Bahamas Anti-Aging Medical Institute

The Bahamas Anti-Aging Medical Institute also specializes in chronic pain management creating integrative programs that incorporate the most cutting edge therapies with standard therapies to assist the patient with management of their chronic pain

What is Chronic Pain

There are two distinct types of pain: acute and chronic pain. Acute pain is a normal sensation triggered by the central nervous system that alerts the individual to a possible injury and the need to take care of one’s self. Chronic pain is very different; chronic pain is a persistent pain, a signal from the central nervous system that continuously fires for weeks, months, even years.

With chronic pain there may have been an initial injury such as a sprained back, serious infection, or there may be an ongoing cause of pain such as arthritis or cancer. Typically, many of the conditions that cause chronic pain occur in older adults. However, some people suffer from chronic pain in the absence of any past injury or evidence of body damage.

Common chronic pain complaints include:

• Low back pain;
• Cancer pain;
• Arthritis pain;
• Neurogenic pain — pain from damage to the peripheral nerves or the central nervous system itself;
• Psychogenic pain — pain unrelated to past disease, injury or damage inside or outside the nervous system;
• Headache;

Treatment

For some individuals with chronic pain common treatments can mitigate their discomfort.However, until the underlying cause of the pain is addressed the individual will continueto require treatment and/or medication.

Common Treatments:

• Medications;
• Low level Laser Therapy
• Acupuncture
• Local electrical stimulation;
• Brain stimulation;
• Surgery;
• Psychotherapy;
• Relaxation;
• Biofeedback;
• Behavior modification;

Low Level Laser Therapy

Laser light of the proper wavelength, at the correct power density, for the appropriate duration of exposure can achieve an analgesic effect on musculoskeletal pathologies. At The Bahamas Anti-Aging Medical Institute we specialize in this cutting edge low level laser therapy. This treatment, in initial studies, has proven to enhance the quality of life for many patients and allowed them to return to a more productive lifestyle.

The Bahamas Anti-Aging Medical Institute believes low level laser therapy. When combined with medication, therapy, and lifestyle changes can significantly improve chronic pain sufferer’s quality of life.

What Research is Being Done?

Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers believe activates endorphin systems. Other experiments with acupuncture have shown that there are higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally prescribed for pain.

Pain Management With Low Level Laser Therapy (LLLT)

Since 1994 there have been more than 125 publications on the use of low level laser therapy for the treatment of everything from chronic prostatitis to chronic pain management ^1-3. Of these publications only 49 have sufficient data to evaluate the study. These studies used a variety of light sources for patient treatment, but generally speaking they fall into 3 major groups, i.e. 500-700 nm, 800-1000 nm and greater than 1000 nm.

The success rate according to the authors (i.e. whether the LLLT effect was greater than placebo) was 81.6 when considering whole studies as positive or negative. Eight studies reported on wavelengths longer than 1000 nm. 100% of these studies reported efficacious treatments. There were twenty-six studies using wavelengths between 800 nm and 1000 nm, of these 80.8% were considered by their authors to be an efficacious treatment. Between 500 nm and 700 nm there were 14 articles that had a 77.0% rate of positive studies. When pooling all wavelengths the reported success rates were 85.3% or conversely a 14.7 failure rate.

The biological effects were interestingly divided into two distinct camps, the 630-670 nm area and the >1000 nm area. The short wavelength group is typified by the 632.8 nm HeNe ^4,12 with low exposure energy of 10-30 nm and short exposure time. The primary disorders treated in these studies were surface, such as reduction of inflammation (13), herpetic infections ^7,14, wound healing and keloid reduction and near surface joints, such as the temporomandibular joint (TMJ)¹⁵. Since it is known that HeNe penetrates only 1-2 cm into the skin and is strongly absorbed by H20, these types of maladies were logical choices for the use of this laser at low energies. In contrast, the wavelengths greater than 1000 nm (Nd:Yag at 1064 and CO2 at 10,000) that are known to penetrate more than 6 cm were highly successful in treating musculoskeletal injury and pain ^16,17,18. This is primarily due to the lack of absorption by tissue and water in the 900 nm to 1200 nm window.^{19, 20} Laser light photons interact with tissue in three ways; (a) the photons are absorbed by the tissue, (b) the photons pass through the tissue or (c) the photons are deflected and scattered by the tissue. General speaking, the laser/tissue interaction is defined by the wavelength of the laser light and wavelengths on both sides of the 900-1100 nm window are progressively absorbed as the distance from the “optical window” grows greater. Within the optical window the tissue is essentially invisible to the beam.^{19, 20} However, the basic tenets of absorption, transmission and scattering of light can be altered in all wavelengths by the power density of the laser beam and the length of exposure. The ultimate question is: how do the photons of laser light effect the cellular changes to increase blood flow in wound healing, cause cell proliferation and exert an analgesic effect on neurons? Although there is a great need for more basic research to understand the mechanisms at work and very little good data is available; the facts are that laser light produces objective results in wound healing and pain relief.

One basic need of all cells for repair of themselves or their environment is a higher state of energy. The initial event in this production can be accomplished through photochemistry, i.e. laser/tissue interaction. It is known that photons absorbed by cytochromes within mitochondria cause an increase in the level of oxidative phosphorylation that results in the formation of ATP or adenosine trip-phosphate.^{21, 22, 23, 24} ATP is the fuel that drives all cell mechanisms for synthesizing proteins, maintaining membrane potentials and ultimately cellular proliferation.

The production of ATP and maintenance of the study state potential of neurons prevents the depolarization of neuronal membranes and transmission of pain impulses to the central nervous system. The attenuation of pain could also be the result of laser light induced mediators such as ACTH and beta endorphins.^8,25 In contrast, seratonin levels are down regulated after laser treatment and are mirrored by the reduction in pain.²⁶ In other studies, laser light has been shown to increase conversion of PGG2 and PGH2 into PG12 (prostacyclin) which has an anti-inflammatory effect on the area that also results in an analgesic effect.^3,27 In summary laser light of the proper wavelength, at the correct power density, for the appropriate duration of exposure can achieve an analgesic effect on musculoskeletal pathologies.

References

1. Mester, E.; Ludani, G.; Selye, M. et al: The stimulatory effects of low power laser rays on biological systems. Laser Reviews 1968;1:3.

2. Shabad, A.L.; Red’kovich, V.I. and Savaroe, R.M.: Laser therapy of chronic prostatitis: Procedure and clinical laboratory results. Urologiva i Nefrologiva 1994;6:26.

3. Tam, G.: Low power laser therapy and analgesic action. J Clin Laser Med Surg 1999;17:29.

4. Giarelli, S.; Hartman, E.; Pisani, L.; Castronuoro, G.; Sprinoglio, L.; Zingone, A. and Fava, A.: Efficacy of low level laser therapy for sympathetic reflex dystrophy syndrome in geriatric patients. Laser Therapy 1996;8:191.

5. Kemmotsu, O.: The role of laser therapy in the pain clinic. Laser Therapy 1996;8:123.

6. Sakihama, H.: Effect of helium-neon laser on cutaneous inflammation. Kurume Medical Journal 1995;42:299.

7. PLEASE NOTE THERE IS NO REFERENCE NOT FOR #7

8. Otsuka, H.; Numazawa, R.; Okubo, K.; Enya, T.; Saito, Y.; Kemmotsu, O.: Effects of helium-neon laser therapy on herpes zoster pain. Laser Therapy1995;7:27.

9. Laakso, E.L.; Cramond, T.; Richardson, C.; Galligan, J.P.: Plasma ACTH and beta-endorphin levels in response to low level laser therapy (LLT) for myofascial trigger points. Laser Therapy 1994;6:133.

10. de Bie, R.A.; de Vet, H.C.; Lenssen, T.F.; van den Wildenberg, F.A.; Kootstra, G.; Knipschild, P.G.: Low-level laser therapy in ankle sprains: a randomized clinical trial. Arch Phys Med Rehabil 1998;79:1415.

11. Giavelli, S.; Fava, G.; Castronuovo, G.; Spinoglia, L.; Galanti, A.: Ylow-levellaser therapy in osteoarticular diseases in geriatric patients. Radiol Med (Torino), 1998;95:303.

12. Pinheiro, A.L.; Cavalcanti, E.T.; Pinheiro, T.I.; Alves, M.J.; Manzi, C.T.: Lowlevel laser therapy in the management of disorders of the maxillofacial region. J Clin Laser Med Surg 1997;15:181.

13. Simunovic, Z.: Low level laser therapy with trigger points technique: a clinical study on 243 patients. J Clin Laser Med Surg 1996;14:163.

14. Sakihama, H.: Effect of a helium-neon laser on cutaneous inflammation. Kurume Medical Journal 1995;42:299.

15. Yaksich, I.; Tan, L.C.; Previn, V.: Low energy laser therapy for treatment of post-herpetic neuralgia. Ann Acad Med Singapore 1993;22:441.

16. Pinheiro, A.L.; Cavalcanti, E.T.; Pinheiro, T.I.; Alves, M.H.; Miranda, E.R.; DeQuervedo, A.S.; Manzi, C.T.; Vieira, A.L.; Rolim, A.B.: Low-level laser therapy is an important tool to treat disorders of the maxillofacial region. J Clin Laser Med Surg 1998;16:223.

17. Takahashi, Tetsu; Calderhead, R. Glen; Fukuda, Masayuki; Homma, Hidetaka; Ohnuki, Takayoshi; Ohtani, Maki: Nd: YAG LLLT in the treatment of temporomandibular disorders: A treatment protocol and preliminary report. Laser Therapy 1998;10:7.

18. Kalinina, O.V.; Alekseva, N.V.; Burtsev, E.M.: Infrared laser therapy in distal diabetic poilyneuropathy. Zhurnal Nevrologii I Psikhiatrii Imeni S.S. Korsakova 1998;98:23.

19. Basford, J.R.; Sheffield, C.G.; Harmsen, W.S.: Laser Threapy : a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil 1999;80:647.

20. Boulnois, J.L.: Photophysical processes in recent medial laser developments: A review. Lasers Med Sci 1986;1:47.

21. Sliney, D.H.: Laser tissue interactions. Clin Chest Med 1985;6:203.

22. Kitzes, M.; Twiggs, G.; Bems, M.W.: Alteration of membrane electrical activity in rat myocardial cells following selective laser microbeam irradiation. J Cell Physiol 1977;93:99.

23. Passarella, S.; Casamassims, E.; Molinary, S. et al: Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by HeNe laser. FEBS Lett 1984:175:95.

24. Passarella, S.; Parlino, E.; Quagliariello, E. et al: Quantitative analysis of lymphocyte-salmonella interaction and effect of lymphocyte irradiation by helium-neon laser. Biochem Biophys Res Comm 1985;130:546.

25. Passarella, S.; Roncall, L.; Cicero, R. et al: New ultrastructural conformations of mitochondria irradiated in vitro with a helium-neon laser. Lasers Life Sci; 1988;2:161.

26. Vizi, E.S.; Mester, E.; Tisza, S. et al: Acetylcholine releasing effect of laser irradiation of Auerbach’s plexus in guinea pig ileum. J Neural Transmission 1977;40:305.

27. Mizokami, T.; Aoki, K.; Iwabuchi, S.; Kasai, K; Yamazaki, Y.; Sakurai, T.; Samejima, K.; Yoshii, N.: LLLT (Low reactive level laser therapy : A clinical study: Relationship between pain attenuation and the serotonergic mechanism. Laser Therapy 1993;5:165.

28. Tam, G.: Low power laser therapy and analgesic action. J Clin Laser Med Surg 1999;17:29.