Category Archives: Rants

BMJ snubs LLLT for neck pain again, but gives drugs with no evidence a pass

As reported here in 2013 there are no licensed drugs for non-specific neck pain because “there isn’t much specific research that shows drugs help neck pain”. For LLLT/PBM however, there are at least 16 (mostly positive) RCTs and a positive systematic review  published in The Lancet. Despite this unequivocal evidence, the 2014 revised patient advice leaflet from the BMJ fails to mention LLLT/PBM but states “your doctor may recommend one or more of the following” and goes on to list pain killers, NSAIDs, antidepressants and muscle relaxants”.

Last year I pursued someone at the BMJ, supplied them with the necessary data including controversial papers and rebuttals (5 months ahead of online publication on their own website). I obtained confirmation it was … Continue reading

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More Class IV laser therapy misinformation

More Class IV laser therapy misinformationThe 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 … Continue reading

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LLLT nomenclature: Cold Low Energy level Laser Soft Therapy Photobiomodulation Phototherapy – Whats in a name ?

Cold Laser NomenclatureAt 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:

Bioregulating Laser
Biostimulating Laser
Broad Band Radiation Therapy
Class IV laser Therapy
Cold Laser Therapy
Diode Laser Therapy
He-Ne Laser therapy
Helium-neon laser irradiation
HILT (High Intensity Laser Therapy)
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LLLT Low level cold class IV laser therapy. Treat the skin directly, preferably in contact (or very close).

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).

These examples will not work

Screen Shot 2014-01-17 at 10.16.59 Screen Shot 2014-01-17 at 10.16.40 Screen Shot 2014-01-17 at 10.16.13 Screen Shot 2014-01-17 at 10.14.44 Screen Shot 2014-01-17 at 10.14.29 Screen Shot 2014-01-17 at 10.12.47

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Kadhim-Saleh laser neck pain review conclusion incorrect. LLLT is clinically effective

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

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LLLT Systematic reviews with meta-analysis are hard to do

LLLT Systematic reviews with meta-analysis are hard to do for all sorts of reasons:

1) LLLT has had a lot of different names (cold laser, laser biostimulation, photobiomodulation, low intensity laser laser therapy, LEDT,  etc) so the literature search is hard (see my post on this from 2008, recently updated)

2) The authors need to have an advanced knowledge of the pathology in question.

3) The authors need to have an advanced knowledge of LLLT too, particularly the matter of irradiation parameters and dose*

4) Then the meta-analysis requires a high degree of competence with medical statistics (see how to write a systematic review with meta-analysis)

* So we should not be surprised when someone who looks at a broad range of interventions for a pathology with lmited knowledge of LLLT struggles (and often fails)  to stratify the data by effective irradiation parameters (wavelength, power, beam area, irradiance, pulses), dose (time, energy, fluence), treatment location, number of treatments and interval between treatments.

It may be that LLLT is not a suitable intervention for the pathology in question … Continue reading

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Class IV laser misleading claims

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) [1]. All the evidence on dose consistently shows  that over treatment reduces effectiveness [2][3], treatment times are longer due to the scanning technique [4] 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![4]

Such … Continue reading

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