Inflammation - Ask Dr. P

What is Red Light Therapy, and Can it Help Arthritis?

by Pain Doc | Feb 13, 2022 | Arthritis, Red light therapy

Red light therapy (RLT) is a type of treatment provided in clinical and cosmetic settings that incorporates red light to improve the skin’s appearance, such as reducing fine wrinkles, scars, redness and acne. It is also used in the medical setting to help reduce pain and increase healing in the joints, such as tendinitis, sprains/strains, and arthritis.

Red Light Therapy is also known as:

Phototherapy
Photodynamic therapy
Photobiomodulation
Low-level laser light therapy*
Low-power laser therapy*
Cold laser therapy*
Biostimulation
Photonic stimulation

*this is a misnomer, because red light therapy does not use laser energy.

Interest in red light therapy emerged decades ago when NASA conducted experiments on growing plants in space and healing injuries to astronauts. Results of this research pointed to a connection between red light and positive, biological effects on human tissues. This ability of light (photons) to alter biological activity in living cells is called photobiomodulation and is the means by which RLT achieves therapeutic benefit.

What is Light?

Understanding this requires some basic knowledge of how the eye works, and physics.

First of all, vision is possible only in the presence of light. This means light must bounce off objects in your visual field and enter your eye, which then “translates” the bounced light into an image that is perceived by your brain.

But how do we perceive color? White light is actually made up of wave energy that propagates in multiple wavelengths. It is this difference in wavelengths, the molecular properties of all objects, and the design of the human eye’s retina that creates the perception of color. Objects that appear a certain color reflect the wavelength of just that color into your eye and absorb all other wavelengths. For example, a red shirt reflects the red wavelengths and absorbs the blue, orange and yellow wavelengths. Altogether, these component wavelengths of white light is called the visible spectrum of the electromagnetic spectrum, which is shown here:

Electromagnetic energy exists as an electrical field with a magnetic field 90 degrees to its axis and propagates at the speed of light. The electromagnetic spectrum is the range, in wavelengths, of electromagnetic energy existing in nature, from the very tiny wavelength gamma ray (.0001 billionth of a meter) to the very long wavelength of AM radio (100 meters). Light is in between these extremes and is the only EM waves humans can see, between the wavelengths of about 380 to 700 nanometers (nm, billionths of a meter).

When light passes through a crystal prism, it bends. Since light is made up of different wavelengths, the component EM waves of white light behave differently (bend at different angles and speeds) as they enter the prism and can now be visually distinguished from one another as separate colors in a band: red, orange, yellow, green, blue, indigo, violet. Similarly, rainbows form when suspended rain droplets bend the sun’s light and separate it into its component colors.

RED light is the longest wavelength of visible light, while VIOLET is the shortest. As the electromagnetic wavelength increases, the frequency (the number of times the wavelength passes a fixed point, measured in hertz – Hz) decreases, and so does the amount of energy it carries. So, the very small wavelength/high frequency gamma and x-rays carry a lot of energy and are dangerous to tissues. You may have heard that ultraviolet (UV) light can cause skin cancer. This is because much of its energy is absorbed by the skin, where it does damage to cells. Red light, being the longest wavelength of light, doesn’t have the energy level of UV and therefore does not pose danger to tissue; in fact, as we will discuss later, it has beneficial effects to tissues.

How Does Red Light Therapy Work?

Red light therapy is used to:

Improve wound healing
Reduce pain in joints
Treat tendonitis
Reduce headaches
Reduce stretch marks
Reduce wrinkles, fine lines and age spots
Improve psoriasis, rosacea and eczema.
Improve appearance of recent scars
Improve hair growth in people
Improve acne

It’s well established that light can initiate biological change in living organisms. Perhaps the most well-known is photosynthesis, the series of biochemical reactions where sunlight energy catalyzes the formation of sugar (glucose molecules) in plants. Photons from light get absorbed by tiny structures in a plant called chloroplasts, which provide the biological machinery to synthesize glucose (basically, stored energy) from inorganic carbon dioxide and water.

Another example of light effecting change in living tissue is vitamin D formation, where the pre-cursor of vitamin D is created when UVB light strikes 7-dehydrocholesterol molecules in the skin

Sunlight catalyzes Vitamin D synthesis in skin

With red light, the pathway is likely similar. Many research studies have been conducted over the years to uncover the mechanism behind red light photobiomodulation; i.e. the nature of its therapeutic effects. What is definitely known is that the red light wavelength (in the 660-700 nm wavelength range) tends to get absorbed in the nucleus and mitochondria of cells, in locations called chromophores. Mitochondria (image below) are the structures where energy is generated for the cell, much like the previously mentioned chloroplasts in plant cells. The nucleus contains the DNA, which is the template for protein synthesis.

We also know that photons can “excite” electrons – the tiny charges that orbit atomic nuclei. Cells and all their parts including the mitochondria are of course made up atoms. An “excited” electron means a movement of an electron to a higher energy orbit (further from/ less attracted to the nucleus).

In short, red light stimulation increases the energy state of electrons in sick tissues, enabling faster/enhanced reaction between adjacent molecules, as electron interactions between atoms are the basis of all biochemical reactions. This may translate into the cell “speeding up” its activities, particularly respiration (ATP formation from glucose via the Krebs cycle, i.e. energy production) as well as waste elimination and gas exchange. Redox signaling is the term used to describe this activity, and is the leading hypothesis for the mechanism of red light photobiomodulation.

With enhanced cellular signaling:

If the cell is a fibroblast, it could lead to faster wound healing, as fibroblasts migrate to the injury/damaged site to synthesize and lay down collagen fibers.
If the cell is a stem cell (undifferentiated cell), it could enhance the transformation of stem cells to fibroblasts or chondrocytes, which make collagen and cartilage, respectively.
If the cell is an epidermal cell, it could mean faster cell turnover to clear out abnormal cells in skin conditions such as eczema and psoriasis.

Cells are programmed to respond to specific extracellular signal molecules for development, tissue repair, immunity, and homeostasis. Errors in signaling interactions may lead to diseases such as cancer, autoimmunity (such as rheumatoid arthritis), and diabetes. Given this, it is feasible to assume that if red light therapy can enhance cell signaling, it can benefit these cellular functions and support tissue healing and pain reduction.

Red Light Therapy is Shown to Reduce Inflammation

Many studies found that red light reduced inflammation in tissues. Inflammation is the body’s response to injury or some kind of irritant and is characterized by redness, swelling, and pain. It involves a complex series of steps involving multiple protein clotting factors in the blood and tissues.

Inflammation also involves several types of cells involved in the reparative process, including macrophages (“cleaner” cells that remove debris), basophils (a type of white blood cell that secretes histamine and heparin to make blood vessels more leaky and manage clotting), and fibroblasts. It also involves cytokines—chemical signaling molecules that cells use to communicate and coordinate activities within themselves and with each other.

Inflammation often gets out of hand at the injury/ damaged tissue site and contributes to the problem by increasing pain and delaying healing. In fact, diseases like arthritis, irritable bowel syndrome, vascular disease, diabetes, and even Alzheimer’s disease involve chronic (ongoing) inflammation. This is the basis for the utilization of anti-inflammatory medications such as steroids and non-steroidal medications (NSAIDs) like Tylenol and Ibuprofen for inflammation.

The inflammation-reducing ability of red light therapy is likely due to its ability to enhance cell signaling and molecular flow in the cell. One study notes that overall reduction in inflammation is one of the most reproducible effects of photobiomodulation [from red light]. This is particularly important for inflammatory diseases affecting joints; acute trauma, lung disorders, and brain injuries resulting in inflammation.

Another proposed model to explain how light therapy works is photon-mediated ion channels in cell membranes (image below). Basically, ion channels are the passageways in membranes (think tiny gated doors) where ions flow through, which require energy to open. An electrical gradient is formed as the ion concentration differs on either side of the membrane, and this gradient can be used to drive movement of molecules into and out of the cell, very much like voltage. In fact, this is how neurons produce nerve impulses. Red light photons may be able to activate these ion channels, thereby boosting efficiency of ion flow and helping the cell maintain equilibrium.

Ion channels create energy potential in cell membranes

Should You Try Red Light Therapy for Arthritis?

Given its photobiomodulation ability, red light can be a useful, self-administered treatment for skin conditions and tissue injury/pain. It has powerful effects of improving cellular function to diseased/ injured tissues, which can improve recovery and healing. Being lower frequency, it is not harmful to the body, unlike UV light.

However, red light therapy should not be considered a “magic bullet” for “curing” things. Every person is different, and if you have complicating factors in your health and/or your condition is advanced, it may not work as well. While the human body has remarkable regenerative and healing abilities, there are limitations.

For example, in the case of advanced degenerative osteoarthritis of the knee or hip, much of the cartilage has worn away, and there are multiple areas of exposed bone. Normal, healthy cartilage that lines joint surfaces is smooth and resilient to pressure. Unlike the epidermis (skin), it does not regenerate very well, so if you lose quite a bit of it or tear it, it cannot regrow back to normal.

Osteoarthritis of the knee

But, if you are at the very early stages of osteoarthritis, red light therapy can be very helpful in arresting its progression. Arthritis usually appears mid-age, but if you engaged in heavy contact or heavy impact sports such as football and gymnastics, it may start earlier. What happens is tiny disruptions in the cartilage start to gradually separate, much like how a tiny crack in your windshield “grows” in length as your car absorbs shock from the road each time you drive. These tiny separations then form pits in the cartilage, which widen. Bone is exposed, inflammation sets in, and you’re on your way to an eventual knee or hip replacement some years later. But if you apply red light therapy to the tiny disruptions as they form, there is a much better chance of arresting their progression by stimulating cartilage growth. The red light will energize chondrocytes, the dormant cells embedded in the cartilage matrix tasked with maintaining it, and can stimulate the proliferation of chondroblasts, the cells that secrete collagen matrix.

You can still apply red light to an advanced osteoarthritic knee for palliative purposes, since red light can suppress inflammation and therefore provide some degree of pain relief. If doing so allows you to stay on your feet a couple more hours in a day, then that is definitely a positive benefit to your quality of life.

A good solution for applying red light therapy to the knee is the 120 LED wrap. It is a flexible pad containing 120 light emitting diodes (LEDs) with each diode containing one (1) 660 nm red light emitter and two (2) 850 nm infrared emitters. You wrap it around your knee and hold it in place with an elastic band that comes with it, and press a button.

Alternatively, if you are patient, you can use a red light torch device. This requires you to hold it in place for a couple of minutes. The good thing about the torch is that you can target small areas. For example, if you know you have a cartilage tear on the inside of your knee joint, you can press the torch over it and concentrate the light on that one spot. The torch is also good for small joints; i.e. knuckles.

As always, when you self-treat conditions use a multi-pronged approach: improve your diet, get enough rest, drink enough water every day (sometimes not easy to remember!), avoid ingesting toxins as best you can (nix smoking, alcohol, processed food, excessive pollution); get fresh, clean air by walking where there are lots of trees; exercise/ move often to strengthen your muscles and heart, and avoid negative thinking, which elevates stress hormones. Do all these things consistently and you can rest assured that you are giving your body its best chances for recovering from disease and pain.

Are You On Your Way to Getting Arthritis?

by Pain Doc | May 8, 2014 | Uncategorized

Arthritis, which translates to “irritation of a joint,” has the potential to develop into a debilitating condition that can significantly reduce your activities of daily living (ADL) and quality of life. It involves pain, stiffness and understandably a reduced ability to move and engage in exercise. Lack of exercise/ mobility promotes weight gain, which can make the arthritis worse as the joint surfaces bear increased weight.

If the pain is strong enough, sufferers resort to over-the-counter medications such as acetaminophen (Tylenol, Paracetamol), NSAIDs, or non-steroidal anti-inflammatories (Ibuprofen, Naproxen); and if the pain is severe, opioid drugs. All of these drugs have dangerous side effects, which become more significant if they are taken long term. This includes liver damage, gastrointestinal problems, muscle and joint pain, and for opioids, constipation, nausea and drug addiction/dependency.

Today, I will address specifically osteoarthritis, or OA. It is the most common form of arthritis and is the major cause of disability in persons aged 65 and over. Osteoarthritis affects primarily the weight-bearing joints such as the ankles, knees, hips, lower spine and lower neck. It starts out non-inflammatory (unlike rheumatoid arthritis, which is an inflammatory auto-immune form of arthritis) and involves gradual wear and tear of the cartilage surfaces of the ends of the bones that form the joint. In advanced stages, the damaged cartilage triggers mild inflammation (swelling, increased vascularity, increased pain) and the condition is better described as inflammatory osteoarthritis.

Osteoarthritis has systemic risk factors and local risk factors.

Systemic risk factors include age, sex, race, bone density, genetic factors, nutrition and hormonal status (which is related to age).

Black Americans have a higher incidence of OA than white Americans; however the association may be rooted in demographics/ cultural factors rather than genetics.
Reduced production of human growth hormone (HGH) and the sex hormones (estrogen, testosterone) are associated with reduced cartilage pliability; i.e. increased brittleness and less thickness.
Cartilage is thought to be highly vulnerable to oxidative stress (free radical damage, oxidation), and high doses of vitamin C and D are protective against the development of OA. Smoking, pollution and a diet high in processed food are factors that promote oxidative stress.

Local risk factors include obesity, occupation, prior joint injuries, existing joint instability, sports/physical activities and congenital joint abnormalities.

Obese individuals experience increased pressure in their weight bearing joints when standing or sitting. This can force water content out of the cartilage and lead to small tears which then lead to larger tears and “bone on bone” contact within the joint.
Occupations that involve repetitious trauma/ forces to the joints increase risk for OA.
Sports, especially football, basketball, long distance running and gymnastics can result in accelerated cartilage degeneration especially after age 40.
Prior injuries/ trauma that subluxated or misaligned a joint will predispose it to accelerated OA as the joint loses its normal mechanical function. The joint surfaces may not articulate properly, and weight distribution along the surface may become uneven following trauma.
Congenital anomalies such as scoliosis and fused vertebral segments can also alter normal joint movement and promote accelerated OA.
Weak muscles can deprive joints of protection and stability, predisposing them to OA. Weak muscles are related to sedentary lifestyles, whether by choice or secondary to an incapacitating condition like advanced Type 2 diabetes.

The bottom line:

If you have systemic risk factors, think in terms of diet and nutrition to ward of their effects. You can’t control aging, you can’t control your sex and race, but you can control the level of oxidative stress in your body and you can “down-regulate” genes that may predispose you to arthritis by adopting a healthy diet and lifestyle.

If you also have several local risk factors for OA, think in terms of minimizing their effects. Unstable joints from prior injuries can benefit from targeted exercises that strengthen the joint; perhaps some occasional spinal and/or extremity adjustments from a chiropractor or therapist; supports/orthotics as applicable; and avoiding activities which over-stress the affected joint. For example, if you have a spondylolisthesis, it’s best to avoid running and instead do speed walking or use an elliptical machine to get your cardio exercise.

If you are suffering from chronic pain in your muscles and joints, nerves and ligaments, stay tuned for a new multi-media educational course being developed, Get Rid of Pain Forever. To receive notice of its launch, visit here.

An Often Neglected Approach to Self-Treat Disc Bulging

by Pain Doc | Aug 27, 2013 | Uncategorized

Disc bulges, or herniations, come in a variety of presentations. They usually are limited to the lower lumbar spine (L3/4 to L5/S1) and the neck (C4/5-C7/T1). In taking the medical history of patients suffering from disc bulges, there is usually a history of a sedentary office job that requires sitting long hours; a previous injury like a sports, work, or car accident injury; and in rare cases, no significant event or habit that could explain how the disc bulge occurred. In fact, there are studies that indicate that degenerative disc disease, which can include varying degrees of disc bulging, can be hereditary.

A common theoretical model for degenerative discs goes like this: something happens that causes the disc to bear excessive weight, which over time forces fluid out of the disc causing it to dessicate. The outer fibers responsible for keeping the disc intact and the nucleus in place weaken, allowing the center nucleus to bulge outwards. Chiropractors often attribute this scenario to subtle misalignments in the vertebrae caused by minor trauma, prolonged sitting and insufficient support from the abdominal muscles and lumbar muscles. Normally the disc should support 80% of the weight above it and the facet joints (the smaller joints behind the disc) about 20%. But if a physical event changes the orientation of the vertebra, it can force the disc to support 90-100% of the weight, accelerating its demise.

Other models reference calcification of the vertebral end plates,the surfaces of the vertebrae above and below the disc, which then prohibits capillaries from feeding nutrients to the disc causing it to die. Bone calcifies in response to trauma; vertebral end plates can sustain “micro-compression” injuries from activities that place a heavy, axial load (perpendicular) to the disc. Examples include basketball, gymnastics, running, and parachuting.

An acute herniated disc can be extremely debilitating, as it tends to last a lot longer than a typical sprain/strain injury. It hurts, limits movement, can make sleep difficult and restricts you from work and physical activity. If it presses on a nerve root it can send shooting pains down the buttock and leg and cause numbness and weakness. The general recommendation for most cases of non-emergency disc herniations is to manage the pain using physiotherapy (ice, heat, muscle stim, laser), do physical therapy including stretching and strengthening exercises and wait for the disc bulge to self-resolve in 2-3 weeks. Once it heals and the inflammation goes down, the pain usually goes down as well.

If your disc herniation is pressing on a nerve root, the disc may shrink as it heals, removing pressure from the nerve. This is the best scenario obviously, as you avoid surgery and get your life back. At this point, it is prudent to avoid activity that risks re-injury (heavy lifting while turning torso) and do everything you can to strengthen your core muscles and spinal muscles to guard against re-injury. Functional exercises should be emphasized, for this purpose.

The thing that can dramatically increase the chances of full recovery without surgery is healing your insides– reduce systemic inflammation by getting down to a healthy weight and maintaining it; stop smoking, avoid alcohol as best you can, reduce stress, reduce insulin levels, maintain normal blood glucose levels, ensure that your gut micro flora is in balance, and get adequate sleep every day. Eat healthy, decrease your portions, and drink enough water to stay hydrated throughout the day. Exercise consistently, 20-40 minutes each time. This is what a healthy lifestyle routine is made of.

People who are in pain usually are concerned about knocking down the pain first, and ignore the health of the rest of their body. Remember, your entire body is essentially a colony of specialized cells that are interconnected via the bloodstream, nerves, and hormones. When one area is injured, the rest can come to its aid.

If you suffer from disc herniations, joint pain or other musculoskeletal form of pain and are overweight, pay more attention to getting yourself healthy inside; it’s the often ignored self-help method to treat pain.

Prolotherapy: A Controversial Remedy for Muscle and Ligament Pain

by Pain Doc | May 28, 2011 | Uncategorized

Prolotherapy, short for proliferation therapy is a controversial technique that involves a series of injections of an inactive irritant substance into a painful joint, or area where ligaments or tendons insert into bone. The injected substance can be dextrose, phenol, saline solution, glycerol, lidocaine, or even cod liver oil extract. Prolotherapy injections are intended to artificially initiate the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue.

Some of the signs that might benefit from prolotherapy include:

Joint laxity, such as in the shoulder, that does not resolve with standard treatment
Distinct tender points at tendons or ligaments as they attach to the bones
Unresolved, intermittent swelling or fullness involving a joint or muscle
Popping, clicking, grinding, or catching sensations in joints
Temporary benefit from chiropractic manipulation or manual mobilization
Aching or burning pain that is referred into an upper or lower extremity
Recurrent headache, face pain, jaw pain, ear pain
Chest wall pain with tenderness along the rib attachments on the spine or along the sternum
Spine pain that does not respond to surgery, or where there is no definitive diagnosis despite X-rays, MRIs and other tests.

So why is prolotherapy considered “controversial?” Because, according to the federal government (Health Care Financing Administration) there is currently no strong, compelling study that proves prolotherapy can cure cases of soft tissue pain. A “strong” study is one that has at least several hundred test subjects; has a control group (who get a placebo, or fake treatment) and is done in a “double-blind” methodology where the test subject and the administering doctor do not know if the injection is a prolotherapy agent (only a third member of the research study knows). However, there are numerous studies in the literature using smaller test populations (less than a hundred) that support prolotherapy as an effective treatment for pain.

A 2005 study entitled A systematic review of prolotherapy for chronic musculoskeletal pain (Clin J Sport Med. 2005 Sep;15(5):376-80) analyzed major studies on prolotherapy and reached the following conclusion:

Two RCTs (randomized controlled trials) on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy
Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations.

There is a research project at the University of Wisconsin involving prolotherapy to treat knee osteoarthritis that is due to publish its results soon.

So, if you have chronic musculoskeletal / joint pain, especially related to trauma, that has not resolved with cortisone injections, chiropractic, physical therapy, personal training, surgery, and time, prolotherapy may be worth investigating. The good thing about it is that it is generally safe.

Back Pain or Arthritis? Try Curcumin and Boswellia Extract

by Pain Doc | Feb 27, 2011 | Uncategorized

Image via Wikipedia

Curcumin is the yellow spice derived from the plant Curcuma longa, commonly called turmeric. Extensive research over the last 50 years indicates that curcumin can both prevent and treat cancer and inhibit inflammation. The anti-cancer potential of curcumin stems from its ability to suppress proliferation of a wide variety of tumor cells and down-regulate or inhibit various enzymes and biochemical pathways involved in cancerous activity and tumor growth.

Curcumin has been described as a potent antioxidant and anti-inflammatory agent. Pharmacologically, curcumin has been found to be safe. Human clinical trials indicated no dose-limiting toxicity when administered at doses up to 10 g/day. All of these studies suggest that curcumin has enormous potential in the prevention and therapy of cancer.

Boswellia frereana (known as Frankincense) comes from a tree native to Somalia. Clinical studies have shown its benefits for both osteo- and rheumatoid arthritis. Its anti-inflammatory properties have also been shown to make frankincense a safe and effective treatment for asthma, inflammatory bowel diseases, such as colitis, Crohn’s disease and ileitis.

A 2010 study on boswellia’s potential to reduce cartilage degeneration showed that it inhibited the breakdown of the collagenous matrix; reduced potency of various metalloproteinases, which are enzymes that break down protein molecules; and significantly reduced the production of inflammatory agents like prostaglandins and cyclooxygenase 2 (COX2). Epi-lupeol was identified as the principal constituent of B. frereana.

This was the first report on the observed anti-inflammatory properties of Boswellia frereana in an in vitro model of cartilage degradation. The researchers demonstrated that B. frereana prevents collagen degradation and inhibits the production of pro-inflammatory mediators and MMPs and therefore should be examined further as a potential therapeutic agent for treating inflammatory symptoms associated with arthritis.

So if you are experiencing chronic, inflammatory pain, it wouldn’t hurt to try increasing your intake of these two herbs.