630/808nm双波长低强度激光照射对大鼠皮肤创伤愈合的影响

背景:低强度激光生物效应已经越来越受到科学工作者和临床医生的重视,其在不引起机体产生不可逆性损伤的前提下对机体代谢的积极调节作用让人们对于它临床上的投入前景非常期待。目的:观察630nm和808nm低强度激光单独照射和联合照射对大鼠背部皮肤创伤愈合的影响。设计、时间及地点:随机对照动物实验,于2008-05/07在天津医科大学完成。材料:清洁级雄性Wistar大鼠32只,体质量(240±20)g。方法:用手术剪在每只Wistar大鼠背部左右对称各造2个圆形皮肤全层切割型创口,4个创口按部位统一编号。将32只大鼠按完全随机分组法分为4组,空白对照组、630nm单波长低强度激光照射组、808nm单波长低强度激光照射组和630/808nm双波长低强度激光照射组,每组8只。3个照射组中的大鼠背部创口分别用不同波长低强度激光连续照射14d,1次/d,每个创口照射10min/次;空白对照组无任何干预措施。主要观察指标:伤后每隔1d用透明薄膜描记每只大鼠Ⅰ号创口的创面,根据积分法计算创面面积收缩率;伤后第3,7,14天对创口取活检做常规苏木精-伊红染色,光镜观察组织形态变化。结果:32只Wistar大鼠均进入结果分析。①与空白对照组相比,630/808nm双波长低强度激光照射组和630nm单波长低强度激光照射组创伤面积收缩速度快,差异具有显著性意义(P<0.05)。②630/808nm双波长低强度激光照射组和630nm单波长低强度激光照射组较其他2组肉芽组织出现早,同时成纤维细胞的数量与胶原分泌量多、创伤愈合情况好。结论:630nm单波长或630/808nm双波长低强度激光照射均能有效促进大鼠皮肤创伤的愈合过程。     

A case report of low intensity laser therapy (LILT) in the management of venous ulceration: potential effects of wound debridement upon efficacy

OBJECTIVE: This single case report (ABA design) was undertaken as a preliminary investigation into the clinical effects of low intensity laser upon venous ulceration, applied to wound margins only, and the potential relevance of wound debridement and wound measurement techniques to any effects observed. METHODS: Ethical approval was granted by the University of Ulster's Research Ethical Committee and the patient recruited was required to attend 3 times per week for a total of 8 weeks. Treatments were carried out using single source irradiation (830 nm; 9 J/cm2, CB Medico, Copenhagen, Denmark) in conjunction with dry dressings during each visit. Assessment of wound surface area, wound appearance, and current pain were completed by an independent investigator. Planimetry and digitizing were completed for wound tracings and for photographs to quantify surface areas. Video image analysis was also performed on photographs of wounds. RESULTS: The primary findings were changes in wound appearance, and a decrease in wound surface area (range 33.3-46.3%), dependent on the choice of measurement method. Video image analysis was used, but rejected as an accurate method of wound measurement. Treatment intervention produced a statistically significant reduction in wound area using the C statistic on digitizing data for photographs (at Phase one only; Z = 2.412; p < 0.05). Wound debridement emerged as an important procedure to be carried out prior to measuring wounds. Despite fluctuating pain levels recorded throughout the duration of the study, VAS scores showed a decrease of 15% at the end of the study. This hypoalgesic effect was, however, statistically significant (using the C statistic) at Phase one only (Z = 2.554; p < 0.05). CONCLUSIONS: Low intensity laser therapy at this dosage, and using single source irradiation would seem to be an effective treatment for patients suffering venous ulceration. Further group studies are indicated to establish the most effective therapeutic dosage for this and other types of ulceration.     

Effect of low-level laser therapy (808 nm) on skeletal muscle after endurance exercise training in rats

BACKGROUND:

Low-level laser therapy (LLLT) has been demonstrated to be effective in optimizing skeletal muscle performance in animal experiments and in clinical trials. However, little is known about the effects of LLLT on muscle recovery after endurance training.

OBJECTIVE:

This study evaluates the effects of low-level laser therapy (LLLT) applied after an endurance training protocol on biochemical markers and morphology of skeletal muscle in rats.

METHOD:

Wistar rats were divided into control group (CG), trained group (TG), and trained and laser irradiated group (TLG). The endurance training was performed on a treadmill, 1 h/day, 5 days/wk, for 8 wk at 60% of the maximal speed reached during the maximal effort test (Tmax) and laser irradiation was applied after training.

RESULTS:

Both trained groups showed significant increase in speed compared to the CG. The TLG demonstrated a significantly reduced lactate level, increased tibialis anterior (TA) fiber cross-section area, and decreased TA fiber density. Myogenin expression was higher in soleus and TA muscles in both trained groups. In addition, LLLT produced myogenin downregulation in the TA muscle of trained animals.

CONCLUSION:

These results suggest that LLLT could be an effective therapeutic approach for stimulating recovery during an endurance exercise protocol.     

The effect of combined therapy (spa and physical therapy) on pain in various chronic diseases

OBJECTIVE: Spa therapy is commonly used in the treatment of daily chronic diseases practice, but its benefits are still the subjects of discussion. This study investigates possible effects of a combined spa and physical therapy program on pain and hemodynamic responses in various chronic diseases. METHODS: The pain intensity and hemodynamic responses of 472 patients involved in a spa and physical therapy program were studied retrospectively. Assessment criteria were pain [Visual Analog Scale (VAS)] and hemodynamic responses (heart rate, blood pressure, respiratory rate). Assessments took place before, immediately after treatment, and after completion of the spa program (before discharge). RESULTS: The patients with ankle arthrosis, fibromyalgia and cervical disc herniation reported the highest VAS score before treatment program (P < 0.05). After the therapy program, VAS scores were seen to decrease compared to before treatment (P < 0.05). The patients with osteoarthritis of the hip (1.3+/-1.2) and soft tissue rheumatism (1.3+/-1.2) had the lowest VAS score before discharge compared to patients with other pathologies (P < 0.05). No statistically significant differences were detected between both sexes in terms of pain improvement (P > 0.05). On discharge, all hemodynamic responses decreased significantly compared to before and immediately after initiation of the therapy program (P < 0.01). CONCLUSION: To decrease pain and high blood pressure without hemodynamic risk, a combined of spa and physical therapy program may help to decrease pain and improve hemodynamic response in patients with irreversible pathologies.     

高能量激光联合本体感觉神经肌肉促进技术对脑卒中后肩痛的影响研究

目的:观察高能量激光联合本体感觉神经肌肉促进技术(PNF)对脑卒中后肩痛的影响。方法:脑卒中肩痛患者60例被随机分为A组、B组和C组,每组20例。3组患者均接受常规肩痛康复治疗,A组加用高能量激光治疗,B组加用PNF治疗,C组加用高能量激光联合PNF治疗。于治疗前和治疗3周后,分别采用简化McGill疼痛问卷评估肩痛,Fugl-Meyer评定量表评估上肢功能,改良Bathel指数评估日常生活活动能力。结果:治疗3周后,3组McGill疼痛评分校治疗前明显降低(P0.01),C组更高于A、B组(P0.01),A、B组之间差异无统计学意义,但B组治疗前后差值明显大于A组(P0.01)。治疗后,3组Fugl-Meyer上肢功能评分和改良Bathel指数评分较治疗前明显提高(P0.01),C组上述各评分明显高于A组和B组(P0.01),B组高于A组(P0.01)。结论:高能量激光联合PNF治疗可明显减轻脑卒中后肩痛程度,改善肩关节运动控制能力,提高患者日常生活活动能力。     

The role of massage therapy in the relief of cancer pain

Massage is increasingly being considered as a means of relieving the pain many cancer patients experience. This article aims to investigate current evidence relating to the safety and effectiveness of using massage to help treat this group of patients.     

The needle effect in the relief of myofascial pain.

In reviewing techniques for therapeutic local anaesthesia of pain spots, it appeared that the common denominator was puncture by the needle and not the anaesthetic employed. The present study examines short- and long-term effects of dry needling in the treatment of chronic myofascial pain. 241 patients and 312 pain sites were treated by needling. When the most painful spot was touched by the needle, immediate analgesia without hypesthesia was observed in 86.8% of cases. Permanent relief of tenderness in the needled structure was obtained for 92 structures; relief for several months in 58; for several weeks in 63; and for several days in 32 out of 288 pain sites followed up. The effectiveness of treatment was related to the intensity of pain produced at the trigger zone, and to the precision with which the site of maximal tenderness was located by the needle. The immediate analgesia produced by needling the pain spot has been called the "needle effect".     

The effect of manual therapy in acute low back pain (LBP)

Summary In 14 patients with acute LBP the effect of manual therapy was examined. The examination was conducted with the Triflexometer, which is an electromechanical measuring instrument for examination of the posture and function of the spine. This instrument makes possible the measurement of the spine in resting as well as in moving positions, and it is also suitable for recording local disturbances of the movement. In our study we measured the spine from C7 to S2 in the sagittal and frontal planes. Improvement in movement was detected in all patients following manual therapy, as well as in ante-, retro- and lateral flexion on both sides, and local functional disturbances also disappeared partially or totally. Our study shows that the Triflexometer makes it possible to record the effect of manual therapy in acute LBP. The proof of the local functional disturbances after manual therapy indicates that these patients have a higher risk of new episodes of acute LBP or perhaps of chronic LBP, and because of that there it is necessary to use other treatment forms.      

The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia

Multidisciplinary treatment has proven to be the best therapeutic option to fibromyalgia (FM) and physiotherapy has an important role in this approach. Considering the controversial results of electrotherapy in this condition, the aim of this study was to assess the effects of combined therapy with pulsed ultrasound and interferential current (CTPI) on pain and sleep in FM. Seventeen patients fulfilling FM criteria were divided into two groups, CTPI and SHAM, and submitted to pain and sleep evaluations. Pain was evaluated by body map (BM) of the painful areas; quantification of pain intensity by visual analog scale (VAS); tender point (TP) count and tenderness threshold (TT). Sleep was assessed by inventory and polysomnography (PSG). After 12 sessions of CTPI or SHAM procedure, patients were evaluated by the same initial protocol. After treatment, CTPI group showed, before and after sleep, subjective improvement of pain in terms of number (BM) and intensity (VAS) of painful areas (P<0.001, both); as well as objective improvement, with decrease in TP count and increase in TT (P<0.001, both). Subjective sleep improvements observed after CTPI treatment included decrease in morning fatigue and in non-refreshing sleep complaint (P<0.001, both). Objectively, PSG in this group showed decrease in sleep latency (P<0.001) and in the percentage of stage 1 (P<0.001), increase in the percentage of slow wave sleep (P<0.001) and in sleep cycle count (P<0.001). Decrease in arousal index (P<0.001), number of sleep stage changes (P<0.05) and wake time after sleep onset (P<0.05), were also observed and no difference regarding pain or sleep parameters were verified after SHAM procedure. This study shows that CTPI can be an effective therapeutic approach for pain and sleep manifestations in FM.     

音乐疗法对缓解产妇分娩过程中疼痛的效果观察

目的探讨音乐疗法对缓解产妇分娩过程中疼痛的效果。方法选取2008年10月-2009年3月在本院产科行围产期保健分娩的孕产妇140例,随机将其分为实验组和对照组各70例。对照组产妇给予常规围产保健及产程护理,实验组产妇在对照组的基础上于预产期前8w开始实施音乐疗法,直至产程结束,比较两组产妇潜伏期、活跃期、第2产程、第3产程疼痛程度。结果在潜伏期、活跃期及第2产程,实验组产妇疼痛程度较对照组明显减轻（均P〈0.01）。结论音乐疗法可明显缓解产妇分娩过程中的疼痛程度。     

Low‐level laser therapy for pain relief after episiotomy: a double‐blind randomised clinical trial

Aims and objectives. To evaluate the effectiveness of a low‐level laser therapy for pain relief in the perineum following episiotomy during childbirth. Background. Laser irradiation is a painless and non‐invasive therapy for perineal pain treatment and its effects have been investigated in several studies, with no clear conclusion on its effectiveness. Design. A double‐blind randomised controlled clinical trial. Method. One hundred and fourteen women who underwent right mediolateral episiotomies during vaginal birth in an in‐hospital birthing centre in São Paulo, Brazil and reported pain ≥3 on a numeric scale (0–10) were randomised into three groups of 38 women each: two experimental groups (treated with red and infrared laser) and a control group. The experimental groups were treated with laser applied at three points directly on the episiotomy after suturing in a single session between 6–56 hours postpartum. We used a diode laser with wavelengths of 660 nm (red laser) and 780 nm (infrared laser). The control group participants underwent all laser procedures, excluding the emission of irradiation. The participants and the pain scores evaluator were blinded to the type of intervention. The perineal pain scores were assessed at three time points: before, immediately after and 30 minutes after low‐level laser therapy. Results. The comparison of perineal pain between the three groups showed no significant differences in the three evaluations (p = 0·445), indicating that the results obtained in the groups treated with low‐level laser therapy were equivalent to the control group. Conclusions. Low‐level laser therapy did not decrease the intensity of perineal pain reported by women who underwent right mediolateral episiotomy. Relevance to clinical practice. The effect of laser in perineal pain relief was not demonstrated in this study. The dosage may not have been sufficient to provide relief from perineal pain after episiotomy during a vaginal birth.     

布洛芬对药物流产疼痛及成功率影响研究

目的：探讨布洛芬对药物流产疼痛及成功率的影响。方法：79例接受药物流产的患者随机分为布洛芬组及对照组,在服用米索前列醇片30min后布洛芬组加服布洛芬片,对照组加服维生素C片,对患者服药后30min,1h,3h,6 h进行视觉模拟评分法（VAS）疼痛评分。比较两组患者的疼痛程度、完全流产率及不良反应的发生情况。结果：布洛芬组在药物流产的疼痛程度上明显轻于对照组,结果均具有统计学意义（P〈0.05）。其对药物流产的成功率无明显影响,且并不增加药物流产的不良反应。结论：布洛芬能够在不影响药物流产成功率及加重其并发症的同时,减轻患者的疼痛。     

Efficacy of multi-wave locked system laser therapy on nerve regeneration after crushing in Wister rats

[Purpose] To investigate the efficacy of the multi-wave locked system laser therapy on the regeneration of peripheral nerve injuries by evaluating the functional, electrophysiological, and morphological changes of the crushed sciatic nerve in Wistar rats. [Materials and Methods] Sixty male Wistar rats (200–250 g) were randomly assigned to control negative, control positive, or laser groups and subjected to no laser therapy or crushing, to crushing without laser therapy, or crushing followed by multi-wave locked system laser therapy five times/week for four weeks (power=1 W, energy density=10 J/cm², total energy=100 J), respectively. Functional, electrophysiological, and morphometric analyses were performed before and 7, 15, 21, and 28 days after crushing. The sciatic functional index, compound motor action potential amplitude, motor nerve conduction velocity, and nerve and myelin sheath diameters were measured. [Results] The sciatic functional index value decreased significantly, while the compound motor action potential amplitude, motor nerve conduction velocity, nerve diameter, and myelin sheath diameter increased significantly in the laser group post-treatment compared to the values in the control groups. [Conclusion] Multi-wave locked system laser therapy was effective in accelerating the regeneration of crushed sciatic nerves in Wistar rats.     

The effect of neurac training in patients with chronic neck pain

[Purpose] This study aimed to investigate the effects of neurac training on pain, function, balance, fatigability, and quality of life. [Subjects and Methods] Subjects with chronic neck pain who were treated in S hospital were included in this study; they were randomly allocated into two groups, i.e., the experimental group (n = 10) and the control group (n = 10). Both groups received traditional physical therapy for 3 sessions for 30 min per week for 4 weeks. The experimental group practiced additional neurac training for 30 min/day, for 3 days per week for 4 weeks. All subjects were evaluated using the visual analogue scale (VAS), the neck disability index (NDI), the biorescue (balance), the questionnaire for fatigue symptoms (fatigue), and the medical outcome 36-item short form health survey (SF-36) pre- and post-intervention. [Results] The experimental group effectively improved their pain, function, balance, fatigability, and quality of life. [Conclusion] Neurac training is thus considered an effective training program that enhances body functionality by improving pain, function, balance ability, fatigability, and quality of life in patients with chronic neck pain.Key words: Chronic neck pain, Sling-neurac training, Function     

The effect of headache pain on attention (encoding) and memory (recognition)

Memory is a key cognitive variable in pain management. This study examined the effect of headaches on participants' encoding of words (attention) and later memory for words. The dependent measures were response time during encoding and recognition memory; headache pain was the independent measure. Eighty participants were randomized to one of four groups: two groups had the same condition (headache pain or no headache pain) for both the encoding and memory tasks and two groups had mixed conditions (i.e. pain during encoding/no pain during recognition; no pain during encoding/pain during recognition). Participants with pain during encoding judged words significantly slower (177.53ms) than participants without pain during encoding. Participants with pain during the memory task recognized significantly fewer words (5.4%) than participants without pain during the memory task, regardless of pain condition during encoding. Results from this and other pain and memory studies conducted in this laboratory suggest that pain, as it adversely affects memory, may operate at a threshold level rather than on a dose-response continuum.     

全膝关节置换多模式联合镇痛的短期效果

背景:全膝关节置换围手术期疼痛处理一直为临床所关注,部分国内医院已经开展多模式镇痛治疗和其他综合围手术期镇痛措施,并报道取得了较好临床效果,但仍缺乏系统化的围手术期疼痛控制方案。目的:通过比较多模式与非多模式两种镇痛方案在围手术期疼痛控制方面的短期临床效果,探索较为有效、规范的围手术期镇痛方案。方法:随机选取2010年10月至2011年10月首都医科大学附属北京朝阳医院接受单侧初次全膝关节置换患者40例。并按照镇痛方案的不同分为多模式镇痛组20例及非多模式镇痛组20例。非多模式镇痛组采取常规的持续硬膜外镇痛,并在置换后给予非类固醇类消炎镇痛药物。多模式镇痛组则进行超前镇痛,置换后留置股神经阻滞管进行初期持续、后期负荷剂量镇痛。结果与结论:多模式镇痛组患者置换后6,12,24h的疼痛目测类比评分均值小于非多模式镇痛组,然而差异无显著性意义(P>0.05)。置换后第2天多模式镇痛组活动痛要明显小于非多模式镇痛组,差异有显著性意义(P<0.01)。置换后第3-7天多模式镇痛组患者静息痛及活动痛均小于非多模式镇痛组,差异有显著性意义(P<0.01)。置换后第2-7天多模式镇痛组患者膝关节活动度均值大于非多模式镇痛组,差异有显著性意义(P<0.05)。结果可见采用多模式疼痛控制方案能够在置换后短期内减少疼痛,加快关节功能的恢复。