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19 Articles in Volume 14, Issue #9
10 Must Have Devices for Your Practice
1. Extracorporeal Shockwave Therapy
2. Pulsed Electromagnetic Fields
3. Class IV Laser
4. H-Wave Electrotherapy
5. Interferential Current Therapy
6. Class IIIb Cold Laser-Auriculotherapy
7. Shortwave Diathermy
8. Microcurrents
9. Infrared Phototherapy
10. Transcutaneous Electrical Neuromuscular Stimulation
Pain and Sleep: Understanding the Interrelationship
The Role of Endogenous Morphine and Nitric Oxide in Pain Management
Treating Pain in Patients With Chronic Kidney Disease: A Review of the Literature
Notalgia Paresthetica: An Enigmatic Condition
Preparing Patients Taking Sublingual Buprenorphine to Treat Addiction for Surgery
Editor's Memo: PAINWeek Going Forward Together
Introducing Practical Pain Management’s Newest Editorial Board Members
Ask the Expert: What are the products to prevent NSAID-related peptic ulcers?

9. Infrared Phototherapy


The use of infrared light as a healing treatment for skin-related problems (acne) and diabetic neuropathy has become popular in clinical settings. Arguably the most popular device in the market place is the Anodyne system, the primary target of which is amelioration of diabetic foot-related numbness/paresthesia (neuropathy). This company boasts over 18 studies related to their product and has a global customer base.

The difference between laser and infrared therapy primarily is one of coherence, but there can be a few more differences, depending on the products being compared. Infrared devices come in a variety of forms and with differing features that affect parameters such as the number of wavelengths emitted (spectral bandwidth). Lasers tend to be monochromatic (single wavelength), whereas light-emitting diodes can be multichromatic, offering emissions at various wavelengths to create a broader treatment effect. Phototherapy devices emit at different wavelengths, depending on the primary physiological goal.

Near infrared (632 nm) devices emit a visible red beam and can be used for skin lesions and superficial pain/inflammation disorders. The far infrared devices (800-940 nm) penetrate more deeply. Testing showed 2 species of infrared phototherapy to be of particular use in our centers: LED phototherapy, such as used by Dynatronics with the flexible twin pads that are comfortably applied to a painful area such as a foot with diabetic neuropathy. The LED emission increases blood perfusion in the area, which helps to re-establish peripheral nerve sensitivity. It is recommended that any patient experiencing painful foot burning, tingling, and numbness should at least try this form of treatment prior to more invasive and risky procedures. The second form of infrared therapy that has been very useful is the Nanobeam 940, a hand-held device that emits in the 940-nm range and distinguishes itself from an engineering standpoint as a device that can comfortably deliver more energy per defined area. This device is manufactured in such a manner that it deflects the excessive heat build-up that inevitably occurs at greater power levels and can become the rate-limiting factor in a treatment regimen. The Nanobeam 940 is designed to deflect heat, allowing more healing energy to be delivered to the target area.

Strength of Treatment

Phototherapy can be delivered in many forms, so it is difficult to assign a score that is representative for all devices. Generally, a treatment session is rather mild from a sensation standpoint, but patients can feel the after effects a few hours later; this can help verify that the patient has received an active treatment. The treatment effect can be very powerful when the right patient is selected for treatment. Because this treatment can sometimes produce gradual resolution of infected and non-healing ulcerations on long-standing diabetic patients who have become unresponsive to other treatments and are being considered for amputation, this therapy qualifies as a top 10.

Ease of Treatment

There is some set-up time with these LED devices, which when applied to feet require some infection control precautions for the involved body part, as well as the device pads because they are re-used for other patients. Used like a hand-held device, such as a laser, the Nanobeam 940 has a convenient touch button display and control on the hand piece.

Patient Adherence

In many cases, practitioners are treating severe problems with a high potential for grave consequences (loss of limbs, amputation) if the problem is not controlled. In such cases, when a patient can experience positive change, they tend to become very compliant and follow instructions well and adhere to treatment requirements. When patients can see the healing effect via serial measurements of the lesion, it becomes very motivating.


Although the clinicl effects can be very positive, the cost for these clinical devices can be prohibitive based on low reimbursement rates. The third-party reimbursement for infrared therapy is dismal to non-existent, with different insurance carriers having different policies. Many carriers choose to label infrared as investigational to push the device into reimbursement limbo. It would make more sense to let the clinicians choose their tools of choice and make their payment decisions based on outcomes, not on their internally biased opinions of whether a clinical tool is valid or not.

Research Base

Having reported on these technologies in the past, I am aware of the research base that is available supporting the use of infrared therapy for various conditions. Evidence comes in many forms, and despite having a number of taxonomies available to evaluate the quality of the research, I have found that no amount of research is enough to convince someone that something works if their belief is that it does not. People tend to become slaves to their beliefs and, unfortunately, our patients might not be the benefactors. In other words, never let your personal beliefs interfere with the prospect of a good treatment. Absence of evidence is not evidence of absence—the two are not the same.

Continue Reading: 10. Transcutaneous Electrical Neuromuscular Stimulation (TENS)

Last updated on: October 16, 2014
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