Arthritis affects almost 70 million Americans. The most common forms of arthritis are osteoarthritis, a degenerative disease in which the cartilage wears away, and rheumatoid arthritis, which is an autoimmune inflammatory condition. Also, there are other conditions that fall under the "umbrella" of arthritis including bursitis, tendonitis, low back and neck pain, carpal tunnel syndrome, and so on.
The common symptom of most forms of arthritis is pain. Pain develops as a result of multiple factors including inflammation with stimulation of neural peripheral pain sensors due to either biochemical factors such as cytokines or to mechanical factors- joint deformity. Arthritis pain may be accompanied byother problems including loss of range of motion and disability.
Laser
While medicines, injections, and surgery all have their place and are valuable, there is still a need for potentially useful adjunctive modalities that might speed up recovery and reduce pain faster.
Low level therapeutic laser, better known as phototherapy, is a relatively new form of treatment. Its premise is that certain wavelengths of light have effects on living tissue. This effect is termed "photobiomodulation."
Phototherapy has been shown in experimental settings to stimulate cell growth, increase cell metabolism, improve cell regeneration, induce an anti-inflammatory response, reduce edema, reduce fibrous tissue formation, reduce levels of substance P, stimulate production of nitric oxide, decrease the formation of bradykinin, histamine, and acetylcholine, and stimulate the production of endorphins. These effects are felt to be what reduce pain.
Most cold lasers in use today use a combination of light emitting diodes and infrared emitting diodes.
The beneficial effects of cold laser were first noted in wound healing in rats (Mester E, Spy T, Sander N, Tito J. Effect of laser ray on wound healing. Am J Surg 1971; 122: 523-535).
Subequently, laser was found to be beneficial in a number of animal models and is till being studied as a possible tool for cartilage regeneration and healing (Lin Y, Chai CY, Yang RC. Effects of helium-neon laser on levels of stress protein and arthritic histopathology in experimental osteoarthritis. Am J Phys Med Rehab. 2004; 83: 758-765).
Data regarding the usefulness of cold laser on different conditions seen in a rheumatology office include:
Rheumatoid arthritis and osteoarthritis (Brosseau L, Welch V, Wells G, Tugwell P, de Bie R, Harman K, Shea B, Morin M. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a meta-analysis. J Rheum. 2000; 27: 1961-9);
Elbow tendonitis (Simunovic Z, Trobonjaca T, Trobonjaca Z. Treatment of medial and lateral epicondylitis- tennis and golfer's elbow- with low level laser therapy: a multicenter double-blind, placebo-controlled clinical study on 324 patients. J Clin Laser Medicine Surg. 1998; 16: 145-51);
Fibromyalgia trigger points (Simunovic Z. Low level laser therapy with trigger points technique: a clinical study on 243 patients. J Clin Laser Medicine Surg. 1996; 14: 163-167);
Neck arthritis (Ozdemir F, Birtane M, Kokino S. The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis. Clin Rheumatology. 2001; 20: 181-184);
Carpal tunnel syndrome (Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and micro amperes transcutaneous electric nerve stimulation: a controlled study. Archives Phys Med Rehab. 2002; 83: 978-988);
Shoulder tendonitis (England S, Ferrell AJ, Coppock JS, Struthers G, Bacon PA. Low power laser therapy of shoulder tendonitis. Scand J Rheum. 1989; 18: 427-431);
Low back pain disorders (Tasaki E, et al. Application of low power laser therapy for relief of low back pain. Ninth Congress of the International Society of Laser Surgery and Medicine. Anaheim, CA. USA. November 2-6, 1991; Tuner J, Hode L. The Laser Therapy handbook. Prima Books. 2004. Sweden, p. 81).
Adequate clinical assessment is vital to determining whether a patient is a good candidate for laser therapy. Also, laser is a complementary therapy; it should be used in conjunction with other therapies as well. Concurrent medications, etc. should not be forgotten.
Phototherapy is FDA approved for a number of applications and has been deemed safe. It also requires relatively little time to perform. Established protocols and tissue dosages have been established that make clinical application relatively easy.
The number of sessions required varies according to disorder, length of time the disorder has been present, and the severity of the disorder.
Contraindications include pregnancy (use of the laser over the pregnant uterus), thyroid exposure, over a pediatric epiphysis, transplant patients, directly on a an active cancer, on an are where there has been a recent (within 24 hours) steroid injection, or on the chest of a patient with a pacemaker.
While cold laser is considered by some to be unproven, it appears so far to be a safe, effective mode of therapy for many rheumatologic disorders and is worth trying before subjecting a patient to more invasive and dangerous procedures.
How Does Cold Laser Work For Arthritis?
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: Arthritis Treatment