Case Study: treating neuropathic and phantom limb pain

Photobiomodulation (laser therapy) with infrared laser light can regulate neuropathic or phantom limb pain by affecting chronic inflammation, among other issues

“In December of 2016 I had a massive heart attack that required open heart surgery. During that surgery, a drug was administered that caused gangrene and ultimately cost me my left leg. I was in enormous pain for a very long time.”

This is the story of Rex Burress, a 53-year-old white male from Atlanta, Ga. The amputation of his left leg caused severe pain of the worst kind — phantom limb pain.

“An issue that a lot of amputees deal with is phantom pain,” Burress said. “This phantom pain manifested itself as the sensation of a steam roller parked on top of my foot, or as if a match was under my foot burning the sole, or of a railroad spike piercing my leg.”

There are nearly 2 million people living with limb loss in the United States, and roughly 185,000 amputations occur each year. Among those living with limb loss, the main causes are vascular disease (54%), including diabetes and peripheral arterial disease; trauma (45%), and cancer (less than 2%).

Pain among the amputee population

Phantom limb pain is an ongoing painful sensation that seems to come from the missing part of the limb. Onset most often occurs soon after surgery, and can feel like burning, twisting, itching or pressure. Nearly 80% of the amputee population worldwide has experienced this kind of pain.

“I went nearly two years thinking this can’t be me,” Burress said. “Initially my physicians had me on narcotics, and I hated the way that felt in my body. To make matters worse the nurses and doctors at that point told me that there was no way they knew of to stop the pain, even with narcotics.”

After years of pain and agony, how did Rex finally get relief? “I did find that Class 4 therapy laser treatment made an immediate difference and improvement,” he said. “The first time Dr. Enrique Crespo used the device on my leg I felt immediate relief. I’ve gotten treatment for three weeks now, and I’ve seen a mammoth reduction in the pain.”

Study results

Animal experiments show that photobiomodulation (PBM, also called ‘laser therapy’) with infrared laser light can regulate neuropathic pain by affecting chronic inflammation, reducing mechanical allodynia, suppressing conduction velocity and lowering amplitude of action potentials. Studies also show that PBM-induced anti-nociception comes from the release of central opioids, helping with pain relief in the early stages of treatment. Later stages of PBM treatment appear to induce permanent neuroplastic changes that maintain the antinociceptive state, without depending on opioid release in the periphery.

Photobiomodulation involves several mechanisms of action, including intra- and extracellular effects, as well as on the cell membrane. Some include absorption of laser photons by water molecules to enhance microcirculation, disassociation of inhibitory nitric oxide from the cytochrome-c oxidase enzyme, activation of light-sensitive ion channels, and activation of transcription factors.

Phantom limb pain and tissue relief

The primary effects of PBM occur when there is direct photonic absorption by chromophores in the tissues. Class 4 therapeutic lasers are FDA-cleared prescription medical devices that can deliver photons of red and infrared laser light to large volumes of tissue in just a few minutes of treatment time.

“This treatment has offered me substantial relief from my phantom pain issues,” Burress said. “I cannot recommend the Class 4 therapy laser highly enough.”

For suffering patients like Burress, photobiomodulation with a Class 4 therapy laser is a safe, effective solution.

Enrique Crespo, DC, graduated with honors from Life University and is licensed by the Georgia Board of Chiropractic Examiners. He has been recognized as a Certified Chiropractic Extremity Practitioner by the Council on Extremity Adjusting, and has been Certified in Functional Movement Techniques and Advanced FMT and IASTM/Advanced Certifications. He holds the prestigious Certificate of Advanced Training from Summus Medical Laser Class IV Therapeutic studies. He has successfully treated NFL players, Major League Baseball players, MMA fighters, Ironman triathletes, elite marathon runners and professional boxers. He enjoys teaching and is currently a clinical instructor with Summus Medical Laser Advanced Training Programs.