****The Effect of Monochromatic Infrared Energy on Transcutaneous Oxygen Measurements and Protective Sensation: Results of a C
- 5/31/2008
- 1 Comments
- 4761 reads
Compared to baseline, sensation improved for group 1 after both six (P <0.02) and 12 (P <0.001) active MIRE treatments. No significant change in the number of sites able to sense the 5.07 SWM after six sham treatments in either group 1 or group 2 was observed.2 Monochromatic infrared energy significantly decreased the number of sites insensitive to the 5.07 SWM in group 1 but improvements in sensation, pain reduction, or neuropathic symptoms among participants with more profound sensory loss (group 2) were not statistically significant. The authors reported no significant improvements in ankle reflexes or vibratory sensitivity to a 128-Hz tuning fork during the study.
According to information listed on the Anodyne Therapy, LLC website (www.anodynetherapy.com), TcPO2 levels improved on a single patient (accessed December 12, 2003) and several scanning laser Doppler (Moor Instruments, Devon, UK) images show increased circulation. Burke9,11 reported that in 30 minutes, MIRE can increase local microcirculation by as much as 3,200%. He further reports, based on an online NO overview for which references are not provided, that in neuropathic feet, MIRE treatment increased microcirculation 10 times more than warmth alone. Finally, Burke11 reported on wound centers in Wisconsin that have noted increases in TcPO2 with MIRE, which he contributes to increased oxygen availability from the vasodilation induced by NO.
Wimberley et al9 report use of TcPO2 measurements as a major trend parameter and valuable indicator of tissue PO2 in adults. A repeated measures study20 compared laser Doppler flowmetry, skin perfusion pressure, and TcPO2 (44° C) on 21 consecutive patients with severe lower extremity arterial disease and found the same magnitude of variation with short-term measurements for all three methods. When the authors excluded TcPO2 measurements below 10 mm Hg, the mean coefficients of variations were 0.08 short-term and 0.31 day-to-day.
Methods
This study expands on the methods used by Leonard et al.2 All study participants served as their own control and the same inclusion criteria (diabetic neuropathy), MIRE pad placement, sensation testing protocol, and sites using the 5.07 (10-g) SWM were used. This study was approved by both the Norwalk Hospital and Nova Southeastern University IRBs.
Design. This was a quasi-experimental, randomized, double-blinded, pretest-posttest controlled study. All participants served as their own control by having each leg randomly assigned to either the sham or active treatment group. The first participant was randomized, by the toss of a coin, to which leg received the active/sham treatment with MIRE units labeled A or B. Subsequent participants were sequentially assigned A or B units for each leg to ensure equal groups. This assignment was consistent for all the treatments, with each leg receiving the same-labeled MIRE units as the first treatment.
The manufacturer, who disabled the sham units internally so no energy was emitted even though the machine power indicator light was on, provided all treatment units. Furthermore, because MIRE therapy pads do not emit visible light on either the active or the sham units, it was impossible for the investigators to distinguish the active from sham units. Thus, the authors, additional investigators, and participants were blinded to the active or sham status of the MIRE units. The principle author performed all pre- and posttest measurements. Investigators were notified of the sham/active status of the MIRE units by the manufacturer on return receipt of the units at the end of the study before data analysis.
1. Kochman AB, Carnegie DH, Burke TJ. Symptomatic reversal of peripheral neuropathy in patients with diabetes. J Am Podiatr Med Assoc. 2002;92(3):125–130.
2. Leonard DR, Farooqi HM, Myers S. Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy. Diabetes Care. 2004;27:168–172.
3. Prendergast JJ, Miranda G, Sanchez M. Improvement of sensory impairment in patients with peripheral neuropathy. Endocr Prac. 2004;10:24–30.
4. Cavanagh PR, Ulbrecht JS, Caputo GM. The biomechanics of the foot in diabetes mellitus. In: Bowker JH, Pfeifer MA, eds. Levin and O’Neal’s The Diabetic Foot. St. Louis, Mo: Mosby, Inc.;2001:181.
5. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2002. Available at: at www.diabetes.org. Accessed March 12, 2004.
6. Kochman AB. Monochromatic infrared photo energy and physical therapy for peripheral neuropathy: influence on sensation, balance, and falls. J Geriatr Phys Ther. 2004;27:16–19.
7. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Available at: www.diabetes.org. Accessed March 14, 2006.
8. Centers for Medicare and Medicaid Services. CMS Decision Memo. Diabetic peripheral neuropathy with loss of protective sensation (LOPS) (CAG-00059N). Available at: www.cms.hhs.gov/mcd/search.asp?clickon=search. Accessed April 16, 2004.
9. Burke TJ. 5 Questions — and answers — about MIRE treatment. Adv Skin Wound Care. 2003;16:369–371.
10. Goldberg N. Monochromatic infrared photo energy and DPN. Diabetic Microvascular Complications Today. 2005;March/April:30–32.
11. Burke TJ. Nitric oxide: its role in diabetes, peripheral neuropathy, and wound healing. Vol. 2005: Diabetes In Control, 2004. Available at: www.diabetesincontrol.com/anodyne/burkeseries.shtml. Accessed January 14, 2005.
12. Horwitz LR, Burke TJ, Carnegie D. Augmentation of wound healing using monochromatic infrared energy. Adv Skin Wound Care. 1999;12:35–40.
13. Rich K. Transcutaneous oxygen measurements: implications for nursing. J Vasc Nurs. 2001;19:55–61.
14. Sheffield PJ, Buckley CJ. Transcutaneous oximetry: a sophisticated tool for assessing tissue oxygenation and potential for wound healing. In: Sheffield PJ, Fife CE, Smith APS, eds. Wound Care Practice. Flagstaff, Ariz: Best Publishing Co.;2004:117–136.
15. Clarke D. Transcutaneous monitoring of pO2 in hyperbaric medicine. Patient Focus Circle™, Vol. DK-2700. Denmark: Radiometer Medical A/S;1997:1–20.
16. Nicasio M, Larson-Lohr V, Kimbrell P. Transcutaneous oxygen measurements. In: Larson-Lohr V, Norvell HC, eds. Hyperbaric Nursing. Flagstaff, Ariz: Best Publishing Co.;2002:304–314.
17. Anodyne® Therapy System Professional Unit 480 JCAHO policy and procedure manual. Vol. 2004: Anodyne® Therapy, 2004.
18. Clifft J, Kasser RJ, Newton TS, Bush AJ. The effect of monochromatic infrared energy on sensation in patients with diabetic peripheral neuropathy. Diabetes Care. 2005;28:2896–2900.
19. Wimberley P, Burnett R, Covington A, et al. Guidelines for transcutaneous po2 and pco2 measurement. Clinica Chimica Acta. 1990;190:S41–S50.
20. Lukkari-Rautiainen E, Lepantalo M, Pietila J. Reproducibility of skin blood flow, perfusion pressure and oxygen tension measurements in advanced lower limb ischaemia. Eur J Vasc Surg. 1989;3:345–350.
21. National Institute of Diabetes and Digestive and Kidney Disease. Feet Can Last a Lifetime: a health care provider’s guide to preventing diabetes foot problems. National Diabetes Education Program;2004.
22. Jörneskog G. Measurements of transcutaneous oxygen tension in patients with diabetic foot complications. Denmark: Radiometer Medical;AS 132; 2001;May 1:1–3.
23. Volkert W, Hassan A, Smock VL, et al. Effectiveness of monochromatic infrared photo energy and physical therapy for peripheral neuropathy: changes in sensation, pain, and balance — a preliminary, multi-center study. Phys Occupational Ther Geriatr. 2005;24:1–17.
24. Dowd G, Linge K, Bentley G. Measurement of transcutaneous oxygen pressure in normal and ischaemic skin. J Bone Joint Surg. 1983;65(suppl B):79–83.
25. Dowd G, Linge K, Bentley G. The effect of age and sex of normal volunteers upon the transcutaneous oxygen tension in the lower limb. Clin Phys Physiol Meas. 1983;4:65–68.
26. Olerud JE, Pecoraro RE, Burgess EM, et al. Reliability of transcutaneous oxygen tension (TcPo2) measurements in elderly normal subjects. Scand J Clin Lab Invest. 1987;47:535–541.
27. de Graaff JC, Ubbink DT, Legemate DA, de Haan RJ, Jacobs J. Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease. J Vasc Surg. 2001;33:1033–1040.
28. DeLellis SL, Carnegie DH, Burke TJ. Improved sensitivity in patients with peripheral neuropathy: effects of monochromatic infrared photo energy. J Am Podiatr Med Assoc. 2005;95:143–147.
29. Harkless L, DeLellis SL, Carnegie DH, Burke TJ. Improved foot sensitivity and pain reduction in patients with peripheral neuropathy after treatment with monochromatic infrared photo energy — MIRE. J Diabetes Complic. 2006;20:81–87.







Very interesting article. Thanks. I used it in my student work.
Ben Stokson
Reply to this comment »---
my hobby: electric infrared heaters
Post new comment