43 LLLT papers for you this month including: Three systematic reviews with meta-analysis on LLLT 1) before, during and after exercises, 2) frozen shoulder/adhesive capsulitis, 3) subacromial impingement syndrome. ALSO a trial showing increased muscle torque in elite athletes, reduced oral mucositis in pediatric cancer patients, LED for TMJ dysfunction, Laser vs LED dentin hypersensitivity, combined autologous PRP and LED for venous ulcers, LED after eccentric exercise (it seems to be a big month for LEDs ) and delightful editorial from Kevin Moore on the early years for LLLT and the World Association for Laser Therapy (WALT).
Last October a systematic review on LLLT for neck pain was written by Kadhim-Saleh et al and published in the British Journal of Sports Medicine. They report that the evidence for LLLT in neck pain is inconclusive. The paper criticises the 2009 Lancet review by Roberta Chow & Bjordal et al on LLLT for non-specific neck pain claiming their review was more stringent. Well you have to read the rebuttal Bjordal shot back to the journal editor revealing the weakness, errors and fundamental flaws in the work of Kadhim-Saleh et al
If you are familiar with many of the light therapy arguments today this should make you smile; I stumbled across a book published in 1946 called Electrotherapy and Light Therapy and I quite enjoyed the cautious speculation and many accuracies that we still discuss today.
The book is 694 pages long, the section on light and infrared therapies is 26 pages, here some samples for you.
In October a paper was published claiming that class IV laser is more effective than class 3B for oral mucositis. The authors attempt to con the reader by asserting they used a “standard” 3B laser protocol, but instead they set up a weak protocol delivering just 15%of the recomended energy in order to make a “class IV laser” product appear more effective.
As you know the marketing claim for class IV devices is that they have more power so should go deeper, should reduce treatment time and should be more effective, well guess what, most of their power is using wavelengths that do not penetrate (970-980nm) . All the evidence on dose consistently shows that over treatment reduces effectiveness , treatment times are longer due to the scanning technique  and when you look at the small handful of clinical trails done with class IV lasers they use the same irradiation parameters used by 3B lasers anyway!
Such misinformation is intended to direct a doctor / therapist away from what is proven to work in favour of something more expensive. If you you see a manuscript with ”HILT” or “class IV laser” in the title watch out for the marketing spin.
I wrote a letter to the journal editor. I will post a link when it is published.
The title of last months PMLS editorial was Low Level Laser Therapy (LLLT) and World Association for Laser Therapy (WALT) Dosage Recommendations. Written by the Scientific Secretary Prof. Jan Bjordal. He describes how far we have come and the importance of the WALT dosage recommendations. No abstract is available for editorials so I have prepared one for you below. Continue reading →
The good news is I received an invite from NICE to go see them.
NICE are the UK’s National Institute for Health and Clinical Excellence. Their guidance helps British health professionals deliver the optimal care based on the best available evidence. It seems they like what we do and want me go show them LLLT. Watch this space. 8-)
A paper titled ”The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis” [ref] showed that 10 Watt Class IV laser (mixed 8W 970nm, 2W 810) was successful in reducing pain and improving function in an RCT with 15 patients, and that there was good statistical significance at 6 months following a course of 6 treatments.
The claim by class IV laser manufacturers is that class IV lasers are better (faster, deeper and more effective) than Class 3b and LED systems. Conversely the 3B laser and LED manufacturers argue that less power density is more effective because delivering energy too quickly can overdose tissues and class IV lasers might burn the skin.
Throughout this paper there are marketing messages claiming the advantages of shorter treatment times than low power LLLT systems and of course the title shouts “10 Watt Class IV laser” just in case the reader is in any doubt that more power is what you need.
Regular readers of this column know my obsession with irradiation parameters, particularly dose rate effects (W/cm2) and will not be surprised to learn that I deconstruced the irradiation parameters used in this trial . Surprise, surprise they were the same low irradiance levels typically used by 3B lasers and LED systems, if not less and the treatment time was longer too.
Yes, it was a 10 Watt laser and yes, 3,000 joules was delivered, however it had a large beam area and treatment was delivered over (45cm2) in a “painting fashion”. The fluence (dose) was 6.6 Joules/cm2 and the power density was a tiny 22mW/cm2, consequently treatment time was a hefty 5 mins.
The average irradiance was not disclosed in the paper and the reader is directed to think that more power is quicker.
P.S. research trials with 3B lasers are typically 30 seconds to 3 mins and our recommended treatment is 1 min with a large LED cluster to the lateral epicondyle and 30 seconds for any related trigger points.
Multiple sclerosis (MS) causes progressive paralysis by destroying nerve cells and the spinal cord. It interrupts vision, balance and even thinking.
On a suggestion from a colleague, Jeri-Anne Lyons decided to test how the disease responded to a radical therapy – exposure to a certain wavelength of light called near-infrared (NIR). Continue reading →
A few weeks ago (September 2013) the BMJ updated their patient information for neck pain and I quote “There isn’t much specific research that shows drugs help neck pain, but your doctor may recommend one or more of the following” and then they list painkillers (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants and muscle relaxants. Well, guess what, there was NO mention of LLLT.
Of course I wrote to the BMJ, pointing out there are at least 17 RCTs for LLLT on neck pain and a systematic review in the Lancet and added “What kind of a review did your team do that missed LLLT and yet suggests drug therapies that lack evidence?” and the reply was “The patient leaflets are written from reviews of the evidence on treatments compiled by our scientific and clinical teams for the Best Practice and Clinical Evidence products. The treatments to be included are decided upon with advice from clinical experts in the field. I will forward your message to the teams involved in deciding the scope of the Clinical Evidence and Best Practice topics linked to the neck pain patient leaflet, so that they can consider your comments when they next review the scope of the topic”
Should I respond and what should I say?
I am a fan of the BMJ. They are not usually a slave to the pharma industry and they are not afraid to confront them or any blinkered “business as usual” physicians so I fully expect LLLT to be in next years guidlines (I shall make sure of it). That is my upbeat comment for this month.
David Sengeh has been developing powered limbs at MIT for amputees (like the bionic man). Where the powered limb attaches to the body (the stump of the original leg) it gets very sore. David has been using our standard THOR products to heal the stump and reduce pain. It works very well, though it takes a lot of time to treat the whole area. I am in Boston now to help David start clinical trials with a new device we designed that will treat the whole stump. The amputee puts the the leg stump into the LED treatment cylinder and gets a complete treatment in just one minute :-)
The BMJ reported that the US Centers for Disease Control and Prevention had declared there was a national epidemic of prescription drug overdoses which led to 14,800 deaths in 2008. This is more than cocaine and heroin combined for the same period. If you think this an exaggeration click here to see the full government report.
They highlight the following key points :
Death from opioid pain relievers (OPR) is an epidemic in the United States.
Sales of OPR quadrupled between 1999 and 2010.
Enough OPRs were prescribed last year to medicate every American adult for a month
Abuse of OPRs costs health insurers approximately $72.5 billion annually in health-care costs.
And just in case you were not astonished already, I will remind those of you that have not heard me say it before that NSAIDs were the 15th biggest cause of death in the USA according to the New England Journal of Medicine 1999. Unfortunately there is no abstract so I am going to show you a little snip from the full paper
Available only to people who have attended a THOR training course in the last 3 years. All treatments are based on our four step method which includes treatment of the injury, trigger points, lymphatics and nerve roots.
Take a look to see how it works and let us know what you think.
A guidance document on myofascial pain syndrome (MPS) published on the International Association for Study of Pain web site finds “strong evidence” for Low Level Laser Therapy (LLLT). We have archived a copy here and you can find the original source here . Myofascial pain syndrome is often confused with fibromyalgia so it may be worth reading this blog to help understand the difference.
The BMJ sports medicine journal (BJSM) published a systematic review of conservative and surgical interventions and found “strong evidence for the effectiveness of laser therapy” adding to the rapidly expanding list of authoritative journals endorsing LLLT.
28 papers for December 2013 starting with a good narrative editorial from Richard Godine DVM who make good points about dose, penetration and treatment guidelines for pets, there is an LLLT study on TMJ pain, a couple of orthodontic tooth movement papers, a clinical trial on subacromial impingement syndrome, Jan Tuner write a nice op ed regarding a failed tinnitus trial pointing the obvious flaws in the dosimetry. There is a trial on muscle fatigue in young women, a lichen planus study, gingival hyperplasia and much more (of course).
At the NZ2008 laser meeting we debated LLLT nomenclature, many scientists prefer to call it Photobiomodulation (and I agree this is the best name). Laser Biostimulation was used for some time by the American Society for Lasers in Surgery and Medicine, who recently adopted Photobiomodulation instead. Pubmed have chosen LLLT (stands for Low Level Laser Therapy) as the MeSH term (MeSH stands for Medical Subject Heading) however they have used that label for almost every form of medical laser treatment (low level or otherwise). Low Level Laser Therapy was a term coined by Oshiro and Calderhead back on the 1980′s.
Here are some words and phrases I have collected over the years:
It is also common for laser wavelength and / or lasing medium to be added to the title . common examples are 810nm laser diode therapy for xyz. In case you are not familiar with the common wavelengths and materials used they are: 660nm 810nm 830nm 904nm
Full list as follows: 590nm 632.8 650nm 635nm 660nm 670nm 680nm 750nm 780nm 705nm 908nm 810nm 820nm 830nm 850nm 870nm 880nm 890nm 904nm 905nm 950nm 940nm 970nm 980nm 1064nm
oh dear, I hope that none of this audience (you) are attempting to treat through clothing. Light does not go through clothing very well (if at all). You must treat the skin directly, preferably in contact (or very close).