Treatment of Scapulohumeral Periarthritis and Post-traumatic Joint Pain

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9 Articles in Volume 9, Issue #2

Acupuncture for Fibromyalgia

Brain Atrophy with Chronic Pain: A Call for Enhanced Treatment

Evaluating Function/Impairment of Low Back Pain Using SEMG

Medication-induced Xerostomia Secondary to Pain Management

Neuroscience, Neurophilosophy, and Neuroethics of Pain, Pain Care, and Policy (N3P3)

Reducing Pain and Anxiety During Reduction of a Fracture

Successful Treatment of Intractable Pain

Treating Chronic Pain by Patient Empowerment

Treatment of Scapulohumeral Periarthritis and Post-traumatic Joint Pain

A review of a Russian hospital-based study using magneto-laser therapy.

By William J. Kneebone, CRNA, DC, CNC, DIHom

In this issue, I want to share with you an interesting study from Russia that I came across several months ago. One of the most interesting features of the study is that it was done at one of the largest medical institutions in Russia having a hospital staff of 920.

This study reported on the results of utilizing a magneto-infrared laser in the treatment of scapulohumeral periarthritis and post-traumatic injury of the joints. This study was overseen by Colonel, Professor Alexander S. Shets, Doctor of Science.1 He is the head of the main clinical hospital in the city of Moscow. This hospital is one of the main hospitals of the Ministry of Internal Affairs of the Russian Federation. It provides medical services to the employees of the Ministry of Internal Affairs.

The hospital staff of 920 includes 11 Doctors of Science and 38 PhDs. This hospital is equipped with the most contemporary medical diagnostic and therapeutic equipment available.

Demographics

This clinical study was performed in the trauma department. This study was performed from February 2000 to October 2000 on patients that were suffering from scapulohumeral periarthritis and post-traumatic joint injuries. Patient demographics are presented in Table 1.

Table 1. Patient Demographics for Each Group
Scapulohumeral Periarthritis Total number of patients = 90 (72 men and 18 women) Patients’ age: 20-30 years old n=12 31-40 years old n=24 41-50 years old n=24 61-70 years old n=10 71 years and older n=9 Medical history of condition: less than 1 year n=7 less than 2 years n=9 less than 3 years n=14 less than 4 years n=22 less than 5 years n=13 6 years and more n=11 Post-traumatic Injury of Joints Total number of patients = 90, (81 men and 9 women) Patients' age: 20-30 years old n=12 31-40 years old n=28 41-50 years old n=24 51-60 years old n=10 61 years and older n=9 Medical history of condition: less than 1 year n=28 less than 2 years n=34 less than 3 years n=4 less than 4 years n=8 5 years and more n=6

Methods

Patients of each condition—scapulohumeral periarthritis or post-traumatic injury of joints—were divided into three groups and treated as follows:

3 therapeutic departments
2 surgical departments including surgical blocks and a trauma unit
burn center
physiotherapy and rehabilitation department
clinical and diagnostic laboratories
Group 1: treated with conventional pharmacological, surgical and physiotherapeutic modalities
Group 2: treated with magneto-laser therapy
Group 3: treated with placebo laser (applicable only to the post-traumatic joint injury cohort)

Patients in group 2 were treated by magneto-laser protocols established by the developer, Medical Quant, and documented in the equipment’s user manual. Figure 1 illustrates treatment of the scapulohumeral region. The treatment consisted of 12 – 15 sessions of daily magneto-laser therapy. The outcome criteria included decrease in pain, improved locomotor function, and positive x-ray examination changes.

Technology Overview

Figure 2 presents a diagrammatic representation of the four technologies used in the emitter of the laser device that was utilized in this study. It incorporates GaAs Infrared laser, pulsed broadband non-coherent IR , red non-coherent light, and a static magnetic field. Doug Johnson, ATC, reviewed some of the concepts relating to how these technologies work together in his article Therapeutic Laser Evolution–Part I in the October 2008 issue of PPM.²

We will recall that laser and light therapy initiates a multi-faceted cascade of biochemical and physiological effects. These include:

Stabilization of the cell membrane³
Research in laser and light therapy has documented that red and near infrared light reduces pain by a combination of these responses:
Increases in ß-Endorphins
Blocked depolarization of C-fiber afferent nerves¹¹
Axonal sprouting and nerve cell regeneration¹²
Decreased Bradikynin levels
Ion channel normalization

Table 2. Study Results for Both Patient Conditions.
Nosology	Number of Patients				Treatment Results
	Total	Group			Group
	Total	I	II	III	I	II	III
Scapulohumeral periarthritis	90	40	50	0	Positive effect 63%	Positive effect 86% Drug dose 27% less • Treatment period 6 days shorter	n/a
Post-traumatic injury of joints	90	45	40	5	Positive effect 56%	Positive effect 81% Drug dose 17% less • Treatment period 2 days shorter	Positive effect 17%

Figure 3 summarizes the mechanism of biological and therapeutic effects of low level laser radation. These multiple biochemical effects can account for much of the clinical results reported in this study.

Study Results

The results for each of the patient cohorts are presented in Table 2. Improved pain relief, less dependency on pharmaceuticals, and a shorter recovery was experienced in the magneto-laser group for both conditions. This is an interesting hospital-based study in that it had 90 subjects per condition and contained a broad range of patient ages, duration of condition prior to treatment, and the post-traumatic joint injury cohort also had a small group of patients subjected to sham laser.

Enhancement of ATP synthesis⁴
Stimulated vasodilation along with increased histamine, NO, and serotonin5
Acceleration of leukocyte activity
Increased Prostaglandin synthesis⁶
Reduction in Interleukin-1 levels⁷
Increased angiogenesis⁸
Enhanced superoxide dismutase⁹
Decreased C-reactive protein and neopterin levels10

View Sources

Resources

1. Shets AS. Magnetro-Laser Therapy in Partients with Scapulohumeral Periarthritis and Post-traumatic Joint Pain. Journal of Medical Care-Publication of the Ministry of Healthcare. April 2003.
2. Johnson D. Therapeutic laser Evolution-Part I. Prac Pain Manag. Oct 2008. 8(8):54,55.
3. Lubart R, Friedmann H, and Lavie R. Photobiostimulation as a function of different wavelengths. Bone regeneration. The Journal of Laser Therapy. Volume 12. World Association of Laser Therapy. 2000.
4. Silviera LB et al. In vivo study mast cells behavior following low intensity and near infrared laser radiation. Laser Surg Med. Abstract issue. Abstract 304. 2004.
5. Tam G. Action of 904 nm. Laser in orthopedics and traumatology. Laser Center. Tolmezzo, Italy. Meridian Co. Ltd.
6. Bjordal JM and Couppe C. What is optimal dose, power density, and timing for low level laser therapy in tendons? A review of in vitro and in vivo trials. Department of Physiotherapy Sciences, University of Bergen. Norway. Abstract from the 7th International Congress of the European Medical Laser Association. Dubrovnik, Croatia. June 2002.
7. Stadler I et al. In vitro effects of low level laser irradiation at 660 nm. On peripheral blood lymphocytes. Lasers Surg Med. 2000. 27(3): 255-61.
8. Kubota J. Laser and sports medicine in plastic and reconstructive surgery. Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan. Abstract from the 11th Congress of the International Association of Laser and Sports Medicine. Rosario, Argentina. March 10-12, 2000.
9. Karu TI. Mechanisms of low power laser light action on the cellular level. Lasers in Medicine and Dentistry. Edited by Simunovic Z. Rijeka. Vitagraph. 2000. pp 97-125.
10. Tsuchya K et al. Diode laser irradiation selectively diminishes slow components of axonal volleys to the dorsal roots from the saphenous nerve. Neuroscience Letters. 1993. 161:65-68.
11. Byrnes KR et al. Cellular invasion following spinal cord lesion and low power laser irradiation. Lasers Surg Med. 2002. S14: 11.
12. Martin R. Laser accelerated inflammation and healing. Prac Pain Manag. Nov/Dec 2003. 3(6): 20-25.