CO2 laser in oral graft-versus-host disease: a pilot study

Abstract

Summary:This paper is the first to report the benefits of CO 2 laser treatment for pain control in severe oral chronic graftversus-host disease (GVHD). A CO 2 laser device was used during 17 treatment sessions in four patients. The CO 2 laser was applied over the mucosal lesions using 1 W for 2-3 s/1 mm 2 . This treatment resulted in a consistent and significant decrease in pain, measured using a standard visual analogue scale. These results suggest that the CO 2 laser can be used for the alleviation of pain in oral chronic GVHD. The treatment for GVHD usually involved first and second lines of treatments with systemic steroids, cyclosporine and azathioprine. However, oral GVHD is often refractory to systemic treatment, necessitating complementary topical treatment. Furthermore, when the oral mucosa is the solitary site of GVHD involvement, a topical approach may prevent the severe side effects associated with systemic treatments. There are several agents currently used topically for oral GVHD. These include palliative rinses, topical immunosuppressive agents (such as steroids, cyclosporine and azathioprine 1,3,4 ) and phototherapy. 5 Adjunctive treatments include oral hygiene to avert infection and measures to prevent complications of xerostomia (such as topical fluorides, saliva substitutes and sialogogues, that is, pilocarpine). 1 A low-energy laser was first reported to prevent radiation-induced mucositis in cancer patients. 6 A randomized trial with 30 patients found that the low-energy He/ Ne laser is capable of decreasing the severity and duration of oral mucositis associated with radiation therapy as well as reducing patient reports of oral pain. 6 Two recent pilot studies have shown the palliative effects of low-energy laser therapy for oral mucositis. 7,8 In these studies, lasers were operated in the milli-Watt range. The CO 2 laser that we selected allows treatments at higher power (1-10 W range).The potential of the CO 2 laser as a pain relief modality was initially reported in a small group of patients suffering from recurrent aphthous ulcers. 9 The palliative effects of the CO 2 laser have not been assessed for other mucosal lesions. Therefore, we speculated that the CO 2 laser can ease suffering from inflammatory lesions of oral chronic GVHD. The exact mechanism of the analgesic effect of the CO 2 laser is unknown. A possible explanation for this is that the CO 2 -laser-activated c-fibers induce a central somatosensory cortical response. 10 Conflicting evidence suggests that the CO 2 laser induces a spinal inhibitory effect via peripheral nerve stimulation. 11 The purpose of our pilot study was to evaluate the efficacy of the CO 2 laser to relieve severe pain caused by oral chronic GVHD. Patients and methodsA total of 17 laser treatments were provided to four HSCT patients (two males, two females) with severe painful oral chronic GVHD. All patients were hospitalized due to GVHD. During days prior to laser treatment, systemic analgesics (morphine and methadone) and local anesthetic mouthwashes (lid...

Non-Thermal, Non-Ablative CO2 Laser Therapy (NACLT): A New Approach to Relieve Pain in Some Painful Oral Diseases

“…The average VAS scores before, during, and immediately after CO 2 laser treatment were 8.09, 3.47, and 4.88 respectively. There was no visual damage to the oral mucosa and no aggravation of the oral lesions (Elad, Or et al 2003).…”

“…In a report, Elad et al suggested that CO 2 laser treatment could be of benefit to control pain in severe oral chronic graft-versus-host-disease (Elad, Or et al 2003). In this study, the oral lesions of four patients were irradiated by CO 2 laser during 17 sessions.…”

“…Recently, there have been few reports about using CO 2 laser in non-ablative manner to reduce pain in painful mucosal lesions (Elad, Or et al 2003;Sharon-Buller and Sela 2004;Zand, Mansouri et al 2009;Zand, Najafi et al 2010).…”

“…In these two reports, water (Elad, Or et al 2003) and transparent gel with high water content (Sharon-Buller and Sela 2004) were used to reduce the beam absorption by the soft tissue.…”

Relieving Pain in Oral Lesions of Pemphigus Vulgaris Using the Non-ablative, Non-thermal, CO2 Laser Therapy (NTCLT): Preliminary Results of a Novel Approach

“…No kind of thermal complications were observed after laser treatment. [7][8][9][10][11] This non-destructive technique was initially called non-ablative CO 2 laser therapy (NACLT) and non-thermal CO 2 laser therapy (NTCLT) afterwards. The results of thermometry and powermetery confirmed the low level phototherapeutic character of NTCLT.…”