Oral mucositis is a term used to describe having a sore mouth, often with multiple painful ulcers. It is a side effect of cancer treatment that affects up to eight in every ten children who have chemotherapy.
This is a film by Leeds Teaching Hospitals NHS Trust about mucositis and a light treatment (called photobiomodulation) that can be used to prevent and treat this. It has been designed and filmed with children and young people who have had mucositis, and those who have had the light treatment.
This video was made as part of a research project, that aimed to find out how acceptable the light treatment was to children as part of their cancer treatment. The children and young people involved in this video hope that it will help to tell other children and their families what mucositis can be like, and what to expect with the light treatment.
Paul Schneider, Head & Neck cancer Patient talking about his experience using the new THOR Photobiomodulation therapy treatment and how it made such a difference to his journey.
Some NovoTHOR testimonials from ReGen Clinic Inc, a full-service laser clinic offering Photobiomodulation red light therapy to Victoria, Colwood, Southern Vancouver Island and surrounding areas.
“I’ve been studying and using laser and PBM therapy clinically for 15 years, and THOR’s training was hands-down the best available. It was well organized and covered the important information to get off the ground with treatment. It really helps that James is likeable, has a good sense of humor, and keeps it fun.”
Jonah Hershowitz
Pain Specialist
San Francisco CA, USA
City Hospital, Birmingham UK (an NHS hospital) published a new paper on NovoTHOR for fibromyalgia.
Sixteen fibromyalgia patients who had been suffering from pain and related sleep and psychological issues for an average of 15.6 ± 7.7 years received 18 NovoTHOR treatments over a 6-week period.
Participants reported significant benefits such as reduced pain, less fatigue, better sleep quality, and improved mobility and energy levels. They also felt happier and more able to engage in daily activities, noting an overall uplift in their quality of life.
The study details several specific improvements in day-to-day functioning such as:
Engagement in Sports and Physical Activities: Some participants reported being able to engage in sports and physical activities again. For example, one participant was able to participate in sporting activities with his wife, such as holding focus mitts for her, which he hadn’t been able to do before.
Increased Social Activities: Participants noted an increased ability to go out to social events. For example, one mentioned going out to the theatre and being able to engage in evening activities without the usual repercussions of fatigue the following day.
Hobbies and Interests: There was a resumption of hobbies and interests, such as arts and crafts, gardening, and reading, which participants had previously set aside due to their symptoms.
Traveling: Improved symptoms allowed some participants to travel longer distances to visit relatives, something they hadn’t been able to do for years due to their condition.
Day-to-Day Tasks: Participants also reported improvements in their ability to perform day-to-day tasks, such as household chores and walking the dog, activities that had been challenging due to pain and fatigue.
Trip to Dignitas was cancelled. Mood showed improvement as early as the first full treatment, most significantly to the point where one patient “no longer wants to take their own life“, another had been saving to go to Dignitas “it gave me hope whereas before I didn’t wanna live. . .I do feel a bit brighter, I do“.
Participants describe feeling much happier in themselves and feeling a lot more positive in their attitude, upbeat, brighter, happier, lighter, more bubbly than normal
chipper
such a boost
my mood’s lifted, and I feel good
I no longer cry at the drop of a hat
I can take things on
my mood’s improved massively
Another acknowledges that their mood is better correlated with getting tasks done.
Being able to dress how I used to because the pain is better
A participant with post-traumatic stress disorder (PTSD) describes feeling lighter with fewer flashbacks that usually cause her to break down in tears.
A participant was struggling with anhedonia (inability to feel pleasure)—”if somebody gave me a newspaper/book to read I just wouldn’t bother with it“. This disinterest has improved exponentially—”I’d certainly say the past month I’ve started using stuff like the rubik’s cube, I mean that’s something I’ve not played on since I was a kid, so I’ve been
doing something to test the mind”.
“I just feel as though I’m not walking through mud anymore. I feel like I can hold my head up and you know, walk on, walk straight. . .I don’t feel like I’ve got a cloud above my head” (Participant A)
“I mean, literally every time I come home I’ve got a smile on my face”
“my depression was bad, really bad, I was suicidal—but now I don’t even feel like that now. . .it’s improving to a state where I don’t even think about taking extra tablets or doing anything stupid. . .it’s definitely helped with my depression. Before I started I was suicidal, very suicidal. And it’s improved to the stage where I don’t want to commit suicide anymore”
Oral mucositis is a common side effect of high-dose chemotherapy or radiotherapy, leaving many patients unable to eat, drink, or swallow and consequently requiring tube feeding.
Until recently, there had been no satisfactory treatment or method of prevention. However, Photobiomodulation (PBM), a light therapy treatment proven safe and effective by the National Institute for Health and Care Excellence (NICE), is now widely used across the NHS with incredible results.
Jenny Gale, a head and neck clinical nurse specialist at East Suffolk and North Essex NHS Trust, said: “It can really make your mouth sore, and it hurts to swallow, which can make eating and drinking difficult, as well as impacting your general wellbeing.”
She added: “PBM is completely painless and very simple to carry out; most patients can do it themselves.
“Evidence shows patients need less pain relief when they’ve had PBM, and they generally cope with their treatment better. It’s really exciting that we are offering it in our hospitals now.”
The breakthrough allowing NHS adoption of PBM is due to the development of the THOR LED lollipop, which patients use by placing it in their mouth for 60 seconds on the tongue and 60 seconds under the tongue.
Photobiomodulation is a low-intensity light therapy that stimulates mitochondria to produce more energy (ATP) and reduce inflammation, rapidly reducing pain and improving healing rates.
It can be used prophylactically to prevent the incidence and severity of oral mucositis or therapeutically after mucositis has developed.
Both the Christie and Leeds Cancer Centres found that PBM reduced morphine prescriptions by 63 per cent and 45 per cent, respectively, in their audits and reduced hospital bed days by 88.7 per cent at Christie and hospitalisation by 89 per cent at Leeds.
There is a rare opportunity to attend the World Association for Photobiomodulation conference, which will be held in London this year from August 23 to 25, where many NHS users of PBM will be presenting their data and discussing it one-on-one with delegates.
“James was very engaging and knowledgeable about the equipment, what happens at a cellular level, the physics of the interactions etc. It was good to see the other uses for the PBM unit and gave me ideas for other things that we could try too. James was open in his discussion and acknowledged his obvious bias to the device, but was realistic of it’s potential.”
Nicola Freeman
Consultant radiographer
Leicester, UK
Cancer survivors are getting their lives back – thanks to a trail-blazing initiative at a bespoke post-cancer service at Nottingham City Hospital.
Nottingham Macmillan Late Effects helps people manage the physical, the psychological, and the psychosexual consequences of cancer treatment – and is the only place in the UK using photobiomodulation (PBM) therapy to treat the long-term effects of radiotherapy.
Cindy Martin, 64, who was left with disfiguring scars after surgery for stage 4 cancer of the saliva gland, says PBM therapy has given her back her life.
“The radiotherapy was so intense, my skin became necrotic. By the time I found Late Effects, I was convinced I would always have open wounds on my face.”
Radiation-induced fibrosis – or tissue scarring – is completely unavoidable and can develop in the area being treated with radiotherapy years after the radiotherapy has stopped – with life-changing effects on patients.
“Looking through photographs from a year ago, my face was awful. Skin would come off in clumps, and I lost my earlobe. It affected my mobility – it was like I had a steel rod in my neck,” says Cindy.
Many patients are being cured of their cancer, but left with disabling and debilitating consequences.
“All my identity had been taken away,” says Cindy. “I couldn’t do my job any more, I’d lost loads of weight, and I looked different.”
The PBM machine has a large ‘shower head’ attachment with LED lights. Patients are trained to administer the treatment themselves. The therapy is quick, simple, non-invasive, drug-free, and doesn’t cause any pain.
Emma Hallam is a Consultant Therapeutic Radiographer at Nottingham University Hospitals NHS Trust – and the person who thought of using PBM on radiation-induced fibrosis; it is usually used to treat lymphoedema – a long-term (chronic) condition that causes swelling.
Emma says: “We have people who have survivor’s guilt – they say that they feel lucky to be alive but sometimes wish that they hadn’t survived due to the long-term – sometimes disabling – side effects.
“Head and neck patients get much more radiation-induced fibrosis – they can’t eat, they can’t drink, can’t sleep – due to dry mouths and thick secretions.
“Our holistic approach helps improve quality of life and address all our patients’ needs, including the physical, psychological and psychosexual.”
PBM is just a small part of the Late Effects Service. The service uses a multi-disciplinary collaborative approach, with a dedicated rehabilitation and follow-up clinic, therapeutic radiographers, dieticians, and speech and language therapists.
“We are getting people swallowing again, who haven’t swallowed in years, people whose necks were immobile moving again, and people who haven’t been out of the house in years going out because they have got their lives back.”
Emma nominated colleague Kerry Clark for the The Skills for Health Our Heroes Clinical Support Worker of the Year award – and she is a finalist.
Kerry said: “It is such a humbling experience and a privilege to be able to offer help and support to patients who are feeling at such a loss after cancer treatment has ended.
“It is such a supportive environment to work in – I love my job and the difference we make to patients.”
And Cindy agrees. “Emma and her team have made such a difference to my life, I just can’t thank them enough – I wouldn’t be here today if it wasn’t for them. I was alive but I wasn’t living.”
The Skills for Health Our Health Heroes Awards is sponsored by NHS England, NHS Employers, NHS Shared Business Services and more. Gold, silver and bronze Clinical Support Worker of the Year award winners will be announced at a ceremony in London on 16 April. Show your support for Kerry by casting your vote here:
Emma now leads on the early management of all head and neck lymphedema, under the expert guidance of the specialist lymphedema team.
Late Effects has developed patient questionnaires as a 10-year monitoring system; identifying late effects early is important as fibrosis becomes more resistant to therapy as it builds up.
Peer-to-peer knowledge sharing across the world, and working with patients and UK charities has been key to educating people of the need for late effects services; Nottingham has been pivotal in helping establish around 20 similar services across the UK, and helped create best practice guidelines with the Pelvic Radiation Disease Association. Emma and her team hope to work with head and neck cancer charities and other late effects services to produce best practice guidelines for this patient group.
We are having great results from our THOR equipment. The week before last I had a chap in who’s had knee problems for ever and has only been able to ski half days since his last operation 4 years ago. I used THOR Giant Laser Cluster (GLC) on him (as well as some other stuff) before he went off skiing last week and he came in yesterday to tell me he was able to ski for full days all last week for the first time in about 4 years!!!… and asking for “a top up” before he heads back out on Saturday.
He was convinced it was due to the GLC – but I had encouraged him to use NovoTHOR a few times before he went out too so I presume it was a bit of both.
The BBC and Daily Mail are helping to reveal PBM (Photobiomodulation Therapy) into the wider community. With more public awareness of the amazing benefits how PBM light therapy is massively improving lives, we hope it will encourage more people to search it out and ask for this treatment in their own locations.
Cancer patients are benefiting from a new light therapy treatment which tackles a common side effect caused by chemotherapy and radiotherapy.
Photobiomodulation (PBM) has launched in hospitals run by East Suffolk and North Essex NHS Foundation Trust (ESNEFT) to prevent or treat oral mucositis. It occurs when cancer treatments damage the lining of the mouth. This can leave the tissue vulnerable to ulceration and infection.
All head and neck cancer patients having radiotherapy are being offered PBM at Colchester and Ipswich hospitals.
The treatments are being overseen by Jenny Gale, radiotherapy sister at Colchester, and Lyndsey Rew Macmillan specialist radiographer at Ipswich.
Jenny is also interim head and neck clinical nurse specialist at ESNEFT. She has had radiotherapy treatment herself so is able to relate to what her patients are feeling and the benefits PBM will bring for them.
She said: “It can really make your mouth sore. It hurts to swallow too which can make eating and drinking difficult, as well as having an impact on your general wellbeing.
“Unlike the side effects, PBM is completely painless. It’s very simple to carry out so most patients can do it themselves and take control of their treatment which is amazing.
“Evidence shows patients need less pain relief when they’ve had PBM, and they generally cope with their treatment better. It’s really exciting that we are offering it in our hospitals now.”
PBM works by applying infrared light to tissue, via two probes, which can reduce inflammation and improve healing.
Funding for two Thor laser machines, one at Colchester Hospital and the other at Ipswich Hospital, was provided thanks to a £31,000 grant from Colchester & Ipswich Hospitals Charity.
Fascinating interview that Dr Beth McDougall did with James Carroll, Founder and CEO of NovoTHOR – one of Beth’s absolute favorite technologies for bio-optimization, biohacking and healing.
Wanda has suffered with chronic pain and tenderness throughout her body for many years. Listen to her testimonial about how NovoTHOR Whole Body Light Therapy has transformed her life after having treatment at the PBM Therapy Clinic in Derby UK.
“I have been using lasers in my dental practice for more than 10 years now, and THOR is my latest addition. After completing the excellent remote training with James Carroll, I started using PMB on TMD cases, and the results have been immediate. The patients are very happy with the rapid remission of their symptoms. I am looking forward to using PMB in a variety of clinical situations in my office.”
Dr. Elizabeth Munteanu D.D.S.
Dentist
Toronto ON, Canada
A recent PDF publication by Michelle Biala, MSN, CRNP, AGACNP-BC, OCN®
Photomodulation (Low-Level Laser Therapy):
A Literature Review of the Prevention and Reduction of Oral Mucositis in Patients Undergoing Stem Cell Transplantation.
Belinda N. Mandrell PhD, RN, PNP has been at St. Jude Children’s Research Hospital for over 30 years. Belinda speaks to James Carroll about how they have been treating their oral mucositis patients with photobiomodulation.
Shepherd University officials held a ribbon cutting ceremony Monday for the expansion of a pain clinic at the school.
The clinic uses a process called photobiomodulation, or PBM. It uses laser light therapy to reduce pain from degenerative diseases.
A PBM bed is included in the university’s Wellness Center expansion and will be used to help those in and around the school’s community. The school received $500,000 through the state’s federal COVID relief funds for the clinic’s expansion.
“The application could be for young and old, healthy and sick,” said James Carroll, CEO of THOR Photomedicine. His company manufactures PBM beds.
“We know with athletes that it’s very good; if you pretreat before training, you have less fatigue, you have less muscle soreness due to less inflammation,” Carroll said. “But then if you’re older, and you have degenerative diseases like osteoarthritis – that’s an inflammatory joint disease – it would reduce the inflammation and therefore they’ll have less pain.”
Praveen Arany is the interim director for Shepherd’s PBM Center for Excellence. He says the process is similar to exercising or taking supplements, helping build resistance against long-term health issues.
“It’s a non-drug, non-interventional, non-invasive procedure; it’s just like treatment,” said Arany. “The advantage of that is there are no known side effects. And more importantly, it works on the wellness or the resilience of the people (being treated).”
Shepherd University officials cutting a ribbon to celebrate the expansion of the school’s PBM facility
The university plans to use the technology to research PBM’s effect on long COVID fatigue and opioid addiction.
Wellness Center director Jennifer Flora says she sees this as a starting point for even more expansion.
“When this building was developed, we labeled it a Wellness Center with hopes to offer additional wellness services – and we do on a very small scale,” Flora said. “It’s really rewarding to actually have an additional wellness service to really live up to our name.”
The Shepherd University Wellness Center is offering three free sessions to the general public starting Wednesday.
St Jude Hospital is the world’s leading research centre for catastrophic diseases in children. They just published a story on our Photobiomodulation treatment of Oral Mucositis, a common side-effect of chemotherapy or radiotherapy treatments.
Shining a Light on Mucositis
A new study conducted by St. Jude Nursing Research uses a painless therapy to help children avoid a common side effect of bone marrow transplantation.
New technology helps prevent oral mucositis for head and neck cancer patients undergoing radiation or chemoradiation
Fort Myers, Fla. & Bethesda, Md., March 08, 2021 (GLOBE NEWSWIRE) — The Center for Cancer and Blood Disorders (CCBD), an American Oncology Network (AON) partner, is pleased to announce it is now offering THOR® Photobiomodulation (PBM) therapy for the prevention and treatment of mouth sores in cancer therapy patients. Patients can now receive light therapy at both office locations in Maryland, Bethesda at 6410 Rockledge Drive, Suite 660 and in Germantown at 19735 Germantown Road, Suite 255.
The positive effects of PBM therapy on oral mucositis have been reported in 42 randomized controlled trials and nine systematic reviews, reducing the incidence of severe mucositis. Guidelines issued by the Multinational Association of Supportive Care in Cancer (MASCC) in 2019 recommend the use of PBM for the prevention and treatment of oral mucositis caused by radiation.
“Cancer patients deal with many side effects when they go through treatment,” said Dr. Mark G. Goldstein of The Center for Cancer and Blood Disorders. “Head and neck cancer patients receiving a high dose of chemoradiation treatment are almost 100 percent guaranteed to get a high level of oral mucositis. These painful mouth sores can make everyday tasks like eating, swallowing or brushing teeth difficult. Being able to offer our patients light therapy can bring therapeutic benefit. Without sores, patients can maintain their treatment schedules and may be able to avoid feeding tubes as well as narcotics. Maintaining treatment schedules can improve cancer control and overall outcome, along with reducing any long-term side effects.”
Each light treatment takes about 60 seconds and is painless. The light unit is shaped like a flat popsicle which is placed inside the mouth. With this single light unit, the entire mouth can be treated including the tongue as well as the areas near and behind the tonsils. Research done in the United States, United Kingdom, Brazil, India and Europe, shows no side effects.
Medical Director and CEO of The Center for Cancer and Blood Disorders Dr. Ralph Boccia added, “New developments continue to improve a patient’s quality of life. Currently only a handful of medical universities offer this light therapy. We’re excited to be one of the first community medical oncology practices in the country to be able to offer and treat mucositis, a major side effect suffered by many cancer patients undergoing chemotherapy treatment.”
AON CEO Brad Prechtl, MBA said, “Bringing the most advanced and innovative technologies to patients is an essential part of CCBD’s mission as a community oncology practice to provide exceptional cancer care to patients close to home.”
AON is an alliance of physicians and seasoned healthcare leaders that provides a unique array of enhanced services to its affiliated community-based oncology practices. It consistently strives to find innovative ways to connect with patients. AON’s community oncology model allows physicians to focus on what matters most — their patients.
About The Center for Cancer and Blood Disorders: (CCBDMD.com)
Specialists in the diagnosis and treatment of blood disorders and cancer, The Center for Cancer and Blood Disorders has been serving patients in the communities and surrounding areas of Bethesda and Germantown, Maryland for more than 25 years. Their individualized approach to patient care includes chemotherapy, targeted therapy, immunotherapy and when appropriate, cutting edge therapies on clinical trials. The practice regularly performs more than 300 clinical trials on new and developing diagnostic devices and techniques for cancer and diseases. Patients receive home delivery of oral cancer medications, in-house lab and pathology and on-site infusion therapy. The practice also offers comprehensive support with nutrition guidance and financial counseling.
About American Oncology Network, LLC: (AONcology.com)
American Oncology Network, LLC (AON) is an alliance of physicians and seasoned healthcare leaders partnering to ensure the long-term success of community oncology. Launched in 2018, the rapidly expanding AON network represents 92 physicians and 62 nurse practitioners and physician assistants practicing across 16 states. The executive management team of AON encompasses more than three decades of oncology practice management experience, enabling physicians to focus on what matters most – providing the highest quality care for patients.
The organization provides unique and comprehensive protocols for managing administrative procedures and enhancing ancillary services for its affiliates. AON is able to aggregate volume and attain economies of scale, as it guides its member physicians and practices through the transition to value-based reimbursement models that improve the patient experience and help to reduce the per-capita cost of cancer care.
AON also provides a unique model of physician led, community-based oncology management. With services such as a centralized specialty pharmacy, diagnostics, pathology, fully integrated electronic medical records, a care management team and a variety of financial assistance programs, an alliance with AON ensures that patients’ experiences will be at the very pinnacle of cancer care today.
Posted inIndustry, Special Feature, THE FUTURE OF PBM/LLLT| on American Oncology Network to be First Medical Oncology Network in United States to Offer THOR® Light Therapy at The Center for Cancer and Blood Disorders
Chemotherapy is difficult for any child, but when it causes mucositis, a painful side effect that causes ulcers to form in the mouth, it gets even harder. These children often require more pain medications and longer hospital stays.
Ben Wilson, 11, of Dilliner, Pa., was one of those patients. He was diagnosed with Ewing sarcoma. The chemotherapy regimen he was on was known to cause mucositis, but it was his best course of treatment. When he developed mucositis, his mother, Alison Wilson, talked to Dr. Hannah Hazard-Jenkins, director of the WVU Cancer Institute, about the trouble Ben was having with sores in his mouth and how difficult it was to maintain a lengthy mouthwash regimen to try to treat them.
“We tried some preventive treatments, including cold therapy, where you have them eat a lot of ice and do a series of seven mouthwashes, ” Alison Wilson said. “The cold therapy didn’t help much. Plus, it’s hard to use seven mouthwashes in a day, especially if you’re a kid, and they don’t taste very good.”
Hazard-Jenkins reached out to Dr. Geraldine Jacobson, WVU Cancer Institute Radiation Oncology chair, who contacted the pediatric oncologists at WVU Medicine Children’s to discuss whether the WVU Cancer Institute’s new THOR device would help Ben.
The THOR photobiomodulation device uses low-level lasers in the near-infrared range that stimulate and promote wound healing and regeneration.
“Low-level laser therapy is indicated by a multinational supportive care association for treatment of oral mucositis in adults, ” Jacobson said. “We have been using this treatment in the Department of Radiation Oncology since June to reduce oral mucositis in our head and neck cancer patients. The THOR device can be used outside the mouth along the cheek, jaw and neck to prevent mucositis lesions or inside the mouth to treat active wounds. There were positive reports of using this treatment for pediatric patients, so we decided to offer it to Ben.”
Dr. Patrick Tomboc, chief of WVU Medicine Children’s Hematology and Oncology, said he was amazed at how quickly the treatments helped Ben and prevented new sores from forming.
“This device greatly improves the quality of life for these patients, ” Tomboc said. “Ben has required much less pain medication than most patients who develop mucositis. We’ve been able to reduce the length of his hospital stays and really help with his pain management without any side effects.”
The device is also indicated for use in wound healing, which helped Ben when the surgical wound on his foot was slow to heal.
“Ben had really been struggling with his wound healing all summer, and it’s always a concern when you start chemotherapy with an open wound because it can slow healing even more, leaving it open to possible infection, ” Alison Wilson said. “After a nurse in Radiation Oncology suggested we try it on his foot as well, we discussed it with his doctors. There were so few possible side effects that we decided to go ahead and see if it would help. We had more healing in one month than we had all summer.”
“We’re really grateful that they were willing to look into using this device on kids to see what other institutions were using it and the pros and cons of the treatment. We’re also really excited that it has opened the door for other pediatric patients here, ” she added.
Alice has had back problems for 50 years with the pain increasing as she got older. Alice goes to Universal Healing & Wellness and is feeling so much better and gives NovoTHOR the credit for this.
Disclaimer: These comments by healthcare professionals and their patients are solely their own. They are uncompensated personal stories about how they have used, or been impacted by, light therapy. These uses have not been reviewed or cleared by FDA.
U.S. CONGRESSIONAL BRIEFING. Ending Opioid Use – Washington DC
James Carroll presented evidence to Congress on the effectiveness of PBM for treating pain and where it can be used in place of opioids. Prof. Praveen Arany explained how and why it works, and Annette Quinn RN gave her first hand experience in treating over 854 patients with Oral Mucositis.
A hundred million adults in the United States are affected by chronic pain and $600 billion a year is spent on health care, direct health care costs and lost productivity because of pain.
49,000 people died from opioids in 2017, 19,000 of which were from prescribed opioids for pain relief.
We believe that Photobiomodulation therapy can help reduce the prescribing of opioid medication for pain relief and we wish to draw attention to the Congress and health care policymakers, NIH and CMS, about this potentially valuable tool.
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 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.
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 →
Posted inRants, Special Feature| on Class IV laser dose concern. An update from Prof. Jan Bjordal. World Association for Laser Therapy (WALT)
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.
Posted inRants, Research| on Class IV laser treatments take longer than 3B lasers
The Treatment Protocol Library is available only to THOR Customers and/or 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.