11/10/2015 LOW LEVEL LASER FOR THE TREATMENT OF PAIN WHAT IS LOW LEVEL LASER THERAPY? WAVELENGTHS IN LOW LEVEL LASER. Cynthia Schmeck, ND, MS, CPT

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1 LOW LEVEL LASER FOR THE TREATMENT OF PAIN Cynthia Schmeck, ND, MS, CPT LASER = Light Amplification by Stimulated Emission of Radiation Focused beam of light Emits photon energy All photons traveling in the same direction at the same wavelength Photons: Bundles of electromagnetic energy measured in electron volts, traveling in specific wavelengths WHAT IS LOW LEVEL LASER THERAPY? Wavelengths < 400 nm Electrons are ejected from atoms Causing Ionization nm Enough energy to excite electrons to a higher level Enhanced Electrons affect adjacent atoms Basis for photobiostimulation > 660 nm Deeper tissue penetration but electron volt energy is so low that increased power needed to affect biostimulation INCREASED WATTAGE PRODUCES HEAT WAVELENGTHS IN LOW LEVEL LASER 1

2 CCO Terminal enzyme of the mitochondrial respiratory chain Catalyzes the transfer of electrons from reduced cytochrome c to molecular oxygen Wavelength or color of the light should maximize CCO absorption LOW LEVEL LASER 635 nm Ability to influence mitochondrial enzyme activity, specifically CCO Leads to mitochondrial activity and ATP synthesis CYTOCHROME-C-OXIDASE (CCO) Effects are biochemical NOT Dermal Can not cause heating and/or damage to living tissue BIOCHEMICAL A single photon can trigger a reaction in one cell that causes emission of several photons in adjacent cells Begins a chain reaction of photon emissions A small signal can be multiplied to cause a rapid and regenerating flow of energy through a biosystem BRANCHED CHAIN EFFECT 2

3 Via integrins Receptors on cell surface linking cells to the surrounding environment Photons are absorbed and the integrin system aids in transduction CELL COMMUNICATION Photons enter tissue Alters cell permeability Photons absorbed by Chromophores on cell membrane Cellular photochemical reaction Absorbed into Mitochondria => ATP+ Effects Rapid cell growth => Increased Metabolic Activity Increased Angiogenesis => Vascular Activity Suppression of COX-2 Pathway => Decreased Inflammation RESPONSE Results in 2 responses Increased Regeneration Due to ATP Production Increased Cellular Regeneration Due to Nervous System Living Matrix Phospholipid cell Membrane Hydration TAKEAWAY MESSAGE: Increased mitochondrial production of ATP WITHOUT increasing the production of free radicals PHOTOBIOSTIMULATION 3

4 Rapid Cell Growth Faster wound healing Stimulates fibroblast development and accelerates collagen synthesis in damaged tissue Increased Metabolic activity Reduced Fibrous Tissue Formation Anti-inflammatory action Increased Vascular activity Produces temporary vasodilation as well as increased angiogenesis Stimulated Nerve Function BIOLOGICAL EFFECTS Carpal Tunnel Syndrome Rotator Cuff Injury/Impingement Subacromial Impingement Frozen Shoulder Intervertebral Disc Disease Chronic Heel Pain/Plantar Fasciitis Lateral Epicondylopathy (Tennis Elbow) Medial Epicondylopathy (Golfer s Elbow) Neuropathy (Chemotherapy Induced, Idiopathic, & Diabetic Induced) Acute Injuries and acute pain For example: Sprained ankle Arthritis Bursitis Operative Wound Healing USES Use over the sight of metastasis or an active tumor Directly over a pregnant uterus Use with extreme caution with epileptics Use with extreme caution directly over the thyroid gland CONTRAINDICATIONS 4

5 IS CONSTANTLY AVOIDING PAIN A HEALTHY WAY TO LIVE? Apply Laser energy to affected areas Inhibits pain at the spinal cord and brain stem levels Pain Management Increased frequency of sensory nerve firing Increased Stimuli to the spinal cord, brain, and brainstem Incorporate Appropriate Laser Settings used to treat affected area Use of a Functional Evaluation Use laser during active movements Use appropriate setting on midline-spine Use appropriate setting on brain MOST EFFECTIVE LLL TREATMENTS FOR MUSCULOSKELETAL/JOINT PAIN 5

6 At least 6-10 treatments needed Each treatment can last anywhere from 3-20 minutes Decrease in pain can occur almost immediately after treatment Appropriate Settings chosen based on patient s location of pain, cause of pain, results of functional evaluation, and previous injuries Neuropathies/nerve pain usually do not require a functional evaluation GENERAL TREATMENT PROTOCOLS FOR PAIN NEUROPATHY Neuropathy and/or Numbness Settings used for treatment Applied to affected area Frequency of treatment: 2 times weekly Treatment Time: 20 minutes Results Can Occur: Within 2-3 treatments If sensation is severely diminished or absent patient will begin to feel mild discomfort in the affected area If sensation is negatively affected but not completely absent patient will begin to feel additional discomfort TREATMENT FOR NEUROPATHY 6

7 Can be used with any patient suffering from neuropathy Chemo-therapy induced neuropathy For those in active treatment or individuals who have completed treatment but neuropathy has not resolved Idiopathic Secondary to DMII Can be used with any age group WHO? 68 yo Female Presents with B/L chemo-therapy induced neuropathy of the feet Was receiving chemotherapy at time of the office visit History of Present illness Onset: 2 years d/t previous chemotherapy Had tried numerous natural supplements and medications to decrease pain with no positive results Symptoms Burning and sharp pain in soles of feet Inability to stand or walk for more than 5-10 minutes Diminished sensation in balls of feet and heels Unable to wear socks or shoes including sneakers Pain Level: 8/10 (10 being most pain) Medical records were reviewed to ensure that there was no metastasis to the local area and that there were no current or previous blood or lymph cancers 7

8 Twice a week for a total of 10 treatments Laser Settings Neuropathy settings Applied to entire affected area Numbness settings Applied to ball of foot and heel B/L Time: 20 minutes per treatment TREATMENT PROTOCOL Third Treatment Began to feel increased pain/sensation specifically in arch of both feet and heels Pain Level: 9/10 (10 being most pain) Fifth Treatment Was able to wear socks but was still not able to wear sneakers Pain Level: 7/10 (10 being most pain) Eighth Treatment Was able to wear dress shoes to a wedding and was able to dance for two full songs without increased pain Pain Level: 4/10 (10 being most pain) Tenth Treatment Arrived to the appointment wearing heeled dress shoes Pain Level: 1/10 (10 being most pain) Present only when she had been active for the entire day Further treatment was offered Pt. declined as she was happy with her progress RESULTS 1: How can LLL therapy penetrate through clothing? Emits approximately 45 billion photons every second Clothing will provide some degree of photon inhibition- the reaction at the cellular level is a 1-to-1 reaction Because of 1-to-1 reaction it only requires 1 photon to produce 1 electron positioned with the photoreceptor 2: Functional Assessments include posture, overhead squat, 1-legged squat, Trunk stability push-up, Valgus jump test, Upper/lower muscle firing patterns, push-up Important to determine indirect sources of pain instead of concentrating on the specific area of pain Can treat an identified problem area before pain occurs 3: Violet lasers, used in conjunction with Red lasers, can be used to balance the PNS and SNS activation of the muscles INTERESTING TIDBITS 1- Penetrating through clothing 2- Taking into account Functional Assessments 3- Different colored lasers and how they can help 8

9 References Carrinho, P., Renno, A., Koeke, P., Salate, A., Parizotto, N. & Vidal, B. (2006). Comparative Study Using 685 nm & 830 nm Lasers in the Tissue Repair of Tenotomized tendons in the mouse. Photomedicine and Laser Surgery, 24(6): Dostalova, T. et al. (2012). Effectiveness of physiotherapy and GaA/As laser in the management of temporomandibular joint disorders. Photomed Laser Surg, 30(5): Enwemeck et al. (2004). The efficacy of low power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg. Aug (4): Fulop, AM, Dhimmer, S. et al. (2010). A meta-analysis of the efficacy of laser phototherapy on pain relief. Clinical Journal of Pain, 26(8): Langevin, H. (2006). Connective Tissue: A Body-Wide signaling network? Medical Hypotheses, Vol 66(6): Morimoto, Y., Saito, A., Tokuhashi, Y. (2013). Low Level Laser Therapy for Sports Injuries. Laser Therapeutics, 22(1):