Cold Laser Reduces Edema in Second Degree Ankle Sprains!

Hello friends, I am just passing along another very positive clinical study demonstrating the therapeutic use of cold laser in reduction of inflammation due to ankle spain.

 Very impressive, indeed:

J Clin Laser Med Surg. 2004 Apr;22(2):125-8.

 

Low-level laser Treatment can Reduce Edema in Second Degree Ankle Sprains

Stergioulas A.

 

OBJECTIVE: Low-level laser therapy (LLLT) has been used for the last few years totreat sports injuries. The purpose of this study was to compare three therapeutic protocols

in treating edema in second degree ankle sprains that did not require immobilization with

a splint, under placebo-controlled conditions.

MATERIALS AND METHODS:

Fortyseven soccer players with second degree ankle sprains, selected at random, were divided

into the following groups: The first group (n = 16) was treated with the conventional

initial treatment (RICE, rest, ice, compression, elevation), the second group (n = 16) was

treated with the RICE method plus placebo laser, and the third group (n = 15) was treated

with the RICE method plus an 820-nm GaA1As diode laser with a radiant power output

of 40 mW at 16 Hz. Before the treatment, and 24, 48, and 72 h later, the volume of the

edema was measured.

RESULTS

 A three by three repeated measures ANOVA with a

follow up post hoc test revealed that the group treated with the RICE and an 820-nm

GaA1As diode laser presented a statistically significant reduction in the volume of the

edema after 24 h (40.3 +/- 2.4 mL, p < 0.01), 48 h (56.4 +/- 3.1 mL, p < 0.002), and 72 h

(65.1 +/- 4.4 mL, p < 0.001).

CONCLUSIONS

 LLLT combined with RICE can reduce

edema in second-degree ankle sprains.

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Chronic Back Pain: Exercise and Cold Laser Therapy More Beneficial Than Exercise Alone

Abstract:

Aust J Physiother. 2007;53(4):216.

QUESTION: Is low level laser therapy an effective adjuvant intervention for chronic low back pain?

DESIGN: Randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Sixty-one patients who had low back pain for at least 12 weeks.

INTERVENTION: One group received laser therapy alone, one received laser therapy and exercise, and the third group received placebo laser therapy and exercise. Laser therapy was performed twice a week for 6 weeks. OUTCOME

MEASURES: Outcomes were pain severity measured using a 10-cm visual analogue scale, lumbar range of motion measured by the Schober Test and maximum active flexion, extension and lateral flexion, and disability measured with the Oswestry Disability Index on admission to the study, after 6 weeks of intervention, and after another 6 weeks of no intervention.

RESULTS: In the laser therapy plus exercise group pain had reduced by 1.8 cm (95% CI 0.1 to 3.3, p = 0.03), lumbar range of movement increased by 0.9 cm (95% CI 0.2 to 1.8, p < 0.01) on the Schober Test and by 15 deg (95% CI 5 to 25, p < 0.01) of active flexion, and disability reduced by 9.4 points (95% CI 2.7 to 16.0, p = 0.03) more than in the exercise group at 12 weeks.

CONCLUSION: In chronic low back pain low level laser therapy combined with exercise is more beneficial than exercise alone in the long term

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How Does Cold Laser work for Arthritis?

Arthritis affects almost 70 million Americans. The most common forms of arthritis are osteoarthritis, a degenerative disease in which the cartilage wears away, and rheumatoid arthritis, which is an autoimmune inflammatory condition. Also, there are other conditions that fall under the “umbrella” of arthritis including bursitis, tendonitis, low back and neck pain, carpal tunnel syndrome, and so on.

The common symptom of most forms of arthritis is pain. Pain develops as a result of multiple factors including inflammation with stimulation of neural peripheral pain sensors due to either biochemical factors such as cytokines or to mechanical factors- joint deformity. Arthritis pain may be accompanied byother problems including loss of range of motion and disability.

While medicines, injections, and surgery all have their place and are valuable, there is still a need for potentially useful adjunctive modalities that might speed up recovery and reduce pain faster.

Low level therapeutic laser, better known as phototherapy, is a relatively new form of treatment. Its premise is that certain wavelengths of light have effects on living tissue. This effect is termed “photobiomodulation.”

Phototherapy has been shown in experimental settings to stimulate cell growth, increase cell metabolism, improve cell regeneration, induce an anti-inflammatory response, reduce edema, reduce fibrous tissue formation, reduce levels of substance P, stimulate production of nitric oxide, decrease the formation of bradykinin, histamine, and acetylcholine, and stimulate the production of endorphins. These effects are felt to be what reduce pain.

Most cold lasers in use today use a combination of light emitting diodes and infrared emitting diodes.

The beneficial effects of cold laser were first noted in wound healing in rats (Mester E, Spy T, Sander N, Tito J. Effect of laser ray on wound healing. Am J Surg 1971; 122: 523-535).

Subequently, laser was found to be beneficial in a number of animal models and is till being studied as a possible tool for cartilage regeneration and healing (Lin Y, Chai CY, Yang RC. Effects of helium-neon laser on levels of stress protein and arthritic histopathology in experimental osteoarthritis. Am J Phys Med Rehab. 2004; 83: 758-765).

Data regarding the usefulness of cold laser on different conditions seen in a rheumatology office include:

Rheumatoid arthritis and osteoarthritis (Brosseau L, Welch V, Wells G, Tugwell P, de Bie R, Harman K, Shea B, Morin M. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a meta-analysis. J Rheum. 2000; 27: 1961-9);

Elbow tendonitis (Simunovic Z, Trobonjaca T, Trobonjaca Z. Treatment of medial and lateral epicondylitis- tennis and golfer’s elbow- with low level laser therapy: a multicenter double-blind, placebo-controlled clinical study on 324 patients. J Clin Laser Medicine Surg. 1998; 16: 145-51);

Fibromyalgia trigger points (Simunovic Z. Low level laser therapy with trigger points technique: a clinical study on 243 patients. J Clin Laser Medicine Surg. 1996; 14: 163-167);

Neck arthritis (Ozdemir F, Birtane M, Kokino S. The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis. Clin Rheumatology. 2001; 20: 181-184);

Carpal tunnel syndrome (Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and micro amperes transcutaneous electric nerve stimulation: a controlled study. Archives Phys Med Rehab. 2002; 83: 978-988);

Shoulder tendonitis (England S, Ferrell AJ, Coppock JS, Struthers G, Bacon PA. Low power laser therapy of shoulder tendonitis. Scand J Rheum. 1989; 18: 427-431);

Low back pain disorders (Tasaki E, et al. Application of low power laser therapy for relief of low back pain. Ninth Congress of the International Society of Laser Surgery and Medicine. Anaheim, CA. USA. November 2-6, 1991; Tuner J, Hode L. The Laser Therapy handbook. Prima Books. 2004. Sweden, p. 81).

Adequate clinical assessment is vital to determining whether a patient is a good candidate for laser therapy. Also, laser is a complementary therapy; it should be used in conjunction with other therapies as well. Concurrent medications, etc. should not be forgotten.

Phototherapy is FDA approved for a number of applications and has been deemed safe. It also requires relatively little time to perform. Established protocols and tissue dosages have been established that make clinical application relatively easy.

The number of sessions required varies according to disorder, length of time the disorder has been present, and the severity of the disorder.

Contraindications include pregnancy (use of the laser over the pregnant uterus), thyroid exposure, over a pediatric epiphysis, transplant patients, directly on a an active cancer, on an are where there has been a recent (within 24 hours) steroid injection, or on the chest of a patient with a pacemaker.

While cold laser is considered by some to be unproven, it appears so far to be a safe, effective mode of therapy for many rheumatologic disorders and is worth trying before subjecting a patient to more invasive and dangerous procedures.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: Arthritis Treatment

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What Type of Pain can a Cold Laser Treat and will It Work for Me? …

Now that you know what a “cold” laser is and what it does you might be asking yourself; “what type of pain can a cold laser treat and will it work for me?” The truth of the matter is that cold laser treatments can treat just about any type of pain and since they’re noninvasive and have no side effects you can seek cold laser treatment as often as you like or as often as your Certified Laser Therapist (CLT) sees fit.

If you’ve got nagging pains anywhere on your body and you remain apprehensive about visiting a cold laser therapy center, the technology now in use at most clinics should be enough to convince you to contact them for at the very least a simple consultation. Doing so will allow us to evaluate your type and level of pain and help and determine if cold laser treatment is right for you.

You’ve got nothing to lose!

Cold Laser Therapy Treats:

Soft Tissue Injuries Herniated disc Knee Pain Planter Fascitis Back and Neck Pain Tendonitis and Carpal Tunnel Shoulder Pain Leg Pain Sprains and Strains Repetitive Strain Injuries Degenerative Joint Problems Arthritis Rheumatoid Arthritis Osteoarthritis Neurogenic Pain Fibromyalgia Trigeminal Neuralgia Sciatic Pain Neuropathy

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What Exercises May Reduce Low Back Pain?

Low back pain: Exercises to reduce pain

Key points Low back pain is very common among adults and is often caused by overuse and muscle strain or injury. Treatment can help you stay as active as possible, and it will help you understand that some continued or repeated back pain is not surprising or dangerous.¹

• Most low back pain can get better if you stay active, avoid positions and activities that may increase or cause back pain, use ice, and take nonprescription pain relievers when you need them.
• When you no longer have acute pain, you may be ready for gentle strengthening exercises for your stomach, back, and legs, and perhaps for some stretching exercises. Exercise may not only help decrease low back pain, but it may also help you recover faster, prevent reinjury to your back, and reduce the risk of disability from back pain.
• Exercises to reduce low back pain are not complicated and can be done at home without any special equipment.
• It’s important that you don’t let fear of pain keep you from trying gentle activity. You should try to be active soon after noticing pain, and gradually increase your activity level.¹ Too little activity can lead to loss of flexibility, strength, and endurance, and then to more pain.

More information about low back pain: 

• Low Back Pain

What exercises may reduce low back pain?

Exercises that may help reduce or prevent low back pain include: 

• Aerobic exercise, to condition your heart and other muscles, maintain health, and speed recovery.
• Strengthening exercises, focusing on your back, stomach, and leg muscles.
• Stretching exercises, to keep your muscles and other supporting tissues flexible and less prone to injury.

Some exercises can aggravate back pain. If you have low back pain, avoid: 

• Straight leg sit-ups.
• Bent leg sit-ups or partial sit-ups (curl-ups) when you have acute back pain.
• Lifting both legs while lying on your back (leg lifts).
• Lifting heavy weights above the waist (standing military press or bicep curls).
• Toe touches while standing.

Test Your Knowledge 

Do not exercise if you have low back pain. 

> True
> False

This answer is incorrect.
If you have low back pain, doing aerobic, strengthening, and gentle stretching exercises may help you gain or maintain good health, strength, and flexibility. Certain exercises may reduce your low back pain. 

This answer is correct.
If you have low back pain, doing aerobic, strengthening, and gentle stretching exercises may help you gain or maintain good health, strength, and flexibility. Certain exercises may reduce your low back pain. 

Why is it important to do exercises for low back pain?

Exercise and staying active may relieve low back pain and can help speed your recovery.^{2, 3} Stretching and strengthening your stomach, back, and leg muscles helps make them less susceptible to injury that can cause back pain. Strong stomach, back, and leg muscles also better support your spine, reducing pressure on your spinal discs. This may help prevent disc injury. 

Aerobic exercises-such as walking, swimming, or walking in waist-deep water-also help you maintain a healthy back. Aerobic exercise makes your heart and other muscles use oxygen more efficiently. Muscles that frequently receive oxygen-rich blood stay healthier. 

Test Your Knowledge 

Exercise and activity may help reduce the risk of disability from back pain. 

> True
> False

This answer is correct.
Exercises stretch and strengthen your back, stomach, and legs. When these muscles are flexible and strong, they can help reduce the risk of disability from back pain. 

This answer is incorrect.
Exercises stretch and strengthen your back, stomach, and legs. When these muscles are flexible and strong, they can help reduce the risk of disability from back pain. 

How do I exercise to reduce low back pain?

Most people who have back pain naturally feel better by doing certain motions. Some feel better sitting (their back and hips are flexed), while others feel better standing (back and hips are extended). Exercise that moves you toward your more comfortable position is usually more successful in treating your back pain.⁴ For example, if you are more comfortable sitting down, exercises that bend you forward-such as partial sit-ups (curl-ups) and knee-to-chest exercises-may help you. 

Talk to your health professional before you start an exercise program, and only do exercises that do not increase your symptoms. 

The most effective exercise programs for chronic low back pain are designed specifically for you and are supervised.⁵ For example, a physical therapist might instruct you in a home exercise program; then you would see the therapist every so often to check on your progress and advance your program. 

• Talk to your doctor or physical therapist if you are unsure how to do these exercises or if you feel any pain as you are doing the exercises.
• Try to exercise a little bit every day.
  • Get some type of aerobic exercise, such as walking, every day. Even a couple of minutes will be helpful, and you can gradually increase your time.
  • Choose a couple of stretching and strengthening exercises that you enjoy doing, or vary them from day to day.

Ask your doctor or physical therapist whether there are additional exercises that will work best for you. 

Stretching and strengthening exercises include: 

• Extension exercises, which stretch tissues along the front of the spine, strengthen the back muscles, and may reduce pain caused by a herniated disc. These are generally a good choice for people whose back pain is eased by standing and walking.
  • Press-up back extension
  • Alternate arm and leg (bird dog) exercise
• Flexion exercises, which strengthen stomach and other muscles, and stretch the muscles and ligaments in the back. These are generally a good choice for people whose back pain is eased by sitting down.
  • Knee-to-chest exercise
  • Curl-ups
• Additional strengthening and stretching exercises.
  • Prone buttocks squeeze
  • Pelvic tilts
  • Bridging
  • Hamstring stretch
  • Hip flexor stretch
  • Wall sit

Aerobic exercise includes walking, swimming, running, and biking. Non–weight-bearing exercise, such as swimming, tends to be a better choice if you have back pain. Walking in water up to your waist or chest is also good aerobic exercise. 

• You should keep taking easy, short walks when you have low back pain. You can likely start more intense aerobic exercise within 1 or 2 weeks after symptoms of back pain start.
• Start slowly so that you don’t overdo it. For example, begin with 10 minutes a day. Build up your exercise program bit by bit. And aim for at least 2½ hours a week of moderate exercise.⁶ It’s fine to be active in blocks of 10 minutes or more throughout your day and week.

Test Your Knowledge 

Exercises to reduce low back pain take a long time and are difficult to do. 

> True
> False

This answer is incorrect.
Even 10 minutes of stretching and strengthening exercises each day can condition the muscles of the back, stomach, and legs, and may relieve low back pain. The exercises listed above do not involve complicated steps and can be done indoors without special equipment. 

This answer is correct.
Even 10 minutes of stretching and strengthening exercises each day can condition the muscles of the back, stomach, and legs, and may relieve low back pain. The exercises listed above do not involve complicated steps and can be done indoors without special equipment. 

Where can I learn more about exercises to reduce low back pain?

For more information about exercises to reduce low back pain, talk to: 

• Your doctor.
• A physical therapist.

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone:	1-800-346-AAOS (1-800-346-2267) (847) 823-7186
Fax:	(847) 823-8125
E-mail:	orthoinfo@aaos.org
Web Address:	http://www.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public’s awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS Web site contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.
Occupational Safety and Health Administration (OSHA), U.S. Department of Labor
200 Constitution Avenue
Washington, DC  20210
Phone:	1-800-321-OSHA (1-800-321-6742)
TDD:	1-877-889-5627 toll-free
Web Address:	http://www.osha.gov
The Occupational Safety and Health Administration (OSHA) provides information about hazards at the workplace and about worker safety.

Citations

1. Carragee EJ (2005). Persistent low back pain. New England Journal of Medicine, 352(18): 1891–1898. 
2. Koes B, Van Tulder M (2006). Low back pain (acute), search date November 2004. Online version of Clinical Evidence (15). 
3. Van Tulder M, Koes B (2006). Low back pain (chronic), search date November 2004. Online version of Clinical Evidence (15). 
4. Long A, et al. (2004). Does it matter which exercise? Spine, 29(23): 2593–2602. 
5. Hayden JA, et al. (2005). Systematic review: Strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine, 142(9): 776–785. 
6. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf. 

  

Talk toxtension exercises, which stretch tissues along the front of the spine, strengthen the back muscles, and may reduce pain caused by a herniated disc. These are generally a good choice for people whose back pain is eased by standing and walking.

• • Press-up back extension
  • Alternate arm and leg (bird dog) exercise
• Flexion exercises, which strengthen stomach and other muscles, and stretch the muscles and ligaments in the back. These are generally a good choice for people whose back pain is eased by sitting down.
  • Knee-to-chest exercise
  • Curl-ups
• Additional strengthening and stretching exercises.
  • Prone buttocks squeeze
  • Pelvic tilts
  • Bridging
  • Hamstring stretch
  • Hip flexor stretch
  • Wall sit

Aerobic exercise includes walking, swimming, running, and biking. Non–weight-bearing exercise, such as swimming, tends to be a better choice if you have back pain. Walking in water up to your waist or chest is also good aerobic exercise. You should keep taking easy, short walks when you have low back pain. You can likely start more intense aerobic exercise within 1 or 2 weeks after symptoms of back pain start.

• Start slowly so that you don’t overdo it. For example, begin with 10 minutes a day. Build up your exercise program bit by bit. And aim for at least 2½ hours a week of moderate exercise.⁶ It’s fine to be active in blocks of 10 minutes or more throughout your day and week.

> False

  

This answer is incorrect.
Even 10 minutes of stretching and strengthening exercises each day can condition the muscles of the back, stomach, and legs, and may relieve low back pain. The exercises listed above do not involve complicated steps and can be done indoors without special equipment.   

This answer is correct.
Even 10 minutes of stretching and strengthening exercises each day can condition the muscles of the back, stomach, and legs, and may relieve low back pain. The exercises listed above do not involve complicated steps and can be done indoors without special equipment.   

Where can I learn more about exercises to reduce low back pain?

For more information about exercises to reduce low back pain, talk to:   

• Your doctor.
• A physical therapist.

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone:	1-800-346-AAOS (1-800-346-2267) (847) 823-7186
Fax:	(847) 823-8125
E-mail:	orthoinfo@aaos.org
Web Address:	http://www.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public’s awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS Web site contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.
Occupational Safety and Health Administration (OSHA), U.S. Department of Labor
200 Constitution Avenue
Washington, DC  20210
Phone:	1-800-321-OSHA (1-800-321-6742)
TDD:	1-877-889-5627 toll-free
Web Address:	http://www.osha.gov
The Occupational Safety and Health Administration (OSHA) provides information about hazards at the workplace and about worker safety.

  

Citations

1. Carragee EJ (2005). Persistent low back pain. New England Journal of Medicine, 352(18): 1891–1898.Koes B, Van Tulder M (2006). Low back pain (acute), search date November 2004. Online version of Clinical Evidence (15).  
2.  Van Tulder M, Koes B (2006). Low back pain (chronic), search date November 2004. Online version of Clinical Evidence (15).   
3. Long A, et al. (2004). Does it matter which exercise? Spine, 29(23): 2593–2602.   
4. Hayden JA, et al. (2005). Systematic review: Strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine, 142(9): 776–785.   
5. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.   

 

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Can Cold Laser Elimiate Heel and Arch Pain?

SHOULD YOU GET LASER THERAPY?

Can a laser therapy cure heel and arch pain?

Inflammation of the tissue along the bottom of the foot, cripples many runners–me included. For four months, I pool-ran, swam, and biked, but what I really wanted to do–run–was too painful. I followed the standard rehab: stretching and icing my heel, popping anti-inflammatories, wearing orthotics, sleeping in a night boot to stretch the plantar fascia overnight. I also tried massage, active-release techniques, and reflexology–even two shots of cortisone in my heel. Nothing worked. Then I heard about low-level laser therapy, a noninvasive treatment that recently got FDA approval. A light beam is placed on the injured area to stimulate cellular reactions that are believed to fight inflammation, reduce pain, and speed recovery, says Robert Duggan, D.P.M., an Orlando-area foot and ankle surgeon. When added to a rehab plan, Duggan says, runners may feel immediate relief. Desperate, I decided to try it for a month.

Day 1: I see a local therapist (CLT) low-level laser therapy . He moves the laser over sore spots on my heel and arch. It’s completely pain-free, and my foot seems to feel better right away. Placebo effect?

Day 2: The therapist explained to me that if the laser is going to help, patients should notice improvement within one to three sessions, and indeed, I use the elliptical machine for 90 minutes without any foot pain.

Day 5: Today’s the real test–a run. My first in 13 weeks. I do two easy miles with minimal discomfort and no flare-up afterward. Later in the day, I have my second laser treatment.

Day 12: I’m up to running five miles comfortably, so I try hill repeats. My heel feels tight as I’m finishing. After my run, I have my third treatment.

Day 24: Four treatments have allowed me to steadily increase my miles (zero to eight over three weeks) and the intensity of my workouts. Still, my foot feels sore walking around the mall.

Day 30: Some people respond when the laser is also applied to trigger points in their hip and calf, which can refer pain to the plantar fascia, so the therapist lasers these points today during my fifth treatment. I didn’t detect a change, though.

Bottom Line: My four-month layoff decreased the acute pain, but it was the laser treatment that gave immediate, near-total relief, and that got me out running again. Well worth 4 appointments and and it cost me less than $70 a session.

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Cold Laser Provides Pain Relief for Up to 22 Weeks- Read On

FRIDAY, Nov. 13 (HealthDay News) — Low-level laser therapy can effectively treat both acute and chronic neck pain, with benefits lasting up to 22 weeks for chronic pain, according to a study published online Nov. 13 in The Lancet. Roberta T. Chow, of the University of Sydney in Australia, and colleagues conducted a meta-analysis of 16 randomized controlled trials including 820 patients to assess the efficacy of low-level laser therapy in the treatment of neck pain compared with active control or placebo.

Two of the trials showed a 69 percent greater likelihood of improvement compared to placebo when low-level laser therapy was used to treat acute neck pain, while five trials showed low-level laser therapy resulted in four-fold higher odds of improvement for treatment of chronic neck pain, the researchers found. Pain relief was felt immediately after treatment for acute pain and persisted for up to 22 weeks for chronic pain. advertisement “These tissue effects of laser irradiation might account for the broad range of conditions that are amenable to low-level laser therapy treatment. Whether specific treatment protocols are necessary to elicit different biological mechanisms is unknown,” the authors write. “Whatever the mechanism of action, clinical benefits of low-level laser therapy occur both when [it] is used as monotherapy and in the context of a regular exercise and stretching program.”

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Common Pain Relievers Raise Heart Risk For Healthy Adults

Common Pain Relievers Raise Heart Risk for Healthy Folks

 TUESDAY, June 8 (HealthDay News) — Healthy people who take nonsteroidal anti-inflammatory drugs to relieve minor aches and pains may raise their risk of dying from heart-related problems, a Danish study finds.

The American Heart Association and the U.S. Food and Drug Administration already warn people with heart disease to be cautious about taking NSAIDs, which include ibuprofen (brand named Advil, Motrin) and diclofenac.

 The new study is the first to show the same kind of increased risk among people without cardiac problems, says a report in the July issue of Circulation: Cardiovascular Quality and Outcomes, published online June 8.

 “Very few studies have been designed to answer the important question: Do NSAIDs also increase the cardiovascular risk among healthy people who use these drugs for minor complaints?” said lead author Dr. Emil L. Fosbol, a cardiologist at Gentofte University Hospital in Hellerup. “This study is the first to confirm that the cardiovascular risk is indeed increased when healthy individuals use some of the drugs.”

 The risks for different NSAIDs — found in an analysis of national medical records of more than one million Danes from 1997 to 2005 — varied widely. Participants, whose average age was 39, who used ibuprofen had a 29 percent greater risk of fatal or nonfatal stroke, compared to those who took no NSAID.

 Use of diclofenac (Voltaren and Cataflam) was associated with a 91 percent higher risk of death from all cardiovascular diseases, while rofecoxib (Vioxx) use was associated with a 66 percent increased risk. But the study found no increased risk of cardiovascular problems — indeed, a slightly lower risk of death — associated with naproxen, sold over the counter with brand names including Aleve.

 For people taking the largest doses, diclofenac was associated with a doubled risk of heart attack, and rofecoxib (Vioxx) was associated with a threefold increased risk of heart attack. Vioxx was taken off the U.S. market in 2004 because of a study finding high rates of heart attack and stroke.

 “These findings are completely consistent with what we have found in patients with cardiovascular disease,” Dr. Michael E. Farkouh, a clinical cardiologist at Mount Sinai Cardiovascular Institute in New York City, said of the Danish study. “Drugs that elevate blood pressure and are associated with a thrombotic [artery-blocking] effect can be harmful in patients who are otherwise healthy.” 

The percentage increases in the study were large, but the absolute overall risk in otherwise healthy people was small, Farkouh said. Nevertheless, “before you take any medication, you should consult with a physician, particularly these medications,” he said.

 That warning applies especially to people who exercise regularly and are thus more likely to take an NSAID for muscle and joint pain, Farkouh said. Regular use of an NSAID increases the risk not only of cardiovascular problems but also of bleeding, a known side effect of the medications, he said.

 In fact, the Danish study found an increased incidence of major bleeding events, some fatal, from all NSAIDs except celecoxib (Celebrex). Celecoxib did not appear to raise the risk of coronary death or stroke either.

 The Danish findings are consistent with a 2007 American Heart Association (AHA) scientific statement about the increased risk of heart attack and stroke associated with NSAID use, said Dr. Elliott Antman, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, lead author of that paper, in a statement issued Tuesday by the AHA.

 The recommendations we made were based on our best estimates from the existing pharmacological and biological research available at the time,” Antman said. “I find this new study reassuring because it endorses the recommendations we made using a large body of actual clinical evidence.” 

Antman’s advice for anyone taking an NSAID regularly is that “it is advisable to discuss with your physician why it was originally recommended or prescribed, whether you need to continue taking it, and at what dose.”

 t may be wise to consider alternatives, the study authors and other experts said.”The majority of studies have shown that naproxen has a safe cardiovascular risk profile and that ibuprofen in low doses (1200 mg and below per day) also is safe in respect to the cardiovacular risk,” Fosbol said.

 

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Comparison of Cold Laser, Accupuncture, and Ultrasound

Comparison of Cold Laser, Acupuncture, Ultrasound And TENS Therapies For Pain Control

The following table compares several “alternative” therapies and tries to make distinctions for each technology. This table is targeting patients with pain control issues. All these therapies are appropriate for some patients and all should be considered for dealing with special health issues. The information is presented here for general purposes. You should consult a local practitioner to help select the best therapy for your specific health problems.

	Cold Laser	Acupuncture	Ultrasound	Electrical Stimulation
Pain Control	Joint, Head, Migraines, Muscular	Joint, Head, Migraines, Muscular	Joint, Muscular	Muscular
Benefits	Increase circulation, faster healing. May reduce inflammation. May permanently eliminate acute and chronic pain.	Increase circulation, faster healing. May permanently eliminate acute and chronic pain	High-energy sound waves penetrate deep into tissue to cause tissue/muscle warming, increased vessel vasodilatation and increase circulation. Short-term changes in cell membrane permeability.	Electrical stimulation produces a mild current that can prevent pain messages from being transmitted to the brain. May raise the level of endorphins (natural pain killers produced by the brain).
Tissues Affected	Absorbed by all tissues including skin, subcutaneous, tendons, muscles, and nerves	Direct tissue contact, may result in bruising and bleeding	Absorbed by white connective tissue	Muscle tissue only
Treatment Times	2-6 Minutes	20-60 Minutes	5-8 Minutes	15-20 Minutes
Body Contact	Dry contact	Penetration of skin	Requires gel or water medium	Requires Electrodes
Patient Comfort	Soft sensation or no sensation (may feel warm)	May experience pain or spasms while needles are in place	Discomfort with excess heating of tissues (especially if not moving electrode)	Mild to severe discomfort with tingling and potential burning
Use On Children	Ok for use on children	Usually limited to acupressure	Use caution	Use extreme caution
Patient Restrictions	Do not use over suspicious or cancerous lesions, or on pregnant women	Do not use on suspicious or cancerous lesions, or on pregnant women	Not for use with patients with circulation or neuropath conditions, pacemakers, cancer, or pregnant women	Not for use with patients with circulation or neuropath conditions, pacemakers, cancer, or pregnant women
Cautions	Eye protection Required	Proper sanitary procedures require since skin is broken	Potential tissue damage	Potential for burns and blisters Potential for cardiac arrhythmia. Electrode placement is critical
Notes:	Also called Low Level Laser (LLL) Can be used in conjunction with other therapies	Can be used in conjunction with other therapies		“TENS” is the acronym for Transcutaneous Electrical Nerve Stimulation.

There is significant overlap between these therapies. In some cases, it may be best to use more than one therapy to maximize healing and shorted your recovery period. Each patient and each condition is unique. Always consult a professional when evaluating therapy options including cold laser therapy.

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Reducing Chronic Pain with Visualization Exercises

Many of my clients that  are successful with cold laser tend to also practice some form of mindful awareness or meditation .  I found a great visualization exercise that you can do in the privacy of your own home that will allow you to let go of work day stressors.  Reducing your daily stressors serves two purposes:

1. Produce feel good chemicals such as “endorphins”  2. May help to reduce pain

Enjoy!

Relaxation and Visualization Exercise

This exercise will take about 20 minutes and will help relax both your body and mind.  Many people find that imagining a special, relaxing place helps them more easily relax.  For this exercise, I’ve used the imagery of the beach.  You can use whatever is your favorite place.

To get started, sit up straight in a comfortable chair, with your feet on the floor.  If there is a more comfortable position for you, certainly use it.  Unless you want to fall asleep, do the exercise sitting up.  At bedtime, you can lie in bed and simply fall asleep with this exercise.  If any step in the exercise isn’t comfortable, either physically or emotionally, just focus on your breathing during that step instead.

Slowly close your eyes, or focus on one spot on the floor or wall if that is more comfortable for you.  Invite your body and mind to begin to relax.  If worries or concerns come to you, now or during this exercise, imagine placing them on clouds slowing drifting across the sky.  You might notice these clouds as they drift by, but you don’t have to get involved with these thoughts.  Slowly your mind will settle down and begin to feel more relaxed and comfortable.

Begin to focus on your breathing.  Take 2 slow, relaxed deep breaths, watching your breathing come in… and then go out.  Then return your breathing to a normal rate and normal depth, and continue to watch your breath.  Imagine that with each breath in, you’re breathing in comfort and relaxation, and with each breath out, you’re breathing out any discomfort or worry.

Next I’ll have you turn your focus to a couple of different areas of your body, first tightening the muscles, and then letting them relax.

To start, I’ll have you focus on your hands.  Tighten those muscles into tight, tense fists… and on the count of 3, relax, 1, 2, 3.  Let any tension or discomfort flow out through your fingertips.

And next, focus on the muscles of your face.  Tighten those muscles by tightly shutting your eyes and clenching your jaw … and on the count of 3, relax 1, 2, 3.  Let your forehead become smooth and your jaw droop slightly.

Now I’ll have you focus on your feet.  Tighten those muscles by pushing your feet into the floor … and on the count of 3, relax, 1, 2, 3.  Let any tension or discomfort flow out through the tips of your toes.

Imagine a wave of relaxation starting at the top of your head, flowing down over your face and the back of your head … flowing down the front and back of your neck … down your shoulders … down your chest and stomach … down your back … and down your legs to the tips of your toes.

Now take 2 more deep breaths in through your nose, blowing the air out through your mouth.  Then return your breathing to normal.

Next I’ll describe a scene that you can imagine yourself in.  Imagine walking over the sand, heading towards the beach.  You can imagine slipping off your shoes and feeling the warm, comfortable temperature of the sand.  Notice how smooth the sand feels between your toes.  As you walk towards the ocean, imagine looking out over the water, looking out towards the horizon.  Notice the different colors of the water, the light blues and dark blues of the ocean.  You might even see a cloud that’s reflected in the water.  You might see some white caps on the waves away from the shore.  And watch the water come into shore, and go back out again.  You can also look up into the sky, noticing how many clouds there are, and if they’re fluffy.

As you reach near the water, imagine laying out a blanket on the sand and sitting down.  Notice the comfortable warmth of the sun on your face and shoulders.  Imagine picking up some sand in your hands and letting it drift through your fingers, noticing how smooth it is.  You can again look out over the water and watch the waves come in and go out … come in and go out.

Now imagine lying down on your blanket and closing your eyes.  Notice what sounds you hear … perhaps some seagulls calling … perhaps some children playing off in the distance.  Listen to the water as the waves come in and go out.  And take a deep breath, noticing what smells come to you … the clean, fresh smell of the ocean air … perhaps the coconut smell of suntan lotion.  Enjoy resting on the beach for several minutes, noticing what each of your senses is experiencing.  (Pause for several minutes.)

Then imagine sitting up again, looking out over the ocean, and then standing up and walking back away from the shore.  You can brush off your feet with your blanket and put your shoes back on.  Even as we get ready to end this exercise, you know that you can return here at any time.  Invite your body and mind to continue to feel comfortable and relaxed, even as your attention turns elsewhere.

Now to bring this exercise to a close, I’ll count down from 10 to 0, and when I reach zero, you can slowly open your eyes.

10 … 9 … 8 … 7 … 6 … 5 …

Continuing to feel comfortable and relaxed, and with energy to resume your day.

4 … 3 … 2 … 1 … 0.

Slowly open your eyes, take a deep breath in and out, and gently wiggle your fingers and toes.  You are ready to continue your day.

Alternatives:
When you use your own favorite places for this imagery exercise, imagine what each of your senses is noticing.  The more sense you involve in your imagery, the more real it will be for you.  Real or imaginary places are fine.

As with the basic relaxation exercise, at bedtime, omit the ending countdown and the phrase “with energy to resume your day,” and instead simply continue to imagine the beach scene, or whatever imagery you’re using.

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