Issue 2 - February 2005

Hot prospects for lasers
By Richard Martin

Getting an “edge” to grow your practice is difficult. One way to get that edge is to incorporate technology into your diagnostics and treatment. And one of the hottest new business and therapeutic opportunities is low-level laser therapy (LLLT).

Presented as the new future in chiropractic medicine for a wide variety of ailments and conditions, laser therapy has gained both popularity and acceptance as an alternative modality. From NASA to prestigious medical institutions, from chiropractors to physical and occu-pational therapists, clinicians and researchers are joining the ranks of believers in the healing power of light.

Backed by volumes of sound clinical evidence (more than 800 clinical studies), including many of the “gold standard” placebo-controlled, double-blind studies, more than sufficient evidence exists to conclude that laser therapy can be effective when the correct device is used.

But choosing the correct device can be confusing. The Food and Drug Administration (FDA) has cleared some 16 laser- and 71 LED light-therapy devices for use and sale in the United States.

KNOW YOUR CLASSES

Before you can decide which type of laser to buy, you need to understand how these devices, which belong to one of four categories, differ from one another:

• Class I lasers — less than .5 mW power output. These lasers are infrequently used as therapeutic devices because of their very low power output. Most laser pointers used in business fall into this power range. These devices are not considered potentially hazardous.

• Class II lasers — less than 1 mW power output. These are therapeutic lasers at the very marginal end of power output and biological response. They have sufficient photonic emission to elicit physiological response, but the low power output limits their magnitude and effective depth of response. Class II lasers make the transition from basically hazard-free to one of low, but recognized, eye hazard.

• Class IIIA lasers — less than 5 mW power output. At the low end of power output and biological response for therapeutic lasers, Class IIIA lasers demonstrate certain therapeutic properties, depending on wavelength and configuration. The FDA has cleared a number of devices in this class.

• Class IIIB lasers — less than 500 mW power output. The majority of therapeutic laser devices fall into this class. With sufficient power density to activate the greatest variety of physiologic responses, Class IIIB lasers dominate the market in numbers. And the largest percent of studies on the clinical evidence for efficacy of laser therapy have been done with Class III lasers. Lasers in this class balance power and safety.

• Class IV lasers — greater than 500 mW power output. Recently arriving on the therapeutic laser scene, Class IV lasers fall far outside the realm of low- or medium-power lasers and can approach the thermally destructive nature of some surgical lasers.

WHICH DEVICE TO CHOOSE?

The obvious challenge for you is to determine which type of device will be effective for the conditions you desire to treat and how your choice will impact your practice in a positive manner.

As more devices come into the marketplace, some clinicians advocate a new paradigm of treatment — reduced exposure or irradiation time with higher power densities. The premise of this “quick fix” approach to treatment is that increasing the power density can shorten the therapy time. While in concept this may seem a reasonable approach, from a scientific and medical efficacy standpoint, this approach should be taken with great care.

Volumes of clinical research have been published validating the relationship between laser irradiations of 100mW to 250 mW and the multitude of physiological responses at the cellular and sub-cellular level. We now know that an elaborate cascade of interactions can be set in motion by laser therapy at these power densities.

However, clinical evidence does not exist to show these same beneficial effects when higher power densities are employed. It is possible that in the quick-flash approach to laser therapy some or many of these physiological interactions may not be stimulated.

Why? Several of the more profound healing and therapeutic actions of laser therapy are the result of a combination of cellular response, enzymatic action and circulatory modulation. In the high-energy, quick-flash mode, these subtle interactions may be inhibited rather than enhanced.

The field of laser therapy is dynamic and evolving and new information and better understanding of the use and applications are ongoing. In the last two years, a marginal and incremental increase in recommended photon dosage has gained acceptance. Clinical studies of a careful escalation of site-specific dosages have driven this trend.

However, the trend does not mean a validation of the high power output lasers. Nearly all of the Class III lasers can easily accommodate this dosage increase without any concurrent escalation in risk. More studies demonstrating equivalent efficacy need to be made and published.

The question still remains: Will laser therapy help your patients and will it grow your practice? With thousands of these devices now in the hands of chiropractic physicians throughout the country, the answer is “yes.”

Particularly in terms of musculoskeletal and inflammatory conditions and joint-injury recovery, laser therapy has had a positive report. When devices of the appropriate wavelength to deliver the photons to the target tissue are employed with recommended dosage protocols, the majority of clinicians report favorable patient response. And favorable patient response generally translates into practice growth.