Application of photobiomodulation for chronic pain-related TMD on pain points versus pre-established points: Randomized clinical trial.

Photobiomodulation therapy (PTB) is a therapeutic possibility for temporomandibular disorders (TMD), but its effectiveness and protocols for use remain controversial. This study is a RCT that compared the effectiveness of PTB on pain points of the masticatory muscles and TMJs, located through palpation versus application of pre-established points in women with painful TMD, diagnosis by DC/TMD (Diagnostic Criteria for Temporomandibular Disorders - Brazilian Portuguese version). Therefore, a total sample of 54 women, aged between 18 and 60 years, was investigated. Volunteers were randomly randomized and PTB was applied in four different groups with a dose of 4 J and 6 J divided into pre-established application points (PE - G1) and pain points (PD - G2) - Groups 4PE, 4PD, 6PE and 6PD. Four laser applications were performed with a wavelength of 780 nm, one session per week, totaling one month of therapy. The following assessments were performed: DC/TMD, Brief Pain Inventory (BPI), McGill Questionnaire - Short Version (SF-MPQ) and Pain Intensity, Visual Analogue Scale (VAS). Friedman's test was used for within-group comparisons, while the Mann-Whitney test was used for between-group comparisons (p < 0.05). According to the results, laser application on pain points (G2) was more effective. McGill's results showed that regardless of dose, the pain point application group had better outcomes (p = 0.004). Pain intensity evaluation (last days) also showed that application at the pain points was more effective regardless of dose (p = 0.0002). Medians and interquartile deviations showed overall that PTB was more effective at pain points, with a trend towards better outcomes at the 6 J dose. Therefore, it can be concluded that in women with chronic painful TMD, the application of PTB at pain points is more effective than the application at pre-established points. Therefore, individualized PTB protocols are proposed, based on examination palpation of the masticatory structures.

Whole-body photobiomodulation therapy for chronic pain: a protocol for a feasibility trial.

INTRODUCTION: Chronic pain conditions are a leading cause of disease and disability. They are associated with symptoms such as fatigue, sleep and mood disturbances. Minimal evidence is available to support effective treatments and alternatives treatment approaches are called for. Photobiomodulation therapy has been highlighted as one promising option. A whole-body therapy device (NovoTHOR) has recently been developed with a number of potential advantages for people with chronic pain. Research is needed to consider the feasibility of this device. METHODS AND ANALYSIS: A single-centre single-armed (no placebo group) feasibility study with an embedded qualitative component will be conducted. The intervention will comprise 18 treatments over 6 weeks, with 6-month follow-up, in the whole-body photobiomodulation device. A non-probability sample of 20 adult participants with a clinician diagnosis of chronic axial pain, polyarthralgia, myofascial pain or widespread pain will be recruited (self-referral and clinician referral). Outcome measures will focus on acceptability of trial processes with a view to guiding a definitive randomised controlled trial. Analyses will use descriptive statistics for quantitative aspects. The qualitative element will be assessed by means of a participant-reported experience questionnaire postintervention and semistructured audio-recorded interviews at three stages; preintervention, midintervention and postintervention. The latter will be transcribed verbatim and a reflexive thematic analysis will be used to identify emerging themes. Exploratory outcomes (participant-reported and performance-based measures) will be analysed according to data distribution. ETHICS AND DISSEMINATION: The study has received ethical approval from the Leicester Central Research and Ethics Committee. Findings will be disseminated via local chronic pain groups, public register update, submission for presentation at scientific meetings and open-access peer-reviewed journals, and via academic social networks. TRIAL REGISTRATION NUMBER: NCT05069363.

Effects of photobiomodulation and deep water running in patients with chronic non-specific low back pain: a randomized controlled trial.

Photobiomodulation therapy (PBM) is often used to treat musculoskeletal disorders such as chronic non-specific low back pain (NSCLBP) as it can have positive effects on biomarkers-creatine kinase (CK) and serum cortisol levels-related to stress caused by physical exercise, such as deep water running (DWR) or by pain. The aim of this study was to evaluate the effects of the combination of PBM and aquatic exercise (DWR) on the intensity of pain, disability, 6-min walk test adapted (6WTA), and on cortisol and creatine kinase (CK) levels in a population with NSCLBP. The participants were allocated into three groups: TGPBM (Photobiomodulation and Training Group), TGPLA (Placebo Photobiomodulation and Training Group), and the GPBM (Photobiomodulation Group). Information regarding anthropometric data, blood pressure, and heart rate were collected, and the questionnaires were applied: IPAQ-Short Form, Oswestry Disability Index, and the Visual Analog Scale for Pain. The submaximal exercise test (6WTA) was performed. Blood was collected for analysis of cortisol and CK levels. The training sessions were performed twice a week, for 4 weeks. In the intragroup comparisons, there were statistically significant changes in the TGPBM and GPBM groups in the outcomes pain intensity, disability (reductions in both groups), and in cortisol (increased in the TGPBM and reduced in the GPBM); in the TGPLA group, there was a statistically significant reduction only in the outcome of pain intensity. In the intergroup comparison, in the comparison between TGPBM and TGPLA, there was a statistically significant difference in the level of cortisol, as well as in the comparison between TGPBM and GPBM, in which there was a statistically significant difference for this same outcome (cortisol) and for the 6WTA outcome. The effects of the combination of PBM and aquatic exercise have positive effects on reducing pain intensity, disability, and cortisol levels, but its effects on other variables (6WTA and CK) are too small to be considered significant. Trial registration number: NCT03465228-April 3, 2019; retrospectively registered (ClinicalTrials.gov).

Pain Relief Reverses Hippocampal Abnormalities in Trigeminal Neuralgia.

Chronic pain patients frequently report memory and concentration difficulties. Objective testing in this population points to poor performance on memory and cognitive tests, and increased comorbid anxiety and depression. Recent evidence has suggested convergence between chronic pain and memory deficits onto the hippocampus. The hippocampus consists of heterogenous subfields involved in memory consolidation, behavior regulation, and stress modulation. Despite significant studies outlining hippocampal changes in human and chronic pain animal models, the effect of pain relief on hippocampal abnormalities remains unknown. Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder which is highly amenable to surgical interventions, providing a unique opportunity to investigate the effect of pain relief. This study investigates the effect of pain relief on hippocampal subfields in TN. Anatomical MR images of 61 TN patients were examined before and 6 months after surgery. Treatment responders (n = 47) reported 95% pain relief, whereas non-responders (n = 14) reported 40% change in pain on average. At baseline, patients had smaller hippocampal volumes, compared to controls. After surgery, responders' hippocampal volumes normalized, largely driven by CA2/3, CA4, and dentate gyrus, which are involved in memory consolidation and neurogenesis. We propose that hippocampal atrophy in TN is pain-driven and successful treatment normalizes such abnormalities. PERSPECTIVE: Chronic pain patients have structural abnormalities in the hippocampus and its subfields. Pain relief normalizes these structural abnormalities and impacts patients in a sex-dependent manner.

Association of photobiomodulation therapy and therapeutic exercises in relation to pain intensity and neck disability in individuals with chronic neck pain: a systematic review of randomized trials.

Exercise is often pointed out as an effective form of treatment in the clinical management of chronic neck pain (CNP). However, due to its complex range of causal factors and great diversity of signs and symptoms, other resources such as photobiomodulation therapy (PBMT) have been routinely used for the treatment of CNP. The aim of this study was to systematically review the literature on the use of the association of PBMT and therapeutic exercises in relation to pain intensity and neck disability in individuals with CNP. PubMed, Medline (via Ovid), Embase (via Ovid), Cinahl (via Ebsco), and Central (via Cochrane library) databases were searched using the following terms: "laser," "low-level laser," "photobiomodulation," "light emitting diodes," "phototherapy," "exercise," "chronic neck pain." After verification and implementation of eligibility criteria, seven manuscripts were considered eligible for data analysis. These manuscripts had methodological quality between 5 and 8 points on the PEDro scale. Most studies used low infrared laser therapy to perform PBMT, with a wide range of parameters and energy density between 2 and 7 J/cm2 and a total treatment time between 2 and 6 weeks. Four studies showed significant benefits in terms of pain intensity at short-term follow-up and one at intermediate-term follow-up. However, only one showed a minimal clinically important change. No studies have shown significant improvement in disability. This review demonstrates that the association of PBMT with therapeutic exercises in general promotes significant benefits only for the intensity of pain. However, it does not seem to promote a minimally effective clinical difference in individuals with CNP.

Pulsed Radiofrequency of the Trigeminal Ganglion for Treating Postherpetic Neuralgia of the Ophthalmic Branch.

Postherpetic neuralgia (PHN) is a painful, long-lasting condition as a consequence of nerve damage resulting from a herpes zoster infection. Although there are many different treatments available to reduce pain duration and severity, PHN is often refractory to them and no single therapy shows an effective cure for all cases of PHN, especially for those involving the ophthalmic branch of the trigeminal nerve. Pulsed radiofrequency (PRF) is a minimally invasive procedure for pain treatment that has been practiced over the past decade. However, its clinical efficacy and safety for treating PHN involving the ophthalmic branch of the trigeminal nerve have not been evaluated. Objective. This study aimed to evaluate the efficacy and safety of PRF for treating PHN involving the ophthalmic branch of the trigeminal ganglion. Study Design. An observational study. Setting. All patients received PRF of the ophthalmic branch of the trigeminal nerve, pain intensity was assessed by a visual analogue scale (VAS), and complications before and after PRF stimulation were noted. Methods. Thirty-two patients with PHN of the ophthalmic branch were treated by PRF of the ophthalmic branch with controlled temperature at 42°C for 8 min. Pain relief, corneal reflex, sleep quality, and satisfaction were assessed for all patients. Results. Thirty out of 32 patients (93.75%) reported significant pain reduction after PRF treatment. Twenty-eight of them (87.5%) were satisfied with their sleep and obtained a pain score lower than 3 following the procedure. Only two patients had a recurrence of the severe burning pain and returned to the hospital for other medical therapies 2 weeks after the PRF procedure. No patient lost the corneal reflex. Limitations. This study is an observational study and a nonprospective trial with a short-term follow-up period. Conclusion. PRF of the trigeminal ganglion of the ophthalmic branch can significantly reduce pain sensation and improve sleep quality and satisfaction for PHN of the ophthalmic branch.

Photobiomodulation (low-level laser) therapy for immediate pain relief of persistent oral ulcers in chronic graft-versus-host disease.

PURPOSE: To determine the immediate pain-relieving effect of photobiomodulation therapy (PBMt) in patients with oral ulcers of chronic graft-versus-host disease (cGVHD) refractory to first line therapy with topical corticosteroids. METHODS: This retrospective study included all patients who underwent PBMt for pain relief of refractory oral cGVHD lesions. PBMt was applied using an intraoral approach to all sites with mucosal lesions, using a 940 nm InGaAsP diode laser device, with the following parameters: pulsed modulation (duty cycle of 50%), power 0.7 W, illuminated spot size 7.1 cm2, irradiance 98.6 mW/cm2, and irradiation time 90 s per point. Pain was self-assessed using a 0-to-10 scale immediately before and after PBMt. RESULTS: Data from eleven patients with a total of 56 PBMt sessions were analyzed. In 48 (85.7%) sessions, the patients reported less pain immediately after treatment, with a reduction of ≥ 50% of the initial pain level in 43 (76.8%) sessions. Mean pre- and post-treatment pain levels were 5.20 ±2.7 and 1.38 ±2.1, respectively (p < 0.001), i.e., a post-treatment reduction of 73.4% of the initial pain level. The benefits of the treatment remained for a mean of 6.50 ±5.4 days (range of 2 to 14 days). No adverse effects were reported. CONCLUSIONS: PBMt seems to be a promising treatment modality for refractory oral cGVHD lesions as a rapid pain reliever with relatively long-lasting effects.

Photobiomodulation Therapy Partially Restores Cartilage Integrity and Reduces Chronic Pain Behavior in a Rat Model of Osteoarthritis: Involvement of Spinal Glial Modulation.

OBJECTIVE: Chronic pain associated with osteoarthritis (OA) often leads to reduced function and engagement in activities of daily living. Current pharmacological treatments remain relatively ineffective. This study investigated the efficacy of photobiomodulation therapy (PBMT) on cartilage integrity and central pain biomarkers in adult male Wistar rats. DESIGN: We evaluated the cartilage degradation and spinal cord sensitization using the monoiodoacetate (MIA) model of OA following 2 weeks of delayed PBMT treatment (i.e., 15 days post-MIA). Multiple behavioral tests and knee joint histology were used to assess deficits related to OA. Immunohistochemistry was performed to assess chronic pain sensitization in spinal cord dorsal horn regions. Furthermore, we analyzed the principal components related to pain-like behavior and cartilage integrity. RESULTS: MIA induced chronic pain-like behavior with respective cartilage degradation. PBMT had no effects on overall locomotor activity, but positive effects on weight support (P = 0.001; effect size [ES] = 1.01) and mechanical allodynia (P = 0.032; ES = 0.51). Greater optical densitometry of PBMT-treated cartilage was evident in superficial layers (P = 0.020; ES = 1.34), likely reflecting the increase of proteoglycan and chondrocyte contents. In addition, PBMT effects were associated to decreased contribution of spinal glial cells to pain-like behavior (P = 0.001; ES = 0.38). CONCLUSION: PBMT during the chronic phase of MIA-induced OA promoted cartilage recovery and reduced the progression or maintenance of spinal cord sensitization. Our data suggest a potential role of PBMT in reducing cartilage degradation and long-term central sensitization associated with chronic OA.

Preliminary clinical experience of low-level laser therapy for the treatment of canine osteoarthritis-associated pain: A retrospective investigation on 17 dogs.

Background: Osteoarthritis (OA) is common in dogs and causes chronic pain that affects the quality of life and may not respond to analgesics. Objective: The objective of this study was to determine whether low-level laser therapy (LLLT) would improve the quality of life and help reducing systemic analgesics, in dogs with OA. Methods: Seventeen client-owned dogs diagnosed with OA and associated pain were included. The diagnosis of OA was confirmed by orthopedic and radiographic examination. Pain was evaluated in each dog with the canine brief pain inventory (CBPI), compiled by the dog owners, as well as with a visual analog scale (VAS) and the colorado state canine chronic pain scale, used by the clinician. The LLLT was performed weekly in each study dog, for a total period of 6 weeks. The CBPI was then repeated at 2, 4, 6, and 8 weeks after the first laser session, whereas the VAS was reassessed at weeks 2 and 6. The dogs were observed for the occurrence of laser-related side effects. Results: Both CBPI and VAS were significantly reduced after the first laser session (9.2 ± 3.8 and 5.2 ± 1.1, respectively) compared to pretreatment values (11.8 ± 3.6 and 7.6 ± 0.9, respectively; and p = 0.018 and p < 0.001, respectively) and continued to decrease over time until the end of the therapy. Based on these results and improved function, as assessed by the orthopedic surgeon, the pharmacological analgesic therapy was reduced by the clinician at week 2 in 13 of 17 dogs. Laser-related side effects were not observed. Conclusion: This retrospective report provides a basis for future investigations, needed to clarify whether laser therapy may be beneficial to treat canine OA-associated pain. The preliminary findings are promising and suggest that LLLT may help reducing the analgesic administration and improving client satisfaction and the quality of life of dogs with OA.

Effect of bipolar pulsed radiofrequency on chronic cervical radicular pain refractory to monopolar pulsed radiofrequency.

BACKGROUND: We aimed to evaluate the effect of bipolar pulsed radiofrequency (PRF) in patients with chronic cervical radicular pain who were refractory to monopolar PRF and transforaminal epidural steroid injection (TFESI). METHODS: Twenty patients with chronic cervical radicular pain who were unresponsive to monopolar PRF and TFESI were included and underwent bipolar PRF of their cervical dorsal root ganglion (DRG). Treatment outcomes were evaluated using the Numeric Rating Scale (NRS) for cervical radicular pain before treatment and 1, 2, and 3 months post-treatment. Successful pain relief was defined as ≥50% reduction in the NRS score compared with the score prior to treatment. Furthermore, at 3 months post-treatment, patient satisfaction levels were evaluated; those with very good (score =7) or good (score =6) results were considered to be satisfied with the bipolar PRF procedure. RESULTS: Cervical radicular pain was significantly reduced at 1, 2, and 3 months post-PRF (P<0.001). In addition, at 3 months post-PRF, half of the patients achieved a successful response and were satisfied with the treatment results. CONCLUSIONS: Bipolar PRF on cervical DRG may be a good treatment option for managing refractory chronic cervical radicular pain.

Dorsal root ganglion pulsed radiofrequency treatment for chronic cervical radicular pain: a retrospective review of outcomes in fifty-nine cases.

Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is used to treat persistent cervical radicular pain that has not responded to conservative therapies. This technique has gained popularity in years for both cervical and lumbosacral radicular pain. The evidence to support its use is still evolving. METHODS: We performed a retrospective review of outcomes in 59 patients who underwent this therapy over a 3-year period in our institution. We evaluated a reduction in pain, duration of pain relief, reduction in use of analgesics and progression to surgery. RESULTS: Our results demonstrated 49 patients experienced some relief. Forty patients of the 59 experienced an improvement in pain of 50% or more. The mean duration of relief in this group was 37 weeks. Seven patients experienced complete resolution of their pain. In this group, the mean duration of relief was 39 weeks. Regarding the 53 patients who were taking medication for pain prior to the procedure, 37 patients reduced or discontinued their usage after the procedure. CONCLUSION: Despite the limitations of a retrospective study, we feel our study adds to the growing evidence base that pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion has a role in the treatment of chronic cervical radicular pain.

Avaliação de protocolo para terapia com laser de baixa intensidade no tratamento da síndrome da ardência bucal: um estudo clínico cego e randomizado / Evaluation of a protocol for laser therapy of low-intensity treatment of the syndrome of burning mouth: a blinded, randomized clinical trial

Até o momento, não existe consenso quanto ao tratamento para a síndrome da ardência bucal (SAB), definida como queimação idiopática que afeta a mucosa bucal e a região perioral clinicamente normais. A terapia a laser de baixa intensidade (TLBI) tem se mostrado método não invasivo favorável, entretanto, a metodologia utilizada na literatura é bastante variada, gerando resultados discrepantes. O presente trabalho objetivou desenvolver um protocolo de TLBI para a SAB e avaliar sua eficácia em atenuar e/ou eliminar os sintomas. O estudo consistiu em um ensaio clínico, cego, randomizado, com controle por placebo. Valeu-se de uma amostra de 10 voluntários com SAB, separados em dois grupos por alocação oculta: 5 do Grupo Intervenção (GI) e 5 do Grupo Controle (GC). A randomização foi feita em blocos. Os voluntários compareceram a 8 consultas, em 5 semanas, e foram submetidos à TLBI ou placebo a partir da segunda consulta, até a penúltima. Além da laserterapia, foram aplicados os questionários de dor Douleur Neuropathique in 4 questions (DN4) e McGill (MPQ) e o Brief Pain Inventory (BPI), utilizados para avaliação clínica da dor. Indivíduos do GI apresentaram redução estatisticamente significativa nos escores do DN4 (p = 0.03), o que não ocorreu com o GC (p > 0.05). Também houve diferença entre os grupos para o MPQ, nos tempos (T) 1 (p = 0.02), 5 (p = 0.04) e 8 (p = 0.03), com redução significativamente distinta entre GI e GC. Tiveram significância estatística no BPI os critérios "habilidade para apreciar a vida" e "percentual de melhora com a laserterapia". No primeiro, houve diferença na comparação entre T1 e os demais tempos (T2-T8) para o GI (p < 0.05), e não para o GC (p > 0.05). Para o segundo critério BPI, no GI, o escore foi reduzido a zero no T2, mantendo-se assim até o T8. O GC, todavia, não expressou resultados estatisticamente significativos na comparação entre os tempos (p > 0.05). Os achados observados neste estudo indicam que a TLBI representa um potencial tratamento para atenuar os sintomas em pacientes com SAB. (au)

Until the present moment there is no consensus regarding to the treatment of the burning mouth syndrome (BMS), which is defined as an idiopathic burning symptom that affects clinically normal oral mucosa and perioral region. Low-level laser therapy (LLLT) has been proved favorable non-invasive method; however, the protocols in the literature is quite varied achieving different results. The present study aimed to develop a LLLT protocol for BMS and evaluate its effectiveness in mitigating and/or eliminating symptoms. The study consisted of a randomized, blinded, placebocontrolled clinical trial. A sample of ten volunteers with BMS was recruited divided into two groups by hidden allocation: five in the Intervention Group (IG) and five in the Control Group (CG). Randomization was performed in sets. The volunteers came to eight appointments, in five weeks, and were submitted to LLLT or placebo from the second appointment, until the day before the last appointment. In addition to laser therapy, the Douler Neuropathique in 4 questions (DN4) and McGill (MPQ) pain questionnaires and a brief pain inventory (BPI), for clinical pain assessment, were applied. IG showed a statistically significant improvement in the DN4 scores (p = 0.03), which did not occur in the CG (p > 0.05). There was also a difference between the groups for the MPQ, at day (T) 1 (p = 0.02), 5 (p = 0.04) and 8 (p = 0.03), with a significantly difference improvement when compare IG with CG. The criteria "ability to enjoy life" and "percentage of improvement with laser therapy" were statistically significant at BPI. In the first, there was a difference in the comparison between T1 and the other days (T2-T8) for the IG (p < 0.05), and not for the CG (p > 0.05). For the second BPI assessment the score for IG was reduced to zero in T2, thus maintaining it until T8. The CG, however, did not express statistically significant results when compared the times (p > 0.05). The findings observed in this study indicate that LLLT represents a potential treatment to improve symptoms in patients with BMS. (AU)

Photomodulation in the treatment of chronic pain in patients with temporomandibular disorder: protocol for cost-effectiveness analysis.

INTRODUCTION: Epidemiological data show that the signs and symptoms of temporomandibular disorder (TMD) start becoming apparent from 6 years of age, and during adolescence these signs and symptoms are similar to those of adults. The present study aims to estimate the direct costs for treatment of chronic muscle pain with photobiomodulation therapy, occlusal splint and placebo in patients with TMD; to evaluate the effectiveness of photobiomodulation therapy and occlusal splint for treatment of muscle pain in patients with TMD; to analyse the cost-effectiveness of the two proposed treatments for pain; and to describe and compare the results of the analyses of these treatments. METHODS AND ANALYSIS: This is a prospective trial of clinical and economic analyses that will include 135 patientswith TMD aged between 15 years and 25 years, randomly assigned to a treatment group: G1 (photobiomodulation), G2 (occlusal splint) and G3 (placebo). The analyses will be based on the cost of each treatment during the 12-month period. The outcome of the analysis of effectiveness will be pain, measured periodically by means of clinical examination of Research Diagnostic Criteria for Temporomandibular Disorders. The cost-effectiveness ratio will be calculated using, as end points, pain and the ratio of the differences in costs between the groups studied. The evaluation of the impact of the treatment on quality of life will be determined by applying the adapted EuroQol-5D. ETHICS AND DISSEMINATION: This protocol has been ethically approved by the local medical ethical committee, protocol number 2.014.339. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT03096301.

Human dorsal root ganglion pulsed radiofrequency treatment modulates cerebrospinal fluid lymphocytes and neuroinflammatory markers in chronic radicular pain.

Radicular pain is a common cause of disability. Traditionally treatment has been either epidural steroid injection providing short-term relief or surgery with associated complications. Pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) is a minimally invasive day-care treatment, which is gaining significant clinical acceptance in a selective group of patients with pure radicular pain. Greater insights into the immunomodulatory effects of this procedure may help to further optimise its application and find alternative treatment options. We have examined it's effect on lymphocyte frequencies and secreted inflammatory markers in the cerebrospinal fluid (CSF) and correlated this with clinical outcome to identify clinical markers of chronic radicular pain. Ten patients were recruited for the study. CSF lymphocyte frequencies and levels of cytokines, chemokines and growth factors were quantified using flow cytometry and enzyme-linked immunosorbent assay (ELISA), respectively. Clinical assessment utilised Brief Pain Inventory scores. Nine out of ten patients (90%) demonstrated significant reduction in pain severity (p = 0.0007) and pain interference scores (p = 0.0015) three months post-treatment. Our data revealed significant reductions in CD56+, CD3-, NK cell frequencies (p = 0.03) and IFN-γ levels (p = 0.03) in treatment responders, while CD8+ T cell frequencies (p = 0.02) and IL-6 levels were increased (p = 0.05). IL-17 inversely correlated with post-treatment pain severity score (p = 0.01) and pre and post-treatment pain interference scores (p = 0.03, p = 0.01). These results support the concept that chronic radicular pain is a centrally mediated neuroimmune phenomenon and the mechanism of action of DRG PRF treatment is immunomodulatory.

Review of Literature on Low-level Laser Therapy Benefits for Nonpharmacological Pain Control in Chronic Pain and Osteoarthritis.

Introduction: Low-level laser therapy (LLLT) is a form of light therapy that triggers biochemical changes within cells. Photons are absorbed by cellular photoreceptors, triggering chemical alterations and potential biochemical benefits to the human body. LLLT has been used in pain management for years and is also known as cold laser therapy, which uses low-frequency continuous laser of typically 600 to 1000 nm wavelength for pain reduction and healing stimulation. Many studies have demonstrated analgesic and anti-inflammatory effects provided by photobiomodulation in both experimental and clinical trials. Objective: The purpose of this research article was to present a summary of the possible pain management benefits of LLLT. Results: In cold laser therapy, coherent light of wavelength 600 to 1000 nm is applied to an area of concern with hope for photo-stimulating the tissues in a way that promotes and accelerates healing. This is evidenced by the similarity in absorption spectra between oxidized cytochrome c oxidase and action spectra from biological responses to light. LLLT, using the properties of coherent light, has been seen to produce pain relief and fibroblastic regeneration in clinical trials and laboratory experiments. LLLT has also been seen to significantly reduce pain in the acute setting; it is proposed that LLLT is able to reduce pain by lowering the level of biochemical markers and oxidative stress, and the formation of edema and hemorrhage. Many studies have demonstrated analgesic and anti-inflammatory effects provided by photobiomodulation in both experimental and clinical trials. Conclusion: Based on current research, the utilization of LLLT for pain management and osteoarthritic conditions may be a complementary strategy used in clinical practice to provide symptom management for patients suffering from osteoarthritis and chronic pain.

The analgesic effect of photobiomodulation therapy (830 nm) on the masticatory muscles: a randomized, double-blind study.

This study assesses the efficacy of photobiomodulation therapy (830 nm) for myalgia treatment of masticatory muscles. Sixty patients with muscular myalgia were selected and randomly allocated into 2 groups (n=30): Group A comprised patients given a placebo (control), and Group B consisted of those undergoing photobiomodulation therapy (PBMT). PBMT and placebo were applied bilaterally to specific points on the masseter and temporal muscles. Referred pain elicited by palpation and maximum mouth opening were measured before (EV1) and after (EV2) the treatments. The data were analyzed using statistical tests, considering a significance level of 5%. No significant differences in range were observed for active or passive mouth opening (p ≥ 0.05). Comparing the final outcomes (EV1-EV2) of both treatments, statistical significance was verified for total pain in the right masseter muscle (p = 0.001) and total pain (p = 0.005). In EV2, significant differences in pain reported with palpation were found between Groups A and B for the following: left posterior temporal muscle (p = 0.025), left superior masseter muscle (p = 0.036), inferior masseter muscle (p = 0.021), total pain (left side) (p = 0.009), total masseter muscle (left side) (p = 0.014), total temporal (left side) (p = 0.024), and total pain (p = 0.035). We concluded that PBMT (830 nm) reduces pain in algic points, but does not influence the extent of mouth opening in patients with myalgia.

Efficacy of Multiwave Locked System Laser on Pain and Function in Patients with Chronic Neck Pain: A Randomized Placebo-Controlled Trial.

BACKGROUND: Multiwave locked system (MLS) laser therapy utilizes the synchronized emission of an 808 nm continuous laser and a 905 nm pulsed laser. It is postulated that MLS enables greater penetration and therapeutic benefit than single-wavelength low-level laser therapy (LLLT). OBJECTIVE: The aim of this research was to evaluate the efficacies of MLS laser therapy and the 830 nm laser in the treatment of patients with chronic neck pain (CNP). MATERIALS AND METHODS: Seventy-five patients with CNP (mean age 46.28 ± 5.89, weight 83.78 ± 5.65 kg, height 1.72 ± 4.96 m, and duration of illness of 5.98 ± 1.44 months). They were randomized into three groups. Group I received MLS laser therapy and exercises, Group II received LLLT and exercises, and Group III received placebo laser therapy plus exercises (PL + EX). Neck pain levels and neck function were measured using the visual analogue scale (VAS) and neck disability index (NDI), respectively. RESULTS: Both VAS and NDI were significantly reduced post-treatment for all treatment groups. After 6 weeks of treatment, MLS plus exercise showed a significantly greater decrease in pain and disability scores {Δ VAS (6.68) and Δ NDI (39.84)} compared to both LLLT plus exercise group {Δ VAS (5.72) and Δ NDI (37.88)} and PL + EX {Δ VAS (4.84) and Δ NDI (36.68)}. CONCLUSIONS: MLS laser therapy in conjunction with exercises decreased pain and increased functional activity following 6 months of therapy. MLS laser therapy in combination with exercises is a more effective therapy for CNP compared to exercise plus LLLT or exercise alone.

Stereotactic Radiosurgery for the Treatment of Chronic Intractable Pain: A Systematic Review.

BACKGROUND: Since the advent of neuromodulation, the role and efficacy of stereotactic radiosurgery (SRS) for chronic pain has not been carefully scrutinized. OBJECTIVE: To perform a systematic review to evaluate the clinical efficacy, both short- and long-term, of SRS for the treatment of chronic intractable pain. METHODS: A systematic search in PubMed, Web of Science, and PsycINFO was performed using keywords and controlled vocabulary. The search included peer-reviewed articles reporting clinical outcomes of SRS for chronic pain with a minimum 3-mo follow-up for nonmalignant and 1 mo for malignant pain. RESULTS: Six articles (113 patients) were evaluated on the basis of radiation target (thalamus vs pituitary) and pain etiology (malignant vs nonmalignant). Across studies, at least 35% of patients were reported to have lasting significant pain relief. By cohort, clinical success was achieved in 51% of pituitary SRS, at least 23% of thalamic SRS, 39% of nonmalignant, and at least 33% of malignant pain patients. Adverse events were noted in 21% of patients; the majority related to hormonal deficits from pituitary SRS. CONCLUSION: Despite decreased utilization, SRS is effective for select patients with chronic pain and is associated with an acceptable complication rate. Pituitary SRS is superior in patients with cancer-related pain (87% success), while thalamic SRS is superior in patients with nonmalignant pain (65% success). Because reports of SRS for pain largely stem from a period before the common use of neuromodulatory and intrathecal therapies, the efficacy in patients who fail such therapies remains unclear and requires further characterization.

Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: a randomized controlled, single-blind, clinical trial.

Shoulder pain can be difficult to treat due to its complex anatomic structure, and different treatment methods can be used. We aimed to examine the efficacy of photobiomodulation therapy (PBMT) and suprascapular nerve (SSN)-pulsed radiofrequency (RF) therapy. In this prospective, randomized, controlled, single-blind study, 59 patients with chronic shoulder pain due to impingement syndrome received PBMT (group H) or SSN-pulsed RF therapy (group P) in addition to exercise therapy for 14 sessions over 2 weeks. Records were taken using visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), and Nottingham Health Profile (NHP) scoring systems for pretreatment (PRT), posttreatment (PST), and PST follow-up at months 1, 3, and 6. There was no statistically significant difference in initial VAS score, SPADI, and NHP values between group H and group P (p > 0.05). Compared to the values of PRT, PST, and PST at months 1, 3, and 6, VAS, SPADI, and NHP values were statistically significantly lower in both groups (p < 0.001). There was no statistically significant difference at all measurement times in VAS, SPADI, and NHP between the two groups. We established that PBMT and SSN-pulsed RF therapy are effective methods, in addition to exercise therapy, in patients with chronic shoulder pain. PBMT seems to be advantageous compared to SSN-pulsed RF therapy, as it is a noninvasive method.

Modulation of the peripheral immune system after low-dose radon spa therapy: Detailed longitudinal immune monitoring of patients within the RAD-ON01 study.

The pain-relieving effects of low-dose radon therapies on patients suffering from chronic painful inflammatory diseases have been described for centuries. Even though it has been suggested that low doses of radiation may attenuate chronic inflammation, the underlying mechanisms remain elusive. Thus, the RAD-ON01 study was initiated to examine the effects of radon spa therapy and its low doses of alpha radiation on the human immune system. In addition to an evaluation of pain parameters, blood was drawn from 100 patients suffering from chronic painful degenerative musculoskeletal diseases before as well as 6, 12, 18, and 30 weeks after the start of therapy. We verified significant long-term pain reduction for the majority of patients which was accompanied by modulations of the peripheral immune cells. Detailed immune monitoring was performed using a multicolor flow cytometry-based whole blood assay. After therapy, the major immune cells were only marginally affected. Nevertheless, a small but long-lasting increase in T cells and monocytes was observed. Moreover, neutrophils, eosinophils and, in particular, dendritic cells were temporarily modulated after therapy. Regarding the immune cell subsets, cytotoxic T and NK cells, in particular, were altered. However, the most prominent effects were identified in a strong reduction of the activation marker CD69 on T, B, and NK cells. Simultaneously, the percentage of HLA-DR+ T cells was elevated after therapy. The RAD-ON01 study showed for the first time a modulation of the peripheral immune cells following standard radon spa therapy. These modulations are in line with attenuation of inflammation.