Benefits of Cold Laser Therapy in Pain Management CURE SOME, COMFORT ALL. Disclaimer, Conflict of Interest. Objectives

Transcription

1 Benefits of Cold Laser Therapy in Pain Management Disclaimer, Conflict of Interest A Guide for Health Care Professionals Jason Reed, MD, Medical Director 2010 Partly Adapted/Revised from Meditech-Bioflex 2005 Slide Presentation, Author Fred Kahn, MD Objectives Mainstream and Alternative? Cold Laser Theory Cellular and Physiologic Effects Clinical Application Outcomes and Literature CURE SOME, COMFORT ALL THE PERFECT DRUG? THE PERFECT DRUG? Hyperglycemia, cataracts, avascular necrosis, osteoporosis, psychosis 1

2 THE PERFECT DRUG? Itching, sedation, falls, constipation, addiction, tolerance THE PERFECT SURGERY? THE PERFECT SURGERY? Weinstein, et al. Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis. N Eng J Med. 2008;358: THE PERFECT SURGERY? Weinstein, et al. Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis. N Eng J Med. 2008;358: Deyo, et al. Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults. JAMA. 2010;303(13): Relief Laser Mission Elimination of pain Obviate the need for drugs Restore normal range of motion Improve quality of life History of Laser 1960 s 1970 s 1980 s Original lab research in Hungary, Japan, and Russia Early clinical application (He-Ne) Initial applications in the West Slow Evolution Lack of English language publications Pharmaceutical culture 2

3 Meditech and Relief Laser s Leap into the 21 st Century Advantages of Laser Therapy Approx. 20 yrs clinical and lab research combined Patented, large-surface flexible array pads Computerized protocols Ability to customize protocols Clinical approach to healing Non-toxic Non-invasive Ease of application No known side effects Feasible alternative to - Analgesics - NSAIDS - Other medications - Cortisone - Surgery? Safe Mechanisms of Action Light is absorbed by cells/tissue - Variety of chromophores, flavoproteins and other micromolecules absorb photons - Light energy is transformed into ATP - Restoration of normal cellular configuration and function Multiple secondary effects - Reduction in pain, edema, and inflammation - Support and acceleration of the natural healing process - Epithelization and wound closure - Re-establishing continuity of the muscle/tendon matrix Cellular Interactions with Light RED LIGHT affects a variety of cell types absorbed by mitochondrial cytochromes INFRARED LIGHT absorbed by specific proteins in cell membrane and directly affects permeability (Ca++, Cl-, Na+ ions) Additional Effects Keys to Successful Outcome Altered nerve conduction Circulation/Angiogenesis Increased metabolism of: --Endorphins --Cortisol --Acetylcholine --Serotonin Immediate Cumulative Increased ATP production Enhanced cellular function: --Growth Factor release --Cytokine production --Mitochondrial replication Increased synthesis of: --DNA --Proteins Accelerated healing Location Pad Placement Penetration Frequency Patient Age Chronicity of Condition Underlying Patient Condition or Co-morbidities Underlying Degenerative Disease Philosophy = Relief 3

4 Contraindications Pregnancy Active Malignancy Further Study Needed Ocular Disease Growth Plates in Adolescents/Children Conditions Treated: General Inflammation Edema Peripheral Nerve Dysfunction Wounds and Epithelium Infection Immune Boost Virucidal Achilles Tendonitis Inflammatory Arthritis Degenerative/Osteoarthritis, Inflammatory/Rheumatologic Acute Injuries or Chronic Conditions Tendonitis/Sprains/Strains Achilles, Rotator Cuff, Medial/Lateral Epicondylitis, Cervical, TMJ, Plantar fasciitis Bursitis Greater Trochanter, Deltoid Before After 12 treatments Lymphedema Peripheral Nerve Dysfunction Peripheral Neuropathy Diabetic Chemotherapy-induced Shingles/Post-Herpetic Neuralgia Before: Edema and Cellulitis After 9 Treatments Trigeminal Neuralgia/Tic Doloreaux 4

5 Wounds and Epithelium Epithelization Immune Boost Increased Circulation Macrophage stimulation Improved lymphatic drainage 5

6 After 23 treatments Diabetic, painful dermal ulceration. 10 Treatments over 3 weeks Infection Early Stasis Ulcer: 5 treatments over 9 days Herpes Simplex, Severe Outbreak: 2 treatments over 3 days Summary Points Safe Effective Non-invasive Non-pharmacologic Protocol driven, customizable Novel Emerging Literature Brosseau, L; Welch, V.; Wells, G. A.; De Bie, R.; Gam, A.; Harman, K.; Morin, M.; Shea, B. et al. (2005). "Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis". Cochrane database of systematic reviews (Online) (4): CD Huang, Y.; Chen, A.; Carroll, J.; Hamblin, M. (2009). "Biphasic Dose Response in Low Level Lightherapy". Dose-Response 7 (4): 358. Bjordal, J. M.; Lopes-Martins, R. A.; Joensen, J.; Couppe, C.; Ljunggren, A. E.; Stergioulas, A.; Johnson, M. I. (2008). "A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)". BMC Musculoskeletal Disorders 9: 75. Jamtvedt, G.; Dahm, K. T.; Christie, A.; Moe, R. H.; Haavardsholm, E.; Holm, I.; Hagen, K. B. (2007). "Physical Therapy Interventions for Patients with Osteoarthritis of the Knee: an Overview of Systematic Reviews". Physical Therapy. Chow, RT.; Johnson, MI.; Lopes-Martins, RA.; Bjordal, JM. (Nov 2009). "Efficacy of lowlevel laser therapy in the management of neck pain: a systematic review and metaanalysis of randomised placebo or active-treatment controlled trials.". Lancet 6

7 Tumilty, S.; Munn, J.; McDonough, S.; Hurley, D. A.; Basford, J. R.; Baxter, G. D. (2010). "Low Level Laser Treatment of Tendinopathy: A Systematic Review with Meta-analysis". Photomedicine and Laser Surgery 28 (1): 3. Yousefi-Nooraie, R.; Schonstein, E.; Heidari, K.; Rashidian, A.; Pennick, V.; Akbari-Kamrani, M.; Irani, S.; Shakiba, B. et al. (2008). Low level laser therapy for nonspecific low-back pain. Da Silva, J. P.; Da Silva, M. A.; Almeida, A. P. F.; Junior, I. L.; Matos, A. P. (2010). "Laser Therapy in the Tissue Repair Process: A Literature Review". Photomedicine and Laser Surgery 28: 17. Bjordal, J. M.; Johnson, M. I.; Iversen, V.; Aimbire, F.; Lopes-Martins, R. A. B. (2006). "Low-Level Laser Therapy in Acute Pain: A Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo Controlled Trials". Photomedicine and Laser Surgery 24 (2): 158. Tafur, J.; Mills, P. J. (2008). "Low-Intensity Light Therapy: Exploring the Role of Redox Mechanisms". Photomedicine and Laser Surgery 26 (4): 323. Karu, T. I. (2008). "Mitochondrial Signaling in Mammalian Cells Activated by Red and Near-IR Radiation". Photochemistry and Photobiology 84 (5): Huang, Y.; Chen, A.; Carroll, J.; Hamblin, M. (2009). "Biphasic Dose Response in Low Level Lightherapy". Dose-Response 7 (4): 358. PUBMED (keyword: low intensity laser) = 1,958 hits Excuses, Excuses 23 major cold laser and diode competitors Most with one wavelength Wavelengths differ slightly Output differs greatly No standardization in literature Most studies published abroad Outcomes 80% improved One half are % improved Duration of Benefit Few return customers 7

8 Jason Reed, MD 2800 Chicago Ave South, LL11 Minneapolis, MN (612) (Now also at The Marsh in Minnetonka) 8