Objective: The purpose of this study was to review available literature about the effect of photobiomodulation (PBM) on mesenchymal stem cells (MSCs).
Background data: The effects of coherent and noncoherent light sources such as low-level lasers and light-emitting diodes (LEDs) on cells and tissues, known as PBM, form the basis of photomedicine. This treatment technique effects cell function, proliferation, and migration, and plays an important role in tissue regeneration. Stem cells have been found to be helpful elements in tissue regeneration, and the combination of stem cell therapy and laser therapy appears to positively affect treatment results.
Materials and methods: An electronic search in PubMed was conducted of publications from the previous 12 years. English language articles related to the subject were found using selected key words. The full texts of potentially suitable articles were assessed according to inclusion and exclusion criteria.
Results: After evaluation, 30 articles were deemed relevant according to the inclusion criteria. The energy density of the laser was 0.7–9 J/cm2. The power used for visible light was 30–110 mW and that used for infrared light was 50–800 mW. Nearly all studies showed that low-level laser therapy had a positive effect on cell proliferation. Similar outcomes were found for LED; however, some studies suggest that the laser alone is not effective, and should be used as an adjunct tool. Conclusions: PBM has positive effects on MSCs. This review concluded that doses of 0.7–4 J/cm2 and wavelengths of 600–700 nm are appropriate for light therapy. The results were dependent upon different parameters; therefore, optimization of parameters used in light therapy to obtain favorable results is required to provide more accurate comparison.
Neuropathic pain is a complex type of chronic back and/or leg pain (eg, sciatica) usually caused by nerve injury. When a nerve is damaged it may not be able to transmit messages completely or correctly between the injury site and the brain. Neuropathic pain is persistent and is sometimes described as unrelenting, although the intensity and characteristics (eg, dull, sharp, shock-like) of pain may change throughout the day and night.
Scrambler Technology for Neuropathic Pain
Scrambler technology (Calmare® Pain Therapy Treatment) is a non-invasive therapy that treats neuropathic and chronic pain by surface electro-stimulation. Electrode patches are precisely placed on the appropriate skin area, but not directly on the painful area. Rather, the electrode patches are placed on one or more dermatomes. A dermatome is an area of skin served by the fibers of a single spinal nerve root. The dermatomes map the front and back of the body as shown below.
Precise Biophysical Electro-Stimulation
Each electrode patch is connected to the scrambler device by a thin cable. The clinician controls the administration of low doses of electro-stimulation delivered through the patches. The therapy scrambles the pain messages transmitted between the pain site and the brain.
Placement of electrode patches on a patient’s low back
Typically, treatment consists of a series of 10 daily treatments that last 30- to 45-minutes. Patients with neuropathic and chronic back pain are as unique as their pain. Therefore, some patients may benefit by more than 10 treatments and/or may periodically return for individual therapy.
Some patients report pain relief as early as the first therapy session. However, many patients experience less pain after several scrambler treatments. As the number of treatments increase, the duration of pain relief may be sustained for a longer period of time. Patients who have experienced chronic pain for a shorter amount of time will generally experience faster results.
An experienced chiropractor has tips to help you get the care you need at your next appointment
For more than three decades, I’ve been treating patients with acute and chronic pain from around the corner here in Rutherford, New Jersey to as far away as Australia and South Africa.
From our patient’s first consultation to the last treatment office visit, the success of any pain treatment we prescribe is contingent upon us (the health care provider) accurately treating the root cause of your pain.
As the patient, precisely describing your acute pain or neuropathic pain is a “high stakes” conversation.
I can read your medical history, referring doctor reports and lab results, but this is all secondary to understanding each patient’s pain mechanics.
It is absolutely essential that this is communicated to your pain management provider as accurately as possible.
If you or a loved one are combatting short-term (acute) pain or a neuropathy (pain lasting 12 weeks or longer), I’d like to offer my own simple tools to help you accurately convey the unique characteristics of your pain so that the most effective treatment protocol can be set into motion.
You may wish to bring this article to your next doctor visit and go over each of the key pain description points I’ve outlined below.
I hope your doctor will ask you these questions, but if not, you can act as your own pain advocate and offer this information.
“Tell Me About Your Pain”
Based upon your medical records, we already know the cause of your pain (injury or disease). Our goal is to eliminate or minimize this symptom so you can resume your highest quality of life possible.
Pain symptoms are personal, unique–and subjective. (What Joe describes as “unbearable pain” may be considered “pretty unpleasant pain” to Mike). Over the years, I developed my own “pain diagnostic” conversation with patients to help my team and I understand what, where, when and how much pain patients are feeling.
I’ve outlined key points below:
This is key to a proper diagnosis. Don’t assume we know you’ve battled this pain for a year, a month or a decade.
Spell it out:
I’ve had this pain for _________________.
How frequently and how long does it last?
What ignites (flare) or lessens your pain and for how long?
Location, Location, Location
Where does it hurt? There is a graphic of a human figure with a back view and a front view (see above).
Doctors may instruct you to mark the area/s where your pain is concentrated. They may also ask you to note a difference between pain that is on the surface and pain that is under the surface.
This tool comes from the McGill Pain Questionnaire which includes other measurements, but the front and back of the unisex human figure are the most recognizable.
How Bad is Your Pain – A Measurement Tool
Most referring physicians, regardless of their medical specialty, use a simple 1 to 10 point pain scale, so I stick with this to keep everyone on the same page.
Simply stated, think about where your pain level falls the majority of the time—unless you experience extreme pain fluctuations.
0 – Pain-free
1 – Pain is very mild, barely noticeable. Most of the time you don’t think about it.
2 – Minor pain. Annoying and may have occasional stronger twinges.
3 – Pain is noticeable and distracting, however, you can get used to it and adapt.
Moderate Pain—Disrupts normal daily living activities
4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.
5 – Moderately strong pain. It can’t be ignored for more than a few minutes, but you still can manage to work or participate in some social activities.
6 – Moderately strong pain that interferes with normal daily activities. Difficulty concentrating.
Severe Pain—Disabling; debilitating, reduces daily quality of life, cannot live independently
7– Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships. Interferes with sleep.
8– Intense pain. Physical activity is severely limited. Conversing requires great effort.
9– Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.
10– Unspeakable pain. Bedridden and possibly delirious. Mobility may be compromised.
“My Pain Feels Like…”
Most of the time, patients experience one or two consistent pain “feelings” but some can experience a range of sensations.
The most common pain types are:
Sharp stabbing pain
Extreme heat or burning sensation
Throbbing, “swollen,” inflamed tissue
Sensitivity to contact / touching
Numbness, tingling, pins and needles
Create a Pain Journal
I always encourage patients or their loved ones to document a week-long pain cycle before they meet with their pain management, chiropractic or alternative medicine team.
Also, jot down any treatments or actions that lessen or increase your discomfort.
For example, perhaps you’ve found that hot showers or cold weather makes you feel worse, but Epsom salt baths or exercise makes the pain more manageable.
If you come prepared with all this information, your time with the doctor can be better spent focusing on next steps and a treatment plan, rather than a lengthy Q & A review of the information provided here.
More importantly, addressing these issues in advance will ensure your doctor receives up-to-date, higher quality information.
As a result, your case can be assessed more quickly and a pain management plan can be put into action to start reducing or eliminating your discomfort as quickly and effectively as possible.
Think about the day after you had a really horrible night’s sleep: You couldn’t think as clearly, you were in a bad mood, perhaps you had a headache and there was no way you were going to exercise. You didn’t feel like eating right and were too tired to socialize.
What if you felt like this every day?
As many of you know all too well, living with chronic pain has a plethora of symptoms and negative side effects. In addition to the physical and emotional pain, may people don’t even remember what it feels like to enjoy a good night’s sleep.
Chronic Pain and Sleeping Problems
For people with RSD, fibromyalgia or pain after surgery, cancer and cancer treatment, sleep problems and insomnia are often nightly occurrences. In fact, up to two-thirds of patients with chronic pain conditions suffer from sleep disorders. If that’s not bad enough, insomnia has been proven to exacerbate chronic pain systems.
Sleeping problems can range from difficulty falling asleep to staying asleep or being unable to enter a deep REM sleep stage. As a result, the normal sleep pattern is disrupted; as a result, in a state of exhaustion, many people sleep during the day (and then awake all night).
Many prescription pain medications can also disrupt or inhibit sleep, in addition to the laundry list of additional negative side effects from these drugs.
When I talk with new Calmare patients about their quality of life before treatment begins, the majority tell me that their inability to get a proper night’s rest is one of the main causes of their mental and physical debilitation.
Lack of sleep can cause mental confusion, inability to exercise or move the body, emotional instability and depression.
How Calmare Helps Patients Sleep Again
Some patients reach out to me after their 10-treatment series concerned about how much they are sleeping—sometimes 12 hours a night or even more. “Is this normal?” I’m asked. “Is something wrong with me?”
No, actually, this a good thing–The improvement in sleep patterns is a response to the calming effect of Calmare MC-5A technology algorithms. “Calmare” in Italian means to calm or soothe. This effect is a result of a reduction of hypersensitivity which caused the chronic pain condition, such as CRPS / RSD. As the brain is retrained, it can also reset its healing priorities.
I respond by asking them how long it’s been since they slept through the night without awakening. Most respond in terms of years, not weeks or months.
“Your body is just catching up on all that missed sleep,” I respond. In most cases, those who report needing extra sleep after scrambler therapy eventually resume normal sleep patterns within a few months.
Six Calmare Patients Share Their Sleep Stories
I posed a query on my Facebook timeline last week inviting people who underwent Calmare Therapy to share their feedback about how their quality of sleep changed after their treatment cycle.
The responses were insightful and enthusiastic:
“I remember the best sleep after my first treatment of Calmare as I had not slept comfortably and I was in constant pain even with high doses of meds for nearly 8-10 months since being diagnosed with CRPS. After my Calmare treatment, I was able to sleep throughout the whole night in any position with even linen and blankets touching my skin.”
“Whenever I get the Calmare treatment, I sleep better than ever. I can sleep for hours at a time and still be tired. Too bad Calmare therapy can’t be used as a treatment option for insomnia!”
“I haven’t been a patient of yours but I’ve had 2 sets of Calmare treatments, once for 10 days and once for 5. I could sleep through the night without waking every 3 to 4 hours to take pain pills. Your articles and efforts help so much. Thank you so, so much for all you do!!”
“Prior to Calmare treatment, I would go days without sleeping and then when I did manage to sleep, it was broken and interrupted. Now… I can sleep all night and sometimes that’s even with an afternoon nap. 💤😘”
“Not only sleep–but dream !! When you take pain meds ( at least for me) I don’t remember dreams and in my dreams I am healthy and pain free so to not only get sleep but dream❤ Thank You Calmare NJ for all you do ! :)”
“I can now sleep on my right side which I haven’t been able to do in over 10 years! So yes! Sleep has improved for sure!!”
Improving Quality of Life
Since we introduced scrambler therapy in 2011, one of the resounding benefits, in addition to lessening chronic pain and other related physical symptoms, is the resumption of the quality of life for patients, including just being able to sleep.
We appreciate when healthcare professionals seek Calmare Therapy, an FDA-cleared treatment to combat many types of neuropathic chronic pain. They have seen firsthand that opioids and invasive treatments may not provide the sustained pain relief they need to achieve a better quality of life.
Beth had managed to work as a nurse in Pennsylvania while silently battling RSD in her foot after a failed surgery. To combat the increasingly severe burning sensation she sustained, she had a spinal cord stimulator implanted, nerve block injections and was prescribed more pain medications than she was willing to take.
But the intensity of the pain only increased over time.
Light in the red to near-infrared (NIR) range (630–1000 nm) generated by low energy laser or light-emitting diodes (LEDs) was reported to have beneficial biological effects in a range of injury models [1, 2]. Such photobiomodulation has been observed to increase the mitochondrial metabolism [3–6], facilitate wound healing [7–9], and promote angiogenesis in the skin , bone , nerve , and skeletal muscle [12–15]. Red and NIR have beneficial effects on cells by “kick-starting” them into immediately creating more adenosine triphosphate (ATP) and increasing the DNA and RNA activity. This effect has been examined extensively since 1987. The positive effects were observed only in injured cells; no benefit was observed in healthy cells. Tissue repair and healing of injured skin are complex processes that involve a dynamic series of events including coagulation, inflammation, granulation tissue formation, wound contraction, and tissue remodeling . The ideal wavelengths were reported to be between 600 and 900 nm with the best results obtained at specific ranges: 610–625, 660–690, 750–770, and 815–860 nm. NIR via LED is a well-accepted therapeutic tool in the treatment of infected, ischemic, and hypoxic wounds, as well as other soft tissue injuries in humans and animals [17, 18]. The mechanism of NIR-LED action is the upregulation of the cytochrome C oxidase activity and the production of ATP, as observed in primary cultures of rat visual cortical neurons inactivated functionally by tetrodotoxin, potassium cyanide (KCN), or sodium azide (N3Na) .
Howard B Cotler,1,2 Roberta T Chow,3 Michael R Hamblin4,5,6
1Gulf Coast Spine Care LTD, USA 2Laser Health Spa LLC, USA 3Brain and Spine Research Institute, University of Sydney, Australia 4Wellman Center for Photo medicine, Massachusetts General Hospital, USA 5Department of Dermatology, Harvard Medical School, USA 6Division of Health Sciences and Technology, USA
Correspondence: Howard B Cotler, Owner and Medical Director, Laser Health Spa LLC, 1200 Binz Street, Suite 970 Houston, Texas, USA 77004, Tel 713-523-8884
Received: May 21, 2015 | Published: June 9, 2015
Citation: Cotler HB, Chow RT, Hamblin MR. The use of Low Level Laser Therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):188-194. DOI: 10.15406/mojor.2015.02.00068
The already known benefits produced by the interaction of coherent light (laser) with biologic tissues determine its use as an adjuvant in the treatment of several complications associated with diabetes. Non-coherent light, such as that emitted by light emitting diodes (LEDs), becomes a promising alternative, because of its low cost and easy handling in these applications. Thirty-six rats were given surgical dorsum lesions. The lesions for the control group did not receive any supporting therapy. The other groups were irradiated only once, 30 min after the establishment of the lesion, with LED (640 nm with 40 nm full bandwidth at half maximum) or laser (660 nm). The histomorphological and histomorphometrical parameters were quantified. The coherent and non-coherent lights produced similar effects during a period of 168 h after the lesions had been made. For the group composed of diabetic animals, 72 h after creation of the lesion, it was observed that the therapy with LEDs had been more efficient than that with the laser in the reduction of the wounds’ diameters.
The objective of the present study was to assess the degree of pain relief obtained by applying infrared (IR) energy to the low back in patients with chronic, intractable low back pain.
Forty patients with chronic low back pain of over six years’ duration were recruited from patients attending the Rothbart Pain Management Clinic, North York, Ontario. They came from the patient lists of three physicians at the clinic, and were randomly assigned to IR therapy or placebo treatment. One patient dropped out of the placebo group; as a result, 21 patients received IR therapy and 18 recieved placebo therapy. The IR therapy was provided by two small, portable units in a sturdy waistband powered by small, rechargeable batteries made by MSCT Infrared Wraps Inc (Canada). These units met safety standards for Food and Drug Administration portability, and are registered with the Food and Drug Administration as a therapeutic device. The unit converted electricity to IR energy at 800 nm to 1200 nm wavelength. The treated group received IR therapy. The placebo group had identical units, but the power was not connected to the circuit-board within the IR pad. Patients attended seven weekly sessions. One baseline and six weekly sets of values were recorded. The principle measure of outcome was pain rated on the numerical rating scale (NRS). The pain was assessed overall, then rotating and bending in different directions.
The mean NRS scores in the treatment group fell from 6.9 of 10 to 3 of 10 at the end of the study. The mean NRS in the placebo group fell from 7.4 of 10 to 6 of 10.
The IR therapy unit used was demonstrated to be effective in reducing chronic low back pain, and no adverse effects were observed.
Abstract : Photobiomodulation by light in the red to near infrared range (630-1000 nm) using low energy lasers or light-emitting diode (LED) arrays has been shown to accelerate wound healing, improve recovery from ischemic injury and attenuate degeneration in the injured optic nerve. At the cellular level, photoirradiation at low fluences can generate significant biological effects including cellular proliferation and the release of growth factors from cells. Mitochondrial cytochromes have been postulated as photoacceptors for red to near-infrared (NIR) light energy and reactive oxygen species or mitochondrial redox changes have been advanced as potential mediators of the biological effects of this light.