Systemic Treatments

Arthritis

See individual syndromes for more specific treatments of different types of arthritis.

Subjective:

There will be swelling, stiffness, and pain. Symptoms may be worse in the morning.

Assessment:

There will be a decrease in swelling and pain. However, with more severe rheumatoid arthritis, light will manage symptoms but will not provide a lasting cure.

Adjunctive Treatment Plan:

Treat most areas with 5 to 25 joules points per point, with smaller joints receiving a total of 25 to 50 joules and larger joints 50 to 600 joules. Remember to treat all four sides of the joint. To improve the depth of penetration, place the device on one spot without moving it. Osteoarthritis seems to respond better than rheumatoid arthritis.

Hands/Fingers:

Treat smaller joints like fingers and toes with fewer joules than larger joints such as the knee and hip. Measure improvement by a decrease in stiffness and swelling, pain-free motion, and measuring grip strength with a pinch gauge or dynamometer.

Wrist:

Treat around the circumference of the joint with special attention to the primary area of pain.

Elbow:

Identify areas of tenderness and treat over the lateral and medial epicondyles as well as the adjacent soft tissue.

Shoulder:

Causes may be multifactorial, involving the shoulder, acromioclavicular and sternoclavicular joints, muscles, tendons, ligaments, and bursae.

TMJ:

Make certain that you treat the TMJ and the adjacent muscles.

Hip:

The most efficient access to the acetabulum is best accomplished from the groin (anterior acetabulum) and sciatic notch.

Knee:

Soft tissues around the knee, such as the subpatellar and suprapatellar tendon and ligaments, respond more quickly than problems deep within the joint.

Ankle:

It is important to treat the area where the problem resides, such as the subtalar or talocrural joint.

Foot/Toes:

Smaller joints such as the fingers and toes usually require no more than 25 to 50 joules per joint. With smaller joints and a larger cluster device, many of the photons are lost because of the poor alignment between the device and the rounded joint structure.

Adjunctive Treatment Plan:

Gentle stretching and range of motion activities are beneficial. Some patients find improvement in symptoms with a combination of oral glucosamine sulfate and MSM (methylsulfonylmethane).

Systemic Treatments

Bursitis

Subjective:

The patient complains of pain and decreased the range of motion due to a swollen bursa. A bursa is the small, fluid-filled sac that can cushion the tendons and muscles near your joints. The most common areas for bursitis are the shoulder, elbow, and hip. But they can also occur in the knee, heel, and the base of the big toe.

Assessment:

With treatment, the area of pain will decrease and pain-free range of motion will increase.

Shoulder:

The most common bursitis is the subacromial bursa. It is just beneath the acromion process of the clavicle and the rotator cuff muscles and tendons. Treat with friction massage, stretching, ice and 1–2 minutes of light therapy.

Hip:

The greater trochanteric bursa is the most common site of hip bursitis. It covers the greater trochanter can create pain with walking. Treat with gentle massage, stretching, ice, and 1–2 minutes of light therapy.

Elbow:

The posterior tip of the elbow is the site of olecranon bursitis. It can swell to resemble part of a golf ball and can require medical care if it becomes infected. Treat with ice and 1–2 minutes of light therapy.

Knee:

The most common sites are: 1. Prepatellar bursitis, just below the kneecap (Housemaid’s Knee), 2. Semimembranosus bursitis which is in the back of the knee (Baker’s Cyst), and 3. Infrapatellar bursitis, which is just below the kneecap.

Light Treatment Plan:

Use 1–2 minutes of light therapy if you have a powerful LED. If you have a low power LED, it could take 15–20 minutes. Use mild pressure to get photons deep into the bursa.

Adjunctive Treatment Plan:

Use 5 minutes of ice before light therapy for the first few days. Then add gentle massage. If the swelling worsens and turns red and inflamed, you may need a physician to rule out the need for antibiotics or draining the fluid with aspiration.

Systemic Treatments

Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy

Adjunctive Treatment Plan:

Medical management is imperative and light therapy must be performed with the approval or supervision of a physician. Range-of-motion stretching, medication, nutritional counseling, and gentle cardiovascular exercise are vital in maintaining the health of the injured limb.

Assessment:

There will be a decrease in pain and an associated normalizing of temperature in the symptomatic limb.

Subjective:

RSD or CRPS is a very painful syndrome that can cause swelling, redness, temperature changes, and moderate to severe pain. It usually occurs in the hands or feet, although it can occur almost anywhere in the body. The cause of the pain is often due to a minor trauma that surprisingly creates this serious pain condition.

Light Treatment Plan:

Treatment can be given two to three times a week for up to three or four weeks to see if light therapy can be of benefit. It is important to start treatment with a very low dose and only increase the dose slowly and carefully, once positive results appear. Positive effects include a decrease in pain and temperature change of one or all of the limbs.Negative effects can be an increase in pain. The first treatment should be no more than 10 to 20 total joules, only increasing if there is no increase in pain. Start by treating along the transverse processes of the thoracic spine (C7 to L2). This correlates with the sympathetic chain ganglia (SCG).

If this does not produce any positive effects, try giving the next treatment to the stellate ganglia (SG), which is located on the anterior lateral transverse process of the seventh cervical vertebra. If symptoms are improved or there is no change, in the next session treat the SCG or the SG with a slightly higher dose, such as 20 to 100 joules. If the symptoms are improved or there is no change, in the next session treat the SCG and the SG. If treating the SCG and the SG produces no side effects, try treating the opposite limb and assess if there is any improvement in symptoms. Only treat the symptomatic limb once treatment has been directed to the SCG, SG, and then opposite limb over a series of treatments with no negative side effects or some mild decrease in symptoms.

Systemic Treatments

Fibromyalgia Syndrome

Subjective:

Most patients complain of morning stiffness and sleep problems. Many complain of feeling as if they have swollen extremities, with numbness and tingling. These symptoms generally are more common in the upper than in the lower extremities.

Assessment:

Improvement is slow and steady.

Light Treatment Plan:

Treat with no more than 25 joules the first treatment, composed of 5 to 10 joules per point. Later, with improving symptoms, the dose can be increased to a total full body dose of 50 to 600 joules as long as it is titrated slowly.

Adjunctive Treatment Plan:

A multidisciplinary treatment plan composed of exercise combined with education and cognitive behavioral therapy can be highly effective. In addition, gentle manipulation and massage can help decrease stiffness and pain. Daily aerobic and flexibility exercises should be performed at least three times weekly starting gently and slowly increasing in intensity. Warm water aquatic therapy is well tolerated and especially helpful for some patients.

Systemic Treatments

Herpes, Shingles, and Postherpetic Neuralgia

Subjective:

Patients complain initially of a small area of painful, red lesions. Over time the severity of pain usually increases and can become severe.

Assessment:

Initially there will be a decrease in pain followed by the disappearance of the lesions.

Light Treatment Plan:

Treatments twice weekly for three weeks are appropriate for acute cases, followed by once per week after there has been a significant decrease in pain. Utilize a maximum of 25 to 100 joules on the first visit.

Adjunctive Treatment Plan:

A referral to a physician for antiviral medication or herbs, laboratory testing, or imaging studies may be necessary in more serious cases.

Systemic Treatments

Postsurgical Pain

Subjective:

Pain in the area of the surgery.

Assessment:

Pain will be reduced within hours and should create less need for analgesics and anti-inflammatories.

Light Treatment Plan:

First treatment is 25 to 50 joules over the average size wound surface. Raise the dose slowly if there is a positive response.

Adjunctive Treatment Plan:

Icing the area prior to treatment can assist in the reduction of inflammation.

Systemic Treatments

(Slow or Non-Healing)

Wounds

Subjective:

Patients report impaired healing of wounds. The problem is more common in diabetics and those with circulation difficulties. Make certain that the patient does not have the obvious signs of infection, including fever higher than 100°F, significant pain, increasing redness or faint red lines, heat, chills, lymph swelling or tenderness, pus, or swelling. If there is any suspicion that the wound is infected, refer the patient to a physician immediately.

Assessment:

The initial goal is to decrease discomfort. The size of the wound will decrease with time as the perimeter begins to heal. Watch for possible signs of infection and refer the patient to a physician if this is suspected.

Light Treatment Plan:

Treatment is ideal after the wound has been cleaned, as the presence of thick, poor-quality tissue will attenuate the absorption of the light beam.

The most common method is to treat the wound by “painting” back and forth over the wound with a cluster of LEDs. A wound that is 2.5 cm (1 inch) in diameter would need an initial dose of approximately 25 to 100 joules. Treatment can commence daily with decreasing frequency as the wound begins to close and heal. Spend two-thirds of the treatment time on the periphery where there is a higher concentration of actively dividing cells and one-third of the time at the center of the wound where more of the cells are less active. This is done to most effectively stimulate cell growth and improve healing.

If you are using a device designed to treat acupuncture and trigger points, it is more effective to treat a grid of points that covers the wound. However, it is still important to deliver more of the photons to the periphery than the center of the wound. Patients may experience an immediate decrease or an increase in pain. Treating with a low dose on the first treatment and then titrating upward with each subsequent session can minimize this reaction.

It is most effective to treat the wound with the laser when changing a bandage or dressing. However, it is not imperative to take the bandage off the wound before treating. Using a red or IR device, it is possible to treat in contact with the sterile dressing. However, you will need to double or triple the dosage because a typical gauze bandage significantly reduces the number of photons passing into the wound.

Wounds can be treated up to two to three times a week, decreasing frequency as the wound heals. It is common for more critical wounds to require 20 visits or more. Less serious wounds can respond after five to ten treatments. Occasional treatments may be necessary afterward to continue promoting tissue regeneration and complete wound resolution.

Studies show that higher doses are more analgesic and lower doses stimulate healing more effectively. Thus, if healing plateaus before resolution, consider increasing or decreasing the dose to a maximum of 600 joules with a high power probe.

Adjunctive Treatment Plan:

Be certain that the wound is not infected by making sure that the physician supervising the treatment is a specialist in wound care. Make sure that the patient has an excellent diet and the wound is cleaned frequently.  We hope the systemic treatments outlined in this page will be helpful to you.

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