3 Biggest mistakes doctors make when buying a therapy laser

Therapeutic lasers are arguably the greatest modality introduced in healthcare in the last 20 years. And some would argue that they should not simply be called a modality. Photobiomodulation treatments performed with a class 4 therapeutic laser can deliver infrared photons of laser light deep into the body where they are absorbed, and the light energy is converted into chemical energy thus initiating healing processes.

Doctors of all healthcare disciplines treating both human and animal patients a realizing the benefits that class 4 therapeutic laser treatments can have for their patients. An important point to remember is that laser therapy treatments do not target specific conditions in the body. Rather, they initiate healing processes in the body.

The three biggest mistakes that doctors make when buying a therapy laser are buying outdated equipment, being misled by "experts", and ignoring training and support. Laser therapy equipment is a significant investment and to achieve a return on in that investment, avoid making these three mistakes.

The first mistake is buying outdated equipment. And the first part of that is to buy a laser with enough power. Early in the development of laser therapy devices most of them were class three devices with power under 1/2 a Watt. But now scientists, researchers, clinicians, and laser experts agree that in order to deliver a significant dosage to targets deep inside of the body a class 4 therapeutic laser is required.

A letter written by four top photobiomodulation and laser experts in the world stated, “…an important advance in photobiomodulation treatments was the recognition that optimization of transcutaneous therapeutic parameters should be based on the photonic dose reaching the target tissue and that often requires higher doses of light at the skin surface to reach deeper tissues.”[i]

When therapeutic laser light is shined on the skin surface it will penetrate into the body. As photons of light are absorbed along the path the light will become dimmer and dimmer and dimmer. The experts are saying that to deliver an appropriate dose deep into the body a higher dose at the skin surface is required.

Therefore, do not make the mistake of buying underpowered equipment. Buy a class 4 therapy laser.

The second part of this first mistake has to do with antiquated equipment. For example, there are two types of laser diodes used in class 4 therapy lasers. One is called a pigtailed diode which was developed in the 1970s and was current technology in the 1980s. Many class 4 therapeutic laser devices being sold today still use pigtail diodes.

In addition, some manufacturer’s will use multiple low-powered diodes, and add up their power to state the total power. Three five-watt diodes are not the same as one fifteen-watt diode. This strategy lowers their cost of production, but it is less effective clinically.

The more advanced type of diode is a semiconductor diode. With a gallium aluminum arsenide (GaAlAs) semiconductor diode there can be one diode for each therapeutic wavelength. The semiconductor diode can be cooled more efficiently which keeps it within its operating power output parameters more efficiently. Semiconductor diodes are sturdier and more dependable. Don’t buy multiple old-fashioned pigtailed diodes - buy a class 4 therapy laser that uses semiconductor diodes, and one diode per wavelength.

There are other aspects of laser equipment and technology. Without going into the specifics, it is suggested to simply look at the laser equipment. Look at it today and look at what it looked like 10 years ago. Is it any different if it does look different are the changes on the shell and the case only? Were any advances made in the internal electronics, display, diodes or optical connections? Buy the latest equipment - do not buy antiquated technology.

The second mistake that a doctor can make when buying a therapeutic laser is to rely on the “experts”, with emphasis on the air-quotes. Sadly, there are many laser promoters who are given the “expert” tag - or should we say they give it to themselves, and the statements that they make cannot be supported scientifically, by studies, or by clinical experience. A few red flags to lookout for: claims that a red laser can be used for musculoskeletal photobiomodulation treatments; claims that super pulsed laser light penetrates deeper into the body; claims that class 4 therapeutic lasers injure patients; claims that a laser can be used for fat loss; and on and on.

As the old adage says - always tell the truth that way your story never changes. Some laser manufacturers have difficulty telling the truth. Rely on people who can back up their statements with science, studies, and a track record of clinical outcomes.

The final mistake is to ignore support and service. Especially for the doctor new to laser therapy. Inevitably questions will arise regarding treatment. Can I treat a patient who's just received a steroid injection? Can I treat a patient who is on blood thinners? What's the best laser treatment protocol for diabetic peripheral neuropathy or plantar fasciitis? Can my assistant do the treatments? Buy your laser from a company that has laser experience and can answer all these questions and more.

In addition, make sure that your company can give rapid equipment support. If you ever have a breakdown or need help with the equipment you want rapid turnaround. Once laser therapy is added to your clinic it will be an integral modality and patients will not want to go without it. Make sure your laser manufacturer can either repair your equipment rapidly and get it back to you or else supply a loaner.

The doctor of the future will use a class 4 therapeutic laser. If you have not yet purchased a class 4 therapy laser for your clinic, consider the three points discussed in this post and ask more questions. Your patience will love you for it!

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[i] https://www.liebertpub.com/doi/full/10.1089/photob.2018.4600

How Photobiomodulation is changing healthcare

The use of lasers in healthcare has a very interesting history. Albert Einstein first theorized the possibility of building a laser device in the early 1900s. In the 1960s Theodore Maimon invented the first laser and soon afterwards nearly all of the laser types used in healthcare were invented.

In 1967 physician Andre Mester was trying to repeat experiments showing that lasers could be used to treat malignant tumors. Mester’s laser device was very low in power and did not have an effect on the tumors; however, it did cause more rapid hair growth in the test animals. This accidental discovery was the landmark moment in the history of laser therapy.

In 2015 a worldwide panel of experts convened to agree upon a term that would be acceptable to everyone involved, that would describe the effect of therapeutic lasers, and would take the place of the dozens of terms being used to that time (i.e., cold laser, low-level laser, low-reactive laser, etc). The term they agreed upon was “photobiomodulation”: using light to modulate biological processes.

The official definition is, “A form of light therapy that utilizes non-ionizing forms of light sources, including LASERS, LEDs, and broad-band light, in the visible and infrared spectrum. It is a non-thermal process involving endogenous chromophores eliciting photophysical (i.e., linear and non-linear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.”

From the 1970s through the 2000s therapeutic lasers used in healthcare were very low in power, being class three laser devices. Like a light bulb, low power with a therapy laser means that the light is not very bright. A 40-Watt light bulb would not be sufficient to fully illuminate a large room. In similar way the earliest therapeutic laser devices were not powerful enough to deliver light deep into the body.

The first therapeutic laser to gain FDA clearance used 100 milliwatts of power and an 830-nanometer wavelength. It was used to treat carpal tunnel syndrome in automobile factory workers. The nerves in the wrist are not very deep, so photons from that device could reach the nerves and have a beneficial effect. However, these devices would not be very effective at treating low back pain, hip pain or at reaching any other tissue deep inside the body.

In 2003 the FDA gave clearance to the first class 4 therapy laser device. In the 18 years since then class 4 therapy lasers have virtually become standard of care in health care clinics treating both human and animal patients. Veterinarians use class 4 therapeutic lasers to treat conditions ranging from post-surgical incision healing to canine ear infections to osteoarthritis and hip dysplasia.

Today in human medicine, therapeutic lasers are used in chiropractic offices for musculoskeletal pain and ailments. They are used in physical therapy clinics, pain management clinics, and concierge medical clinics. Class 4 therapeutic lasers are used widely in sports athletic training rooms. Athletic trainers have realized the benefit of using laser therapy over ice for acute injuries.

Regenerative medicine is the use of various injections to stimulate healing in the body. These would include prolotherapy, platelet rich plasma therapy, and stem cell injections. Whenever these injections are performed the patient will have significant post injection pain. Class 4 therapeutic lasers can be used immediately after these injections to help with that pain.

New studies are showing that therapeutic lasers help with the effectiveness of regenerative medicine injections. We are on the brink of an exciting field in health care. New techniques, materials and methods are showing great promise to help patients recover from traumatic injuries, peripheral neuropathy, neuro degenerative diseases and more.

Photobiomodulation is here to stay. Class 4 therapeutic lasers are here to stay. In the 18 years since gaining FDA clearance the numbers of units used in healthcare has grown exponentially. The future is bright - these devices will become standard of care in all healthcare disciplines.

Photobiomodulation (Laser Therapy) & Immune Function

By Phil Harrington, DC, CMLSO, FASLMS

The coronavirus pandemic has affected the lives of millions, either through direct infection or unprecedented government-imposed quarantines and stay-at-home orders. Due to its deleterious effects, all science-based solutions should be explored and implemented if the benefits outweigh any potential risks.

 

Photobiomodulation (PBM, also known as laser therapy) uses a light source from lasers, light-emitting diodes or broadband light in the visible and near-infrared spectrum. Different methods to deliver PBM to target tissue include the following:1

• Intravenous (IV), directly irradiating the bloodstream
• Transcutaneous, to target the bloodstream for systemic effects
• Transcutaneous, to directly target tissues deep in the body
• Therapeutic Laser as an Immunomodulator

The human immune system acts a defense mechanism against potentially harmful invaders, such as bacteria and viruses. Photobiomodulation treatments can stimulate immune responses, and treatment targeting the lymph nodes or spleen can amplify the effect. Therapeutic laser is a safe, effective immunomodulator that can be applied to patients of all ages with a wide variety of clinical conditions.2

 

Intravenous PBM treatments are invasive, breaking the skin with a large-gauge needle. Systemic treatments use low-powered red lasers, which are held for 30 minutes or more on areas where the blood is near the skin surface, such as the wrist or popliteal fossa. Class 4 therapy lasers use infrared wavelengths that deliver adequate dosages to cells and tissues deep in the body.3

 

One paper concluded: "PBM has been shown to act on immune system cells in several ways, activating the irradiated cells to a higher level of activity. It has been shown to increase both the phagocytic and chemotactic activity of human leukocytes in vitro. PBM has also been shown to act directly and selectively on the autoimmune system, restoring immunocompetence to cells."4

 

Another study found pronounced improvement of the immunological indices in patients with positive clinical dynamics.5 PBM may be used as a supplemental therapy or even an alternative without side effects and drug interactions.6 Another source catalogs numerous studies on PBM and the immune system.7

 

A very recent paper reviewed the history of both disease pandemics and light-based therapies, and stated the following: "These early results suggest that red and near infrared light have the potential to reduce some of the critical complications of coronavirus infections, i.e., pulmonary inflammation and lung fibrosis."8

 

Nitric Oxide Production With Photobiomodulation

 

According to the authors of a study published in Experimental Biology and Medicine, "Studies that have focused specifically on the mechanism of light therapy have shown increases in cellular metabolites and signaling molecules including ATP, reactive oxygen species (ROS) and nitric oxide (NO), leading to the currently accepted belief that the mitochondrial respiratory chain enzyme cytochrome c oxidase is the chromophore, receiving photostimulation."9

 

Nitric oxide mediates vasodilation by relaxing vascular smooth muscle and increasing vessel diameter, and has been implicated in a number of mechanisms mediating wound healing. It also modulates the inflammatory and immune response by "inhibiting T- and B-cell proliferation, antibody production by CD5 B-cells, T- and B-cell diversification and leukocyte recruitment."10

 

Potential Role of Laser in Viral Infection Defense

 

Evidence suggests some patients with COVID-19 might have a cytokine storm syndrome, and acute lung injury is a common consequence of this syndrome. The damage caused by the virus could be mitigated with an adjuvant therapy that reaches all organs, with a special interest in the respiratory system. 11

 

Effective COVID-19 management must include increased oxygenation and faster rehabilitation of the damaged tissue, antiviral effects, and finally, reduction or controlling of the cytokine storm by reducing inflammatory agents. 12 Treatments are focused on the antiviral and anti-inflammatory by stifling the cytokine storm and increasing tissue oxygenation.13

 

A paper in the Journal of Virology states that nitric oxide (NO) has an inhibitory effect on some virus infections, and that NO inhibits viral protein and RNA synthesis. It also states: "NO specifically inhibits the replication cycle of SARS CoV, most probably during the early steps of infection, suggesting that the production of NO results in an antiviral effect."14

 

A recent letter in Photobiomodulation, Photomedicine, and Laser Surgery opined, "Previous studies show that PBM improves the immune system. In consequence, we suggest taking special attention to the superoxide dismutase (SOD) synthesis increment as a result of this therapy and to evaluate if transdermal PBM could control the cytokine storm that may occur in patients with COVID-19."15

 

According to Praveen Arany, PhD, current president of the World Association for Photobiomodulation Therapy (WALT), "Many of us have clinical and, perhaps personal experiences with PBM treatment have clearly noted its ability to improve anti-viral response and host immunity showcasing the potential utility of this treatment in the current health crisis. Nonetheless, as far as we are aware there have been no direct, controlled studies to date on the COVID-19 specifically."16

 

Since nitric oxide is an established mediator in photobiomodulation mechanisms, and since nitric oxide is also proven to have antiviral effects, photobiomodulation is a potential viable treatment option for coronavirus patients.

 

References

1. Fekrazad R. "Photobiomodulation and antiviral photodynamic therapy as a possible novel approach in

COVID-19 management" (guest editorial). Photobiomod, Photomed, and Laser Surg, 2020;38(5):1-3.

2. Kneebone WJ. Immune-modulating effects of therapeutic laser. Practical Pain Manag, 2014;10(9).

3. Harrington P, Vickers J. Class IV therapy lasers maximize primary biostimulative effects. Practical

Pain Manag, Jan 2012;8(7).

4. Tadakuma; Possible application of the laser in immunobiology. Keio J Med, 1993 Dec;42(4):180-2.

5. Kut’ko II, et al. [The effect of endovascular laser therapy and antioxidants on the immune status and

energy metabolism of patients with treatment-resistant forms of schizophrenia.] Zh Nevrol Psikhiatr Im

SS Korsakova, Dec 1995;96(2):34-38.

6. Fekrazad R, Op Cit.

7. Photobiomodulation (PBM) / Low level Laser Therapy (LLLT) / Red/NIR Phototherapy Studies - A

Comprehensive Database. Click here to access.

8. Enwemeka CS, Bumah VV, Masson-Meyers DS. Light as a potential treatment for pandemic

coronavirus infections: a perspective. J Photochem & Photobiol, 2020 May 1;207:111891

- 3 -

9. Prindeze NJ, et al. Mechanisms of action for light therapy: a review of molecular interactions. Exper

Biol and Med, 2012;237:1241–1248.

10. Bogdan C. Nitric oxide and the immune response. Nat Immunol, 2001;2:907-16.

11. Dominguez A, et al; "Can Transdermal Photobiomodulation Help Us at the Time of COVID-19?"

(letter to the editor). Photobiomod, Photomed, and Laser Surg, 2020;38(5):1-2.

12. De Lima FM, Villaverde AB, Albertini R, et al. Dual effect of low-level laser therapy (LLLT) on the

acute lung inflammation induced by intestinal ischemia and reperfusion: action on anti- and

pro-inflammatory cytokines. Lasers Surg Med, 2011;43:410-420.

13. Monteil V, Kwon H, Pradoet P, et al. Inhibition of SARSCoV-2 infections in engineered human tissues

using clinical-grade soluble human ACE2. Cell, 2020 May 14;181(4):905-913.e7.

14. Akerstrom S, et al. Nitric oxide inhibits the replication cycle of severe acute respiratory syndrome

coronavirus. J Virology, Feb 2005;79(3):1966-1969.

15. Dominguez A, et al., Op Cit.

16. Praveen Arany, PhD, president of the World Association for Photobiomodulation Therapy. Open letter

to colleagues, March 14, 2020.

Dr. Phil Harrington is a certified medical laser safety officer and serves on the subcommittee reviewing

the ANSI Standards for Safe Use of Lasers in Health Care Facilities. He is a 1996 Palmer graduate and also

holds a bachelor’s degree in physics. He is the medical director, clinical manager and laser safety officer for

Summus Medical Laser (www.summuslaser.com).

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By Phil Harrington, DC, CMLSO, FASLMSThe coronavirus pandemic has affected the lives of millions, either through direct infection orunprecedented government-imposed quarantines and stay-at-home orders. Due to its deleterious effects, allscience-based solutions should be explored and implemented if the benefits outweigh any potential risks.Photobiomodulation (PBM, also known as laser therapy) uses a light source from lasers, light-emittingdiodes or broadband light in the visible and near-infrared spectrum. Different methods to deliver PBM totarget tissue include the following: 1Intravenous (IV), directly irradiating the bloodstreamTranscutaneous, to target the bloodstream for systemic effectsTranscutaneous, to directly target tissues deep in the bodyTherapeutic Laser as an ImmunomodulatorThe human immune system acts a defense mechanism against potentially harmful invaders, such as bacteriaand viruses. Photobiomodulation treatments can stimulate immune responses, and treatment targeting thelymph nodes or spleen can amplify the effect. Therapeutic laser is a safe, effective immunomodulator thatcan be applied to patients of all ages with a wide variety of clinical conditions. 2Intravenous PBM treatments are invasive, breaking the skin with a large-gauge needle. Systemic treatmentsuse low-powered red lasers, which are held for 30 minutes or more on areas where the blood is near the skinsurface, such as the wrist or popliteal fossa. Class 4 therapy lasers use infrared wavelengths that deliveradequate dosages to cells and tissues deep in the body. 3One paper concluded: "PBM has been shown to act on immune system cells in several ways, activating theirradiated cells to a higher level of activity. It has been shown to increase both the phagocytic andchemotactic activity of human leukocytes in vitro. PBM has also been shown to act directly and selectivelyon the autoimmune system, restoring immunocompetence to cells." 4- 1 -Another study found pronounced improvement of the immunological indices in patients with positiveclinical dynamics. 5 PBM may be used as a supplemental therapy or even an alternative without side effectsand drug interactions. 6 Another source catalogs numerous studies on PBM and the immune system. 7A very recent paper reviewed the history of both disease pandemics and light-based therapies, and stated thefollowing: "These early results suggest that red and near infrared light have the potential to reduce some ofthe critical complications of coronavirus infections, i.e., pulmonary inflammation and lung fibrosis." 8Nitric Oxide Production With PhotobiomodulationAccording to the authors of a study published in Experimental Biology and Medicine, "Studies that havefocused specifically on the mechanism of light therapy have shown increases in cellular metabolites andsignaling molecules including ATP, reactive oxygen species (ROS) and nitric oxide (NO), leading to thecurrently accepted belief that the mitochondrial respiratory chain enzyme cytochrome c oxidase is thechromophore, receiving photostimulation." 9Nitric oxide mediates vasodilation by relaxing vascular smooth muscle and increasing vessel diameter, andhas been implicated in a number of mechanisms mediating wound healing. It also modulates theinflammatory and immune response by "inhibiting T- and B-cell proliferation, antibody production by CD5B-cells, T- and B-cell diversification and leukocyte recruitment." 10Potential Role of Laser in Viral Infection DefenseEvidence suggests some patients with COVID-19 might have a cytokine storm syndrome, and acute lunginjury is a common consequence of this syndrome. The damage caused by the virus could be mitigated withan adjuvant therapy that reaches all organs, with a special interest in the respiratory system. 11Effective COVID-19 management must include increased oxygenation and faster rehabilitation of thedamaged tissue, antiviral effects, and finally, reduction or controlling of the cytokine storm by reducinginflammatory agents. 12 Treatments are focused on the antiviral and anti-inflammatory by stifling thecytokine storm and increasing tissue oxygenation. 13A paper in the Journal of Virology states that nitric oxide (NO) has an inhibitory effect on some virusinfections, and that NO inhibits viral protein and RNA synthesis. It also states: "NO specifically inhibits thereplication cycle of SARS CoV, most probably during the early steps of infection, suggesting that the- 2 -production of NO results in an antiviral effect." 14A recent letter in Photobiomodulation, Photomedicine, and Laser Surgery opined, "Previous studies showthat PBM improves the immune system. In consequence, we suggest taking special attention to thesuperoxide dismutase (SOD) synthesis increment as a result of this therapy and to evaluate if transdermalPBM could control the cytokine storm that may occur in patients with COVID-19." 15According to Praveen Arany, PhD, current president of the World Association for PhotobiomodulationTherapy (WALT), "Many of us have clinical and, perhaps personal experiences with PBM treatment haveclearly noted its ability to improve anti-viral response and host immunity showcasing the potential utility ofthis treatment in the current health crisis. Nonetheless, as far as we are aware there have been no direct,controlled studies to date on the COVID-19 specifically." 16Since nitric oxide is an established mediator in photobiomodulation mechanisms, and since nitric oxide isalso proven to have antiviral effects, photobiomodulation is a potential viable treatment option forcoronavirus patients.References1. Fekrazad R. "Photobiomodulation and antiviral photodynamic therapy as a possible novel approach inCOVID-19 management" (guest editorial). Photobiomod, Photomed, and Laser Surg, 2020;38(5):1-3.2. Kneebone WJ. Immune-modulating effects of therapeutic laser. Practical Pain Manag, 2014;10(9).3. Harrington P, Vickers J. Class IV therapy lasers maximize primary biostimulative effects. PracticalPain Manag, Jan 2012;8(7).4. Tadakuma; Possible application of the laser in immunobiology. Keio J Med, 1993 Dec;42(4):180-2.5. Kut’ko II, et al. [The effect of endovascular laser therapy and antioxidants on the immune status andenergy metabolism of patients with treatment-resistant forms of schizophrenia.] Zh Nevrol Psikhiatr ImSS Korsakova, Dec 1995;96(2):34-38.6. Fekrazad R, Op Cit.7. Photobiomodulation (PBM) / Low level Laser Therapy (LLLT) / Red/NIR Phototherapy Studies - AComprehensive Database. Click here to access.8. Enwemeka CS, Bumah VV, Masson-Meyers DS. Light as a potential treatment for pandemiccoronavirus infections: a perspective. J Photochem & Photobiol, 2020 May 1;207:111891- 3 -9. Prindeze NJ, et al. Mechanisms of action for light therapy: a review of molecular interactions. ExperBiol and Med, 2012;237:1241–1248.10. Bogdan C. Nitric oxide and the immune response. Nat Immunol, 2001;2:907-16.11. Dominguez A, et al; "Can Transdermal Photobiomodulation Help Us at the Time of COVID-19?"(letter to the editor). Photobiomod, Photomed, and Laser Surg, 2020;38(5):1-2.12. De Lima FM, Villaverde AB, Albertini R, et al. Dual effect of low-level laser therapy (LLLT) on theacute lung inflammation induced by intestinal ischemia and reperfusion: action on anti- andpro-inflammatory cytokines. Lasers Surg Med, 2011;43:410-420.13. Monteil V, Kwon H, Pradoet P, et al. Inhibition of SARSCoV-2 infections in engineered human tissuesusing clinical-grade soluble human ACE2. Cell, 2020 May 14;181(4):905-913.e7.14. Akerstrom S, et al. Nitric oxide inhibits the replication cycle of severe acute respiratory syndromecoronavirus. J Virology, Feb 2005;79(3):1966-1969.15. Dominguez A, et al., Op Cit.16. Praveen Arany, PhD, president of the World Association for Photobiomodulation Therapy. Open letterto colleagues, March 14, 2020.Dr. Phil Harrington is a certified medical laser safety officer and serves on the subcommittee reviewingthe ANSI Standards for Safe Use of Lasers in Health Care Facilities. He is a 1996 Palmer graduate and alsoholds a bachelor’s degree in physics. He is the medical director, clinical manager and laser safety officer forSummus Medical Laser (www.summuslaser.com).

From:https://www.dynamicchiropractic.com/mpacms/dc/article.php?id=58686&fbclid=IwAR3LC_410XQd7koV5lsqRQT2r28KY-ue20pQ47iGg9-QxCXKV-LlvB8IBdA&no_paginate=true&p_friendly=true?no_b=true

Class IV Therapy Lasers: Maximizing the Primary Effects of Laser Therapy

Laser Lessons from Dr. Phil · Class IV Therapy Lasers: Maximizing the Primary Effects of Laser Therapy

Walter Reed Military Medical Center

On Wednesday September 5th I visited Walter Reed (aka Bethesda Naval Hospital) with three doctors from Logan University. I gave a 90-minute presentation on laser therapy to a room full of doctors and internists. Big day!