Cold Laser Therapy not Just a New Toy for your Clinic
ANCILLARY
Scott Coletti
DC
In 1967, Entire Mester discovered that by applying laser light to mice in his laboratory in Budapest he could stimulate wound healing.1 The impact of this revelation—the healing power of cold lasers— is still in its nascency fifty years later. However, times are changing, and there is a movement of chiropractors across the country who view cold laser therapy or low-level laser therapy (LLLT) as the future of pahi relief.
So why is there so much fanfare about a therapy that has been around since the sixties? In healthcare new technology takes an exorbitant amount of tune before it reaches mainstream approval. Over years of research, Everett Rogers identified how people react to an innovation.2
He segmented five distinct groups: the innovators (2.5%) those who take risks, have the highest social class, and the closest contact with scientific sources. Then comes the early adopters (13.5%) they were the first to have an iPhone before others had even heard of Steve Jobs. They record the highest degree of opinion leadership, and they realize that their shrewd choice of adoption will sustain their position of authority. Next to arrive at the shop are the early majority (34%) who have contact with early adopters but seldom hold positions of opinion leadership in a system. Presently, for LLLT it is the early adopters who evangelize about deploying lasers to combat patient pain, but breaking through the hype what does the science tell us?
Pain is the most recurring reason for physician consultation in the United States, with one in three Americans affected by chronic pahi. Right now, they can choose from non-steroidal antiinflammatory drags, steroid injections, opiate pahi medications and surgery. Medication is problematic. The country is being ravaged by an opioid epidemic, and a forecast by STAT predicts that nearly 500,000 people could die in the next decade.3 It is evident to everyone from physicians to chiropractors that we need to remodel how we treat pain. Fueled by a powerful pharmaceutical industry, it is often all too easy to rely on drags to counteract chronic pahi. Indeed, there is certainly a time and a place to treat pain with pharmaceuticals, but it should never be the first choice.
Musculoskeletal pahi affects 116 million Americans each year costing them $63 5 billion in medical expenses.4 Each treatment has benefits but bears different side effects and risks. LLLT can be used to treat nociceptive and neuropathic pain by triggering biochemical changes within cells similar to the process of photosynthesis in plants. Light used in the red to near infrared region can penetrate the skin and soft/hard tissue. Clinical trials have proven that the lasers have a good effect on pain, inflammation, and tissue repair.
The result is that patients experience a reduction hi inflammation, pain relief, and accelerated tissue regeneration. People are getting excited because at low doses LLLT has been shown to enhance cell proliferation of fibroblasts.5 But, less is more when it comes to LLLT, and many studies have observed that there is a biphasic dose response at play which has noteworthy hnplications for the use of LLLT to treat pain. Why is that? LLLT stimulates mitochondria and is more likely to increase metabolism and transport of action potentials in neurons rather than decrease it. On the contrary, higher intensity LLLT produced by a focused laser spot acting on a nerve has the opposite effect.4
While supporters of LLLT in chiropractic settings are confident of the benefits to patients and the concomitant fillip to revenue streams, it is still an adjuvant form of therapy. The first port of call remains traditional chiropractic procedures. To provide service users with an effective and affordable pain reducing treatment cold laser therapy has its advantages. Firstly, it is non-invasive, so no surgical incision is necessary; thus reducing recovery time. The second advantage is that it does not involve taking medications as we touched on before. Moving to medication-free pain treatment is the way forward. Patients become more aware of their pain, less desensitized and this makes the work of chiropractors much more effective.
However, there are some downsides. Medicare and Medicaid do not cover cold laser therapy expenses at the moment. That’s not to say that will not change hi the future. In 2016, an HCPCSII code (S8948) was developed which is a specific timed code that can be used to bill LLLT, but as yet Medicare does not recognize the code. As a result, many clinics facilitate cash options for their patients.
Secondly, full relief from pain or inflammation is not experienced after just one session. It takes a series of treatments depend-
mg on the severity of the condition. Many top athletes suffering from musculoskeletal injuries visit their doctor two to four tunes per week; of course, their professional career is dependent on a speedy recovery which is not the case for the average patient. But, for sports injuries, the duration of the treatment has proven benefits. The Surugadai Nihon University Hospital reported a 65.9 percent rate of effectiveness (27/41) for patients suffering from sports injuries like jumper’s knee, tennis elbow, and Achilles tendinitis.5
Importantly, it is crucial to use the right dosimetric parameters which are patient specific. If the wavelength, irradiance (power density), pulse structure, coherence, polarization, energy, fluence, irradiation tune, contact vs non-contact application, and repetition regimen are non-opthnal, this can result in reduced effectiveness or even tissue damage.6 As a chiropractor, just buying a machine is not enough. There is a duty to patients to understand the parameters of the machine. Advances in cold laser therapy software make it easier to find the optimal treatment settings and provide a more data based therapy for patients. The latest LLLT software allows a chiropractor to make accurate predictions about recovery tune, the number of treatments required and the esthnation of how their pain profile will be hi the future.
In brief, pain is a very complex condition, and it manifests itself in a wide variety of forms. F or example, chronic pain which is pam that persists for greater than 12 weeks may include but is not limited to chronic neck pain and lower back pain, myofascial pain syndrome, and fibromyalgia. It might be that there is no set
standard of care that will cover every patient’s needs, but it is clear that cold laser therapy when used correctly may be beneficial for a broad spectrum of pain sufferers regardless of their underlying condition.
References:
1. MesterE, etal. Effect oflaser rays on wound healing. AmJSurg. 1971 Oct;122(4):532-5.
2. 2. Greg Orr. Diffusion of Innovations, by Everett Rogers (1995). Web. Stanford, edit.
3. Max Blau. STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade. STAT
4. Cotier, el al. The Use of Low Level Laser Therapy (LLLT) for Musculoskeletal Pain. US National Library of Medicine. MOJ Orthop Rheumatol. 2015; 2(5): 00068.
5. Morimoto, el al. Low level laser therapy for sports injuries. US National Library of Medicine. 2013;22(l):17-20
6. Semin Cutan Med Surg. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. US National Library of Medicine. 2013 Mar; 32(1): 41-52.
Scott Coletti DC has been in private practice in Florida since 2000. He Co-founded Cold Laser Protocols™, a software in which he developed to assist other practitioners in growing Cold Laser within their practice. He invites those highly intrigued to visit his site at https:// coldlaserprotocols.com . Dr. Coletti grew this passion when he saw his patients andpractice soar, especially when it fell into his lap. He was adamant that he wanted to help other doctors though making it so simple a Kindergartner could follow. He is also asking doctors to complete a simple survey to fine tune the software prior to launch. This can be seen at https://coldlaserprotocols.com/amc. You can reach Dr. Coletti at 727-741-0838.
