ABSTRACT
The purpose of this study was to determine whether the application of near infrared (NIR) light could positively modulate symptoms associated with restless legs syndrome (RLS). Twenty-one subjects with RLS were treated with NIR three times weekly for four weeks. Baseline measures of: (1) international restless legs syndrome rating scale (IRLSRS) score; (2) Semmes Weinstein monofilament (SWM) test; (3) visual analog pain scale (VAS); (4) ankle-brachial index (ABI); and (5) sonographic imaging of the popliteal and posterior tibial arteries were compared to post-treatment values. NIR (850 nm) was delivered transcutaneously at 8 J/cm2 to four locations on each leg and the plantar surface of each foot. A pre-test–post-test one group design was employed. Baseline and post-treatment measures were compared using either a dependent t-test when data were normal or the Wilcoxon signed rank test in the absence of normality. A significant improvement in IRLSRS scores was observed. Sensation improved from less than protective in 16.6% of sites tested at the baseline to 13.4% post-intervention. There was a significant improvement in ABI scores. VAS and sonographic imaging measures other than ABI remained unchanged. The use of NIR to modulate symptoms associated with RLS was supported by the data.

Abstract:
We describe a treatment for patients suffering from peripheral neuropathy. Current treatment is focused on prevention of adverse outcomes, rather than addressing the associated circulatory and sensory deficits common to peripheral neuropathy. We describe the use of near-IR light to address the patient’s sensory loss, pain and lowered function.

A 62 year old Caucasian male diagnosed as Type II diabetic was treated in this study. Using the Semmes Weinstein Monfilament Test, the Visual Analog Pain Scale and the Foot Function Index, he was found to have decreased foot sensation, pain and decreased lower extremity function. He received near-IR at 12 J/cm2 per treatment location, 3 times per week for 6 weeks. The light treatment was administered using a hand held probe over the lumbosacral spinal roots paravertebrally and on six locations on each foot. Post testing showed marked improvement in all three areas measured. These improvements were clinically significant based on the established minimally clinically important difference values for each of the three measures. The results suggest that near-IR energy may be an effective intervention to decrease pain, improve function, and increase sensation in individuals suffering from peripheral neuropathy. Basic research suggests that near-IR may increase blood flow. This result is believed to be achieved as a result of the relationship near-IR has with nitric oxide. Additional research is needed to establish the efficacy and generalizability of this treatment for patient populations similar to the patient represented in this case report.

Diabetes is a very common cause of peripheral neuropathy, and there is no optimal intervention universally accepted by clinicians.Monochromatic infrared photo energy is a relatively new modality used in the United States for reducing pain and increasing circulation. This study investigated the effects of monochromatic infrared photo energy on reducing pain, improving sensation, and increasing balance in patients with diabetic peripheral neuropathy. Thirty-five patients with diabetic peripheral neuropathy completed the program and were randomly assigned into two groups. Group 1 (experimental,
n = 18) received monochromatic infrared photo energy, therapeutic exercises, and balance training. Group 2 (control, n = 17) received therapeutic exercises and balance training. Both groups received three treatment sessions per week for 4 weeks. Outcome included pain intensity measured on a visual analogue scale, sensation measured with the Semmes-Weinstein monofilament 5.07, and balance measured with theBerg score, before and after the 12 therapy sessions (1 month after the start of the intervention). Analysis of covariance tests revealed statistically significant improvements, specifically, P =.01, .014, and .0001, for pain, sensation, and balance, respectively, in the experimental group. Within the limitations of this study, monochromatic infrared photo energy may play a role in treating diabetic peripheral neuropathy by reducing pain, improving sensation, and increasing balance.

Abstract
Nitric oxide is an important messenger in numerous biological processes, such as angiogenesis, hypoxicvasodilation, and cardioprotection. Although nitric oxide synthases (NOS) produce the bulk of NO, there is increasing interest in NOS independent generation of NO in vivo, particularly during hypoxia or anoxia,where low oxygen tensions limit NOS activity. Interventions that can increase NO bioavailability have signicant therapeutic potential. The use of far red and near infrared light (R/NIR) can reduce infarct size,protect neurons from methanol toxicity, and stimulate angiogenesis. How R/NIR modulates these processes in vivo and in vitro is unknown, but it has been suggested that increases in NO levels are involved. In this study we examined if R/NIR light could facilitate the release of NO from nitrosyl heme proteins. In addition,we examined if R/NIR light could enhance the protective effects of nitrite on ischemia and reperfusion injuryin the rabbit heart. We show both in purified systems and in myocardium that R/NIR light can decay nitrosylhemes and release NO, and that this released NO may enhance the cardioprotective effects of nitrite. Thus, the photodissociation to NO and its synergistic effect with sodium nitrite may represent a noninvasive and site-specic means for increasing NO bioavailability.

Abstract
Pulsed infrared light therapy (PILT) has been shown to increase peripheral sensation in diabetic patients with diabetic peripheral neuropathy (DPN). However, most studies last for very short periods, with the subjects receiving only 6-20 treatments. The purpose of this study was to evaluate the effectiveness of an eight-week course of PILT in reversing long-standing, profound DPN in patients with type 1 and type 2 diabetes. Twenty-two subjects with a diagnosis of type 1 (n=2) or type 2 (n=20) diabetes participated in the study. PILT was administered to one foot chosen at random with the other foot serving as a within-subject control (no treatment). Patients underwent 24 treatments (3 times/week, for eight weeks) for 30 min per treatment. Changes in peripheral protective sensation (PPS) were measured using Semmes-Weinstein monofilaments (SWM) ranging from 3.7 to 6.48. PILT improved PPS even in patients with long-standing chronic neuropathies whose initial pre-study sensation was not measurable with a 200-g SWM. PILT significantly improves PPS. While the exact mechanism of action is not understood, infrared light may improve peripheral neuropathies by improving foot perfusion by stimulating nitric oxide production.

Abstract
The medical records of 2239 patients (mean age=73 years) with established peripheral neuropathy (PN) were examined to determinewhether treatment with MIRE was, in fact, associated with increased foot sensitivity to the Semmes Weinstein monofilament (SWM) 5.07and a reduction in neuropathic pain. The PN in 1395 of these patients (62%) was due to diabetes. Prior to treatment with MIRE, of the10 tested sites (5 on each foot), 7.1±2.9 were insensitive to the SWM 5.07, and 2078 patients (93%) exhibited loss of protective sensationdefined by Medicare as a loss of sensation at two or more sites on either foot. After treatment, the number of insensate sites on both feet decreased to 2.4±2.6, an improvement of 66%. Of the 2078 (93%) patients initially presenting with loss of protective sensation, 1106 (53%)no longer had loss of protective sensation after treatment (P<.0001); 1563 patients (70%) also exhibited neuropathic pain in addition tosensory impairment. Prior to treatment with MIRE, pain measured on the 11-point visual analogue scale (VAS) was 7.2±2.2 points, despitethe use of a variety of pain-relieving therapeutic agents. After treatment with MIRE, pain was reduced by 4.8±2.4 points, a 67% reduction.Therefore, MIRE appears to be associated with significant clinical improvement in foot sensation and, simultaneously, a reduction inneuropathic pain in a large cohort of primarily Medicare aged, community-dwelling patients, initially diagnosed with PN. The quality of lifeassociated with these two outcomes cannot be underappreciated.

Objective:
To evaluate the effect of monochromatic infrared photo energy (MIRE™) combined with physical therapy in reducing pain, improving sensation, and increasing balance in patients with peripheral neuropathy.
Methods:
Pain [VAS scale], diminished foot sensation [SemmesWeinstein Monofilament 5.07], and balance deficits [Tinetti Assessment Tool] of 272 patients, average age 69 years, were documented before and after receiving treatments at eight physical therapy clinics.
Results:
Neuropathic pain, diminished foot sensation, and balance impairments at baseline were present in 93% of patients. After an aver-age of 18 treatments, neuropathic pain decreased by 38%, lower extrem-ity sensory impairment improved by 77%, and balance deficits decreased by 73% [P ≤ 0.006 for all results].
Conclusions:
Compared with the literature, preliminary findings suggest that MIRE™ plus manual physical therapy improves pain, balance,and sensation symptoms in patients with peripheral neuropathy, at least temporarily.

Abstract
The medical records of 1,047 patients (mean age, 73 years) with established peripheral neuropathy were examined to determine whether treatment with monochromatic infrared photo energy was associated with in-creased foot sensitivity to the 5.07 Semmes-Weinstein monofilament.The peripheral neuropathy in 790 of these patients (75%) was due to diabetes mellitus. Before treatment with monochromatic infrared photo energy, of the ten tested sites (five on each foot), a mean ±SD of 7.9 ±2.4 sites were insensitive to the 5.07 Semmes-Weinstein monofilament, and 1,033 patients exhibited loss of protective sensation. After treatment, the mean ±SD number of insensate sites on both feet was 2.3 ±2.4, an improvement of 71%. Only 453 of 1,033 patients (43.9%) continued to have loss of protective sensation after treatment. Therefore, monochromatic infrared photo energy treatment seems to be associated with significant clinical improvement in foot sensation in patients, primarily Medicare aged,with peripheral neuropathy. Because insensitivity to the 5.07 Semmes-Weinstein monofilament has been reported to be a major risk factor for diabetic foot wounds, the use of monochromatic infrared photo energy maybe associated with a reduced incidence of diabetic foot wounds and amputations.

A physical therapy approach using monochromatic infrared energy and a balance program was shown to be effective in significantly reducing fall risk, reversing the loss of protective sensation, and improving functional ability

OBJECTIVE
To determine if improved foot sensitivity to the Semmes-Weinstein 10-g (5.07) monofilament, originally impaired because of diabetic peripheral neuropathy, might be associated with a reduced incidence of new diabetic foot wounds.