Category Archives: Back Pain

External Laser Therapy and Laserneedle Acupuncture for Chronic Pain

Featured Image:   Comb Jelly (Mnemiopsis sp.)

https://i.ytimg.com/vi/weeFO6kLu5o/maxresdefault.jpg

Dear Pain Matters blog readers,

External laser therapy is used to exert various biological/cellular effects in the body including:

  • Stimulation of various acupuncture points (via noninvasive, painless Laserneedle acupuncture); and
  • Treatment of local damaged areas within the tissue.  Local laser therapy may be done for pain management, rehabilitation and regeneration of damaged tissue.

External laser therapy uses various laser wavelengths (i.e. colours) to penetrate different depths and tissues beneath the skin including:

  • Infrared laser (800 – 900 nanometers, ‘nm’; 810 nm, may be used) – 5 to 7 cm depth below the skin;
  • Red laser (630 – 680 nm; 658 nm may be used) – 2 to 3 cm depth below the skin.  Red laser can increase cellular activity and blood circulation as well as stimulate immune cells, fibroblasts and mitochondria, leading to regeneration and improved healing including wound healing;
  • Green laser  (532 nm) – 0.5 to 1 cm depth beneath the skin.  Green light is largely absorbed by haemoglobin in the red blood cells; and
  • Blue laser (405 nm) – 1 to 2 mm depth only.  Blue laser light has anti-inflammatory effects.

External laser therapy can be applied via:

  • Single point lasers.  Only one point and 1 wavelength can be used in single point lasers; or
  • Laserneedles.  Up to 12 multi-channel lasers/points including different wavelengths/colours/power outputs may be used at the same time (e.g. Weberneedle system, Lasershower).

External laser therapy may treat various painful medical conditions including:

  • Spine syndromes/back pain;
  • Osteoarthritis;
  • Rheumatoid diseases;
  • Tendon inflammation;
  • Migraine/headache; and
  • Trigeminal neuralgia

(Michael Weber MD).

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Source:   http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/external-laser-therapy/

Fibromyalgia:

A study involving laser acupuncture treatment for fibromyalgia patients reported an average Pain Scale of 4.4, post-laser acupuncture (compared to an average Pain Scale of 8.5, pre-laser acupuncture).

Further improvements occurred when laser acupuncture plus intravenous laser was offered to fibromyalgia patients (i.e. average Pain Scale of 2.9, post-laser acupuncture plus intravenous laser, compared to 8.9, pre-treatment).

Both:

  • Laser acupuncture; and
  • Laser acupuncture plus intravenous laser

were more effective for pain management than medication alone (6.8, post-medication, versus 8.7, pre-medication) and metal needle acupuncture (6.0, post-treatment, versus 8.5, pre-treatment) in fibromyalgia patients (Wieden).

(For more on intravenous laser, please refer to:
http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/intravenous-laser-therapy/.)

Possible Mechanisms:

I urge all interested readers to read Chapter 4 called ‘Rewiring a Brain with Light’, in Norman Doidge’s 2nd book, ‘The Brain’s Way of Healing’.  This book provides an excellent introduction into phototherapy (i.e. low level laser therapy; LLLT) (Doidge, 2016).  

Scientists have recently shown that humans (including the human eye and brain) may detect and perceive a single photon (Tinsley et al, 2016).  This is very interesting as it shows the sensitivity of the human body to the biological (hence potential healing) effects of natural light including its visible wavelengths from 400 to 700 nm (blue to red) and invisible wavelengths from 800 to 900 nm (near infrared).

Summary:

Whilst relatively new (and undergoing further research), external laser therapy and Laserneedle acupuncture may be useful for reducing pain in many chronic pain conditions including fibromyalgia.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

junggebauer@webermedical.com

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

http://www.dr-weber-laser-clinic.com/en/home/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

(1A) Michael Weber MD

Laser in Pain Therapy and Rehabilitation

http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/pain-therapy-rehabilitation/

http://www.webermedical.com/en/the-business/dr-weber/

http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

(1B) Michael Weber MD, Robert Weber, Martin Junggebauer

Medical Low Level Laser Therapy – Foundations and Clinical Applications (2nd Edition, June 2015)

http://www.isla-laser.org/en/

(1C) Michael Weber MD, President of International Society for Medical Laser Applications (ISLA)

International Society for Medical Laser Applications (ISLA)

http://www.isla-laser.org/en/

(1D) Michael Weber MD, Thomas Fussgänger-May MD, Tillman Wolf MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

http://www.my-dr.de/FG/texte/infounten/Publikationen/Medical_Acupuncture.pdf

(1E) Michael Weber MD, Zulia Frost MD

Multi-Laser Needle Acupuncture and Laser Blood Irradiation Therapy – Clinical Application of Biological Laser Therapy (Pages 1-50)

http://www.metgesacupuntors.org/resources/pdfs/congres_2009/17_30Z_Frost.pdf

Other Papers, Articles and a Blog by Fred Kahn, MD FRCS(C):

(2) Wieden, Torsten E. (MD Anaesthesiologist, Special pain therapy)

e-mail: wieden@schmerzpraxis-celle.de

Fibromyalgia in Pain Therapy – Mechanisms and Treatment Options in Laser Therapy

http://www.isla-laser.org/wp-content/uploads/Fibromyalgia-in-Pain-Therapy.pdf

(3) Pryor, Brian A

Class IV Laser Therapy – Interventional and Case Reports Confirm Positive Therapeutic Outcomes in Multiple Clinical Indications (2009)

http://www1.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/11-12/September/PryorLaserPromotional.pdf

(4) Class IV Laser Therapy – Case Study Reports (Pages 1-39)

http://www.madisonlasertherapy.com/uploads/6/4/3/2/6432749/class_iv_therapy_laser_case_studies_report_2013.pdf

(5) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture Using Laser Needles Modulates Brain Function: First Evidence From Functional Transcranial Doppler Sonography and Functional Magnetic Resonance Imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

http://www.ncbi.nlm.nih.gov/pubmed/15316852

(6) Norman Doidge MD

The Brain’s Way of Healing – Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (Chapter 4 – Rewiring a Brain with Light)

Publisher: Penguin Publishing Group (26 January 2016)

ISBN: 9780143128373

http://www.normandoidge.com/?page_id=1042

(7) Blog by Fred Kahn, MD FRCS(C), LLLT Specialist

http://fredkahnmd.com/2016/07/12/current-research-on-the-management-of-pain/

(8) Tinsley JN et al

Direct detection of a single photon by humans.

Nat. Commun. 7:12172

doi: 10.1038/ncomms12172 (2016).

http://www.nature.com/articles/ncomms12172

 

 

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Interstitial and Intra-Articular Laser Therapy for Chronic Pain Including Back Pain and Painful Osteoarthritis

Featured Image – Intra-articular laser treatment

Source:   http://www.webermedical.com/en/weber-medical-for-patients/the-principle/

Dear Pain Matters blog readers,

Recent developments have enabled the delivery of low level laser therapy (LLLT) beneath the skin including via:

  • Interstitial laser therapy;
  • Intra-articular laser therapy; and
  • Intravenous laser therapy.

492001f88f.jpg

Dr. Med. Dipl. Chem. Michael Weber

Source:   http://www.webermedical.com/en/the-business/dr-weber/

Overview:

This Blog Post will focus on:

  • Interstitial laser therapy; and
  • Intra-articular laser therapy

for pain management.

Different laser lights are used in interstitial and intra-articular laser therapy including:

  • Red laser light – Red laser may increase cell activity and blood circulation as well as enhance regeneration of damaged body tissues in chronic pain conditions;
  • Green laser light – Green laser may have anti-inflammatory effects in acute painful conditions including acute swellings; and
  • Blue laser light – Blue laser may have strong anti-inflammatory effects, hence reduce acute pain as well as promote wound healing.

Interstitial Laser Therapy:

(Percutaneous) interstitial laser therapy may offer some pain relief for chronic back pain (spinal pain) including:

  • Chronic spinal illnesses;
  • Slipped discs;
  • Scar pain after slipped disc surgery;
  • Spinal stenoses;
  • Neural lesions; and
  • Deep tendinitis and strains.

Interstitial laser therapy uses a sterile catheter to enable laser light (e.g. green and blue laser light) to access deep within the tissue (up to 12 cm penetration depth).  Thus, for example, blue laser light can exert its anti-inflammatory effects deep within the body tissue.

Without a sterile catheter, green and blue laser light cannot access deep body tissue regions.  Instead, most of the higher energy waves (i.e. green and blue) are absorbed in the skin during external laser therapy only.

a88d9186f2.jpg

Interstitial laser therapy

Source:   http://www.webermedical.com/en/weber-medical-for-patients/the-principle/

A Study Involving Interstitial Laser Therapy for Back Pain: 

Eleven (11) patients with chronic spinal disorders (disc herniation and spinal stenosis) received interstitial laser spine laser treatments (average = 7.64 treatments per patient).

26e7178d17.jpg

Where:

Red = Pain (before interstitial laser spine treatments)

Green = Pain (after interstitial laser spine treatments)

(‘Kreuzschmerzen’, in German = Back pain; VAS = visual analogue scale; Pain from 0 to 10)

Chronic back pain before interstitial laser spine treatment averaged 5.45 (VAS) (Refer to red).

Chronic back pain after 7 interstitial laser spine treatments decreased to an average of 2.55 (VAS) (Refer to green) (Weber).

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/clinical-results/

Intra-Articular Laser Therapy: 

Intra-articular laser therapy may offer some pain relief for painful arthroses including:

  • Knee osteoarthritis;
  • Hip osteoarthritis;
  • Painful shoulder syndromes; and
  • Ankle joint osteoarthritis.

Specifically, intra-articular laser therapy allows direct access into painful and injured/diseased intra-articular joints including knee and shoulder joints.

0693eda699.jpg

Intra-articular laser therapy

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

A Study Involving Intra-Articular Laser Therapy for Shoulder Pain:

Ten (10) patients with chronic shoulder pain received intra-articular laser treatments (average = 9.2 treatments per patient).

52560c56a3.jpg

Where:

Red = Pain (before intra-articular laser treatments)

Green = Pain (after intra-articular laser treatments)

(‘Schulterschmerzen’, in German = Shoulder pain; VAS = visual analogue scale; Pain from 0 to 10)

Chronic shoulder pain before intra-articular laser treatments averaged 6.2 (VAS) (Refer to red).

Chronic shoulder pain after 7 intra-articular laser treatments decreased to an average of 2.8 (VAS) (Refer to green) (Weber).

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/clinical-results/

Other Information About Low Level Laser Therapy (LLLT):

Classical low level laser therapy (LLLT) can be topically and non-invasively applied to the skin surface and may include:

  • External laser therapy;
  • Laser needle acupuncture; and
  • Laser needle treatment of the skull (transcranial) and the ear.

Low level laser therapy (LLLT) can also form part of photodynamic therapy including external/topical, systemic and interstitial.  Photodynamic therapy includes:

  • Photodynamic tumor therapy (for cancer); and
  • Anti-microbial photodynamic therapy.

Treatment and research involving stem cells and laser therapy is ongoing.

Summary:

Whilst relatively new (and undergoing further research), interstitial laser therapy may be useful for reducing chronic back pain (spinal pain), while intra-articular laser therapy may provide certain relief from painful arthroses including knee osteoarthritis, hip osteoarthritis, painful shoulder syndromes and ankle joint osteoarthritis.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

junggebauer@webermedical.com

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

http://www.dr-weber-laser-clinic.com/en/home/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

“Medical knowledge is not enough; we must apply it with a passion”

Dr Henri Basam, Spine Care Center, Cairo, Egypt

REFERENCES

(1A) Michael Weber, MD, President of International Society for Medical Laser Applications (ISLA)

http://www.webermedical.com/en/the-business/dr-weber/

http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

(1B) Medical Low-Level-Lasertherapy – Foundations and Clinical Applications (2nd Edition, June 2015)

Michael Weber, MD, Robert Weber, Martin Junggebauer

http://www.isla-laser.org/en/

(1C) Michael Weber, MD

Interstitial and intraarticular laser therapy – attractive new therapeutic option for the treatment of spinal diseases and advanced joint osteoarthritis

http://www.lyranara.com/content/Weberlaser_Interstitial%20Weber.pdf

(1D) Dr Henri Basam, Sherry N Fanous

Knee Pain Management Using Ultrasound-Guided Weberneedle Endo-Laser in Comparison to Fluoroscopy-Guided Thermal Radio-Frequency (2015) (9AP5-10)

Spine Care Center, Cairo, Egypt

http://www.basemhenri.com/en/scc/article/48

(1E) Michael Weber, MD, Thomas Fussgänger-May, MD, Tillman Wolf, MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

http://www.my-dr.de/FG/texte/infounten/Publikationen/Medical_Acupuncture.pdf

(1F) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture using laser needles modulates brain function: first evidence from functional transcranial Doppler sonography and functional magnetic resonance imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

http://www.ncbi.nlm.nih.gov/pubmed/15316852

(1G) International Society for Medical Laser Applications (ISLA)

http://www.isla-laser.org/en/

YouTubes (in English and German):

(http://www.webermedical.com/en/weber-medical-for-patients/news/)

http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/interstitial-and-intra-articular-laser-therapy/

(2A) New fiber optic cannula. Interstitial therapy at the root of the Ischia hernia

(2B)

(2C) Where ‘Coxarthrosis’ = Osteoarthritis of the hip joint

(2D)

Traditional Chinese Medicine (TCM) For Chronic Pain? Let’s Talk About Corydalis, A Traditional Chinese Herbal Remedy For Chronic Pain

Source of Featured Image:

Courtesy of Shutterstock

and

http://www.medicaldaily.com/chinese-poppy-plant-corydalis-works-chronic-pain-266215

Dear Pain Matters blog readers,

Is traditional chinese medicine (TCM) a treasure box that needs to be opened more fully??

In other words, should more research be done to scientifically explore the hidden treasures of TCM?  If we did this, would we find additional effective pain treatment options not yet offered by conventional medicine?

Consider this ancient, nonaddictive, Chinese herbal remedy for chronic nerve pain that may, at times, offer longer lasting pain relief than opiates:

The roots of a flowering poppy plant called Corydalis yanhusuo (C. yanhusuo; Corydalis) has been used for centuries as a Chinese remedy for chronic pain.  Corydalis is grown in China, Japan and Siberia.  The underground tubers from the Corydalis plant must be harvested, dried, ground, and boiled in hot vinegar before they can be used as a remedy for pain including headaches, back pain, menstrual cramps, chest pain and abdominal pain.

535S18a-i5.jpg

Source of photo showing Corydalis yanhusuo:  

http://www.nature.com/nature/journal/v535/n7611_supp/full/535S18a.html

In collaboration with Chinese scientists, University of California researchers have recently identified and isolated a key pain-relieving compound called dehydrocorybulbine (DHCB) in the roots of Corydalis.  Specifically, basic research showed that DHCB (extracted from the Corydalis tubers) reduced acute pain, inflammatory pain as well as injury-induced nerve pain.  The compound, DHCB, blocks dopamine D2 receptors.

More importantly, the DHCB does not interact with the morphine receptor.  As such, the effectiveness of DHCB will not weaken over time, nor will tolerance, addiction and drug dependence become issues (as often occurs with conventional opiate medicine including codeine and morphine).

Researchers felt that DHCB could offer some relief for low-level chronic pain without the risk of addiction or tolerance following repeated use (Zhang et al, 2014; Ingram, 2014).

Patient experiences with Corydalis yanhusuo extracts:

While not scientifically verifiable, the following (partially copied) user comments are interesting to read:

Refer:

User Reviews & Rating – CORYDALIS

http://www.webmd.com/vitamins-supplements/ingredientreview-415-CORYDALIS.aspx?drugid=415&drugname=CORYDALIS

Quoting comments from a disappointed pain patient:

Patient –

“I took my first capsule this morning and have felt tired, dragged out, strangely a little depressed and above all light-headed–dizzy enough to stumble and fall. If anything, my painful back, hips and knees hurt more today. Obviously I won’t take it again.

Quoting positive comments from people with chronic pain who use Corydalis:

Patient –

“…both knees replaced at the same time, and also suffer from frequent headaches.  I began using this product after my surgery and it has provided me with great relief!  ….easier on my GI system….Love Corydalis!  Been a lifesaver for me!

Patient –

“I have been taking 1-2 capsules a day.  It helps my joint pain considerably which I’ve had for 20 years….”

Patient –

“I have had severe knee pain for several years due to old sports injuries and have began using the Cordyalis 10:1 pills recently. The first day my pain was so subtle that I hardly noticed it at all. Stairs were a nightmare for me, but they are much, much easier to handle. I know that nothing can completely remove the pain I suffer from, but this is positively changing my quality of life!!

Patient –

“I have degenerative disc disease and get spinal headaches from intermittent neck pain. I was instructed by a Taiwanese doctor to take 20g boiled in water from 500cc down to 250cc (about 25 minutes on electric stove med-hi), straining out and discarding the root at the end. I found 20g was too much (I experienced worse spasms), tried 5g, and ended up using 10g per serving, up to twice a day. I found that taking it daily was less effective than taking as needed (was hoping to keep the pain away by taking daily.) When I first used it, it made me “high” like cough syrup. After a few servings, I no longer feel that. It’s probably the most effective thing I’ve taken for the pain (I will not take opioids, which tend to make me sick anyway.) …. The tea from root tastes horrible….”

Patient –

“I have had constant shoulder and neck pain for 2 yrs which also cause headaches and migraines. Muscle relaxers and fiorcet are my daily regimine but still constant pain that made me so tired and energy draining. Since using corydalis i have energy and no shoulder pain.

Patient –

“Has eased my intractable nerve pain.”

Patient –

“Female, 66 – for sciatica. I take the powder: premixed, in hot water – drink it fast so as to obscure the taste. Worked in 30 min. the first time taken. I take it 1/2 hr before eating dinner. I’ve learned to put Stevia in it – helps with the taste.”

Patient –

This stuff works, however, I have only taken it in the powdered form. It tastes terrible … Its hard to figure out dosages. I take two teaspoons per day on most days to augment my pain medication, hydrocodone. It dramatically extends the time the hydrocodone works and seems to add some additional relief. I am concerned about possible harmful effects and standardization of strengths of the herb……

[Blogger’s comments:

Based on above, is it possible that the effectiveness of certain conventional pain medication (in this case, hydrocodone) may be increased, and/or prolonged, through the use of Corydalis?  Further research is warranted.]   

Patient –

I have experience chronic low back pain for about 2 years. The pain is 24/7 and worsens with inactivity or excessive physical fitness. I purchased capsules. The serving size is 8 capsules and I only took 3 and felt amazing relief. I lifted weights today for my legs and shoulders then did 15 minutes of interval sprints and my back feels PHENOMENAL! For $15.99 it is worth the try!….

Patient –

“I have a bulging disk and pain 24/7, at times it feels like to torture. Corydalis has helped the pain a little so my pain level is 4 instead of 7 or 8.

Patient –

“I have had fibromyalgia for 25 years and now suffer spinal stenosis after car wreck 10 years ago. I have found acupuncture and this herb to help the pain and neurological problems.….”

A huge word of caution:

While DHCB is currently not available, TCM practitioners can offer Chinese herbal remedies/extracts that specifically include Corydalis yanhusuo extracts or roots/tubers (as they have already done for many centuries).  Corydalis extracts are also available in Chinese specialist stores and on-line.

However, in Dr Civelli’s words, “DHCB is present in low quantities, but it’s there” (Chia, 2014).

Thus, traditional Chinese remedies that include Corydalis yanhusuo extracts or tubers are certainly worth trying (after discussing with your GP first).  

Please discuss with your GP before deciding to undergo any TCM treatments and/or other alternative/complementary medical treatments (as well as post-TCM treatment, if necessary).

Conclusion:

Increased funding and research into TCM including ancient Chinese herbal remedies for pain are warranted.

In particular, we need to expand research into Corydalis, and its key pain-relieving ingredient, DHCB (as well as research into other effective pain-alleviating remedies offered by TCM).

After all, the best approach is a global and unified approach to the global challenge of chronic pain.

Sabina Walker

REFERENCES

(1) Zhang et al; A Novel Analgesic Isolated From a Traditional Chinese Medicine; Current Biology (20 January 2014); 24(2): 117-123.

doi: 10.1016/j.cub.2013.11.039

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912990/

http://www.ncbi.nlm.nih.gov/pubmed/24388848

(2) Ingram; Pain: Identification of novel analgesics from traditional Chinese medicines; Current Biology (3 February 3 2014); 24(3): R114–R116.

doi: 10.1016/j.cub.2013.12.030

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980722/

(3A) Plant Used in Chinese Medicine Fights Chronic Pain; Cell Press (2 January 2014).

http://www.eurekalert.org/pub_releases/2014-01/cp-pui122713.php

(3B) Zhang, Wang, et al; Chinese Herbal Compound Relieves Inflammatory and Neuropathic Pain; UCI News (2 January 2014).

http://news.uci.edu/press-releases/chinese-herbal-compound-relieves-inflammatory-and-neuropathic-pain/

(3C) Ericson, John; Chinese Poppy Plant, Corydalis, Works For Chronic Pain; Drugs (2 January 2014).

http://www.medicaldaily.com/chinese-poppy-plant-corydalis-works-chronic-pain-266215

(3D) Chia, Jessica; The Plant That Could Erase Chronic Pain; Prevention (2 January 2014).

http://www.prevention.com/print/health/health-concerns/chinese-remedy-corydalis-pain

(3E) Pain, Stephanie

Painful Progress

Nature (14 July 2016); 535, S18–S19

doi:10.1038/535S18a

http://www.nature.com/nature/journal/v535/n7611_supp/full/535S18a.html

(4) User Reviews & Rating – CORYDALIS

http://www.webmd.com/vitamins-supplements/ingredientreview-415-CORYDALIS.aspx?drugid=415&drugname=CORYDALIS