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Laser Treatment for Neuropathy – Is It Effective?

Neuropathy is a term used to describe nerve damage. It can occur as the result of a variety of medical conditions. However the most common cause of neuropathy is diabetes. The complication develops secondary to poor blood circulation that compromises the supply of nutrients and oxygen to the distal parts of the body. Without a sufficient, reliable blood supply, the nervous tissues in the feet and hands are prone to developing peripheral neuropathy which presents itself in the form of tactile sensory disturbances.

Unfortunately, doctors have yet to find a way to reverse the effects of neuropathy. This is because nervous tissue does not repair itself, unlike the other tissues in our bodies. So any damage they sustain is likely to be irreparable. For that reason, anyone who suffers from neuropathy should observe the necessary steps in order to prevent the complication from worsening. For individuals with diabetes, the most effective step would be to maintain blood glucose levels to cease the further development of neuropathy.

Conventional Methods for Managing Neuropathy

While neuropathy can’t be reversed, there are a variety of management methods that medical professionals suggest in order to help alleviate the pain and discomfort that the complication might cause. These methods target only the symptoms, and simply help make day to day life a little more bearable for those who suffer from the sensory issues that neuropathy might cause.

For the most part, neuropathy is managed with medications that aim to mitigate pain. Over the counter pain killers are often the first treatment option, however they’re not usually the most ideal for long-term use. This is because chronic use of pain medication can have significant effects on the liver and kidney. What’s more, advanced cases of neuropathy often come hand in hand with pain that’s too severe for simple OTCs pain management medications to resolve.

Some other methods for treating neuropathy involve the use of topical creams. The most effective is capsaicin which works to alleviate pain by reducing a chemical in the nerves that is responsible for transmitting pain signals. In part, capsaicin also helps by dampening the pain receptors in the areas over which the cream is applied.

More aggressive treatments for neuropathy include antidepressants, SNRIs, spinal cord stimulators, and sodium channel blocker. These work in different ways to reduce pain and are prescribed only after extensive analysis by doctors and specialists. Figuring out which of these treatments will work best often depends on the type and severity of the pain experienced, as neuropathies can be slightly different from person to person.

Aside from these aforementioned treatments, new studies suggest that laser treatment can also be an effective solution against neuropathic pain. But is it really as beneficial as these new findings suggest?

How Does Laser Treatment for Neuropathy Work?

In medicine, lasers have long been used for a variety of purposes. Many different types of surgery involve the use of lasers to cut precise incisions along delicate parts of the body, such as the eyes. Aside from this, studies have found that the therapeutic use of low level lasers on neuropathy can help target the pain and discomfort that the condition might cause.

The most popular form of laser therapy used for neuropathic pain is cold laser treatment. The method works by stimulating blood circulation around the affected areas. This is beneficial because of the lack of blood supply around the distal parts of the body, as a result of increased glucose levels.

In doing this, the nerve fibers that have been damaged can receive sufficient nutrition and oxygen, thus helping repair and optimize their functionality. The end result is decreased neuropathic pain and discomfort.

The process is painless and works to relieve other symptoms associated with diabetic neuropathy as well, including inflammation and wound healing. Depending on the extent of the complication, it may be necessary to receive laser treatment multiple times in a week.

What Do Studies Say?

Laser treatment for neuropathy is fairly new, so we’re only just beginning to understand how it works and whether it truly provides relief from neuropathic pain. However, despite the lack of in-depth understanding regarding the treatment, existing studies point to the same conclusion – that laser treatment might be effective, especially when used appropriately.

The issue that most studies found is that while the treatment itself is a promising solution against neuropathic disturbance, a uniform method of administration has yet to be established. Without a structured treatment method, the extent of the benefits that the modality could provide widely varies from study to study.

According to research published in 2017, low level laser therapy can improve sensory function in individuals with peripheral neuropathy however, the variations in laser treatment regimens and the lack of a specific treatment protocol could have an effect on the efficacy of the treatment.

Another study measured pain management by way of the Michigan Neuropathy Screening Instrument – a standardized test that quantifies the level of pain experienced by an individual. Based on their findings, low level laser therapy was found to significantly reduce pain in individuals with Type 2 Diabetes. This was the same result collected from a study conducted in 2011.

Based on all of this research, it’s easy to see that laser light treatment can be a promising method for neuropathic pain relief. It is hoped that further research will help LLLT become an accredited medical treatment so that more health care professionals will make it accessible to individuals seeking relief from neuropathic pain.

Who Provides Laser Treatment for Neuropathy?

While most of us would expect that neurologists and neurosurgeons would be the best equipped to administer laser treatment for peripheral neuropathies, that’s not actually the case. In fact, it’s rare that you will find a licensed medical doctor prescribing this form of treatment because it’s considered an alternative medicine. That is, laser treatments have yet to be accepted in the medical field as a sound, reliable management for neuropathy.

Currently, laser treatments for neuropathies can be provided by chiropractors or pain management clinics. Keep in mind that because of the limited research on laser treatment, it’s not covered by any sort of insurance. As it can be quite expensive – ranging from $125 to $175 USD per session – it might not be practical for a lot of individuals.

Low Level Laser Treatment at Home

While the use of medical lasers at home isn’t recommended, there are FDA-cleared devices that can be safely and effectively used in the comfort and privacy of your own space. These lasers cost quite a pretty penny, so it would be wise to undergo a few clinic-based treatments first to find out whether or not the therapy actually provides you any relief.

If you’re certain that LLLT is right for you, then there are a variety of low level lasers that you can purchase in order to treat the pain yourself. The biggest consideration you need to make is the level of power you will need to make the most of your purchase. A class 1 laser will only be able to excite a small number of cells over a given area, while a class 4 laser can excite anywhere from 100 to 1,000 times the coverage of a class 1.

While you might be thinking that more power means better results, that isn’t always the case. This is especially true if your neuropathy presents only as tingling or numbness without pain. It also pays to consider the fact that lasers that fall within the 3 and 4 classes come with their own safety protocol because they can become hazardous in the wrong hands. Often, retailers will request some sort of proof of your condition or a clearance from a certified laser therapy provider before they can sell you higher class lasers.

Of course, there are non-FDA class 3 and 4 lasers that you can purchase without all the red tape. However it is assumed that any device that fails to get clearance from the FDA might have some sort of functionality or safety issues, so you will have to make that purchase at your own risk.

In Closing

Peripheral neuropathy can be a major drawback for your functionality and independence and may even have some heavy emotional and psychological effects. However there are ways that you can treat the condition.

Aside from talking to your doctor about possible medication alternatives, consider discussing the potential of LLLT for neuropathy. While this particular treatment is fairly new in the industry, countless studies and anecdotal sources have testified for its efficacy. Plus, there really isn’t anything to lose if you want to give it a shot – especially if that means giving yourself a chance at a pain-free life.

Comments

  1. Did nothing for me other than loss a bunch of money to them.

  2. Angin Elle Lapun says

    My wife diabetes symptom was diabetic neuropathy. We didn’t know she was diabetic until we went to my doctor complaining about constant foot pain. After a multitude of tests for everything from rheumatoid arthritis to muscular dystrophy, an emergency room physician checked her blood sugar.After reviewing a letter written by my doctor, where I read he had prescribed Celebrex for her due to pain of Arthritis which had really messed her neck, back and knees, I found that one of the side effects of Celebrex is Diabetes, my wife was able to effectively cure herbal condition multivitamincare org It is too much for a patient to endure such as they slowly begin to pass away if the right medication is not taken organic herbal treatment.Having a positive mind is a powerful tool .My prayers goes out to diabetes patients and their care givers.

  3. Michael jones says

    Where do you buy the machine and how much does it cost

  4. Dr Peter J Stanton says

    There are many types of neuropathy as you can see from reading the posts here. Paul’s tutorial on dose, frequency and the effects on cells is what I have read from the manufacturers of these devices. In theory it *should* heal the nerve cells. I have had this done on me at several medical conventions where vendors are always pushing products. Once I had three treatments for “tennis elbow” over three days. It did nothing. Another time I had a vendor treat medial knee pain from some cartilage degeneration. It did nothing. Was it the wrong dose or frequency? Maybe, but until they develop effective protocols I think it’s a waste.

    For the love of God avoid any Chiro or other practitioner who has you “sign up” and pay in advance!!!!! To prescribe a treatment that is not working is unethical and sleazy in my opinion. The machines cost us about 10k – 20k. Charging $4000 for a series of treatments is outrageous. How about $30 per session and pay as you go and stop when you want?

    Medicine is about money these days and you are a consumer. Buyer beware. I decided NOT to purchase one of these devices because I cannot charge a patient for something that I do not think works.

    If you have nerve pain from a DISK issue the most effective treatment is called “Flexion Distraction” or “Cox” treatment developed by Dr James Cox in the late 70s. It is a type of traction that is focused at the spinal level where the bulging disk is located. Be sure to ask if your Doc has a “Cox” table. It is just billed as a modality like ultrasound for about $15 bucks in addition to your other treatments. Over 90% of my patients recover and regain lost muscles strength if their problem has not been going on for too long. If I see a patient with muscle loss who has be suffering for months, after treatment, they may have some residual muscle weakness or a weak reflex that is permanent. They almost always are out of pain.

    This “Cox” treatment won’t help diabetic neuropathy or damage from chemo. Some of my patients with chronic pain have done well with radiofrequency nerve ablation (RFNA) They essential burn the nerve and it can relieve pain for months at a time. Check with a pain specialist and also beware of their unproven treatment methods like “prolotherapy”. GL
    Peter J. Stanton, DC, MS, DABCO
    Chiropractic Orthopedist

  5. Is it possible to cure tinnitus with laser therapy? Thanks.

  6. Cheryl Cross says

    My feet and toes have been numb for 4 years, and now I’m having pain. My neurologist just gives me prescription for medication. I think if you find out the root to your neuropathy that it easier to find out the best treatment. I know some people are diabetic, doing Chemo, have had injuries or surgery. I don’t know what triggered mines. I wish that Neurologist or podiatrist would sell the laser machines for people to purchase so their insurance could cover it. If it”s FDA approved than why does’nt our insurance cover it if it is working. Does stem cell help or acupunture?

  7. I am a Physician. I have severe neuropathy from chemotherapy. Low level laser treatment does NOT work for neuropathy, no matter what anyone tells you. The article above explains why it does not work. High intensity laser works. I have had HILT. Unfortunately the patents are owned by Chiropractors who have not done the studies to get FDA approval. They are not interested in this. They do not want to spend the money for the studies. They just want to make money running cash only businesses and avoiding insurance. One of the original patent holders told me this when I talked to him about how easy it would be to do the studies.

  8. I have done cold laser therapy on my neuropathic feet in the last few years. Usually do 12 sessions in 4 weeks and is quite helpful. My foot doctor charges $250 for the series. I am now having sciatic pain from my lower back to my knee. I am hopi g to find somewhere I can try it before actually purchasing my own.

  9. Jan Tomas says

    I have neuropathy caused by chemotherapy (treatment ended 2015 ) and it has spread with numbness up to my knees. I get relief from Lyrica but I am still having balance issues. Knee surgery didn’t help. Before knee surgery, my foot doctor made three different cuts from below my knees and scraped junk tissue off veins. (Sorry, that’s the way I understood it.) It seemed similar to the sort of back surgeries I had heard about. So I took a chance, insurance covered it, and it didn’t work and I had that surgery to recover from. In fairness to the doctor, I live alone and couldn’t sit around eating chocolates. I had simple meals to prepare, plus light housekeeping tasks. When I called the dr. to complain about the pain, he informed me I was doing too much, which was true. My question is this: am I going to get worse until all I can do is get around in a wheelchair? Or with proper p.t. can I make any gains? I hate to give up, I now use a walker/wheelchair after knee surgery last October, then broken bones (same leg) from a fall at the end of December, which didn’t end until the dislocated kneecap could be resewn. Whew! It’s been a fun year. I keep fairly active for my 82 years. Should I quit p.t. and just sign up at the Y for one or two of their activities and hope to maintain the level of neuropathy, or keep up with p.t? Insurance pays for the p.t.
    I could use some candor from a health professional. Mostly I get put off from what I suspect to be the truth. I have a few things to do before I die, and maybe I better get going.
    Regards,
    Jan

  10. Andrea Bobby says

    Hi, I’m a very athletic 58 yr old. I started laser treatments about 3 weeks ago for Neuropathy in my feet from back fusion, L3L4 5 yrs ago. I’ve had 9 treatments, with no good results. What I’m nervous about is that I started having like a drop foot on the left side. I can’t dorsi-flex while standing. Not sure if it’s from the treatments or next stage in the Neuropathy. I’m quite nervous about this new symptom. Cost was over $4000 up front.

  11. Am interested in purchasing a use at home Class IV laser to treat chronic lumbar pain (transitional pain when bending, stooping; difficult to do anything – weed, vacuum, laundry) for more than 15 minutes, and to treat early stages of peripheral neuropathy in feet. Cost is an issue, is it possible to purchase a Class IV laser for less than a $1,000.00? Many thanks, Patty

  12. I have peripheral nephropathy due to chemotherapy. I have not tried the laser treatment. In the past 10 years I have found that alpha lipoic acid 600mg twice a day brings the most relief. With it, the pain is bearable. I also use a hand held tens machine bought on amazon under $50, I wear compression socks and comfortable shows with cushion inserts. I hope this helps someone else. One more thing, not all alpha lipoic acid is made the same, buy from a reputable company.

  13. I am currently going to the Nerve and Laser Institute in Clermont Fl because I have peripheral nephropathy . They said I should go twice a week on Mondays and Fridays for 10 weeks. So far I’ve only been going for one week. I asked if by the 5th week I see no significant difference can I get a refund. and they said I would have to pay for the treatments I already received but would refund the last five weeks. Can you or anyone tell me if they have had these treatments. if they worked and would they recommend them. Also any information on The Nerve and Laser Institute in Clermont FL

  14. MIKE M
    HAD 3 TREATMENTS OF LASER. SEEMED TO BURN WORSE (THEY CALL IT RECOVERY SENSATIONS). TALKED TO PEOPLE WITH SOME SUCCESS AND SOME WITH AS MANY AS 10 TREATMENTS WITH NO SUCCESS. WENT TO REALIEF CENTER IN MAPLE GROVE. THEY SAID I WAS MAKING GOOD PROGRESS. 125 DOLLARS PER TREATMENT (HALF OFF DUE TO INCOME) CANT DECIDE IF I SHOULD RESTART TREATMENTS. IF YOU STOP, THE CONDITION WORSENS BACK TO ORIGINAL.

  15. Gabriella Book says

    My chiropractor wants me to purchase an anodyne therapy kit $6300. I’ve read some negativity on this, waste of time and money. I’ve also read cold laser treatments have not helped a friend. I take alpha lipoic acid. Is there other supplements that can help. Also haka med helped me, but the chiropractor can’t bill medicare for it, only adjustments, yet I’ve read in medicare that its an approved therapy. Why aren’t more doctors buying this machine along with laser to help people.

  16. I had a bout of sciatica. Suddenly peripheral neuropathy appears. Could the sciatica has caused this? I am not diabetic.. I appreciated your article. Thank you for posting it.

  17. I have just started this laser treatment and have two sittings. I am an old man of 91 years and have been suffering from peripheral diabetes for over fifteen years. My feet and legs below the knees have become numb and painful with itching.
    I had all medicines but the net result was zero.
    Just after two sittings I feel somewhat better and looks like I will be quite OK after full treatment of 4-5 months.
    It is AIIMS Delhi where I am having this laser treatment.
    I am 81 years old not 91 years written due to mistake for which I may be excused.

  18. I am getting laser treatments for my toes and hands for Neuropathy pain . I have had 19 treatments,I have paid 4000.00 dollars in advance.I have had no relief I feel been ripped off.

  19. Debbi Franks Srp says

    What a freaking waste of money. These chiropractors ALL advertise in the same wording. My local one advertises we can be pain free! BS At 125$ – 175$ a pop and a full 13 treatments the only thing positive is your chiro got wealthier! If this REALLY worked, do you think there would be millions of people still suffering? If I was cured, I can guarantee I would be posting on every neuropathy support group. Pathetic

  20. What kind of laser treatment or any other kind of treatment would be best for me. I am not diabetic, and I have had nerve testing done. The doctor said I don’t have large fiber neuropathy but I might have small nerve fiber issues. He suggested a skin punch biopsy , but he said even if that is positive, still the only treatment are drugs like Lyrica which I have been taking and they make me feel drunk. Someone else suggested Anodyne treatment. What ideas do you you could share? I’ve been suffering for 4 years with pain and I am losing hope.

  21. Need for nerve damage on head from a truck accident in 1994 & the pain is worse than delivering my babies at 10lbs!
    I hae bad hips & knees & I live on$650. a mth (SSI). Would like to be able to do at home. I am dying of breast cancer & doing chemo which makes me sick & Hydrocodone doesn’t exactly help & I refuse to take that OxyContin at all!! I know it won’t help the cancer but would help the pain on head between the skull & scalp & it hurts like hell so bad I puke. What is price of unit?

  22. Peggy Allen says

    Paul, thank you for the knowledge you share.
    I have postherpetic neuralgia/neuropathy on my forehead from brow bone to scalp.
    The prickling sensation is in bearable. Since that are doesn’t have a lot of adipose tissue, what do you suggest? Ic I chose the class 4 laser treatment, how often should I get the treatment? Is it an accumulative process?
    Also, would NIR bd effective?

  23. Guido Spadafora says

    Please, I suffer from peripheral neuropathy. It is possible to know the prices of your laser products, and wath would be the prices. Thanks very much

  24. Rhoda rosenzweig says

    Is laser treatment good for neiropathy

  25. i developed nephropathy as a result of Chemotherapy , do you think laser treatment will help me ??

  26. Marlon Green says

    I have been dealing with PN for 20 years. Unlike most people I believe mine was medically induced or the result of a medical error during a hospital visit. There is not much pain but the numbness and balance problems is something I have never gotten use to. I’m looking into electronic as well as light and laser therapies. I know it works on apes for various conditions. I sure can use some help.

  27. Brian Donnelly says

    Paul, do you have any updated info on using laser therapy? I just got back from Mayo and they did nothing for me. Said I have mild poly neuropathy but I can see and feel my feet are getting worse. I had all kinds of blood work that showed Lack of copper amongst other things they just sent me home and asked if I wanted some medication I have diabetes but is under control. I eat pretty well, perfect weight, exercise. I’m only 54, 6 ft tall, 180 pounds After losing 50 pound months earlier. I need help NOW. I’ll do ANYTHING

  28. danny fletcher says

    I am contemplating laser treatment from a chiropractor
    I have varying degrees of tingling and numbness but no pain other than the cramping in my calves mostly in bed when I get up or roll over. I am 77 years old and have had
    Varying symptoms until now but they seem to be progressively getting worse. I suppose I might like your recommended dosage and frequency and length of treatment for my particular situation

  29. Ted Lessler says

    What is the optimal dosage, wavelength, nm and wattage for Neuropathy to reduce inflammation, tingling and numbness?

  30. I have neuropathy and fibromyalgia and am not diabetic. This is from a spider bite. I’m on gabapentin and tramadol.
    I have had 4 MLS treatments and the first two seemed mild. The third and most recent have caused terrible sharp pains in both feet running up to the knee. I will not be having any more treatments .
    I hope they can get it dialed in better, more studies need to be done. Pain not worth it!!

  31. bharpurn grewal says

    I am not diabetic and my sugar level is good. I have no pain, but my feet get numb, not all the time. If i sit on a sofa/couch and watch TV, my feet get numb. Recently, I started getting MLS Laser Therapy and i had five treatments of MLS Laser Therapy, but I don’t feel any difference yet. I am committed for six treatments. I am still optimistic and kind of believe in Laser. I believe Laser is the future, not only for Neuropathy, but in general.

  32. Lynne Sanforx says

    Very interesting article. My problem is I’m not a diabetic. Will laser work for me.
    Thank you, Lynne Sanford

  33. Barbara Smith says

    thank you for your info……
    I would like to help my legs and feet at home with a laser that is safe……I now have just numbness and in the calves and feet…aches in the thigs….but I walk each day with my walker for 30minutes……

  34. Is there ant LLLT trials going on at present time?

  35. What if you have Neuropathy because of back problem? Is this still effect? Is this just away of making money
    for these doctors? I have a friend that spent $15,000 and it did nothing, another one that spent $5,000 and then
    stopped it. I have neuropathy in my legs, feet and hands, I would like an honest person to tell me the truth,
    if could stop from going to a wheel chair in the future. I’m a active person, and cannot see myself in a wheel chair.

  36. Paul Schwen says

    Cindy,

    Thank you for a well-written article. It is important to understand in laser therapy dose effectiveness is dependent on a variety of patient tissue factors, all other variables being equal. Variables affecting photonic energy depth of penetration, absorption, and attenuation are the following tissue factors:

    • Tissue Density: Adiposity Index vs BMI, Or Body Mass Index
    • Tissue Structure: Permeability of tissue structure
    • Tissue Proximity: (depth of tissue (shallow vs. deep)
    • Tissue Pigmentation: six levels, from white to black
    • Tissue Hydration: Min. 54.8% to Max. 78.1% – this seems like it should be a crucial factor
    • Tissue Stress: Bio-behavioral factors that induce cell damage
    • Tissue Age: from atrophic to neoplastic

    Low Level laser treatment may be fine for the oral cavity and other shallow, deeply pigmented, moist warm tissues – in most cases, a much higher level of energy is required for energy/tissue interactions (ree Reciprocity Rule in Photobiology).
    Laser light attenuates the further from the surface it penetrates, until it reaches a point at which the laser photon density is so low that no biological effect of the light can be measured. The biologically effective stimulatory depth photonic energy is dependent on the targeted tissues and varies according to the tissue factors listed above. Secondary and tertiary photobiomodulatory effects, as well as systemic effects, are additionally observed at greater tissue depths.

    Primary, Secondary, and Tertiary Effects
    Primary response is elicited when photons emitted by the laser reach the mitochondria and cell membranes of low lying cells such as fibroblasts, where the photonic energy is absorbed by chromophores and is converted to chemical kinetic energy within the cell. Chromophores absorb photons with wavelengths between 700 and 1100 nanometers (NIR, or near infra-red), with those in the 790nm neighborhood being the deepest penetrating, as discussed earlier.

    Secondary reactions lead to the amplification of the primary actions. A cascade of metabolic effects results in various physiological changes at the cellular level—such as changes in cell membrane permeability. Calcium is released from the mitochondria resulting in changes of intracellular calcium levels. This stimulates cell metabolism and the regulation of signaling pathways responsible for significant events required for tissue repair such as cell migration, RNA and DNA synthesis, cell mitosis, protein secretion, and cell proliferation.

    Tertiary effects are induced at a distance from the cells in which the secondary events occur. Energized cells communicate with each other and with nonirradiated cells through increased levels of cytokines or growth factors. This intercellular communication results in an increase in the immune response with the activation of T-lymphocytes, macrophages, and number of mast cells. An increase in the synthesis of endorphins and a decrease in bradykinin results in pain relief. Tertiary effects are the least predictable because they rely on intercellular interactions and vary according to tissue factor variables.

    Treatment Dosage
    Dosage refers to the amount of energy per unit area of tissue surface. Energy is measured in joules, the area in square centimeters and thus the dosage in joules per square centimeter, J/cm2. The power of a laser is the rate of energy delivery and is measured in watts, or milliwatts. One watt equals one Joule per second. Class IV therapy lasers have power output from 0.5 to 60Watts. As an example, a laser operating at 6 watts continuous wave would deliver 240 joules in one minute, and 120 J/min in pulsed mode set at a 50% duty cycle. If the treatment area was 50cm², the dosage would be 240J/50 cm², or 4.8 J/ cm² in continuous wave, and 2.4J/ cm² in pulsed mode at 50% output.

    Biostimulation has been reported with doses from as low as 5J/ cm² to 300 J/ cm² (there is no ceiling dose in laser therapy). This wide range is explained by the vast differences in irradiating tissue cultures in a laboratory and treating a deep-lying condition in a clinical setting. Correct dosage is very complicated, as tissue factors must be considered, as well as wavelength, power density, type of tissue, condition of the tissue, acuteness or chronicity of the problem, pigmentation, treatment technique, etc. Nonetheless, there is a dosage window below which no biostimulation will occur, common with LLLT (Low Level Laser Therapy).

    Numerous studies have supported the use of higher doses of laser irradiation. Substantial amounts of photonic energy applied at the surface will be reflected, absorbed, and scattered in the superficial tissues. If the target of laser therapy is several centimeters deep, a higher dose at the surface will be reduced to a moderate dose in the desired zone. At least 50% of the surface-applied energy will be lost, so a dosage of 10J/cm² would be diminished to 5J/cm² or less at a deep target site. This rate of diminishment decreases with higher output power levels.

    Critics of high-powered laser therapy claim damage will occur in the overlying healthy tissue. It is said that surface doses of 10J/cm² or more will be harmful. However, in the treatment of healthy, optimally functioning tissue, almost any dose can be used without noticeable macroscopic negative effects. This is the case in the use of surgical lasers which use very high power and energy densities for cutting, evaporating, and coagulating tissue. Adjacent to the destructive zone, very high levels of power density and dose also occur, but this is not found to be negative. In daily practice, thousands of clinicians are safely treating tens of thousands of patients daily with Class IV therapy lasers.

    When treating with a GaAlAs diode laser, the current accepted dosage for deep-seated pain is 50-60J/cm². Simple calculations show that if the condition being treated is lumbar pain, the area being treated could be 100cm² to 400cm², or even larger, if it is accompanied by radiculopathy. This equates to a total treatment dosage of 10,000 to 12,000 joules. If the treatment device was a 500mW laser, it would take all day to administer this dosage; however, a high-intensity Class IV therapy laser could accomplish this dosage in less than 10 minutes.

    The output wattage used with a Class IV therapy laser depends on a number of factors. A deeper target calls for a higher wattage so that a sufficient number of photons reach the target and produce the desired primary effects of photobiomodulation. For example, 18Watts would be used for lateral epicondylitis, 12Watts for cervical pain, and 30Watts for lumbar pain. Clinical judgment would prompt the laser therapist to adjust these numbers higher or lower.

    Treatment Modes
    Class IV laser treatment is best delivered in a combination of continuous wave and various frequencies of pulsation. The human body tends to adapt to and become less responsive to any steady stimulus, so varying the pulsation rate will improve clinical outcomes. In pulsed, or modulated mode, the laser can operate at a duty cycle of 1% to 100% (CW) and the frequency of pulsation can be varied from 1 to 50,000 times per second, or Hertz (Hz). Empirical evidence has not clearly distinguished which frequencies are suitable for various problems, but there is a substantial body of anecdotal evidence to provide some guidance. Differing frequencies of pulsation produce unique physiological responses from the tissue, with optimal frequencies at 1Hz to 80Hz, and higher rates being more beneficial for deeper tissues.

    Some Class IV therapy laser manufactures suggest the following:
    • lower frequencies, from 2-10 Hz are shown to have an analgesic effect;
    • mid-range numbers around 500 Hz are biostimulatory;
    • pulse frequencies above 2,500 Hz have an anti-inflammatory effect; and
    • frequencies above 5,000 Hz are anti-microbial and anti-fungal.15

    There are no published research studies to support these conclusions, and evidence suggests they are simply random in nature.

    Optimal laser therapy treatment would utilize several pulsed frequencies along with CW (continuous wave) over the course of a treatment plan to produce a combination of analgesia, anti-inflammatory effects, and biostimulation.

    Effective clinical results come from a developed understanding of variable tissue factors resulting in optimal treatment modalities, rather than simply dumping high doses of continuous wave energy on targeted tissues.

    Please contact me if you would like additional information, as there is a great deal of confusion regarding this issue and our foundation is committed to finally resolving this!

    All the best,

    Paul

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