Napawan Punyaniyama,PhD, RN Gil Case,PhD, MBA
Low Level Laser Therapy (LLLT)
Considerable insight into the effect of wavelength on LLLT has been gained from the work of Tiina Karu, who over a period of years [1,2,3] conducted extensive research using cell cultures of various types. Her work has provided an action spectrum for bio-stimulation of the rate of DNA synthesis in HeLa cells, and for the proliferation of bacteria and yeast_colonies. These spectra show peaks in the blue (404 and 454 nm), red (620 nm), and near infrared (760 and 830 nm) wavelengths. Her findings also reveal that individual spectral bands may give antagonistic effects on the all-important electron transport chain, for example, blue versus red, and ultraviolet versus red, when these respective wavelengths are delivered in sequence . Wound healing consists of several distinct phases [4,5,6], all of which can be affected at the cellular level by LLLT. The initial, pro-inflammatory and vaso-active phases of_inflammation include clotting of any cut blood vessels and deposition of a platelet plug, after which the site is infiltrated by neutrophils and macrophages. These infiltrating cells, together with resident tissue cells and fibroblasts, release a variety of biologically active substances including growth factors. For example, enhanced production of fibroblast growth factor can occur with Low Level Laser Therapy from fibroblasts and macrophages. Faster wound closure is of great importance in compromised patients, such as diabetics, and patients undergoing treatment for malignancies. Because PBM/LLLT can enhance the release of growth factors from fibroblasts, and can stimulate cell proliferation, it is able to improve wound healing in such compromised patients. Histological studies have demonstrated that laser irradiation improves wound epithelialization, cellular content, granulation tissue formation, and collagen deposition in laser-treated wounds, compared to untreated sites [4,9]. These findings have been confirmed in oral mucosal wound healing in clinical studies in humans.
There are three very effective, yet unique uses of low level lasers:
PUVA, PDT and PBM.
PUVA (psoralen and ultraviolet A) uses UVA & UVB wavelengths cures Eczemia, Psorassi & Vitiligo to a 92% level on an early detect basis. As shown in the above before, after, and after with makeup, better hairdo & smile.
The skin is clearer and the cosmetic appearance is greatly improved.
Advanced Medical Health Clinic recognizes this treatment method and refers patients to beauty salons for this purpose.
PhotoDynamicTherapy (PDT) used in the treatment of some cancers.
Notice the dramatic improvement in airway passage from the upper left photo and the lower right photo.
Photodynamic therapy, is a form of phototherapy involving light and a photosensitizing chemical substance, used in conjunction with molecular oxygen to elicit cell death. PDT has proven ability to kill microbial cells, including bacteria, fungi and viruses. PDT is popularly used in treating acne. It is used clinically to treat a wide range of medical conditions, including wet age-related macular degeneration, psoriasis, atherosclerosis and has shown some efficacy in anti-viral treatments, including herpes. It also treats malignant cancers including head and neck, lung, bladder and particular skin.
The above image shows a three beamed PBM laser unit penetrating the skin layer.
There are three wavelengths that are most effective:
a) Blue light: 405 & 470 nm wavelengths. Used to kill surface bacteria on the skin or in open surgery, Has many other more technical uses, since it produces Nitric Oxide (NO) at the cellular level. The increase in NO has at least 8 beneficial cellular effects. one can search the Internet or PUBMED.gov to find the latest uses of Blue Light to generate NO.
b) Red light, 635nm wavelength, delivers a 5 to 8 times increase in healing. Penetrates about 3/8" into the skin.
c) Near Infrared, 808nm wavelength, 2-3" deep penetration, similar to red light but penetrates to deeper relieve neuromuscular and joint problems. Photobiomodulation or Low Level Laser Therapy (LLLT) is indicated for: natural tendon and ligament repair for tennis elbow, shoulder tears, meniscus injuries in the knee; ankle and hip joint problems; state-of-the-art hair_growth for men and women; and many other applications supported by a large number of peer-reviewed, up-to-date journal studies proving the efficiency of this technology. Photomed Laser Surg. 2008 Jun;26(3):241-5. Low-level_laser therapy improves vision in patients with age-related wet or dry macular degeneration. Ivandic BT, Ivandic T. Source University of Heidelberg, Otto-Meyerhof Centre, Heidelberg.
While many studies have shown a positive effect of PBM, a number have failed to show a benefit and, in fact, some reports have shown negative outcomes. Unfortunately, in many of the historical studies, important laser parameters were omitted or incorrectly presented.
Often, laser output total power is reported without consideration the effectiveness of action on the target tissue. Therefore, power density, the most relevant parameter, is not reported and results are, predictably, inconsistent.
Clinical Trials at Advanced Medical Health Clinic with a test patient base of 62 patients determined that the upward limit to 100% effective in healing humans is to use no more than 4W of energy. More than that causes too little time to incite the cells to heal effectively. Some Class 4 laser companies push the higher wattage, say 10W to hasten the treatment. Thus the practitioner saves treatment time by going to the higher wattage above 4W, but delivers much less effectiveness to healing patients based on the study mentioned above. Also, the protocol of making a circle or spiral movement for the Class 4 laser actually spends less time on the damaged area and results in a significant reduction in healing.
The best protocol to obtain best healing in the shortest time is to turn down the watts below 4 Watts and let the laser rest on the skin for at least 20 seconds. This is the minimum reaction time required to heal, again based on the above clinical study.
Contraindications: these laser units should not be used for direct irradiation of the eyes, should not be used for use over the pregnant uterus, should not be used for use with carcinoma or any known primary or secondary lesions, should not be used over the thyroid gland, and should not be used for hemorrhage,
Only a very small subset of research has been shown on this website. The PBM/LLLT literature is large, with more than 60,000 papers published on this topic, under PUBMED.gov It is a real task to dissect this literature due to the variation in laser equipment, methodology and dosimetry between the different studies It is important to have sham-irradiated controls in clinical studies as an important element, since placebo effects can be important .
The latest laser diode technology has made significant breakthroughs in significantly lower costs, improving capabilities and decreasing sizes of these incredible low level laser devices within the last 10 years .
1. Karu TI. Photobiology of low-power laser therapy. London: Harwood Academic Publishers. 1989.
2. Karu TI. Photobiological fundamentals of low-power laser therapy. IEEE J Quant Electron QE-2 1987:3:1703-1717.
3. Karu TI. Molecular mechanism of the therapeutic effect of low-intensity laser radiation. Lasers Life Sci 1988:2:53-74.
4. Yu W, Naim JO, Lanzafame RJ. Effects of photostimulation on wound healing in diabetic mice. Lasers Surg Med 1997:20:56ï¿½63.
5. Mester E, Mester AF, Mester A. The biomedical effects of laser applications. Lasers Surg Med 1985:5:31-39.
6. Walsh LJ, Murphy GF. The role of adhesion molecules in cutaneous_inflammation and neoplasia. J Cutan Pathol 1992:19:161-171.
7. Laakso EL, Richardson CR, Cramond T. Factors affecting low level laser therapy. Aust J Physio 1993:39:95-99.
8. Lyons RF, Abergel RP, White RA, Dwyer RM, Castel JC, Uitto J. Biostimulation of wound healing in vivo by a helium-neon laser. Ann Plast Surg. 1987:18(1):47-50.
9. Marei MK, Abdel-Meguid SH, Mokhtar SA, Rizk SA. Effect of low-energy _laser_application in the treatment of denture-induced mucosal lesions. J Prosthet Dent. 1997:77(3):256-264.