Laser Therapy for Natural Pain Relief
excerpt taken from Dr. Toshio Ohshiro's paper: "27 YEARS OF LASER TREATMENT: A PERSONAL PERSPECTIVE"
Pain Attenuation
The first main applications of laser therapy were in the area of pain attenuation, and the pain clinic remains a major part of my LLLT indications. Typically in the pain clinic we treat acute and chronic pain entities of the musculoskeletal system including postherpetic neuralgia (PHN) [5] spinal pain entities including lumbar pain [6], a variety of headaches [7,8], whiplash syndrome [9], periarthroses of the major joints [10], frozen shoulder [11] and so on.
At the 1981 ISLSM meeting in Tokyo, Laser Tokyo '81, my JMLL group presented a paper comparing the use of the defocused Nd:YAG with the first 15 mW GaAlAs portable 830 nm diode laser system for pain attenuation, [12]. Even at that early stage, our results with the comparatively lowpowered diode system were extremely promising. As I developed more powerful systems, I designed a series of trials to elicit the best combination of power and available wavelengths for pain attenuation. From these I discovered that 830 nm produced the most effective overall attenuation of chronic and acute pain, and that the gallium aluminium arsenide diode was most efficient in generating this wavelength. I further found that the output power of 60mW with the continuous wave (cw) GaAlAs system I had developed, the OhLase-3D1, was significantly more effective than 50 mW and below, but greater output powers did not produce concomitantly better results, thus this system was designed to optimize these parameters and has had great success, remaining till today the main system I use in my pain clinics. The system delivers an incident power density of approximately 3 W/cm2, and I usually deliver between 15 J/cm2 and 50 J/cm2 per point in the contact pressure method.
One of my earliest patients was a professional baseball pitcher with extreme acute pain of his arms and intercostal regions diagnosed as muscle strain after overtraining. The thermographic findings pre and post treatment with 60mW 830 nm cw diode laser therapy are seen in Figure 13. The areas of elevated temperature associated with underlying inflammation are clearly seen in the upper figure, and are removed in the lower. Unable to pitch when he presented at my clinic, he went on the three days later to pitch a shutout after one intensive treatment session. In 1987 I took my OhLase-3D1 system to Dr Kevin Moore of Oldham, U.K., no stranger to readers of Laser Therapy. Dr Moore had assembled 26 problematic patients from his extensive pain clinic with a variety of acute and chronic entities. Figures 14 and 15 show two representative examples of an acute sprain and chronic frozen shoulder, respectively, pre and post treatment, taken from a video footage shot by Royal Oldham technicians. We also successfully treated a case of chronic postherpetic neuralgia, which prompted Dr Moore to design his well known double blind cross-over study on PHN,(5) which was subsequently replicated with approximately the same degree of significant success here in Japan, (13) and in Canada.(14)
In addition to acute pain, I also found the system extremely good for chronic pain. Figure 16 shows the thermographic findings in a young lady with chronic abdominal pain, areas of pain and numbness in her upper extremities, painfully cold hands, and irregular menstruation. Contrary to the findings with acute pain, the areas of elevated temperature are replaced with areas of decreased temperature indicative of circulatory problems caused by the chronic nature of the pain. Acute pain, if untreated or treated incorrectly, gradually results in fibrotic nodule formation which compresses nerves and blood vessels resulting in result point seen in the upper part of Figure 16. outcome. The painful sites are now no longer under direct control of the nervous systems, which in turn are the responsibility of the brain. (15) My theory postulates that LLLT removes the fibrosis and restarts the stagnant lymphatic flow, thereby restoring local control to the mother brain. In the lower portion of the figure the dramatic rise in temperature over the entire head, torso and upper extremities is indicative of the whole body warming effect seen with laser therapy,and documented in excellent articles by my colleague Dr Asagai, who treated adult cerebral palsy patients with the OhLase-3D1 as part of a total functional training program with good results.(16) This has led to the extension of my theory of laser therapy-mediated reversal of the sympathetic-dominant highly tense state as seen in Figure 16, pretreatment, and to a parasympathetic-dominant relaxed state, as seen in the post-LLLT findings.
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