Pratibha Bansal
M.D., Romanth Waghmarae M.D. DABA, FIPP.
, Louis Banas B.S. , M.S. CLT ; Buffalo, New York, June 2012
Note: Dr’s Bansal and Waghmarae are Board Certified Pain Management Physicians
who have practicing Pain Management in Buffalo, New York for over 20 years. Louis
Banas is a laser specialist who has treated over 2500 hundred patients for
chronic pain issues. He has treated over 60 adults for headaches of various
types with significant success in most cases.
Abstract:
Migraine headache
due to trauma or otherwise is a major health concern worldwide with massive
financial and social impact. Conventional treatments primarily focus on the
prevention of further damage to the brain parenchyma, while failing to address
the already existent symptoms. Previous clinical studies have shown that Low
Level Laser Therapy (LLLT) can significantly reduce pain and induce temporary
vasodilation in capillaries. The authors
demonstrate how LLLT can be used to improve the quality of life in patients by
treating their current symptoms,. This case report illustrates the use of LLLT
in the treatment of several patients with a severe headache and the clinical
success achieved in the reduction of pain, as measured by VAS - achievable
within 2-8 treatments.
Abstract:
Objective
Information and Background.
The following case studies were followed at
a Pain Management Clinic in Buffalo
New York. Pain Rehab is staffed with two board
certified Pain Management Specialists who will see 300 to 400 patients weekly. Most
patients were being seen do to traumatic injuries suffered at work, home or
auto accident and in most cases had little or no relief with physical therapy,
chiropractic, massage or surgery. Pain Rehab is very progressive in utilizing
new and proven technology and reluctantly prescribes opiates and NSAIDS . All patients
suffered from moderate to severe, debilitating pain on a daily basis. After a very
positive evaluation of laser therapy on patients, a physical therapy clinic was
added to the practice, therefore enabling this new modality to be readily
available to their patients. Several patients suffering from chronic,
debilitating headaches due to trauma or congenital defects were treated during
a four month period. (It is important to note that headaches were just part of
the overall pain complaints except for two patients noted in cases 4 and 7.) Over
twenty patients were treated and only two patients out of twenty did not
respond well. The treatments were performed by a laser specialist with four
years of laser experience. Listed below
are a few of the significant, more interesting cases.
Case # 1.
A 28 y.o. female suffered severe whiplash in an auto injury and
complained of daily, severe headaches with a vas value of 7-8 accompanied by
blurred vision for a 12 month period. Laser was applied to bilateral temples
and mastoid for 2 minutes, delivering 15 joules to five
sites, which included bilateral temple and mastoid sites and right cervical
spine. Patient was not able tolerate minimal
cervical spine treatment. , including 6 joules per site for a 3 minute
duration. Note: Patient is African
American and due to nerve damage or skin pigmentation could not tolerate
prescribed dosage. Treatment was given 3 times per week for two
weeks at a reduced dosage for a total of six treatments. Pain levels were substantially reduced and
patient now only suffers 2-3 episodes per week with a vas value of 2-3.
Case #2 .
38 y.o. female, auto injury. Previous
physical therapy was unsuccessful. Patient complained of daily headaches 7-8 on the vas scale for two years. Treatment included bilateral c-spine and
right trapezium for 3 minutes time delivering 42.5 joules to each site, for a
period of two weeks and levels increase to 72 joules for second week as patient
healed and was more able to tolerate the procedure. Patient received 12 treatments over a three
week period and now experiences mild to
moderate headaches once or twice per month.
Case 3#.
58 y.o. male was injured on the job and suffered a severe neck and left
clavicle injury. Headaches were daily which were debilitating and patient
reported a 7-8 level on the vas scale. Treatments of 8 sessions included 76.5
joules applied to left cervical spine and clavicle. 15 joules were applied to
left cervical 1 area, after 10 treatments the headaches were entirely eliminated.
Case # 4. A 23 y.o. Female suffered from
headaches 3-4 times per week since six years of age. Patient has a high stress job as customer
service representative. One treatment was applied at both temples delivering 15
joules in a two minute session. Patient was headache free for one week.
Case#5.
A 57 y.o. female, auto injury 17
years ago and had damage to both frontal lobes. 28 Joules was applied to her
forehead at two sites. Due to transportation difficulties her treatments are
sporadic but after two treatments she now wakes up with minimal or no pain on
most mornings.
Case #6. A 52 y.o. male fell at work and hit back of
head. Headaches occur on daily basis since accident 4 months ago. Two treatments were performed two days apart
delivering 25 joules to injured area. Patient states that headaches are
significantly reduced and sleep patterns are substantially improved.
Case # 7. A 31 y.o. female former military
P.A. presented herself with migraine headaches with a vas value of 7-8 on a
daily basis. She has suffered with them since the age of 8. The patient had seen several specialists
including neurologists who were unable to help. The patient had military
training as a physician’s assistant and realized she needed detoxing from drug
overload which had been prescribed for the problem. A
single laser treatment was administered which included 48 joules at 2 sites on the forehead and 28
joules to four sites which included bilateral temple and mastoid areas. The patient had significant relief for a 7
day period at which point she felt the change in medications was to blame. She returned
for a single visit one day after the relapse and the procedure was repeated. The patient reported to be pain free within
minutes after the procedure. She feels
she is completely healed.
Technical
data:
The system utilized is the Theralase super
pulsed Low Level Laser medical system. It
The system is equipped with a multiple probe hand piece (5 x 905 nm
wavelength @0-100 mw average power per laser diode and 4 x 660 nm wavelength
@25 mw . power per laser diode. (This allows for deep penetration of tissue
when necessary with minimal heat transference to the tissue).
Healing
pathways- Discussion
The majority of patients seen in this
clinic have multiple injuries and headaches are a by-product of some type of trauma.
Therefore, it may be safe to assume that vascular insufficiency is the main
cause. A recently published a peer review paper concludes that the equipment
used utilizes a 905 nm. Wavelength increasing Nitric acid up to 700 percent
which expands capillary delivery of oxygenated blood. Currently Dr. Michael
Whalen, working at Massachusetts General Hospital, is conducting controlled
studies using a low level laser with the hopes of bringing this new technology
into the forefront of neuroscience and medicine. These case studies give examples
of how LLLT can be used to treat chronic migraines, specifically those that are
a result of traumatic brain injuries. LLLT has been shown to reduce pain and
inflammation, create a state of vasodilation by activating the nitric oxide
pathway and further even promote angiogenesis.
ATP production. Cold laser has the unique ability to generate
the production of ATP Adenosine Tri-phosphate through a process called
biostimualtion. Vacuoles (cytochromes and chromaphores) in the mitochondria of
the cell absorb specific light wavelengths causing a cascade effect which
rejuvenates damaged cells lacking this essential fuel molecule. Although this
may be the main pathway for treating the traumatic injures, it is arguable that
the nitric oxide production is the primary source of pain reduction.
Summary.
LLLT is now becoming a valuable but slowly
recognized modality for acute and chronic pain as well as wound care in the
United States. It has been used extensively in Canada for over 12 years.
REFERENCES
1. Faul
M, X.L., Wald MM, Coronado VG, Traumatic
brain injury in the United States: emergency department visits,
hospitalizations, and deaths. 2010.
2. Finkelstein E, C.P., Miller T and associates, The Incidence and Economic Burden of
Injuries in the United States. Oxford University Press, 2006.
3. Sahni, T., et al., Use
of hyperbaric oxygen in traumatic brain injury: retrospective analysis of data
of 20 patients treated at a tertiary care centre. Br J Neurosurg, 2012. 26(2): p. 202-7.
4. Naeser, M.A. and M.R. Hamblin, Potential for transcranial laser or LED therapy to treat stroke,
traumatic brain injury, and neurodegenerative disease. Photomed Laser Surg,
2011. 29(7): p. 443-6.
5. Moriyama, Y., et al., In
vivo effects of low level laser therapy on inducible nitric oxide synthase.
Lasers Surg Med, 2009. 41(3): p.
227-31.
6. Wu, Q., et al., Low-level
laser therapy for closed-head traumatic brain injury in mice: effect of
different wavelengths. Lasers Surg Med, 2012. 44(3): p. 218-26.
7.
Stephan, W. et al . Efficacy of super –pulsed 905 nm Low Level Laser Therapy in the Management
of
Traumatic Brain Injury (TBI) World Journal of Neuroscience November 2012 www.scirp.org/journal/wjnsl
For further information, please visit www.theralase.com or call 1-855-494-7246
