Can LLLT Therapy Help Relieve Pain for Amputees?
Santamaria E, Ribas C, Palva W, et. al. Use of low intensity laser treatment in neuropathic pain refractory to clinical treatment in amputation stumps. Dove Press, September 2012 Volume 2012:5 Pages 739—742, https://www.dovepress.com/use-of-low-intensity-laser-treatment-in-neuropathic-pain-refractory-to-peer-reviewed-article-IJGM.
Neil MJE, Pain after amputation. Oxford Academic, BJA Education, Volume 16, Issue 3, March 2016, Pages 107–112, https://doi.org/10.1093/bjaed/mkv028
Amputation of a limb is one of the oldest recorded surgical procedures. Traumatic amputation and use of a prosthesis is found written in Sanskrit texts dating from 1800 to 3500 BC. Today, amputation remains a commonly performed surgical procedure. Debilitating stump pain following amputation surgery is a major problem when it affects the patient's quality of life, often making the patient totally dependent on others for their day-to-day care. Attempts have been made to treat those patients through pharmacological, psychological, and physical therapies, but in many cases, these fail to relieve the pain.
Santamaria’s article focuses on patients with chronic, intense, and debilitating stump pain who were previously treated with pain medications, but with little success. Neil reports post-amputation pain management remains a challenging area of clinical practice. A wide variety of pain problems present after operation which need careful clinical assessment to differentiate. Despite considerable advances in surgical and anesthetic practices, pain related morbidity remains high after amputation. The evidence base for optimal analgesic management is incomplete but it is wrong to use this reason as a basis for persevering with conventional treatment strategies that have proved ineffective.
There are an estimated 150,000 surgical amputations per year in the US, most of which are secondary in nature, arising from diabetes mellitus, vascular disease, trauma, and cancer. Residual pain in amputation stumps can extend beyond the normal recovery time and is seen in 13%–71% of cases. After the nerve injury, spontaneous nerve activity develops at the site of injury and the corresponding dorsal root ganglia. These changes are followed by sensitization, reduction of the pain threshold, exaggerated response to nociceptive stimuli (hyperalgesia) or non-nociceptive (alodinea), and phantom sensations. The syndrome of a phantom limb with associated pain is found in 70%–85% of amputees, and pain persists in 5%–10% of these people. Sensory abnormalities are also described in more than 50% of patients with amputation stumps. The residual pain may be due to several factors, such as an underlying disease, bone deformities, wound healing, or neuropathic pain.
The patients in Santamaria’s study underwent nine sessions of low-intensity laser therapy (LILT) [LLLT] to the stump. All patients reported a decrease in the intensity of their pain and increased ability to perform daily living activities during a 4-month follow-up.
The main objective of the study was to assess whether LILT [LLLT] treatment would result in pain relief in the amputated stump, expressed by a decrease in VAS scores. As a secondary objective of the study, the effect of LLLT on the improvement of independency and functionality of the patient was also assessed (this would be expressed by an increase in the Barthel and Lawton scales).
All patients reported subjective pain relief after nine sessions of low-intensity laser. The patients had allodynia and hyperpathia prior to treatment, and the LLLT treatment produced a verified remission in hyperpathia and significant control of allodynia. The patients’ post-treatment reporting of pain through the VAS also showed a significant reduction in pain in all cases with pain dropping by five to seven points.
“The application of low-intensity laser treatment contributed to an improvement in our patients’ reported pain intensity, their ability to carry out daily living activities (Barthel scale), and their impairment in the carrying out of daily tasks (Lawton scale)”. A reduction in pain without the use of analgesic drugs can help reduce the excessive use of medication, reducing the potential side effects of high [or multiple] doses. Since no side effects were observed in the use of LLLT, its use can probably be started at a very early stage and on patients suffering from less pain.
It is known that pain causes loss of function and decreased independence of the individual, often leading to reduced mobility and increased rates of depression. The Santamaria study shows that LLLT can result in an improvement in patient independence, with an average gain of 50% in the Barthel scale and 37.5% in the Lawton scale, and all study patients improved to the point where they gave themselves the highest scores possible for the scales used in the study. This indicates that LLLT can be used to decrease pain in patients following amputations.
The results of the Santamaria, et al study provide competent and reliable scientific evidence that LLLT can have a beneficial effect in those with post amputation stump pain.