Double Blind Crossover Trial Of Low Level Laser Therapy In The Treatment Of Post
Herpetic Neuralgia
Kevin C Moore Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar and Toshio Oshiro
Post herpetic. neuralgia can he an extremely painful condition which in many cases proves
resistant lo all the accepted forms of treatment. II is frequently most severe in the elderly and may persist for years with no predictable course. This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received tour consecutive laser treatments. The results ides demonstrate a significant reduction in both pain intensity and distribution following a course of low level laser therapy.

Efficacy Of Laser Irradiation On The Area Near The Stellate Ganglion Is Dose-Dependent: Double-Blind Crossover Placebo-Controlled Study
Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital,
Sapporo, Japan
In the present study we evaluate the effects of laser irradiation on the area near the stellate
ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover and placebo-controlled study was designed to deny the placebo effect of laser irradiation. Eight in patients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three sessions of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS).

Measurement were performed before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by
placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no
changes in VAS were obtained by placebo treatment. These changes in the temperature and
VAS were further dependent on the energy density, i.e the dose. Results demonstrate that laser
irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our
results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Addressee for Correspondance: Toshikazu Hashimoto MD, Department of
Anesthesia, I Hokkaido University I Hospital N15, W7, Kita-ku Sapporo, Japan
060. 3/97 Rep US $ 8-10 12 ©1997 by LT Publishers l. .K., Ltd. LASER THERAPY 1997:9:7-- 12

Efficacy Of Low Reactive-Level Laser Therapy For Pain Attenuation Of Postherpetic
Neuralgia
Osamu Kemmotsu, Kenichi Sato,Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura Department of Anaesthesiology,
Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan.
The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with
postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males. 38 females with an
average age of 69 years) managed at our pain clinic over the past four years. A double blind
assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium
aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). Pain scores (PS)
were obtained using a linear analog scale (i) to 10))) before and after LLLT. The immediate effect
after the initial LLLT was very good (PS: (}3) in 26, and good (PS: 7-4) in 30 patients. The longterm effect at the end of LLLT (the average number of treatments 36 + 12) resulted in no pain
(PS: 0) in 12patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to
LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases
of the body surface temperature by LLLT were significantly greater than those that occurred with
the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in
PHN patients and because LLLT is a noninvasive, painless and safe method of therapy, it is well
acceptable by patients.

Addressee for correspondence:
Osamu Kemmotsu, Department of Anaesthesiology,Hokkaido University School of Medicine, N-
15, W-7, Kita-ku, Sapporo 060,Japan. 0898-5901/91/020071-05$05.00 Ì 1991 by John Wiley & Sons, Ltd.

Laser therapy of human herpes simplex lesions

By Arturo Guerra Alfonso and Pedro José Muñoz, Clinic "Leonardo Fernández Sánchez" , Cienfuegos, Cuba.
Email

Herpes simplex is an illness caused by the human herpes virus types 1 and 2 that generally present a primary lesion, with periods of latency and a tendency to relapse. It is also known as Button of fever or Bladder of fever. According to the World Health Organisation (WHO) an international prevalence of about 60% is observed (1, 2). 

An experimental study was carried out, where 232 patients affected by the Herpes simplex type 1 virus were treated. All patients attended the clinic "Leonardo Fernández" of the area 3 of the municipality of Cienfuegos, during the period of January 2001 to January 2003, with the objective of determining the time of recurrence of the labial Herpes in the groups, studied before and after treatment, and to evaluate the effectiveness of the Laser of low power in the treatment of the infection of the virus.

Two groups were selected (study and control) with 116 patients in each group, distributed and classified according to the clinical stage in which they went to consultation. In the study group the patients were offered treatment with a LASERMED 670 DL, a GaAlAs diode laser (30mW – 40 sec) in the prodromal stage and stage of vesicles; or (20mW – 2 min) in the crust stage and in lesions infected secondarily. To all these patients was also applied radiation among the vertebras C2-C3 where the resident ganglion of the virus is located during the latent periods (30mW - 30sec). 

The control group was offered indicated treatment with antivirals (Aciclovir in cream and in pills) and other palliative therapies. 

After having carried out the analysis of the data obtained, the following results were obtained:

Chart No. 1                                                           

The patients of the study group. Distribution according to the frequency of annual recurrence of the labial herpes before and after receiving treatment. 

When analyzing the chart No.1 it is observed that the groups of patients that had Labial Herpes with high frequencies of recurrence (after being treated with Laser and to wait one year to evaluate their effectiveness), reported recurrence for more elongated periods of time and 32 patients didn't even have any more recurrence.

Chart No.2                                                                                        

The patients of the control group. Distribution according to the annual recurrence frequency of the labial herpes before and after receiving treatment.

In the chart No. 2 the same previous aspects are reflected but in the control group. As can be observed the cases diminished in number, although discreetly; those that presented more recurrence and of equal number of recurrencies increased in number of patient in the periods of more lingering recurrence. In this group 2 patients reported not to have had more lesions during the analyzed year.

Chart No.3                                                                     

The patients of both groups. Distribution according to the annual recurrence frequency of the labial herpes after receiving treatment.

In the chart No. 3 are compared both groups as for the annual frequency of recurrence after having received the corresponding treatment. When analyzing this, the superiority of the group treated with Laser becomes evident.

Chart No. 4                                                                                       

The patients' of both groups. Distribution with relationship to the clinical stage in that we intervened and the time of cure of the same ones.

As can be observed in the chart 4, in the study group 100% of the prodromal stages, 95% of the vesicular ones and 91% of crust stages were able to cure during the first 48 hours. The patients with lesions infected secondarily needed more than 48 hours to cure, although they never surpassed 5 days. 

These results, although astonishing, are corroborated by authors like Tunér and Schindl where they highlight that a treatment with laser in the initial stages of the Labial Herpes has a percentage of superior success compared to conventional treatments, besides achieving an almost immediate relief of the symptoms (3, 11). 

In the control group remarkable differences are appreciated when comparing them with that of the study group. The therapy with Aciclovir in early stages (the first 72 hours) has been broadly suitable for many professionals and their use against the Labial Herpes has been studied by some authors (5).

CONCLUSIONS 

- The periods of annual recurrence in the study group were prolonged considerably after having received the treatment, while in the control group so evident changes were not shown. 

- In the prodromal period the patients treated with Laser all cured in the first 48 hours, while those treated conventionally needed from 3 to 4 days to cure. - In the vesicular period and of crust, those of the study group cured in majority during the first 48 hours, while those of the control group needed more than 5 days. 

- In infected lesions those treated with Laser cured mainly from 3 to 4 days, while those treated with medications needed more than 7 days to cure.

References:

1. Santana JC. Atlas of pathology of the buccal complex. Havana: Editorial scientific-technique, 1985:30-34. 

2. Eversole LR. Buccal pathology. Diagnosis and Treatment. Havana: Editorial scientific-technique, 1985:82-87. 3. Tunér J, Hode L. Low level laser therapy - clinical practice and scientific background. 1999. ISBN 91-630-7616-0. 

4. Parker J et al. The effects of laser therapy on tissue repair and pain control: a meta-analysis of the literature. Proc. Third Congress World Assn for Laser Therapy, Athens, Greece, May 10-13 2000; p. 77.  

5. Vélez-González M et al.  Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and area pudenda with low power HeNe-laser or Acyclovir administrated orally. SPIE PROC. 1995; Vol. 2630: 43-50 

6. Garrigó MI, Valiant C. Biological Effects of the radiation Laser of low power in the repair hística. Rev. Cub Estomat, 1996; 33(2). 7. In: Simunovic Z, editor: Lasers in Medicine and Dentistry. Vitagraf, Croatia, 2000. 

8. Valiant C, Garrigó MI. Laser therapy in the treatment of dental affections. Ed. Academy, Havana, 1995: 30-32. 

9. Valiant C. Cuban Experience in the application of the Laser of low power. I study international: Application of the Laser of low power in dentistry. CIMEQ, City of Havana, April 2001. 

10. Garrigó MI. Clinical procedures with Laser in bucodental illnesses. I study international: Application of the Laser of low power in dentistry. CIMEQ, City of Havana, 2001. 

11.Schindl A, Neuman R. Low-intensity laser therapy is an effective treatment forrecurrent herpes simplex infection. Results from a randomized double-blind placebo-controlled study. J Invest Dermatol. 1999: 113 (2): 221-223.