Can Low-Level Laser Therapy Have An Impact For Small Fiber Neuropathy?

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Author(s): 
Kerry Zang, DPM, Janna Kroleski, DPM, Shahram Askari, DPM, and Sanford Kaner, DPM

   Perhaps the variance in baseline epidermal nerve fiber density of the legs and feet we observed in study participants contributed to the failure to achieve statistically significant post-treatment improvements. Another possibility is that for some participants, we may have prematurely acquired the post-treatment biopsy to assess epidermal nerve fiber density of the legs and feet. We obtained all the post-laser biopsies immediately after the final laser treatment. In retrospect, waiting six to eight weeks after treatment may be preferable as the effects of the laser may not be immediate. It is our belief that waiting several weeks after the final laser application would allow the acute effects of the laser to transpire and promote an observable improvement in epidermal nerve fiber density.

   Treatments for small fiber neuropathy have been pharmaceutical in nature and have produced varying success rates. Low-level laser therapy is a non-invasive, low-risk treatment that we have shown to be effective in increasing the density of small fiber nerves in the epidermis in some patients. When one assesses the results collectively, these data demonstrate improvements at the micro- and macroscopic levels as a majority of participants exhibited improvements in epidermal nerve fiber density of the feet and legs along with each patient revealing improvements in the Total Neuropathy Score along with perceived pain.

   This multidimensional study attempted to assess neuropathic pain from multiple perspectives in order to successfully quantify and qualify the utility of low-level laser therapy. Given that we observed improvements across all study outcome measures, continuous investigation of this application is necessary.

   There is clearly a great need for quality research to evaluate the effects of low-level laser therapy on patients with small fiber neuropathy. The limitations of this study include a small patient population and the lack of a control group. Ideally, we would like to initiate a large cohort, double-blind, randomized control trial with a sham laser and a rigid protocol of how many laser treatments each patient receives and a more clearly defined schedule for the timing of the biopsies.

   We chose to present these findings as preliminary data because the patient response to the laser therapy was so promising. Given that low-level laser therapy is non-invasive and has no reported side effects, it is a very low-risk treatment option for patients with small fiber neuropathy. Patients are reporting a decrease in their neuropathy symptoms and, in some cases, are regenerating the small fiber nerves in the epidermis.

   Dr. Zang is the founder of the Arizona Institute of Footcare Physicians and is in private practice in Mesa, Az. He is a Fellow of the American College of Foot and Ankle Surgeons, and is a Diplomate of the American Board of Podiatric Surgery. Dr. Zang is an Adjunct Professor of Surgery at Midwestern University in Glendale, Az.

   Dr. Kroleski is in private practice at the Arizona Institute of Footcare Physicians in Mesa, Az.

   Dr. Askari is in private practice at the Arizona Institute of Footcare Physicians in Mesa, Az.

   Dr. Kaner is a Diplomate of the American Board of Podiatric Surgery and is in private practice at the Arizona Institute of Footcare Physicians in Mesa, Ariz.

References

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