Effect of optically modified polyethylene terephthalate fiber socks on chronic foot pain
© York and Gordon; licensee BioMed Central Ltd. 2009
Received: 27 August 2008
Accepted: 22 April 2009
Published: 22 April 2009
Increasing experimental and clinical evidence suggests that illumination of the skin with relatively low intensity light may lead to therapeutic results such as reduced pain or improved wound healing. The goal of this study was to evaluate prospectively whether socks made from polyethylene terephthalate (PET) incorporating optically active particles (Celliant™) ameliorates chronic foot pain resulting from diabetic neuropathy or other disorders. Such optically modified fiber is thought to modify the illumination of the skin in the visible and infrared portions of the spectrum, and consequently reduce pain.
A double-blind, randomized trial with 55 subjects (38 men, 17 women) enrolled (average age 59.7 ± 11.9 years), 26 with diabetic neuropathy and 29 with other pain etiologies. Subjects twice completed the Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), McGill Pain Questionnaire (MPQ), and SF-36 a week apart (W1+2) before receiving either control or Celliant™ socks. The same questionnaires were answered again one and two weeks (W3+4) later. The questionnaires provided nine scores for analyzing pain reduction: one VAS score, two BPI scores, five MPQ scores, and the bodily pain score on the SF-36. Mean W1+2 and W3+4 scores were compared to measure pain reduction.
More pain reduction was reported by Celliant™ subjects for 8 of the 9 pain questions employed, with a significant (p = 0.043) difference between controls and Celliant™ for McGill question III. In neuropathic subjects, Celliant™ caused more pain reduction in 6 of the 9 questions, but not significantly. In non-neuropathic subjects 8 of 9 questions showed more pain reduction with the Celliant™ socks.
Socks with optically modified PET (Celliant™) appear to have a beneficial impact on chronic foot pain. The mechanism could be related to the effects seen with illumination of tissues with visible and infrared light.
Celliant™ is a polymer fabric constructed from polyethylene terephthalate (PET) yarn containing optically active particles – a proprietary mixture of natural and inorganic materials – which scatter and reflect visible and near infrared light. Garments constructed with such optically modified fibers are thought to influence transmission and reflectance of electromagnetic energy into underlying tissue and skin. Numerous anecdotal reports from patients with a variety of chronic pain syndromes indicate that wearing Celliant™ garments for even a few days leads to dramatic improvement or complete resolution in subjective pain. We report here the results of a prospective, blinded study designed to substantiate the ability of Celliant™ socks to ameliorate chronic pain resulting from diabetic neuropathy and other disorders of the foot.
Pain etiologies in non-DPN subgroup
At screening (week 1) subjects underwent physical examination including monofilament testing and completed a series of four questionnaires (Visual Analogue Scale  [VAS], Brief Pain Inventory [2, 3] [BPI], MPQ , and SF-36 Quality of Life Inventory ). Only the bodily pain score from the SF-36 questionnaire was used to assess pain responses. Subjects completed the same questionnaires a week later (week 2) and were given 3 pairs of socks in a closed container and asked to wear them exclusively for the next two weeks. One (week 3) and two weeks (week 4) later they filled out the same panel of questions. Controls received socks made from standard 1.2 denier PET fabric, while the Celliant™ group received otherwise identical socks except PET containing Celliant™ particles was used to fashion the bottom (plantar) half of the garments. Both study personnel and subjects were blinded to the treatment assigned.
As the MPQ has 5 components (Ia, Ib, Ia+b, II, III) and the BPI 2 components (Pain Severity, Pain Interference), a total of 9 questions assessing pain were analyzed to measure subjects' responses. Mean scores for individual questions were calculated for the first two (W1+2) and final two visits (W3+4). Differences between W1+2 and W3+4 scores reflected changes in perceived pain resulting from wearing socks. Non-parametric two tailed t-test analysis (Mann-Whitney) was used to compare changes in scores [(mean W1+2) - (mean W3+4)] for individual questions reported by control and Celliant™ subjects. Analyses were performed on all 55 subjects as well as DPN and non-DPN subgroups.
Subject Characteristics Prior to Treatment
57.7 ± 11.8
1.2 ± 0.8
0.6 ± 0.7
1.9 ± 1.5
4.7 ± 2.4
2.6 ± 1.0
61.6 ± 11.8
1.3 ± 0.7
1.1 ± 1.0
2.4 ± 1.6
5.4 ± 2.8
3.1 ± 1.1
63.0 ± 7.7
1.2 ± 0.9
0.6 ± 0.7
1.9 ± 1.5
5.1 ± 2.6
2.7 ± 1.1
63.9 ± 11.0
1.4 ± 0.7
1.2 ± 1.1
2.5 ± 1.7
5.2 ± 2.9
2.9 ± 0.9
52.7 ± 13.1
1.2 ± 0.8
0.6 ± 0.8
1.9 ± 1.5
4.4 ± 2.3
2.4 ± 0.9
59.5 ± 12.3
1.3 ± 0.8
1.1 ± 1.0
2.3 ± 1.6
5.6 ± 2.8
3.3 ± 1.2
Brief Pain Inventory
SF-36: Bodily Pain
4.2 ± 2.4
5.8 ± 2.4
37.8 ± 8.1
4.2 ± 2.4
5.5 ± 2.6
6.4 ± 1.8
34.6 ± 7.8
5.5 ± 2.6
4.9 ± 2.0
4.7 ± 2.5
5.9 ± 2.4
34.2 ± 7.4
5.1 ± 2.3
5.5 ± 2.9
6.1 ± 1.9
36.1 ± 7.5
3.9 ± 1.9*
3.8 ± 2.3*
5.8 ± 2.5
40.8 ± 7.7
5.3 ± 1.6*
5.6 ± 2.3*
6.6 ± 1.8
33.3 ± 8.1
Both control and Celliant™ subjects reported decreased subjective pain after wearing socks for every question based on comparing W1+2 scores to W3+4 scores (see Figures). The differences between W1+2 and W3+4 scores were significant (p < 0.05, Mann Whitney) in 6 of 9 questions for Celliant™ subjects and in 4 of 9 questions for controls. Improvement in pain scores before and after treatment is characteristic of a strong placebo effect generally seen in pain studies. For most questions, however, more improvement was reported by the entire Celliant™ group compared to the entire control group based on the magnitude of differences in [W1+2 - W3+4] scores.
Results of pain questions
BPI Pain Severity
BPI Pain Interference
SF-36 Bodily Pain
Overall the data reported show more improvement in pain reported by subjects wearing the Celliant® socks compared to the controls. The lack of statistical significance for the differences in results with most of the questions may be due to the relatively low number of subjects in this pilot study as well as a lack of homogeneity in the subjects.
In our study each questionnaire was administered twice before and after dispensing the study garments with the results averaged, in the hopes of increasing the precision of the pain assessments. This might skew the data if the therapeutic effect of the Celliant™ socks changes with time – either increasing or decreasing. In future studies employing larger number of subjects this methodological problem should be avoided by administering each set of pain questionnaires only once.
In general, non-DPN subjects showed more sensitivity to the beneficial effect of Celliant™ than subjects with DPN. Assuming the effect of Celliant™ on tissue is relatively localized, one might expect less of an effect to be seen in neuropathy, as only a portion of the diseased neuron fibers are in close proximity to the plantar aspect of the socks, and thus likely subject to the effect of the modified fabric.
This raises the question of what mechanism could account for the apparent beneficial impact of optically modified fiber garments. Two unpublished studies, one in healthy subjects and one in diabetics, demonstrated significant increases in transcutaneous oxygen tensions in the skin of the hands and feet when Celliant™ garments were worn compared to placebo garments (Lavery LA, 2003; McClue GM and Lavery LA, 2003). The increased oxygen tensions were observed by 10 minutes and persisted during repeated measurements over 60 minutes. The increase in healthy subjects ranged from 10 to 24%; diabetic subjects showed an average increase of 10%. It is conceivable that some interaction of the Celliant™ particles with light increases reflection or transmission of light in the visible or near infrared portion of the spectrum into the skin, leading to vasodilation of the microcirculation and enhanced perfusion of tissue, which plausibly could ameliorate some causes of chronic pain. Alternatively, the enhanced illumination of the skin and underlying tissues could influence the biologic activity of endogenous chromophores (cytochromes, flavins, and poryphyrins) involved in energy metabolism in a manner leading to anti-inflammatory or anti-nocioceptive effects.
A large body of evidence suggests that short periods of illuminating skin, tissue, and cells with visible or infrared light has positive effects on pain, injury recovery, and wound healing. A number of studies have looked at joint pain such as temporomandibular joint pain , finding that near infrared light (810 nm) appears to reduce pain compared to sham illumination regimens. A meta-analysis of 20 trials employing laser therapy for chronic joint disorders found that when sufficiently intense light was employed, such therapy had a direct anti-inflammatory effect on the joint capsule . A study of the effects of infrared (950 nm) on sural nerve conduction showed significant impact of illumination on nerve conduction velocity and negative peak latency compared to sham illumination . Several studies on diabetic neuropathy showed a favourable impact of intermittent illumination with infrared at 890 nm on sensation and pain [11, 12]. Low level illumination of joints affected by osteoarthritis by infrared diodes emitting at 890 nm has also been reported as effective for alleviating pain, and the effect has been postulated to be related to stimulation of constitutive nitric oxide synthetase . Low intensity laser therapy at 810–820 nm combined with exercise regimens has been shown to benefit patients with chronic back pain and Achilles tendonopathy [14, 15]. Several studies using animal models of wound healing or cell cultures have examined the effects of short exposures to red (e.g., 632 nm, 670 nm) or infrared light (e.g., 830 nm), finding wound healing to be significantly accelerated or increased expression of genes and proteins associated with proliferation [16–21].
Previous studies generally entailed short illumination periods of a few minutes at intensities of 1 to 20 Joules/cm which are much higher than the presumptive low intensity optical effects of Celliant™ garments. Our subjects were wearing socks under ambient light conditions and often shoes. Past demonstrations of interactions between tissues and external light, nonetheless, support the possibility that Celliant™'s effect is due to prolonged exposure of underlying structures to an altered electromagnetic environment. Given the putative anti-inflammatory effects of infrared light, the ability of longer wavelengths to penetrate more deeply, and the likelihood that Celliant™ particles significantly reflect and scatter infrared light, plausibly the Celliant™ effect is mediated by perturbations in the infrared portion of the spectrum. Conceivably, but we think unlikely, the Celliant™ effect may be due to higher skin temperatures resulting from more efficient reflection of infrared energy, but this requires further investigation. We are now planning further studies employing thermography and hyperspectral imaging of skin blood flow to further characterize the effects of wearing Celliant™ garments.
The data from this pilot study suggests that wearing Celliant™ fabric socks may reduce the pain associated with chronic foot disorders. Future studies in larger numbers of subjects looking at other chronic pain conditions such as carpal tunnel syndrome and knee arthropathies are warranted as well as attempts to elucidate the mechanism by examining the influence of the modified garments on tissue perfusion, temperature, oxygen levels, and inflammation.
This study was financially supported by a contract with Hologenix, LLC. This funding source held a minor role in study design and no role in data collection, analysis, and interpretation of data; writing the manuscript; or decision to submit the manuscript for publication.
- Cleeland CS, Ryan KM: Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994, 23: 129-138.PubMed
- Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001, 94: 149-158. 10.1016/S0304-3959(01)00349-9.View ArticlePubMed
- Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL: Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005, 352: 1324-1334. 10.1056/NEJMoa042580.View ArticlePubMed
- Melzack R: The short-form McGill Pain Questionnaire. Pain. 1987, 30: 191-197. 10.1016/0304-3959(87)91074-8.View ArticlePubMed
- Tan G, Jesen M: Validation of the Brief Pain Inventory for chronic nonmalignant pain. J Pain. 2004, 5: 133-137. 10.1016/j.jpain.2003.12.005.View ArticlePubMed
- Ware JE, Snow KK, Kosisnki M, Gandek B: SF-36 health survey manual and interpretation guide. 1993, Boston, The Health Institute, New England Medical Center
- Wernicke JF, Pritchett YL, D'Souza DN, Waninger A, Tran P, Iyengar S, Raskin J: A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology. 2006, 67: 1411-1420. 10.1212/01.wnl.0000240225.04000.1a.View ArticlePubMed
- Fikackova H, Dostalova T, Vosicka R, Peterova V, Navratil L, Lesak J: Arthralgia of the temporomandibular joint and low-level laser therapy. Photomed Laser Surg. 2006, 24: 522-527. 10.1089/pho.2006.24.522.View ArticlePubMed
- Bjordal JM, Couppe C, Chow RT, Tuner J, Ljunggren EA: A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother. 2003, 49: 107-116.View ArticlePubMed
- Vinck E, Coorevits P, Cagnie B, De Muynck M, Vanderstraeten G, Cambier D: Evidence of changes in sural nerve conduction mediated by light emitting diode irradiation. Lasers Med Sci. 2005, 20: 35-40. 10.1007/s10103-005-0333-2.View ArticlePubMed
- Leonard DR, Farooqi MH, Myers S: Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy: a double-blind, randomized, placebo-controlled study with monochromatic near-infrared treatment. Diabetes Care. 2004, 27: 168-172. 10.2337/diacare.27.1.168.View ArticlePubMed
- Harkless LB, DeLellis S, 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 Complications. 2006, 20: 81-87. 10.1016/j.jdiacomp.2005.06.002.View ArticlePubMed
- Hancock CM, Riegger-Krugh C: Modulation of pain in osteoarthritis: The role of nitric oxide. Clin J Pain. 2008, 24 (4): 353-365.View ArticlePubMed
- Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G: In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomized trial. Aust J Physiother. 2007, 52: 155-160.View Article
- Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RAB, Bjordal JM: Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendonopathy. Am J Sports Med. 2008, 36 (5): 881-887. 10.1177/0363546507312165.View ArticlePubMed
- Enwemeka CS, Parker JC, Dowdy DS, Harkness LE, Woodruff LD: The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg. 2004, 22: 323-329. 10.1089/pho.2004.22.323.View ArticlePubMed
- Erdle BJ, Brouxhon S, Kaplan M, Vanbuskirk J, Pentland AP: Effect of continuous-wave (670-nm) red light on wound healing. Dermatol Surg. 2008, 34: 320-325. 10.1111/j.1524-4725.2007.34065.x.PubMed
- Mendez TMTV, Pinheiro ALB, Pacheco MTT, Nascimento PM, Ramalho LMP: Dose and wavelength of laser light have influence on the repair of cutaneous wounds. J Clin Laser Med Surg. 2004, 22: 19-25. 10.1089/104454704773660930.View ArticlePubMed
- Rabelo SB, Villaverde AB, Nicolau RA, Castillo Salgado MA, Melo MDS, Pacheco MTT: Comparison between wound healing in induced diabetic and nondiabetic rats after low-level laser therapy. Photomed Laser Surg. 2006, 24: 474-479. 10.1089/pho.2006.24.474.View ArticlePubMed
- Schramm JM, Warner D, Hardesty RA, Oberg KC: A unique combination of infrared and microwave radiation accelerates wound healing. Plast Reconstr Surg. 2003, 111: 258-266. 10.1097/00006534-200301000-00044.View ArticlePubMed
- Hawkins D, Abrahamse H: Influence of broad-spectrum and infrared light in combination with laser irradiation on the proliferation of wounded skin fibroblasts. Photomed Laser Surg. 2007, 25: 159-169. 10.1089/pho.2007.2010.View ArticlePubMed
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6882/9/10/prepub
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