Low Level Laser Therapy in Details
Medical experiments with laser light started in the 60-s, soon after the creation of lasers. High output lasers were able to damage tissues, cause burns and even evaporation. Currently such lasers are used to cut tissues and to evaporate caner cells. Laser light can cause the release of free radicals from some chemical substances. In high concentrations free radicals can also damage cells. This is one of the main ideas of photodynamic therapy of cancer.
The biological effects of low level (non-thermal intensity) laser light irradiation were first discovered by Endre Mester and colleagues (Hungary) in the 60-s. They irradiated shaved skin of experimental animals (mice) with a low power ruby laser to check if laser irradiation can cause cancer. No cancer growth was detected. Instead, faster hair growth rate was detected in laser treated animals in comparison with control animals. That was the beginning of application of low level lasers in biology and medicine.
The first low level laser therapy systems were based on HeNe (632.8 nm) lasers. Later (in the 80-s) semiconductor lasers were developed. Not only red, but also IR band laser radiation became available for clinical application.
Currently diode lasers are replacing HeNe lasers. Diode lasers are very small, simple in maintenance, have a long lifespan, inexpensive in application and have high clinical efficiency. Blue and ultraviolet lasers can be used for treatment of infection and viral diseases, infected wounds, activation of immune system, activation of stem cells. But at the moment they are not available for routine clinical application.
Application of LLLT in different countries
Low Level Laser Therapy (LLLT) is an acceptable method of medical therapy in several countries. For example, in USSR and currently in Russia and other former USSR countries LLLT is applied in hospitals since 1974, when the Ministry of Health of USSR gave permission for clinical application for the first HeNe laser based device for laser therapy.
In Russia LLLT is applied by specially trained medical doctors or nurses under control of medical doctors. Application of LLLT by medical personnel helps to achieve reasonably good treatment results. Usually LLLT is applied with other methods of therapy (together with medication, surgery and so on). For example, laser therapy can be applied in case of infection and inflammatory processes together with antibiotics to increase the concentration of medication in the focus of inflammation, after surgery to speed up recovery and prevent inflammatory complications, together with anti-aggregant medication to increase blood supply in case of ischemic heart disease and atherosclerosis and so on. LLLT it is not considered to be an alternative therapy method, so it is not replacing other routine methods of treatment, but enhances them.
Application of laser therapy (as well as any other treatment method) and manufacturing of laser therapy systems are under the control of the Ministry of Health in Russia and other countries of former USSR. Medical doctors and nurses in Russia can learn about laser therapy in the State Scientific Center of Laser Medicine (Moscow) or several other regional scientific laser centers. Laser equipment manufactures can produce laser system only after receiving approval from the Committee for new medical technology of the Russian Ministry of Health.
Several conferences on laser medicine and laser therapy are conducted in Moscow and other cities of Russia and Ukraine annually, specialized magazines and books are published. Scientific research institutions are involved in studies of mechanisms and effects of laser irradiation.
LLLT is a popular therapy method also in some other countries. A number of studies on LLLT are reported from Australia, Brazil, China, Finland, France, Germany, Great Britain, Italy, Japan, Korea and USA .
Several national and international associations, including the World Association for Laser Therapy, are united professionals in the field of LLLT. Regularly several conferences and congresses are taking place in different countries.
An international team of medical doctors and researchers is working in Helsinki (Finland). Prof. Anu Makela MD., PhD., (Australia , Finland) has been working in the field of laser therapy and laser acupuncture as a doctor, researcher and teacher for more than 20 years. She participated in the development of the method of electro-laser acupuncture, the method of combined simultaneous influence of laser light and electricity on acupuncture points. The unusually wide scientific interests of Anu Makela help to combine information from biology, chemistry, physics and medicine not only for scientific research, but also for better treatment of patients. Several literature reviews, theoretical lectures and practical articles are presented in different conferences by Prof. Makela. She has held training courses in Finland about LLLT for several years now. As a result of teaching activity of Prof. Makela, several doctors, nurses, physiotherapists and professionals in different regions of Finland and Europe are using electro-laser therapy in their daily practice.
Levon Gasparyan MD., PhD. (Armenia , currently in Finland) is mainly concentrated in research in the field of mechanisms of influence of laser and light irradiation on cellular and body levels, including influence of laser light on some functions of stem cells, angiogenesis, blood platelets. He also involved in the development of new laser and LED therapy equipment.
Several scientific studies are together with Prof. Grigori Brill PhD. (Russia) in the area of basic research of LLLT mechanisms.
Unfortunately, the attitude towards LLLT in some countries is not so favorable. In the USA LLLT currently is in the process of receiving FDA clearance. In some places LLLT is considered to be a method of alternative therapy. As a result it is not conducted by medical doctors and even more, medical doctors in general are ignoring LLLT as not a scientifically proved method of therapy. The majority of insurance companies are not paying for this therapy, which makes wider expansion of the method even more difficult.
Medical application of LLLT
The influence of low level laser irradiation on the organism has several clinical and biological effects, including anti-inflammatory, immunostimulatory, neurotrophic, analgesic, desensitizing, bactericidal, antioedemic, normalizing the blood rheology and hemodynamics effects (depending the condition of the patient and the pathology). Accordingly LLLT can be applied for the therapy of several pathologic conditions in various branches of medicine, including disorders and diseases of the
musculoskeletal system - osteochondrosis, back pain, arthritis, disorders and traumatic injuries of muscles and ligaments,
cardiovascular system - ischemic heart disease, stenocardia, myocardial infarction, hypertension, atherosclerosis;
ENT organs - chronic inflammation of accessory nasal sinus, pharyngolaryngitis, tonsillitis, otitis, rhinitis, hearing loss, Menier's syndrome;
gastrointestinal and digestion system - peptic ulcer of the stomach and duodenum, dyskinesia of the gallbladder and biliary duct, colitis, chronic pancreatitis, chronic cholecystitis;
skin - dermatitis, dermatosis, neurodermitis;
respiratory system - pneumonia, bronchitis, bronchial asthma;
female reproductive system - adnexitis, vaginitis, disorders of menstrual cycle;
renal and urinary system - pyelonephritis, cystitis, prostatitis, prostate enlargement;
nervous system - neuritis and neuralgia of peripheral nerves, neuralgia, facial neuritis, cerebro-vascular insufficiency;
teeth and gums - caries, pulpitis, periodontitis, paradontitis.
as well in the therapy of infectious disease (viral hepatitis, tuberculosis, chlamydiasis), for prevention of complications of surgery and many other cases.
In Western countries, the generally accepted application area of laser therapy is mainly in case of muscular and joint problems, while in Russia it is applied to a much wider variety of disorders. Western studies, which are generally published in English, are easy available in magazines and in the Internet. Laser World (www.laser.nu) is the most reliable source of information about LLLT, including research, books, conferences, manufactures of LLLT systems. Studies from Russia are less available in English. Small collection of reports from Russia and Ukraine can show the range of pathologies laser therapy can be applied.
Z. G. Basiev et al. (2004) compared different methods of laser therapy (intravenous laser blood irradiation, transcutaneous laser blood irradiation, local application of infrared laser on thorax) and their combinations for the therapy of bronchial asthma. They reported that different combinations of LLLT methods are required for different patients depending of the stage of disease and complications. Authors observed the improvement in the condition of patients and immunological parameters, and reported that patients were able to cut the amount of applied medications after LLLT.
G. I. Mavrov et al. (2004) examined application of infrared laser light together with medications for elimination of Trichomonas vaginalis. Laser light improved the rate of elimination of Trichomonas vaginalis and decreased the rate of relapses of the disease.
I. A. Utz et al. (2004) reported about their experience of application of transcutaneous red (633 nm) laser blood irradiation for children with secondary pyelonephritis and glomerulonephritis. The condition of children underwent laser therapy was better than those without laser irradiation even after 2 years after therapy.
N. F. Posohov (2003) studied therapy results of patients with trigeminal neuropathy. He investigated effects of different wavelengths of red and infrared laser light, different methods of application (local irradiation on the area of trigeminal nerve, distant and local acupuncture points, irradiation of scalp as well as intravenous laser blood irradiation) and frequency modulation. He developed a protocol for application of laser light according to the condition of patients and stage of pathology.
V. V. Makasova et al. (2002) reported about positive trial results of laser therapy in the treatment of patients with viral hepatitis C.
G. V. Babushkina et al. (1999) studied the effectiveness of LLLT in the treatment of patients with ischemic heart disease. They studied 1200 patients with stenocardia. Patients were under control for 5-10 years. Patients were divided into control and test (LLLT) groups. During the treatment the test group patients decreased the doses of nitroglycerin, nitrates and other anti-anginal medication. The changes were statistically reliable. In control group patients no significant changes were registered. The authors also reported about higher sensitivity towards nitrates after LLLT. They considered that this increase of sensitivity is the result of morphological changes in erythrocyte membranes, reconstruction of lipid bilayer of cell membranes, due to improvement in phospholipid molecule construct under HeNe laser blood irradiation.
V. P. Avdoshin et al. (1999) studied the influence of magneto-laser therapy on frequency of a stone relapse after kidney stone elimination. 33 patients were treated with medicaments and medical plants. 35 patients besides common therapy got magneto-laser therapy on kidney area. The number of sessions was 8-12 during the course of treatment. It was found, that after 3 months of observations LLLT group patients had lower rate of active stone formation that control group patients. So magneto-laser therapy can decrease the risk of stone formation for patients with kidney stone disease.
E. V. Kulchavenia (1996, 1999) reported about positive influence of LLLI for the treatment of patients with nephrotuberculosis. The applied medication therapy (antibiotics) is not always enough to eliminate Mycobacterium tuberculosis completely from kidneys. The growth of mycobacteria slows down in case of limited oxygen supply, influence of low and high temperature of the body and some other reasons. This makes mycobacteria less sensitive to antibiotics and helps them to survive. Laser therapy can improve blood circulation and significantly increase oxygen supply into tissues. Higher oxygen supply stimulates mycobacteria reproduction, making them sensitive for medication again. Laser influence also significantly increases the concentration of antibacterial medication in kidneys, which can even more strengthen bactericidal effect of chemotherapy, and results in better clinical effect.
Low level HeNe laser light irradiation can help in the therapy of epidedymitis. V. P. Miroshnikov (1994) and L. L. Reznikov (1989) reported about reduction in pain, swelling, pyrexia and other symptoms of acute epidedymitis after LLLT. Application of laser therapy also reduced the necessity of surgical interventions. Theses researchers also reported about positive effects of HeNe laser irradiation for the treatment of chronic urethritis. LLLT produced reduction in pain, improvement in microscopic investigations, especially as regards the number of leukocytes. Other authors also presented similar reports. B. I. Miroshnikov et al. (1990) demonstrated that laser irradiation in certain doses can increase the sperm motility in vitro. So the danger associated with laser irradiation of or near the gonads is minimal.
V. P. Avdoshin et al. (1992) demonstrated the increase of sensitivity of several microorganisms towards antibiotics after laser irradiation in vivo and in vitro. In the same time red and IR laser irradiation does not have direct bactericidal effect.
R. K. Kabisov et al. (1999) reported about their 14-year experience in using LLLT in oncology. They treated over 2000 cancer patients with modern methods of radio- and chemo- therapy together with laser therapy. Authors reported that LLLT improved the results of radio- and chemo- therapy of oncological patients. Other indications were prevention and treatment of radio reactions, complications of chemotherapy, postoperative complications, associated diseases, pain syndrome. The results of the investigation showed that the anti-inflammatory effect was observed in 96.1 % cases, the analgetic effect was in 84.0%. The protection of the normal tissue during radiotherapy was 94.8%.