Rufus R. Noble Pain is the most frequently cited reason for a physician’s consultation within the United States. One in three Americans suffers from chronic pain every year. The primary reason for not working or missing school is musculoskeletal discomfort. Current treatments are non-steroidal anti-inflammatory medicines, including steroid injections and surgeries, and painkillers derived from opiates, each with a distinct risk profile. Efficient treatment options for pain with a low-risk profile are required. Over the past forty years, low-level light (light) therapy (LLLT) and LED (light emitting diode) therapy (also called photobiomodulation) has been proven to decrease edema and inflammation-inducing analgesia, as well as improve healing in a variety of musculoskeletal disorders. This paper aims to discuss the benefits of LLLT to treat pain, the biochemical mechanism of treatment, the dose-response curves, and how orthopedic surgeons could use LLLT to improve outcomes and minimize adverse incidents.
With the expected rise of chronic pain in developed nations, It is crucial to test cost-effective, safe methods of managing pain to allow patients to lead active lives and be full of energy. Furthermore, the introduction of LLLT (utilized by numerous disciplines worldwide) to be incorporated into the arsenal of the American health provider will enable new treatments for patients. A unique and cost-effective method of treating pain can improve quality of life and reduce costs.
Introduction
Musculoskeletal discomfort affects the lives of 116 million Americans yearly at the cost of 635 billion annually in medical expenses, loss of productivity, and missed school or work 1., 22. Every therapeutic procedure has advantages but comes with various risks, side effects, or complications. The current treatment options for muscle and joint pain include modalities, immobilization, medication and chiropractic, physical therapy, psychological treatment, and injections or surgery. These traditional therapies come with specific risks and side effects which include gastric bleeding and peptic ulcers, the impact of systemic disease (cardiovascular) [4), infection (including an epidural abscess) [5], addiction to narcotics [6), deformities such as well as neurologic problems and surgical complications [77. The ordinary course for chronic pain is growing dysfunction, impairment, and possibly disability.
A definition for pain used by The “International Association for the Study of Pain” says, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage [ 8]”. The withdrawal of the stimulus generally relieves pain fast. However, sometimes pain persists regardless of eliminating the inspiration or after the body has healed. The pain can also manifest without any trauma, illness, or stimulus. Acute pain is deemed to last for less than 30 days, whereas chronic pain is more than six months or “pain that extends beyond the expected period of healing.” There are three kinds of pain, nociceptive central and neuropathic. The current treatment method for pain medication or analgesics is targeted at different stages in the pathways for pain ( Figure 1). Clinically, low-level laser therapy (LLLT) can treat pain that is not inflammatory 9, and neuropathopathic pain 10however central pain has not been proven to respond to LLLT.
What is LLLT?
Low-Level Laser Therapy (LLLT), often called Low-Level Light Therapy or Photobiomodulation (PBM), uses very low-intensity light therapy. The result is photochemical, not thermal. The light causes biochemical changes in cells. It is comparable to photosynthetic processes that occur in plants. The photons are absorbed by the photoreceptors of cells and trigger chemical changes.
History of LLLT
In 1903 1903, and 1903, Dr. Nils Finsen was awarded the Nobel Prize for his contribution to treating illnesses, particularly lupus vulgaris using concentrated light radiation 11]. In 1960 professor Maiman T. 12 created the first operational red ruby laser 12 However, it wasn’t until 1967 that Mester E et were able to demonstrate the phenomenon of “laser biostimulation. 13, 14] 13, 14], 14were able to show the effect that is known as “laser biostimulation” [ 13, 1413 14. In 1999, Whelan H et al. 1999, Whelan H and colleagues 15 presented their research on the medical uses using LEDs that emit light (LED) to be used in NASA’s space station. NASA space station 15[ 15]. Over 400 Phase III randomized, double-masked controlled trials with placebos have been published in the following years, including more than 4000 laboratory studies on LLLT. (Pubmed.gov)
A laser is a machine that produces light via an optical amplification process based on electromagnetic wave stimulation. Four primary categories of lasers are defined in the International Engineering Consortium (IEC standard 60825.) These classifications indicate the potential danger the radiation could pose to the eyes.
- Class 1/1M-CD player
- Class 2/2M – laser pointer
- Class 3R/3B LT and DVD and CD writers
- Class 4 Laser Surgical
LLLT is the use of light (usually that of a low-powered laser or LED ), a power is (10mW-500mW). The light that is in the near-infrared to the red part of the spectrum (660nm-905nm) is commonly used because of the capability to penetrate the skin and soft and hard tissue ( Figure 2) and has been demonstrated by clinical trials to have a positive result on inflammation, pain, and repair of tissue. Power density (irradiance) is typically between 5W/cm 2 and placed on an area of injury or the site of discomfort for 30-60 seconds several times per week for a few weeks. The result is decreased pain, inflammation, and an acceleration of tissue regeneration. Most of the time, the LEDs or lasers employed for LLLT emit an unfocused beam (not focused or collimated) since collimation is not lost in the tissues. Consequently, the risks to the eyes are decreased over a longer distance.
