A review from clinical
experience.
Studies prove photochemical actions and reactions are true, you can’t
see it happen. You can’t smell the oxygen being released. And,
if you tasted the plants, they are BITTER, not sweet like glucose.
No, it’s absolutely too good to be true. EXCEPT that it happens,
and our planet and its inhabitants survive solely because of this
process.
In addition to photosynthesis,
there is PHOTOMORPHOGENESIS (genesis=development, morph=form of an
organism, photo=influenced by light). An example in plants is the
action of red light (633nm) on an inactive molecule called PHYTOCHROME.
Upon absorption of this light, the phytochrome becomes active. This
induces a cascade of enzymatic reactions that lead to such responses
as seed germination and flowering among others (Karu, 1998). This
is analogous to actions that occur within human tissue.
It is arguable that light
is one of the most critical sources of energy for our planet. Societies
living in areas deprived of sunlight have a significantly higher suicide
rate than those where the sun shines almost daily.
The Bible and earliest
history refer to the sun (hence light). Please note that in the first
paragraph of the first book of the Bible, Genesis, It says, ”Let
there be LIGHT”.
For approximately thirty
years, light, in the form of Low Intensity Laser Therapy (LILT) has
been used to treat a myriad of conditions. Significant advances with
this technology have occurred since the mid-eighties. However, the
available information was only sparingly disseminated to the scientific
community. Little was known by the clinician (Baxter et al, 1991)
until it was utilized, primarily in Europe and Asia, with very little
information available in North America.
When being applied properly,
LILT has proven to be tremendously effective. Unfortunately, until
recently there has been a lack of scientific scrutiny concerning the
clinical efficacy of this procedure (Baxter et al, 1997). This does
not mean that LILT doesn’t work. Despite the lack of scientific
research, clinical results have been outstanding. While patients were
getting better, clinicians didn’t know why or understand the
reasons for this improvement.
The “why” appears
to be important only when a new procedure/philosophy wants to gain
acceptance. To prove this point I refer to the American edition of
the Physicians Desk Reference (any year will do). Please note the
statements under ACTIONS for each of the following; ELAVIL (amitriptyline),
Naprosyn (naproxen) and Robaxisal (methocarbamal and asperin). In
the first it states, “…the mechanism of action in man is
not known”. In the second, it says, “…the mode of action
is not known”. The third states”…the method of action
in man is unknown”. Nevertheless, all three are commonly prescribed
medications.
This paradox is easily
explained: treating the symptoms is an accepted practice throughout
the industrialized world. LILT, however, deals with HEALING on the
cellular level, which secondarily (and quickly) relieves the symptoms.
This is such a radically different philosophy that greater scrutiny
and proof will be required before it will be generally accepted by
mainstream medicine.
How long will this process
take? Consider that Einstein, in 1917, published a paper which outlined
the key principles for the stimulated emission of photons. This was
based upon an earlier concept by Planck concerning quantal energies.
It has only taken about 85 years to get this far.
In the past few years however,
more and more pieces have been found to exist in the completion of
the “why puzzle”. Dr. Kendrick C. Smith observed that the
activation of an enzyme or the induction of the synthesis of an enzyme
are excellent candidates for the biological basis for LILT, because
only a few photons are needed for these processes to begin. Once an
enzyme is activated, it can catalyze thousands of chemical reactions.
There is a large amplification factor involved. A few photons can
produce a huge biological effect.
In LILT, Red (633nm) and
infrared (830nm) have different effects on molecules. Red (visible)
light can produce chemical changes while infrared radiation can only
produce physical changes in molecules. In spite of this, both result
in clinical improvement.
Visible light enhances
cell proliferation through photochemical changes in the mitochondria,
which then set in motion a chain of biological events that ultimately,
affect cellular membranes. This, in turn, has an effect on messenger
RNA synthesis, which ultimately leads to the observed enhancement
of cell proliferation.
Pores in membranes open
and close to let ions, such as calcium, in and out of cells as a consequence
of physical changes in the membrane pore molecules. Calcium ions act
as intracellular messengers in many signal-transducing pathways. The
cellular calcium ion concentration can be abruptly raised for signaling
purposes by transiently opening calcium channels in the plasma or
intracellular membranes.
The catalytic activities
of many enzymes are regulated by the calcium concentration. Since
infrared radiation affects the physical state of molecules, they can
affect the pore molecules directly. Thus, a similar effect on cell
proliferation can occur whether the cells were irradiated with visible
light at 633nm or infrared at 830nm.
Specific types of molecules
absorb specific wavelengths of light, both visible and infrared. Absorbed
radiation produces specific biological effects in tissue, depending
upon which types of molecules absorb the light (Karu, 1998).
Trelles et al reviewed
the use of local irradiation with LILT. They found this approach elicited
the following types of effects: biostimulatory, analgesic, antiexudative,
antihaemorrhagic, antiinflamatory, antineuralgic, antioedematous,
antispasmotic and vasodilatory (among others).Trelles,
et al, (1989) and Muxeneder, (1988) also reviewed the effects of LILT
in vertebral pain, headaches and local immune responses. They found
the main clinical uses included wound healing, pain control, soft
tissue injury, arthropathy and osteopathy and treatment of existing
scars. They observed local irradiation stimulated extremely rapid
healing, even of extensive indolent superficial wounds. It was considered
effective and safe. Scarring was minimal.
According to Mester, et
al, (1985) and Muxeneder, (1988), the effects of LILT on wound healing
are dramatic. They stated, “many irradiated septic wounds heal
as if by first intention”.
Numerous clinical studies,
and this author’s experience as team physician for a nationally
ranked college hockey program, all indicate that swelling and inflammation
in superficial muscles, tendons, ligaments, bursae and sheaths can
be alleviated by irradiation of the affected areas. In arthropathy
and osteopathy, mid-range lasers can alleviate pain swelling and inflammation
of accessible joints, especially if the primary sites are irradiated.
Initially, the effect was thought to be anti-inflammatory, but recent
work has shown that LILT enhances the inflammatory process and allows
the body to reach the healing stage much faster. It is also effective
in pain control and resolution of osteitis and periostitis in superficial
areas. It was (and still is) preferable to ultrasound in these conditions
as the latter can only heat bones, potentially causing damage.
Old scars (surgical or
traumatic) can act as trigger points if there are tender areas, keloid
formation and adhesions along the scar. Such scars can be associated
with chronic, reflex pain, lameness and autonomic effects. LILT of
such tissue can produce dramatic clinical improvement in most cases.
The earlier lasers were
“powered” by gases such as Helium and Neon (He-Ne). It was
not until the 1980s that the semiconductor diode systems became available.
The most popular of these for clinical use are the gallium arsenide
(GaAs) and the gallium aluminum arsenide (GaAlAs). These superluminous
diodes are mounted into a “treatment head” for easy application.
The emitted light includes far and near ultra-violet, the visual spectrum
and near, mid and far infrared.
In LILT, nothing happens
unless the tissue absorbs the photons (bundles of light). In the therapeutic
near infrared range absorption takes place in the tissue water (about
70%) and organic molecules (about 30%). For this purpose, absorption
may be defined as the conversion of light into some other form of
energy. Once absorbed, the photons have different effects on amino
acids, nucleic acid bases and other groups called chromophores. The
former is the basis for DNA and proteins. The latter involves porphyrins,
which are bio-organic molecules (hemoglobin and melanin are examples).
Another factor in the photochemical
action of LILT is attenuation, or how much light is lost as it travels
through tissue. This depends upon the ratio between absorption and
scattering. This ratio varies according to the type of tissue irradiated
and the wavelength applied. Where light absorption is low, (600 –
1200 nm), scattering predominates. In human tissue, scattering tends
to be in a forward direction.
Considerable cellular research
concerning laser irradiation has been done since the 1970s. At that
time the focus was primarily on wound healing due to the great clinical
success using LILT. For obvious reasons, the studies related to this
involved observing the actions of fibroblasts, lymphocytes, monocytes/macrophages
as well as epithelial and endothelial cells.
All studies exhibited the
positive effects on the healing mechanisms involved with the cells
being tested, either by stimulation or inhibition. As a result, one
could explain why wounds heal faster with LILT. However, the exact
mechanism is still unknown; The effect on the patient and how it affects
healing is however, known. What remains unknown is the exact mechanism
by which light causes these photochemical reactions.
Of at least equal importance
(more so for the practitioner) is the role of LILT in pain relief.
This, more than wound healing, results in the, ”too good to be
true” attitude within the American medical community. After all,
EVERYONE knows the only ways to relieve pain are by medication and
surgery. If these don’t work, psychotherapy is the last alternative.
However, since 1986 world-respected
researchers have recommended LILT for such use (Seitz & Kleinkort
1986; Zhou Yo Cheng 1988; Woolley-Hart 1988; Kert & Rose, 1989).
In addition, clinicians around the world, based upon their professional
experiences, confirm the analgesic effect of LILT.
Unfortunately, from a strictly
scientific point of view, these reports are hardly conclusive. There
has been little or no standardization in the application of LILT.
The type of laser used, the wavelength, contact or non-contact mode,
length of treatment as well as skin color, age of the patient and
body type are all variables that can effect outcomes. As a result,
the majority of reports concerning the efficacy of LILT have been
considered anecdotal. A great many of those were reported in foreign
languages, which often resulted in obscuring information during the
translation.
Another major obstacle
involves the subjectivity of pain. The very nature of pain is such
that there is no truly scientific way to measure it. Also, some people
have higher or lower sensitivities. They also react differently to
having it (victim vs. survivor). On almost a daily basis, pain sensitivity
can vary depending upon physical, chemical and/or emotional factors.
In spite of these limitations,
the number of clinicians and patients who report significant analgesia
from LILT has grown dramatically. Whether or not we know exactly why,
LILT is proving to be a very valuable modality in the treatment of
pain. In fact, clinicians using LILT and other forms of electrotherapy
consistently report the clear superiority of the former. In a growing
number of instances, it is now used as the first treatment of choice
for pain. Perhaps even more important is the fact that, to date, there
has never been a report of a serious, long-term negative side effect
attributable to this procedure.
The list of painful conditions
treated with LILT is extremely impressive. In fact, clinically it
would be easier to list conditions on which LILT does not work. Even
then, failure is not outright. It is more appropriate to say that
the percentage of success in some patients, with some conditions,
is lower. These conditions include spinal stenosis, where there is
direct bony pressure on a nerve(s), reflex sympathetic dystrophy and
advanced neuropathy.
After a double blind clinical
trial conducted by General Motors Corporation using LILT for Carpal
Tunnel Syndrome, the company has established laser treatment facilities
in all of its manufacturing plants.
While the neurophysiological
effects of pain have been studied in both animals and humans, no major
recent studies have been completed recently. The latest reviewed was
Basford et al, 1990. Overall, the findings were inconsistent and even
contradictory with human subjects. However, once again, there was
no standardization. It does appear that the use of He-Ne lasers at
low doses (less than 1 J/cm squared) would consistently have no appreciable
effect on nerve conduction latency.
The Arrant-Schultz Law
(Baxter, (1997); Ohshiro & Calderhead, (1988) may explain the
inconsistent findings of researchers. It is to photobiological activation
what the law of diminishing returns is to economics. Basically, it
says there is a threshold amount of energy (laser light) that is required
to effect a change in cellular activity. This amount varies with individuals.
When the dosage is increased above threshold (relatively little),
the degree of cellular biological activity also increases. When the
dosage increases further, above a certain level (variable), a plateau
effect occurs. There is simply no increase in cellular activity. When
the dosage is increased above the plateau level, there is an inhibitory
effect upon the cells. Using this model as justification, many experts
in the field of LILT contend that it is not possible to “overdose”
with laser treatment.
Low Intensity Laser Therapy
has been clinically proven to be superior to all other forms of pain
therapy. In comparative applications, it has worked better than medication,
ultra-sound, electrotherapy, heat, ice, etc. It also does not have
some of the severe side effects, as do other forms of treatment.
LILT is not a “magic
wand”. It is a medical device which promotes rapid healing and
pain relief. This is a PROCESS, not an on/off switch. However, millions
of patients have been helped when no other form of treatment has worked.
Laser therapy also dramatically
reduces healing time when compared to other traditionally used modalities.
Hospitals in Great Britain use LILT in post-surgical recovery rooms.
They have found patients have much less pain, take 50% less pain medication,
heal in half the time and have significantly less scar tissue. To
those of us who have been privileged to use this technology, our patients’
permanent recoveries are not only believable, but also expected.
In this author’s opinion
and experience, the most superior form of low intensity laser therapy
is via the BioFlex computer-driven laser instrument, produced by Meditech
International, in Toronto, Canada. Besides dozens of pre-set protocols
(see the partial list above), it can also accommodate customized protocols.
All parameters can be altered to truly individualize each treatment.
Even such things as age, skin color and body type can be considered
when choosing the appropriate amount of light exposure. Once chosen,
it is calculated automatically.
Another of the unit’s
most unique features is the “Flex” part of the name BioFlex.
The treatment heads can wrap around joints (knee, elbow, wrist, etc.),
delivering light through either 60 or 180 superluminus diodes. This
author, while treating almost 4,000 patients, found that the BioFlex
was clearly superior to the other laser devices he used previously.
References
