L.D.Tondy
SRI of laser biology and laser medicine of KhSU, Kharkov,
Ukraine
When pain appears and informs about the presence of a morbid
process, the human organism immediately determines the strategy and tactics of
therapeutical-rehabilitation actions, which are sure to switch on the cupping of
the pain syndrome and its treatment. It is known that "pain - is a complex
psycho-physical phenomenon, which involves the mechanisms of emotion regulation
and formation, motoric, humoral, hemodynamic manifestations" (V.A.Michailovich,
Y.D. Ignatov, 1990).
The formation of pain syndrome has a direct connection with
neuro-physiologic mechanisms of convergence of integration, co-operation of
nociceptive and antinociceptive afferent signals. Thus, it is clear, that the
presence of pain syndrome is open to such hazards as the aggravation of the
patient's condition, the reduction of possibilities for quick reverse
development of histological reactions, and also the increasing activity of the
mechanisms of sanogenesis, such as restitution, regeneration, compensation,
immunity.
It is known, that a large quantity of analgetics, even narcotic
analgetics, is used to fight a pain. But many of them are characterised by a
number of side-effects, form a habit, produce an unfavourable influence on
digestive organs, rheologic characteristics of blood and so on. There exists a
large danger of polypragmasy, about which S.P.Botkin wrote at his time.
With regard to the listed above, one should pay attention to
the possibilities of alternative treatment in such situation. In this
connection, therapeutic physic factors (TPF), both natural and preformed, are of
a special interest. The peculiarity of their action in case of a disease is the
realisation of its analgetic, alongside with anti-inflammatory, anti-edema,
trophic-regenerative, immunocorrective, hyposensitising, effects (DDT, halvanic
current, square current and so on). One of the advantages is its active
stimulation of the sanogenesis mechanisms, mentioned above.
Yet, even among TPF there exists its own hierarchy, concerning
the intensity and peculiarities of the influence on pain syndrome.
Clinisists are interested in the facts, which would
simultaneously meet certain requirements: effective and quick action on
pathogenetic and sanogenetic diseases processes, and also a prominent analgetic
effect.
In this connection,
low-level laser therapy (LLLT) deserves a
special attention.
The fundamental investigations, carried out by the scientists
of the ex-USSR (O.K.Skobelkin, V.M.Inyushin, N.F.Gamaleya, V.I.Kozlov,
V.D.Popov, E.F.Stranadko and others) prove the appropriateness of LLLT
application in cases of numerous diseases and syndromes.
Taking into account the urgency of the study of LLLT influence
on the treatment of various diseases, where the pain syndrome constantly
manifests itself and asthenises CNS, reducing protective powers of an organism,
results in the disbalance of working capacity, we summed up the results of laser
therapy application, with due regard to the fundamental study of the influence
on pain syndrome. It allows us to give practical recommendations for the
treatment of a number of common diseases.
We observed 425 patients at the age-range from 18 to 72 with
diseases of degeneration-dystrophic character: vertebral osteochondrosis (100
patients) with the effect of cervicalgia, thoracalgia, lumbago, lumbalgia, lumbo
and myalgia - the I group of patients.
70 observed patients (the II group) had osteoarthrosis
deformans with pain syndrome.
The pain intensity was estimated by the method of academic
Antonov, according to 4 degrees of pain intensity. The III group (82 people)
were patients with cardialgia of neurogenetic metabolic, dishormonal genesis.
The IV group - patients with diskinetic pains caused by spasmodic conditions of
the smooth muscles of small intestine, constrictors in the digestive tract
passage (50 people).
The V group included patients with chronic persisting
hepatitis, in some cases with enlarged liver (18 people), which caused pain. The
patients under observation didn't get analgetics.
The VI group consisted of HID patients, including patients
after myocardial infarction a month ago, who had attacks of stenocardia of
strain (11-111 functional class) and cardialgias of different origin. In total
105 patients.
The patients were having sanitation treatment in clinics and
departments of the Centre of Laser Technologies, the Institute of Laser Medicine
and biology, Kharkov Institute of the Advanced Training, specialised sanatoria
of the suburban type ("Roscha", "Rai-Elenovka").
The applied therapeutic factor was based on low-level laser
radiation in the red part of the optic spectrum (l=632.8 nm) in the continuous
mode. The choice of the factor is explained by the fact, that he
physiotherapeutical service of the Ukraine is rather well supplied with
therapeutical devices, generating monochromatic, coherent, polarised red
radiation. Methods of distant, contact and combined action, with regard to the
influence on the projection of a sore organ, reflex zones, biologically active
points, were applied.
Moderate energy loading was used:
In the case of a distant action 5-25 mW/cm2 on BAT -
1-3 mW/cm2 with the corresponding exposition -up to 5 min. on a zone,
up to 600 seconds on a point (4-6 points during I session. The course - 7-14
sessions).
In the case of supravenous and intravenous actions ... up to 5
mW/cm2 with the exposition up to 10 minutes were used, 4-5 sessions
in 2-3 days.
We analysed the obtained results with regard to the type of
pain - physical or psychological, acute, subacute, chronicle; the time of the
positive dynamics appearance, taking into account the peculiarities of the
treatment.
The obtained data allow to conclude, that the analgetic action
of LLLT in the red spectrum is effective, when applied to all patients with the
above-listed diseases, and to confirm the preventive action of LLLT in the case
of stenocardia of strain of... patients.
Thus, 92% of patients with neurologic forms of osteochondrosis
developed a positive dynamics (the disappearance of pain syndrome by the seventh
session or its considerable decrease).
In cases of acute pains (lumbago), the effect was obvious by
the 3-4-th session. The most effective application of the above-mentioned laser
radiation proved to be in cases of thoracalgia (14 from 15).
In the case of osteoarthrosis deformans, the positive dynamics
of 85.8% of patients with pain syndrome was observed.
In cases of the patients with cardialgias of various genesis,
the disappearance and lowering of the intensity of pain syndrome was observed in
92.74% of patients. The effect was lacking in the cases of patients with
cardialgia ofdisharmonal genesis (grave pathological climacterium).
In cases of pain syndrome, caused by spasms of smooth muscles
of intestine, constrictors, the positive effect was obtained in 96% cases, after
1-3 sessions.
When the pain was caused by the increased size of liver and the
distension of Glisson's capsule, the decrease of pain syndrome was noticed in
the half of the patients. The pain disappeared after diuretic procedures.
Patients on the sanatorium stage of rehabilitation after HID,
myocardial infarction were given laser therapy with regard to the frequency of
stenocardia attacks, disfunction of the hemodynamics of cardiac rhythms.
Patients with stenocardia of strain of the II functional class
received treatment, according to the distant method (on the precardial area up
to 5 mW/cm2 and up to 5 minutes).
In cases of stenocardia of strain of the III functional class,
ventricular extrasystole, blood circulation disorders IIA, macrofocal myocardial
infarction, the method of intravenous radiation was used. This group of patients
received nitrates, antiarrhythmic medicines, diuretics.
For the objective estimation of the results, they were compared
to the results of the control group (52 patients who didn't receive
lasertherapy).
The course of 7-10 sessions allowed to decrease the dose of
nitrates or do without them in 76% cases. The study of catamnesis during a year
period showed the absence of repetitive myocardial infarction among those, who
had received intravenous radiation.
It is clear, that the anaesthetic effect accompanied the
reverse development of the pathologic process, the remission stage of the
disease.
The treatment of patients with the locomotor system pathology
resulted in the decrease of the signs of degenerative-dystrophic process (the
joints deformity, the improvement of the indexes of flexion and extension).
In cases with HID patients, the improvement of coronary and
myocardial reserve can be estimated according to the ECG , the indexes of
central and peripheral hemodynamics.
In cases of digestion diseases, there was the improvement of
the repetitive function of the intestine, bile passage. According to the data of
the test Garkavi-Kvakina-Ukolova, the examined patients demonstrated the
restoration of adaptation physiologic reactions. The study of zeta-potential of
the buccal cells nuclei allows to speak about the improvement of
electro-physiologic processes, which is characteristic of the mobilisation of
sanogenetic mechanisms in the course of laser therapy.
Conclusions.
1. In cases of diseases, going on with a distinct pain
syndrome, the method of the choice of treatment may be
LLLT in the spectrum red
range.
2. The action of laser irradiation with the wavelength 632.8 nm
in the continuous mode, accompanied by the use of distant and local methods,
shows a favourable influence on the reverse development of the pathologic
process, thus causing the lessening of pain syndrome of various genesis.
3. The availability of corresponding devices and the simplicity
of procedure actions allow to make a good use of
LLLT in practical medical
care.
