Comparative Study of the Physiotherapeutic and Drug Protocol and Low-Level Laser Irradiation in the Treatment of Pain Associated with Temporomandibular Dysfunction.

BACKGROUND: The temporomandibular joint (TMJ) is a structure of the craniofacial complex affected by neurological diseases. Orthopedic and musculoskeletal changes can also cause temporomandibular disorders (TMD) and pain. Low-level laser (LLL) therapy has been studied in the treatment of temporomandibular jaw (TMJ) dysfunction, and controversial results were obtained. OBJECTIVE: The objective of this work was comparing the physiotherapeutic and drug protocol (PDP) to LLL therapy in the treatment of pain associated with TMD. METHODS: A sample of 60 female patients, 20-50 years of age, TMD triggering agents (stress, parafunctional habits) controlled, was randomly divided into three groups, group 1 (G1)-LLL (780 nm laser, dose of 35.0 J/cm2, for 20 sec, thrice a week, for 4 weeks); group 2 (G2)-PDP (hot packs thrice a day, morning, afternoon, and evening, for 15 min, exercise of opening and closing the mouth, twice a day, myorelaxing and anti-inflammatory drug administration); and group 3 (G3)-Placebo (450 nm halogen lamp, Max LD Gnatus, light curing unit). RESULTS: Patients were evaluated every return appointment for the presence (P) or absence (A) of pain for 4 weeks and results were statistically analyzed. First week: 60% of G1, 100% G2, and 70% of G3-related pain. Second week: 55% of G1, 15% of G2, and 100% of G3-related pain. Third week: 10% of G1, 15% of G2, and 85% of G3-related pain. Last week: 0% of G1, 0% of G2, and 100% of G3-related pain. CONCLUSIONS: Based on obtained data, we concluded that, compared to PDP, LLL treatment is effective to control pain associated with TMD.

Analysis of the effect of phototherapy in model with traumatic Achilles tendon injury in rats.

The aim of this study was to investigate the effect of low-intensity laser (LILT) infrared (830 nm) therapy in tendon inflammation, tendinitis induced by mechanical trauma in rat Achilles tendon. For this, we used 65 young male Wistar rats, weighing ± 300 g divided into different groups: C = control (n = 5) and experimental (n = 10/group), with two different times of sacrifice such as treated with L = laser, D = treated with diclofenac, and T = untreated injured. The tendon inflammation was induced by controlled contusion in the medial region of the Achilles tendon of the animals. The treated groups received some kind of intervention every 24 h, all groups were sacrificed on the 7th or 14th day after the trauma. The tendons were dissected, extracted, and sent for analysis. Histological analysis of the L group showed a decrease in the number of inflammatory cells in relation to other groups in both periods studied. The comparative results between the number of inflammatory cells in the control and treated groups at 7 and 14 days showed statistically significant differences. Qualitative analysis findings obtained by the picrosirius red technique under polarized light showed that in 7 days, the T group presented collagen types I and III in the same proportion; group D presented a predominance of type III fibers, while in group L, type I collagen predominated. The 14-day group D showed collagen types I and III in the same proportion, while in group L, there was a predominance of type I fibers. Biomechanical analysis showed that 7-day groups L and C showed similar stiffness and increased breaking strength. The 14-day groups L and C showed greater rupturing strength as well as increased stiffness angle. Group D showed a decrease of maximum traction strength and degree of rigidity. It was concluded that treatment with LIL in the parameters used and the times studied reduces migration of inflammatory cells and improves the quality of repair while reducing the functional limitations.

The effect of low-level laser irradiation (In-Ga-Al-AsP - 660 nm) on melanoma in vitro and in vivo.

BACKGROUND: It has been speculated that the biostimulatory effect of Low Level Laser Therapy could cause undesirable enhancement of tumor growth in neoplastic diseases. The aim of the present study is to analyze the behavior of melanoma cells (B16F10) in vitro and the in vivo development of melanoma in mice after laser irradiation. METHODS: We performed a controlled in vitro study on B16F10 melanoma cells to investigate cell viability and cell cycle changes by the Tripan Blue, MTT and cell quest histogram tests at 24, 48 and 72 h post irradiation. The in vivo mouse model (male Balb C, n = 21) of melanoma was used to analyze tumor volume and histological characteristics. Laser irradiation was performed three times (once a day for three consecutive days) with a 660 nm 50 mW CW laser, beam spot size 2 mm(2), irradiance 2.5 W/cm(2) and irradiation times of 60s (dose 150 J/cm(2)) and 420s (dose 1050 J/cm(2)) respectively. RESULTS: There were no statistically significant differences between the in vitro groups, except for an increase in the hypodiploid melanoma cells (8.48 +/- 1.40% and 4.26 +/- 0.60%) at 72 h post-irradiation. This cancer-protective effect was not reproduced in the in vivo experiment where outcome measures for the 150 J/cm(2) dose group were not significantly different from controls. For the 1050 J/cm(2) dose group, there were significant increases in tumor volume, blood vessels and cell abnormalities compared to the other groups. CONCLUSION: LLLT Irradiation should be avoided over melanomas as the combination of high irradiance (2.5 W/cm(2)) and high dose (1050 J/cm(2)) significantly increases melanoma tumor growth in vivo.

Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.

BACKGROUND: Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. METHODS: We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. FINDINGS: We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo. INTERPRETATION: We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. FUNDING: None.

Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy.

BACKGROUND: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset. HYPOTHESIS: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (lambda = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm(2) and a total dose of 5.4 J per session. RESULTS: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group. CONCLUSION: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK.

Efeitos da suplementação aguda de aspartato de arginina na fadiga muscular em voluntários treinados / Effects of the acute arginine aspartate supplement on the muscular fatigue in trained volunteers

A atividade física influi em mecanismos específicos responsáveis pela redução da produção de força e conseqüentemente à fadiga. A preocupação em melhorar o desempenho físico tem sido propostos; observamos que estudos dão atenção para reduzir acúmulos dos metabólitos que diminuem a fadiga durante o exercício físico intenso, usando aminoácidos conhecidos por induzir mudanças metabólicas, entre eles a arginina. O presente estudo teve como objetivo estudar o efeito da suplementação aguda de aspartato de arginina em indivíduos sadios treinados submetidos a um protocolo de exaustão em um cicloergômetro. Foram utilizados 12 indivíduos treinados do sexo masculino, idade de 22,6 ± 3,5 anos. Realizaram três testes 90 minutos após a administração em dose única do aspartato de arginina ou solução placebo, em um cicloergômetro, em que incrementos de cargas foram adicionados até a exaustão. Amostras sanguíneas foram obtidas para análises bioquímicas como: creatinina, uréia, glicose e lactato. Diferenças estatísticas não foram encontradas ao comparar os valores de Freqüência Cardíaca Máxima, Tempo Máximo e Carga Máxima e também ao comparar os resultados anteriores e posteriores ao teste para uréia, creatinina e glicose. As concentrações de lactato (mmol/l) apresentaram diferença estatística ao comparar os valores pré-teste (Controle: 2,2 ± 0,14; Arginina: 2,43 ± 0,23; Placebo: 2,26 ± 0,11) com valores pós-teste (Controle 10,35 ± 0,57; Arginina: 12,07 ± 0,88; Placebo: 12,2 ± 0,96), p < 0,001. Os principais resultados deste estudo indicam que a administração aguda de aspartato de arginina não se mostrou efetiva em aumentar a tolerância à fadiga dos indivíduos avaliados e tratados no protocolo de teste incremental até a exaustão. Assim, podemos concluir que a dose utilizada não foi capaz de aumentar a tolerância à fadiga muscular.

The physical activity influences specific mechanisms responsible by a reduction in the power production, and consequently on the fatigue. It has been proposed premises to improve the physical performance, and we observed that some studies have been focused on the reduction of the metabolites that decrease the fatigue on intense physical exercising, using aminoacids known for their properties to induce to metabolic changes, and among these, it is the arginine. The present study had the purpose to study the effects of the acute arginine aspartate supplement in trained healthy individuals submitted to an exhaustion protocol on ergonomic bicycle. Twelve 22.6 ± 3.5 years old trained individuals were used in the research. After taking a single dose of arginine aspartate or a placebo solution, they performed three 90 minute test on an ergonomic bicycle to which load increments were added up to reaching the exhaustion. The blood samples were obtained through biochemical analysis, such as: creatinine, urea, glycosis, and lactate. It was found no statistical differences upon the comparison of the Maximal Heart Rate, Maximal Time and Load, and also comparing to the previous and later results on the urea, creatinine and glycosis tests. The lactate concentrations (mmol/l) presented statistical differences compared to the pre-test values (Control: 2.2 ± 0.14; Arginine: 2.43 ± 0.23; Placebo: 2.26 ± 0.11) to the post-test values (Control 10.35 ± 0.57; Arginine: 12.07 ± 0.88; Placebo: 12.2 ± 0.96), p < 0.001. The main results found in this study indicate that the acute administration of the arginine aspartate did not show effective to increase the fatigue tolerance in the individuals evaluated and treated in the incremental test protocol up to the exhaustion. Thus, it can be concluded that the dosage used was not able to increase the muscular fatigue tolerance.

La actividad física influencia los mecanismos específicos responsables por la reducción de la producción de fuerza y por consiguiente a la fatiga. La preocupación por mejorar la acción física se ha propuesto constantemente; nosotros hemos observamos que los estudios prestan la atención para reducir acumulaciones del metabólitos que reducen la fatiga durante el intenso ejercicio físico, mientras se usan los aminoácidos conocidos que puedan inducir cambios metabólicos, entre ellos la arginina. El estudio presente tiene como objetivo el analizar los estudios del efecto de la suplementación de aspartato del arginina en individuos saludables sometidos a un protocolo de agotamiento en un cicloergómetro. Se usaron 12 individuos especializados de sexo masculino, de edad de 22,6 ± 3,5 años. Ellos lograron tres pruebas de 90 minutos después de la administración en una sóla dosis del aspartato del arginina o de solución placebo, en un cicloergómetro dónde se incrementaron las cargas hasta el agotamiento. Se obtuvieron las muestras sanguíneas para los análisis bioquímicos como de creatinina, urea, glucosa y lactato. No se encontraron diferencias con las estadísticas al comparar los valores de frecuencia máxima del corazón FMC, Tiempo Máximo y Carga Máxima y también al comparar los resultados anteriores y subsecuentes a la prueba para el urea, creatinina y glucosa. Las concentraciones del lactato (el mmol/l) si, presentaron la diferencia estadística al comparar el pré-prueba de valores (Controles: 2,2 ± 0,14; Arginina: 2,43 ± 0,23; Placebo: 2,26 ± 0,11) con el power-proof de valores (Control 10,35 ± 0,57; Arginina: 12,07 ± 0,88; Placebo: 12,2 ± 0,96), p < 0,001. Los resultados principales de este estudio indican que la administración marcada de aspartato del arginina no fue demostrada aumentando la tolerancia a la fatiga de los individuos estimados y tratados en el protocolo de prueba incremental al agotamiento. Así, podemos concluir que la dosis...

Effect of Bothrops leucurus venom in chick biventer cervicis preparations.

Bothrops leucurus is a poorly studied pitviper found in northeastern Brazil. We examined the action of B. leucurus venom (5-100 microg/ml) on contractile responses in chick biventer cervicis preparations. Muscle damage was assessed by quantifying the release of creatine kinase (CK) and by histological analysis. B. leucurus venom dose-dependently inhibited the contractile responses of indirectly stimulated preparations, the maximum inhibition with 100 microg of venom/ml being 74.0+/-6.6% (mean+/-SEM) after 120 min. The venom also reduced contractures to exogenous acetylcholine (55 and 110 microM) and K(+) (13.4mM) (85-100% reduction with 100 microg of venom/ml) and increased the release of CK (348+/-139 U/ml in controls vs 1260+/-263 U/ml with 20 microg of venom/ml after 120 min, p<0.05). The accompanying morphological changes included multivacuolated, swollen, amorphous fibers and agglutinated myofibrils. These results indicate that B. leucurus venom can adversely affect neuromuscular transmission and produce muscle damage in avian preparations.