Laser Therapy and Pain Management
In recent years, laser therapy has gained popularity as a treatment option for various conditions. However, its acceptance within the mainstream of science and medicine, particularly in the United States, has been limited. The reasons for this lack of endorsement are multifaceted. One significant factor is the emergence of unscrupulous individuals and laser companies that indiscriminately applied laser treatment to a wide range of conditions and made exaggerated claims about its efficacy, lacking substantial support from evidence.
A proliferation of so-called “scientific” publications flooded the field, often resembling marketing materials disguised as scientific research. Even well-intentioned research faced challenges, with outcomes often appearing questionable due to researchers lacking a comprehensive understanding of crucial laser specifications essential for experiment control, such as power density, irradiance, and fluence. Additionally, many studies suffered from the use of inadequate laser equipment, further compromising the reliability of their findings.
Another contributing factor to the skepticism surrounding laser therapy is the prevalence of poorly designed clinical study protocols. Many studies lacked proper controls, blinding, and quantitative measures of success, leading to uncertainties about the validity of their results. This accumulation of shortcomings has collectively tarnished the reputation of laser therapy within the scientific and medical communities.
Nevertheless, there is a growing body of clinical applications for lasers, and the accumulation of anecdotal evidence highlighting their benefits raises a crucial question: are we dismissing a potentially valuable treatment, to the detriment of patients who could experience positive outcomes?
Wound healing
The positive impact of laser therapy on wound healing stands out as one of its well-established benefits. Studies involving controlled incisions have generated quantitative data, demonstrating an increase in the tensile strength of scars when treated with laser therapy. The postoperative scar appearance has also improved, which is of a particular significance in plastic surgery.
Laser therapy appears to contribute positively throughout all three phases of the wound healing process: inflammation, proliferation, and remodeling. The physiological processes induced by lasers vary based on the wavelength used. For example, pulsed dye lasers have demonstrated a significant reduction in pruritus during the healing process, and certain studies suggest a decrease in scar thickness. Red lasers appear to stimulate cellular activity, leading to enhanced tissue healing and more robust wound epithelialization. Additionally, violet lasers’ anti-microbial light contributes to wound sanitation.
The reality is that the majority of wounds are not controlled; they exhibit irregular shapes, sizes, and depths, and are frequently contaminated. Moreover, poorely managed wounds may progress to ulceration. An illustrative case is neuropathic skin ulcers that can develop from minor wounds in diabetic patients. Traditional medical approaches often fall short in addressing these wounds in diabetic patients. While laser therapy for such lesions may not adhere strictly to purist scientific requirements due to the inherent difficulty in establishing controls due to the nature of the injury, clinical practice has consistently shown its effectiveness in promoting the healing of such complex wounds.
Let's explore the practical aspects of laser therapy.
Pain management
More than 30% of the United States population is affected by chronic pain. Unfortunately, the pharmacological approach to this problem using non-steroidal anti-inflammatory drugs and opioids caused the opioid crisis. Presently, from 5 to 8 million Americans resort to opioids for managing chronic pain. Laser therapy emerges as a non-invasive alternative that has demonstrated effectiveness in both chronic and acute pain management, garnering FDA approval for various indications, including relief of muscle and joint pain, relaxation of muscles and spasms, temporary increase in local blood circulation, and alleviation of pain and stiffness associated with arthritis.
Despite substantial evidence supporting the efficacy of laser therapy in certain cases of pain, it remains on the outskirts of modern medicine’s arsenal. Partially, because the outcomes are inconsistent. One can blame it on the lack of well-established treatment protocols, or frequent use of inadequate equipment, but perhaps the underlying cause of variable outcomes in the etiology of pain. Not all pains are created equal.
Pain is a subjective phenomenon, making it exceedingly challenging to generalize, as it manifests in diverse forms and is experienced uniquely by individuals.
Nociceptive pain is caused by injury or damage to tissue, and can be acute or chronic.
Neuropathic pain is caused by damage to the nerves, and it is predominantly chronic.
Idiopathic pain comes from an unknown cause that defies explanation. Idiopathic pain can be psychological or physiological in origin.
It would be naïve to expect that laser therapy is the universal modality for all types of pain. Besides, the mechanism of pain suppression by laser therapy remains unknown. Several mechanisms for the analgesic activity of laser therapy have been proposed:
It would be naive to anticipate that laser therapy serves as a universal modality for all types of pain, particularly given the current ambiguity surrounding the mechanism of pain suppression by laser therapy. Several hypotheses have been proposed to explain the analgesic activity of laser therapy:
- Light may directly interact with neurons, inhibiting axonal transport through its impact on the sodium-potassium pump. This alteration in nerve impulse conduction results in decreased pain perception. This hypothesis seems to be the only one capable of explaining the rapid response time (30 seconds to 1 minute) observed in acute pain suppression, as other proposed mechanisms would necessitate a longer time for the response.
- Laser therapy might stimulate the production of endorphins, naturally occurring compounds that act on pain receptors, competing with neurotransmitters for pain relief.
- Laser therapy may prevent the release of prostaglandins and other inflammatory mediators, consequently reducing pain perception.
While a definitive understanding of which mechanism, or a potential combination of them, or even the possibility that none of them are accurate, is lacking, it shouldn’t impede the practical use of laser therapy for pain management. The establishment of optimal treatment parameters (wavelength, power, dose, treatment regimen, etc.) and the identification of indications that can benefit from laser therapy are best determined through practical experience rather than waiting for a conclusive model for pain suppression.
Inflammation
The standard care for numerous inflammatory diseases typically involves immunosuppressive pharmaceuticals, which often come with undesirable toxicities. In contrast, laser therapy presents a distinctive and non-invasive approach with minimal side effects. Its proven ability to modulate the immune system, particularly at the skin level, positions laser therapy as an appealing therapeutic option for various pathologies characterized by inflammatory states.
Despite the promising aspects of laser therapy, studies have generated conflicting results, potentially due to inconsistent treatment protocols that necessitate further investigation.
Several mechanisms underlie the beneficial effects of laser therapy:
- Photobiomodulation:This primary effect stimulates the organism at the cellular level. It is hypothesized that the absorption of infrared light by cytochrome c oxidase, a mitochondrial protein, accelerates oxygen and metabolite exchange. Consequently, mitochondria increase ATP production, serving as an energy source for cellular activities that contribute to faster recovery, healing, and reduced edema in the treated area.
- Temperature Increase Effect:High-Intensity Laser therapy results in the absorption of laser light by water and fat, causing a temperature increase in the tissue. This elevation in tissue temperature induces vasodilation, enhancing blood perfusion. Consequently, larger amounts of oxygen are delivered to the tissue, accelerating metabolic processes and promoting muscle relaxation. This, in turn, relieves pain caused by muscle tension and leads to an immediate increase in the range of motion.
The Eclipse® – 980 and Eclipse® – IV from OmniLase® are state-of-the-art therapeutic laser systems. Their unmatched uniformity of illumination in the treated area ensures the high efficacy of procedures and ultimate comfort for patients.