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8 Articles in Volume 6, Issue #6
Choosing and Using a Low Level Laser in Pain Management
Clinical Bioethics
Cranial Electrotherapy Stimulation in the Treatment of Fibromyalgia
Fibromyalgia: New Hope and New Pharmaceuticals
Identifica tion and Management of Cardiac -Adrenal-Pain Syndrome
Interventional Therapy
Superior Pharyngeal Constrictor Muscle Pain
Treating Neuropathic Pain in Multiple Sclerosis (MS)

Choosing and Using a Low Level Laser in Pain Management

In the last issue of Practical Pain Management, I discussed how the body communicates from cell to cell by generating its own infrared light, called biophotons.1 Biophotons carry information that affects the health and reproduction of cells.2 Low level laser therapy not only promotes healing in injured cells, but it also stimulates the generation of endorphins that control pain regardless of the location.3 Low level laser therapy interrupts the pain process by delivering electrons back to the injured cells to aid in healing.4

One wave length laser cannot efficiently be used for all disorders.5 To maximize the benefits of low level lasers, one needs to employ both resonating and stimulating lasers to maximize the benefits of therapy. When treating musculoskeletal pain, it is best to release the tight muscles related to the bone or joint with a resonating low level laser first then applying the stimulating laser directly to the painful area (joints, nerves, ligaments cartilage and tendons).4

Laser Treatment Strategy

Resonating low level lasers are first applied to soft tissue such as bellies of muscles, organs, and glands because they need less energy and the energy needs to be delivered with a larger beam that spreads out over a larger area.4,6 By contrast, resonating low level lasers produce a smaller dose of energy than stimulating lasers and they usually operate under 5mW. They can be either a single wave length or a multiple wavelength diode laser, but better clinical results seem to be achieved with multi wavelength lasers. If the pain is in an organ or gland, a resonating laser may be all that is needed to control the pain.7

Once the overlying soft tissues have been treated, a stimulating laser—delivering more Joules of concentrated energy at the site—is used on bones, nerves, joints, tendons, cartilage, and ligaments since these tissues require more direct laser energy to control pain. Stimulating low level lasers operate from 5mW to 500mW. However, there are a few brands of lasers that have received FDA 510k pre-market clearance based on comparable heat-producing devices that operate at much higher wattage. While these lasers are sold under the low level laser label, they are not low level lasers and have potentially greater risks for burns and over dosing. Most stimulating lasers available today are single wavelength lasers or multiples of the same wavelengths.

Informed Consent

I am not aware of any court cases where the plaintiff charged that she/he was harmed by low level laser therapy however, it is prudent to have the patient sign an informed consent specific for laser treatment. Following is a sample informed consent; however, I strongly recommend that you have your attorney draft an informed consent consistent with the laws of the state where you practice. I like the arbitration statement in the last paragraph and recommend that doctors read that paragraph out loud to the patient. Arbitration does not subjugate the patient’s day in court—it is their day in court. An arbitration agreement removes the risk of costly legal battles, saves time, and reduces stress on the doctor.

INFORMED CONSENT AGREEMENT

I HEREBY accept full and complete responsibility for my health and all conditions thereof related. I acknowledge that neither Dr. ____________, nor any representative thereof, has made promises or treatment claims to me or anyone representing me regarding the use of low level laser therapy.

The undersigned jointly and severally hereby forever release, discharge, acquit, forgive and hold harmless from any and all claims, actions, suits, demands, agreements, and each of them, if more than one, liabilities, judgments, and proceedings both at law and in equity arising from the beginning of time to the date of these presents and as more particularly related to or arriving from the use of a laser device or product, including but not limited __________________(list the brand of your lasers). Releaser understands and acknowledges that these laser devices or products are registered with the FDA; however the FDA has not yet studied these lasers for efficacy for treating ______________(list the disorder) and that neither Dr.____________ nor any individual associated with him nor the company that manufacturers the lasers make any medical claims regarding the use of these devices or products or any low level laser product. This release shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives. It is further agreed that any controversy, dispute or claim between Dr. ___________ or his/her representatives and any other party arising out of/or involving any treatment or care provided by Dr. ___________ shall be resolved by binding arbitration, and shall be submitted to the American Arbitration Association for arbitration which shall be conducted in accordance with the Association’s arbitration rules in effect at the time of applying for arbitration. The arbitral award is final and binding upon both parties. The demand for arbitration must be in writing and must be made by the aggrieved party within ninety (90) days of the event giving rise to the demand.

Signed this __________ day of _________________, 20_____.

In the Presence of: _____________________________________________________

Releaser or Guardian of: _____________________________________________________

Table 1. The Electromagnetic Spectrum

How to Choose a Laser System

A suitable low level laser system for your practice should have the following attributes:

  • Registered with the FDA for safety
  • Possesses state of the art technology
  • Is handheld, portable, rechargeable and easy to use
  • Multiple wavelengths
  • Multiple frequencies
  • Ability to penetrate
  • Availability of training and of a professional consultant

Registered With The FDA For Safety

If the laser is registered with the FDA, the manufacturer must put the safety classification on the label. (Refer to the laser therapy article describing FDA classification in the May/June 2006 issue.) Pre-market clearance is necessary before any manufacturer or salesperson can make efficacy claims for their instrument to treat a specific disorder. Then those claims are limited to the specific disorder as proven by clinical IRB studies and can not be interpreted to extend to other parts of the body. As an example, if a laser is approved for carpal tunnel syndrome, it cannot be construed that it is approved to treat back pain. Making claims beyond clinical trials is not authorized by the FDA. However in most states, if the device is approved for safety, doctors can use that instrument if they get an informed consent.

State Of The Art Technology

Many doctors may say they have a laser, but it might be a single wave length laser manufactured many years ago. It therefore does not contain computerized technology to control the power density or frequency and cannot trouble shoot internal problems. Many doctors have asked the question: my laser seemed to work well when I first applied it and then it seemed to get progressively poorer results — why? Lasers can appear “on” and still not be working properly, especially DC-battery powered lasers. When the battery bleeds off, the laser appears “on” but it is no longer delivering the joules of energy or dosage as it did when the battery was fully charged. This inconsistency in dosage may be the biggest problem with low level lasers today because the body builds up impedance or polarizes against inconsistent laser output. Computerized state of the art technology insures consistent output.

Handheld, Portable, Rechargeable and Easy To Use

Your low level laser system should be able to be carried with you from operatory to operatory and even carried home with you at night. If your laser needs to be plugged into 110 or 220 volt outlet, it is not portable and therefore not easy to use. Even though the power levels may be able to be controlled and it may be an efficient stimulating low level laser, it is not an efficient resonating low level laser. Every electrical line and cord has an energy field around the line and when a laser is plugged into an electrical outlet, the subtle energy dosage is altered because of the electromagnetic contamination coming down the high power line. This electromagnetic contamination alters the frequency programmed into the low level laser instruments. The body builds up impedance, and polarizes against the incoming energy and will not respond as favorably as it does to the subtle energy produced by computer controlled DC battery powered low level lasers. Some low level lasers, such as laser pointers, are sold to medical practitioners for acupuncture therapy. While they are portable and easy to use, they operate on disposable batteries, usually two or three double AA batteries. These are not efficient because the batteries bleed off rapidly, lose their charge, and thereby chang the laser dosage.

Multiple Wavelengths

All lasers are in the visible and infrared spectrum (see Table 1). The device should have the capability to be switched to different wavelengths for different applications. A discussion of the relationship between wavelength and frequency is presented in Appendix A.

Frequency Capabilities

Some lasers have the ability to program in different frequencies (software) by the operator; others come pre-programmed from the manufacturer and still others have the ability to program additional frequencies if returned to the manufacturer. There is a question among some laser professionals if frequency is really all that important or if the results are achieved by delivering energy, period. Richard Gerber says “we live in an ocean of frequencies as fish live in water. Man has been totally unaware of the possibilities of the vast ocean of frequencies in which he lives.”10 Dona Eden states in Energy Medicine that everything–from food you eat to the people you encounter—carries its own frequency and impacts your nervous system. While most vibrations (frequencies) exist below the threshold of your awareness, your body resonates to some and tenses against others. In the human brain for instance, the four basic frequencies are delta, theta, alpha, and beta. These frequencies are the rate at which electrical charges move through the brain’s neurons.8 And then, when we consider the role of constructive and destructive frequencies, as I discussed in the July/August issue, it seems prudent to buy a low level laser with the capability of multiple frequencies.

Penetration

The ability to get pure energy deep into the tissue without increasing the power level is essential in subtle energy healing. Some manufacturers think laser energy can be forced into the body by increasing the power. This principle seems to work somewhat for stimulating lasers but not at all for resonating low level lasers. Increasing power reaches a point at which the body sets up impedance or polarizes against too much energy. Absorption for blue and green light waves is negligible and conventional visible red laser light, while very beneficial, only penetrates 1-3mm. According to the literature, infrared low level lasers penetrates deeper, from 10-15mm, however infrared lasers are not as beneficial for certain aspects of healing as visible light lasers (see Table 2). When two identical waves are combined, they form a soliton wave which penetrates much deeper.5 Clinically, the soliton wave has demonstrated beneficial affects twelve or more inches into the body. Some manufacturers are getting superior results by combining wavelengths and piggybacking the beneficial effects of LEDs and visible wavelength diodes onto the penetrating capability of the infrared wavelength diodes. Penetration is enhanced when this strategy is combined with the soliton wave.

Table 2.

Availability of Training and a Professional Consultant

To assist you in implementing low level lasers into your practice, some laser manufacturing companies have good engineers but do not have trained medical professionals available. Many medical devices are never used to their full potential because there was either no training available (other than the salesman) or training was inadequate and too hard to assimilate. While most lasers are simple to use, it is important to have a user’s manual for reference, good training, and a medical professional that you can call when needed.

Appendix A. The relationship between laser wavelength and frequency

There is a great deal of confusion between wavelength and frequency among some doctors and many laypeople. The relationship between wavelength (ë) and frequency (v) is where c = the speed of light.

ë x v = c

Within the part of the electromagnetic spectrum we call the radio frequency field (table 1) frequency is often used instead of wavelength (e.g. for FM radio stations – 100 MHz ), whereas in the other parts of the spectrum we would have to use unmanageably high numbers and therefore I use the wavelength in all but a few cases.16 Most laser terminology refers to wavelength as hardware and frequency as software Frequency denotes pulsed radiation and is the number of pulses or interruptions per second applied to the wave. Another way of saying wavelength is color. Wavelength is measured in nanometers (one thousands of a meter) and is measured from tip of the wave to tip of the wave. Blue waves are shorter than red waves (see Table 2). The colors or waves are the same throughout the universe. It doesn’t matter whether you are looking at blue waves in a rainbow or blue waves in the crayon box – they are the same length.17

Conclusion

Low level lasers are safe and very effective. It is the author’s contention that every doctor who treats pain should have one. If they fail to live up to your, or the patient’s, expectations, please review the following check list:

  1. Are you following the manufacturer’s protocol?
  2. Are you using the right laser?
  3. Are you delivering the right dosage — the right amount of Joules?
  4. If treating joint disorders, have you first released the tight muscles associated with the joint using a resonating laser?

Be patient—some conditions require more treatments over a longer period of time. An example is the yet to be published study done by Dr. Roberta Chow, a GP from Australia, who conducted a randomized, placebo-controlled study on chronic neck pain using low level laser therapy. She treated 90 patients for chronic neck pain with 14 low level laser treatments over 7 weeks. At 3 months from baseline, 84% of patients in the active group achieved positive response vs. only 40% in the placebo group.

If you have followed the correct low level laser protocol and still have not gotten the results expected, the reason might be faulty proprioceptive feedback to the brain – that is, the brain has not released the signal to the muscles and continually keeps tightening muscles that affect the joint. I will discuss more on this in future articles.

Last updated on: January 24, 2012
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