Advocating the rotating diode in therapy care, and the theory of hormesis in laser applications
The burden of low-back pain (LBP) in America today is huge. It is the most common cause of disability worldwide, affecting 80% of the population at some point during life. 1 It is estimated that approximately half of American adults suffer from chronic pain, and hormesis plays a part in treatment.
Chronic pain in the U.S. and worldwide
In July 2019, the chronic pain problem was summarized in the journal Pain Medicine, stating: 3 “Chronic pain is a major world-wide problem … In the United States, it is estimated that more than 100 million people suffer from chronic pain, with costs between $560-635 billion dollars per year … These numbers do not describe the full impact that chronic pain has on productivity, quality of life, and human suffering.”
In September 2018, the journal Public Library of Science (PLoS) One stated: 4 “Non-specific low-back pain is one of the most common and costly health care problems in society today … The burden of disabling low-back pain on individuals, families, communities, industries and societies is substantial and is now the leading cause of activity limitation and work absence in the world.”
By far (63%), the primary reason people go to chiropractors is for the management of low-back pain. 5
Pain anatomy and physiology
Chronic low-back pain is primarily discogenic. 6,7,8 The inter-vertebral disc has a nerve supply. 9,10 The nucleus pulposus of degenerated discs may develop nociceptive innervation in a process called “neoneuralisation.” 1,11,12,13,14
Pain frequently begins as an inflammatory cascade. 15 The two classes of pain-producing inflammatory chemicals are eicosanoids 16, 17, 18 and cytokines. 19, 20, 21
Non-thermal laser and pain management
For optimal effectiveness of pain management, both the inflam-matory eicosanoids and the inflammatory cytokines would have to be reduced. Non-thermal red laser has been shown to inhibit both eicosanoids 22, 23 and cytokines. 24, 25, 26 The photochemical reduction of pain also results in enhanced healing. 27
Non-thermal low-level laser therapy has been shown to significantly help with a variety of pain syndromes, including:
- Pain after breast augmentation 28
- The pain of chronic plantar fasciitis 29, 30
- Chronic neck and shoulder pain 31
- Chronic low-back pain 32
Hormesis and the hermetic threshold
Biologically, hormesis says everything that is good for you may become bad for you if done in excess. 33, 34 This includes exercise, sleep, vegetable and fruit consumption, water, temperature, etc. Laser therapy also conforms to hormesis. More exposure to laser beams may be counterproductive. 35,36,37,38,29,40,41,42,43,44,45
The threshold for hormesis for laser therapy is determined by joules/centimeter 2. A brilliant strategy for assuring that one does not exceed the threshold for hormesis is to move the diode(s). Developing a laser device that constantly rotates the diode(s) (as opposed to having a person move them) saves time and overhead while increasing efficiency.
For the first time, in July 2018, the U.S. Food & Drug Administration (FDA) granted FDA 510(k) market clearance for the management of chronic low-back pain with non-thermal low-level laser therapy to a laser manufacturer.
The study submitted was a placebo-controlled, randomized, double-blind, parallel group, multi-center clinical study. The success criteria were defined as a minimum of a 30% decrease in chronic low-back pain and that 35% of patients in the treated group would experience the minimum pain reduction compared to the placebo group. Overall, 72% of patients met the success criteria.
On June 1, 2019, the manufacturer was granted an additional market clearance for the treatment of pain in other bodily regions. 46 The FDA device classification was worded: “Powered Light-Based Laser Non-Thermal Instrument with Non-Heating Effect for Adjunctive Use in Pain Therapy.”
Adding non-thermal low-level laser therapy to chiropractic clinical practices gives chiropractors a proven and FDA-market-cleared modality for the management of one of the world’s most common, persistent and costly disorders. This modality, added to traditional spinal adjusting and other adjunctive supports (diet, supplements, exercise, etc.) will undoubtedly enhance clinical outcomes and patient satisfaction.
Dan Murphy, DC, DABCO, offers the chiropractic profession the
highest quality in whiplash education and trains doctors in the bulletproof management of personal injury cases with both documentation and treatment. He writes for Erchonia and can be reached at danmurphydc.com.