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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. 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.

  2. 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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