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Neuropathy - Light Treatment
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Neuropathy - Light Treatment - February 5, 2005 6:17:00 AM
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JLS_PT_OCS
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I have heard recently about a new treatment for peripheral neuropathy using light or low level laser / LED therapy.
Although I am familiar with this type of treatment for musculoskeletal things (new generation ultrasound, I guess), I have not seen it in the context of treating neuropathy.
Anyone come across this or have any experience?
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Neuropathy - Light Treatment - February 5, 2005 3:47:00 PM
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Jon Newman
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Well there is this study (see link to free full text). The authors were compensated by the company that makes the product if you believe it may matter.
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14693984]link[/URL]
jon
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Re: Neuropathy - Light Treatment - February 6, 2005 3:30:00 AM
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jma
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In the world of research, the fact that authors were compensated for using the company's piece of equipment in their study, biases everything in the study. Not the way it should have been done.
JMA
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Re: Neuropathy - Light Treatment - February 6, 2005 4:13:00 AM
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Jon Newman
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JMA,
I agree. But how could bias slip into a double blinded RCT? It must work right?
jon
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Re: Neuropathy - Light Treatment - February 6, 2005 7:42:00 AM
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jma
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Yes, you do have a point. However, I did not read the article, so I was not aware if the author's were compenstated before or after the study was completed. I am assuming it was the latter.
JMA
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Re: Neuropathy - Light Treatment - February 6, 2005 8:25:00 AM
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Jon Newman
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Hi Jma,
At the end of the article, under footnotes and acknowledgements, the following sentences are written. That is all the info I know.
“D.R.L., M.H.F., and S.M. (the authors) have received laboratory funds from the Medassist Group.”
“The Medassist Group (Tampa, FL) underwrote portions of this study.”
jon
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Re: Neuropathy - Light Treatment - February 8, 2005 12:10:00 AM
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JLS_PT_OCS
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Thanks for the responses.
I have found precious little to recommend this treatment thus far, but like any new therapy, it seems to be in it's infancy.
So I think they have yet to decide what the treatment parameters are and other variables that will influence the research process, and therefore the outcomes to be expected.
Thanks again...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Neuropathy - Light Treatment - February 8, 2005 4:27:00 AM
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jma
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Since this new therapy is in its "infancy", future studies pertaining to this may have a profound effect on future results published, now that financial incentives have been given to the authors. The same pattern may continue for future studies. Knowing that financial rewards will be given does not favor negative outcomes.
JMA
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Re: Neuropathy - Light Treatment - February 8, 2005 5:08:00 AM
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Jon Newman
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Jason,
You suprise me. This is a double blind RCT, what other proof do you need? What other proven methods to treat neuropathy are you using?
jon
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Re: Neuropathy - Light Treatment - February 8, 2005 6:37:00 AM
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JLS_PT_OCS
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Jon-
I think one RCT is definitely sufficient to recommend this treatment for those with diabetic foot neuropathy. At least for those who are not insensate to the 6.65 monofilament.
Had I a patient or family member who fit the criteria, I would recommend it.
I think the improvement in sensation is encouraging, though to say their balance was improved because an outcome measure questionnaire showed it is tenuous. Balance confidence and balance are two different things, though one may be just as important as another.
My comments reference it's infancy noted that we haven't established good parameters for it's general use. For example, in other areas of the body, for other types of neuropathy, long term effects, etc.
Good study, and thanks for the post, I hadn't found that one yet.
I had intended my question just as an exploration, and my comments about the current limitation in information should not be construed as a comparison to some superior treatment I am using. I don't treat this population now, but I have in the past, and my interventions usually focused on foot care and wound care, and none aimed at reversing the neuropathy itself.
I'm not sure there's anything out there that does that.
Anyone else know?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Neuropathy - Light Treatment - February 8, 2005 9:05:00 AM
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Shill
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Jon,
Money talks. The double blind RCT can still be performed creatively, and yes, dishonestly. There is incentive behind a favorable outcome for the company, and I do feel they will go to great lengths to show that their product works.
Any time a study is funded by the company that makes the product, it is bound to be (and should be) viewed with an untrusting eye, for that very reason. Sad but true.
That said, I have seen these things, and they are certainly not harmful, so I might try it too. There isnt a great number of proven treatments for neuropathy, as you said.
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Steve Hill PT
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Re: Neuropathy - Light Treatment - February 8, 2005 9:54:00 AM
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Jon Newman
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Hi Shill,
I agree. Do you suppose the only time bias creeps into an RCT is when money changes hands?
While some might find it banal, why do you suppose it works?
jon
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Re: Neuropathy - Light Treatment - February 8, 2005 4:43:00 PM
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Jon Newman
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Well I'm guessing the rationale comes from this line of thinking.
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12824453]link 1[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9747594]link 2[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10612563]link 3[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9529548]link 4[/URL]
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Re: Neuropathy - Light Treatment - February 17, 2005 8:25:00 AM
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JLS_PT_OCS
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I see there will be a paper on this for peripheral neuropathy at CSM, I will try to get some info while I am down there, and post it when I get back...
Jason.
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Neuropathy - Light Treatment - February 19, 2005 5:12:00 PM
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Randy Dixon
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Jason,
Make sure you post it. My wife, a Dir. of Rehab. at a hospital, is considering getting the Anodyne unit, (at my suggestion so I need some back up). Cost is about $7000. I live on the Mexican border where diabetes is rampant and figured it is worth a shot.
About balance and balance confidence, I found your comment interesting since only yesterday I was reading an article about Tai-Chi training vs. computer controlled vibration. They both appeared to be equally effective in preventing falls and improving gait, but the Tai-chi apparently did it only by improving confidence.
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Re: Neuropathy - Light Treatment - February 21, 2005 2:15:00 PM
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PTupdate.com
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I found this article quite intersting:
http://www.anodynetherapy.com/PDF%20Files/MedscapeCME.pdf
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Neuropathy - Light Treatment - February 21, 2005 2:59:00 PM
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Jon Newman
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Hi Randy,
Based on the unfortunate financial underwriting of this project and the short term outcome measures I would weigh the cost/benefit of what you could spend that 7000 dollars on.
Perhaps 7000 dollars toward establishing or improving a diabetic mangement program may be better as this system is likely to offer only temporary symptomatic relief versus actual improved health. If the improvement in balance only lasts while on anodyne therapy, and it is not curative, are you prepared to do this for life? Not that there is anything inherently wrong with that.
jon
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Re: Neuropathy - Light Treatment - March 4, 2005 7:57:00 AM
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JLS_PT_OCS
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Randy, I'm afraid you will be disappointed at the following abstract...it again measured the effect in diabetics, but found no difference. It's a placebo controlled trial as well.
Here it is:
The effect of monochromatic infrared energy on sensation in patients with peripheral neuropathy: a double-blind, placebo-controlled study
SESSION TYPE: Poster;
SESSION TOPIC: Clinical Electrophysiology;
Abstract Details
AUTHORS (ALL): Clifft, Judy1; Newton, Scott1; Kasser, Richard1.
INSTITUTIONS (ALL): 1. Physical Therapy, University of Tennessee Health Science Center, Memphis, TN, USA.
ABSTRACT BODY:
Purpose/Hypothesis : Monochromatic infrared energy (MIRE) is a relatively new modality purported to increase circulation and decrease pain, but the most recent studies suggest that MIRE may be effective in improving sensation in patients with peripheral neuropathy. The purpose of this study was to determine if the application of MIRE to the lower extremity (LE) of patients with peripheral neuropathy was associated with improved pressure sensation. Our research hypothesis was that the average number of sites that patients could sense the 5.07 Semmes-Weinstein (S-W) monofilament would increase in the active treatment group when compared to the placebo group.
Number of Subjects : Eighty-two LEs of 48 patients with self-reported diabetes met the inclusion criteria. Patients who were unable to sense the 5.07 S-W monofilament at any of 4 test sites on the plantar foot were considered to have peripheral neuropathy and were included in the study.
Materials/Methods : Four MIRE therapy units were provided and labeled A or B by the manufacturer: 2 treatment units delivered 1.95 J/cm2/min when activated and 2 placebo units delivered no energy when activated. However, the indicator lights illuminated on all units when the intensity switch was in the "on" position to ensure blinding of both patients and therapists during the data collection period. Patients were randomly assigned to receive treatment from either machine A or B. Four flexible therapy pads from the MIRE unit were placed above the ankle and on the plantar foot of each subject; each pad contained 60 superluminous infrared diodes. Treatments were administered for 30 minutes, 3 days/week for 4 weeks. Sensation was tested with S-W monofilaments at 4 sites on the plantar foot at the beginning of the study (M1), following 4 weeks of treatment (M2), and after an additional 4 weeks of non-treatment (M3). The number of sites that could sense the 5.07 monofilament was totaled at M1, M2, and M3. These data were analyzed using a repeated measures ANOVA followed by a post-hoc Tukey's test.
Results : The average number of sites that patients could sense the 5.07 monofilament increased for both the active and placebo groups at M2 and M3 (M3>M2>M1), but no significant differences were found between the active and placebo groups at M1, M2, and M3.
Conclusions : Thirty minutes of active MIRE applied 3 days/week for 4 weeks was no more effective than placebo MIRE in increasing the number of sites that patients with diabetic peripheral neuropathy could sense the 5.07 monofilament on the plantar foot.
Clinical Relevance : Clinicians should be aware that MIRE, as applied in this study, may not be effective in improving pressure sensation in patients with diabetic neuropathy.
****************************************************
Latest and greatest, I guess....
Jason
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Neuropathy - Light Treatment - March 4, 2005 8:25:00 PM
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Randy Dixon
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I guess I'll buy a black shoe box that makes cool humming noises instead.
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