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 [MRS], Pain Disability Index [PDI], and Short Form Health Survey [SF-12]. Data collected were analyzed using analysis of variance [ANOVA], Mann-Whitney and f 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

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"

[ effect of bupivacaine 0.5% versus lidocaine 2% injection for pain control in patients after percutaneous nephrolithotomy [PCNL]]

Controlling pain in the post-operative period is still one of the challenging issues for anaesthesiologists as it tremendously helps patients to return to their daily life as soon as possible. In this survey we have tried to compare the efficacy of 0.5% bupivacaine and 2% lidocaine with normal saline for controlling pain after PCNL. In a double blind clinical trial, 60 patients were enrolled being divided into 3 groups. 0.5% Bupivacaine in a dose of 0.5 mg/kg diluted in 20 cc normal saline was injected, into the insertion site and also the tract of the PCNL probe in group one. In our second group, 2% lidocaine [4mg/kg] diluted in 20 cc normal saline, and in the third group, just 20cc NS were injected in the same manner and direction. VAS was measured at 0, 3, 6, 9, 12, 15, and 18 hours post-operatively in order to evaluate pain control. The mean VAS measured 0, 3, and 6 hours post-operatively in the bupivacaine and lidocaine groups was less than the normal saline group [P<0/05]. The average time to injection of the first dose of pethedine was longer in the bupivacaine and lidocaine groups than the normal saline group. [p<0/05]. Injection of 0.5% bupivacaine and 2% lidocaine in the puncture site of PCNL is effective for pain control after PCNL surgery according to our results

[ effect of mindfulness-based stress reduction on the rate of depression in patients with chronic low back pain]

The main purpose of this study was to investigate effectiveness of Mindfulness-Based Stress Reduction [MBSR] on decreasing depression in patients with chronic low back pain. The statistical population included patients with chronic low back pain who appointed the pain clinics in Tehran. Among whom 23 participants were enrolled with convenience sampling and randomly assigned into two equal experimental and control groups. The questionnaire was consisted of the depression subscale of short form known as the depression anxiety stress scale [DASS -21] which was completed by the patients in pre-test and post-test formats. The results of this research, using Mann-Whitney test, showed that the mean depression score in the experimental group has reduced significantly in comparison with the control group. According to the findings of our study, the Mindfulness-Based Stress Reduction Therapy is significantly effective in decreasing depression in patients with chronic low back pain

Low level laser therapy for painful joints

Low Level Laser Therapy [LLLT] uses a light source that generates extremely pure light, of a single wavelength1. 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

Low level laser therapy [LLLT] combined with physical exercise, a more effective treatment in low back pain

Low back pain is one of the most common musculoskeletal disorders, which is prevalent among the public population. Depending on the severity of the patients' pain, different treatments are selected for them. Few studies have addressed, so far, the therapeutic effects of laser in such pains and different results have been published in this regard. The aim of this study is to investigate the therapeutic effect of low intensity laser therapy [LILT] on these diseases. Sixty patients are randomly divided into three groups, one received low intensity laser therapy [LILT], the second group the low intensity laser and physical exercises simultaneously and the other the laser placebo and physical exercises simultaneously. Laser therapy was performed for 6 weeks, two sessions per week. Pain and disability were measured and compared, at 0, 6 and 12 weeks after the treatment in the three groups. Patient's disability in groups 1 and 2 at week 6 showed a significant improvement compared to the beginning of the study. [Group I, P=0.02, P=0.012, group II, P=0.031, P=0.042, respectively].The rate of pain and disability at the week 12 improved significantly compared to the week 6 of the study in each group of 1 and 2. [Group I, P=0.002, P=0.02, group II, P=0.043, P=0.02, respectively]. In the comparison of the groups at week 12, the values of pain [P=0.02] and disability [P=0.03] had improved in group I [laser therapy accompanied with physical exercise]. Our Results revealed that laser therapy accompanied with physical exercise can be the most effective way for improving the chronic back pains including pain relief and reduction of disability in the patients

[Evaluation of patients' satisfaction following postoperative acute pain management]

Patients often suffer from inadequate treatment of postoperative pain. The aim of this study was to investigate patients' satisfaction after postoperative acute pain management. In this prospective study, from September 2009 to Augest 2010, 1424 patients presented by general surgery, orthopedic, obstetric and gynecology, ophthalmology and neurosurgery specialists to acute and chronic pain service of Imam Hossein Hospital. A satisfaction questionnaire with 26 items was given on discharge to this patients, were asked to fill out it and then collected by ward nurse. Patients' satisfaction was high in 1421 [99.8%] and moderate in 3 [0.2%]. Financial patients' satisfaction was moderate in 980 [68.8%] and low in 444 [31.2%]. Patients' satisfaction of products support was high in 1418 [99.6%] and moderate in 6 [0.4%]. Patients' satisfaction was high for acute and chronic pain service, and low for the costs. So, more studies and efforts are needed to make improvements in the cost-related problems of postoperative acute pain management

[Infraclavicular block: the results of neurostimulation versus ultreasound plus neurostimulation]

Infraclavicular nerve block [ICNB] is one of the most efficacious peripheral nerve blocks for upper extremity procedures, associated with several potential complications. Recently, some authors have recommended ultrasound-guided ICNB. The current study is aimed to compare the outcomes of ICNB utilizing combined ultrasound guidance and neurostimulation with the outcomes of ICNB using neurostimulation alone. There were 60 patients, candidate for elective upper extremity surgery, who contributed in the current double-blinded randomized clinical trail. Patients were randomly allocated into 2 groups of either ultrasound plus neurostimulation [UN] guided block or neurostimulation [N] group. The procedure time, time interval between injection and drug effect, the rate of successful blocks, sensory and motor block duration, and complications were compared between the two groups. The mean procedure time and the time interval between injection and drug effect were comparable. We found significantly longer sensory [66.8 +/- 11.7 V.s 60.9 +/- 10.2 min; p=0.04] and motor [57 +/- 11.4 V.s 50.8 +/- 10.4 min; p=0.032] block duration in UN group. ICNB failed in 10 patients in the N group and 2 patients in the UN group [p=0.021]. There were one patient with subcutaneous hematoma in the UN group and 3 patients in the N group. ICNB utilizing ultrasound guidance combined with neurostimulation is a safe and efficacious technique with a higher success rate compared to neurostimulation alone

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

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

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

[Evaluating the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and restricted range of motion following cerebrovascular accidents]

Shoulder pain is a common complication of cerebrovascular accidents. This study was conducted to assess the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and on restricted range of motion following brain events. This single-blind clinical trial study included 35 patients with chronic shoulder pain [the controls] and 35 patients with chronic shoulder pain due to brain events [the case group]. The study was done at Imam Hossein Hospital and Gandhi Day Clinic during the year 2008-2010. The patients in the two groups received bupivacaine and triamcinolone acetate for subacromial bursa injection and suprascapular nerve block by following the protocol described by Dangoisse et al. The patients were followed up for 12 weeks and they were evaluated for pain and range of motion 1, 6, and 12 weeks after the injections. The mean age of the patients was 60.9 +/- 9.07 years. Statistically significant improvements in pain score [P=0.001] and shoulder joint range of motion [P=0.001] were observed in patients with chronic shoulder pain versus patients with brain events 12 weeks after suprascapulare nerve block and subacromial bours injections by bupivacaine and triamcinolone acetate. Suprascapular nerve block and subacromial bursa injections of bupivacaine and triamcinolone acetate is a safe and efficacious treatment for the treatment of chronic shoulder pain and restricted range of motion but it is not efficacious or of significant value for the treatment of shoulder pain in patients with brain events

Comparison between sedation effects of two combination drugs: propofol+fentanyl and propofol+midazolam in microlaryngeal procedures

Complete regional anesthesia of larynx accompanied by sedation is used for microlaryngeal procedures performed in the vicinity of airway system. In this study we have compared the sedative effects of two combinations of sedative drugs during microlaryngoscopic surgery. 40 patients who were candidates for microlaryngoscopic surgeries were selected for this study. All patients were in ASA class I-II. At first Laryngeal anesthesia was given by using Lidocaine as superior Laryngeal block and scattering lidocaine as spray on the tongue and pharynx. Intratracheal block was done for all patients. All 40 patients received 0.5 mg/kg of propofol intravenously as bolus, followed by 50 microg/kg/min as an IV infusion. Patients were then randomly divided into two groups. Group I received 0.03 mg/kg of midazolam intravenously and group II received fentanyl 2 micro g/kg intravenously. Blood pressure, heart rate and oxygen saturation of arterial blood was checked in all patients after induction of sedation, one minute after initiating Laryngoscopy and one minute after relieving the Laryngoscope stimulation. Time of complete awareness and recovery and also side effects, such as shivering, nausea and vomiting were evaluated. Induction using Fentanyl and propofol was accompanied by a greater degree of bradycardia as compared to the midazolam group, [p<0.02]. In addition, decrease in the level of oxygen saturation during laryngoscopy was more marked in the fentanyl group [P <0.05]. During the entire procedure, blood pressure showed fluctuation in both groups but reverted to normal faster after eliminating the stimulation in the midazolam group. [P <0.01] Eye opening and complete awareness were faster in the midazolam group. [P <0.01] Nausea occurred in 2 patients of fentanyl group. Recall about the procedure was present in 50% of fentanyl group and 10% of midazolam group [P < 0.01]. Sedating patients by midazolam accompanied by Laryngeal block has faster recovery and less recall and also fewer episodes of arterial oxygen desaturation during microlaryngoscopic surgical procedures

[ effects of tranexamic acid on hemorrhage in femoral fracture surgery]

Hemostasis has turned into one of the major concerns in surgery and anesthesia. Anesthesiologists are always pursuing new methods and medications to avoid allogenic and autologous blood transfusion. The present study aimed at examining the effects of tranexamic acid on the reduction of hemorrhage and the need for transfusion. A sequential controlled clinical trial was performed on 60 patients referred to Imam Hossein Hospital, with femoral fracture, aged between 20 to 50, and with no coexisting diseases. The patients were divided into trial and control groups of 30 each. Prior to the surgery, the trial group received 10mg/kg dose of Tranexamic acid. There were significant differences between the two groups with the average blood loss in trial group 675 +/- 208.7cc and in control group 998.4 +/- 230.9cc. In trial group, 5 patients and in control group 14 patients received Allogenic blood in which the difference was also statistically significant [P<0.02]. It is concluded that the use of Tranexamic acid reduces operational hemorrhage and blood transfusion during femoral fracture surgery. Further evaluation of safety is required before recommending the use of antifibrinolytics in orthopedic surgery