173 new LLLT papers for you this month. The big news is that “laser regenerates teeth” (details here) and that LED improves symptoms in chronic Traumatic Brain Injury patients (details here). There is my latest paper on LLLT in dentistry, an LED vs Laser study on oral mucostits and a cost effectiveness study for OM, laser vs corticosteroid for subacromial impingement syndrome, LLLT reduction of postoperative complications Post Myocardial Revascularization, a single case report on LLLT for retinitis pigmentosa, an RCT on carpal tunnel syndrome, a multicentre RCT on Male and Female Pattern Hair Loss, a study on the effect of LED on resorption during orthodontic treatment, a systematic review of LLLT for accelerating tooth movement during orthodontic treatment, the effect of LED on implant stability, LLLT treatment of Chronic Plantar Fasciitis, a TMJ RCT, a wrist fracture RCT, a review of LLLT and photosensitive medication, a fibromyalgia RCT, and another misleading Class IV vs 3B laser study (on knee osteoarthritis).
TV, radio and newspapers all over the world got very excited last week reporting that “laser regenerates teeth” following a Harvard study. The study showed that LLLT stimulates the stem cells resident in the tooth pulp to form dentin (for details click below). This is the highest profile announcement for any LLLT paper ever and will add significant awareness and credibility for everyone in the field. Congratulations and huge thanks to the author Dr Praveen Arany B.D.S., M.D.S., M.M.Sc., Ph.D. who is now a Clinical Investigator at NIH.
This 15 minute video starts with an overview of Photobiomodulation and low level light therapy. Later in the presentation James introduces the Lumithera treatment for Dry Age related Macular Degeneration (AMD).
The VA, Boston University and Harvard Medical School published the results of a Transcranial LLLT (LED) pilot study on mild Traumatic Brain Injury (TBI). Incredibly; TBI is a leading cause of death and disability among children and young adults in the United States. Each year an estimated 1.5 million Americans sustain a TBI, 50,000 people die as a consequence, 230,000 are hospitalized and an estimated 5.3 million currently live with a permanent TBI-related disability (because there is no cure). This study showed significant improvement in Executive Function, Verbal Learning, Long Delay Free Recall and fewer post-traumatic stress disorder (PTSD) symptoms. Participants and family reported better ability to perform social, interpersonal, and occupational functions. This was a small pilot study on just eleven patients with chronic mTBI, there was no placebo control group so further studies are necessary to truly establish the effect size.
The paper “High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial” Kheshie et al 2014 pitches the 3B BTL laser against the HIRO class IV “High intensity” laser. The results appear to show that the HIRO class IV “High intensity laser” was more effective than the “Low Level Laser”. HOWEVER, the HIRO class IV “High intensity” laser was delivered over a large area (not adequately defined but approx 100cm2 by my estimation) so the intensity was actually very low (about 13mW/cm2 which is less than most LED systems), and the 3B BTL “Low Level Laser” was actually very high (4 x 200mW small, high intensity beams) and were held stationary on the patella for over half an hour, YES, HALF AN HOUR IN ONE SPOT! This is insane.
This paper leads people to think that the class IV Hiro laser was more effective because it was higher intensity when in fact the beam distribution meant the average intensity distribution was low (13mW/cm2). The 3B laser was not so effective because it was held stationary such that it would cause an overdose. If the 3B laser treatment had been delivered in using same scanning technique as the class IV then they would likely have achieved the same result. (I am not a fan of scanning because you can never be sure how much energy you have delivered to an area, better to use a low intensity device and hold it still in my view).
This paper misdirects the reader towards favouring class IV lasers rather than 3b or LED by misinforming the reader.
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.