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Category Archives: Rants
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 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.
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Class IV laser dose concern. An update from Prof. Jan Bjordal. World Association for Laser Therapy (WALT)
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. (more…)
Posted in Rants, Special Feature
on Class IV laser dose concern. An update from Prof. Jan Bjordal. World Association for Laser Therapy (WALT)
Class IV laser treatments take longer than 3B lasers
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.
Protected: Class IV laser misinformation
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on Protected: Class IV laser misinformation
Protected: Class IV laser vs Class 3B laser vs LEDs
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on Protected: Class IV laser vs Class 3B laser vs LEDs
None so blind as the BMJ who will not see
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.
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The Bottom Line – lazy or ignorant professors?
Irradiation parameters and dose are critical aspects of LLLT and if you are a doctor or therapist you probably trust the research you read. Prepare to be disappointed.
Posted in Rants
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