Low Level Laser Therapy For Chronic Pain and Fibromyalgia

By Bernard Filner, MD

Bernard E. Filner, MD

. http://thepaincenter.us/

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Low Level Laser Therapy For Chronic Pain and Fibromyalgia

Fibromyalgia Syndrome (FMS), at its core, is a disease of abnormal pain processing in the thalamus. This area of the midbrain, through which essentially all pain impulses travel, becomes “hyperirritable” to incoming pain impulses (via a process known as wind-up) over time, after some type of peripheral injury. This injury is almost always the development of muscle trigger points (TPs) in a myofascal pain syndrome (MFPS).

Myofascial pain is defined as pain at the site of active trigger points, referred pain from these trigger points to known areas, and muscle dysfunction. TPs are hyperirritable spots in a taut band of skeletal muscle that give rise to pain and may limit range of motion of affected muscles. This “hyperirritability” in FMS patients is usually seen as a near total-body allodynia (the response to a stimulus as painful, when such stimulus is not perceived as painful in “normal” subjects such as light touch, wind, or clothing). This widespread allodynia, combined with the pain of active trigger points in muscles, referred pain from active and latent trigger points, and limitations of the range of motion of these affected muscles, can explain most, if not all the clinical symptoms of FMS.

In a patient with widespread chronic pain all the palpable trigger points must be found and inactivated by a variety of possible treatments, which include injection, heat, stretching and low level laser therapy (LLLT). MFPS is generally responsive to the varied treatments. On the other hand, if pain that has the quality of allodynia persists after various treatments, and the patient has a history of “sleep problems”, depression, and/or “Fibro-Fog”, then the patient clinically appears to have FMS. If the allodynia persists, Cranial Electrotherapy Stimulation (CES) via ear-clip electrodes is helpful in resolving it. In the past six years, use of the Low Level Laser Therapy (LLLT), also called cold laser, in patients with FMS and MFPS has largely replaced TP injections. The treatment with LLLT has been the most beneficial new approach to FMS therapy.

In the past, physicians treating FMS noted the difficulties and resistance to response in these patients. This resistance may have been due to the previous use of trigger point injections, which were used to inactivate the muscular trigger points and reduce pain, but which were themselves extremely painful, if only for a few seconds (or longer if a large needle and/or steroid were used for the injection). The main point was the injection pain that was caused, set off a reaction that often outlasted the therapeutic effectiveness of the TP injection. Treatment of hypersensitive FMS patients with the newer LLLT method provides relief and avoids the pain of TP injection.