 83.3% in the control and cryoanalgesia groups, respectively (P < 0.01). Pethidine consumption was 151.6 ± 27 mg in the control group and 87.5 ±48 mg in the cryoanalgesia group on the first day post-operation (P < 0.001). Cryoanalgesia is a useful technique with not serious side effects in order to alleviate post-thoracotomy pain and reduce the need for opiate consumption.

Iranian migrants' discourses of health and the implications for using standardized health measures with minority groups.

This paper explores the concept of health implied in the SF-36 within a group of Iranians in Australia. Qualitative data were collected from a sample of 21 people--10 females and 11 males. For the first time, the NUD*IST program was used to organize and manage the data in Persian (also known as Farsi), the language spoken by Iranians. Health was defined in terms of holistic, spiritual, social, physical/emotional aspects, and absence-of-disorder dimensions. Among these, physical, absence of disorder, holistic, and spiritual aspects of health were mentioned more frequently than other themes. The findings of the study raise concerns about the extent to which the SF-36 captures the diversity of the concept of health as expressed by the sample of Iranian migrants.