“I’ve tried various prescriptions for this pain. How can a laser help?” Often I am confronted with this and other similar questions regarding post-herpetic neuralgia (PHN) and other types of nerve pain. I have had the pleasure of seeing patients’ smiling faces when they begin having a decrease and/or resolution of nerve pain.
Cold laser therapy is known by many similar names: low-level laser therapy (LLLT), low-power laser therapy (LPLT), soft laser biostimulation therapy, photobiomodulation and low-intensity laser therapy. The U.S. Department of Labor has classified lasers into 4 classes. An example of the first class of lasers (i.e., class 1) would be a simple laser pointer. The surgical lasers that cauterize tissue and are used as a scalpel are in the 4th class (IV). Cold lasers do not burn or cut tissues, but penetrate into tissues through the skin. Cold lasers do remain a potential for injury as they are hazardous to the eyes if the laser is directly viewed.
Cold laser therapy machines can be found in all classes of lasers. Ultimately, each laser’s class is based on its ability to injury the eye(s) and the amount of power in miliwatts of a single beam. Anything that is greater than 500 miliwatts either in a single beam or in combination of multiple beans is a class IV. Additionally, the depth of penetration into the tissues is based on the wavelength of the laser light itself. As the class of laser increased, so does the ability to penetrate further into the body (down to joints). “It is the general consensus that wavelengths below 660 nanometers are very easily absorbed in the surface tissue and are not optimized for deep tissue healing” (coldlasers.org). Superficial tissue is commonly treated with wavelengths between 600 and 700 nanometers (nm). For deeper penetration, wavelengths between 780 and 950 nm are used. Thus, the higher the class of laser the greater the depth of penetration into the body, the greater the restrictions and potential to harm; but it can not be said that the greater the power the more effective the laser. Review of treatment protocols often shows that depending upon the focus of the treatment (pain management or healing), may mean less intensity and more time OR visa versa.
“The goal of laser therapy is to deliver light energy units from red and infrared laser radiation, called photons, to damaged cells. It is the consensus of experts is that photons absorbed by the cells stimulate the mitochondria to accelerate production of ATP. This biochemical increase in cell energy is used to transform live cells from a state of illness to a stable, healthy state” (Coldlasers.org). “Cold laser therapy is a non-invasive way to stimulate the body to do its own natural ability to heal” (Pietrangelo, 2018). When considering acute and chronic issues such as shingles, carpel tunnel syndrome, peripheral neuropathy, musculoskeletal pain, and wound healing it is not uncommon for Western medical practitioners to shrug their shoulders once physical therapy and/or drugs have failed. Thankfully, there are starting to be in-roads to complementary and alternative modalities such as cold lasers usefulness.
“Clinicians should consider the use of low-level laser therapy to decrease pain and stiffness in patients with Achilles tendinopathy.”
– American Physical Therapy Association (APTA)
“Laser therapy is beneficial in treatment of neck pain.”
– World Health Organization (WHO)
“Laser therapy shows strong evidence of effectiveness for pain relief.”
– International Association for the Study of Pain (IASP)
Cold laser treatment can be time intensive for the patient. “One of the drawbacks of this therapy may be time. While each cold laser therapy session only takes a few minutes, it may take as long as a month (with as many as four treatments a week) before you can gauge its effectiveness” (Pietrangelo, 2018). Additionally, insurance companies vary in coverage of this treatment. Those companies that do cover this will require prior authorization with documentation from a provider indicating the complementary and alternative treatment is medically necessary.
Receiving treatment is generally painless. The treatment is soundless and without vibration. While some patients report feeling a tingling or stimulation of the nerves, the majority of people often don’t feel anything. Mostly each treatment is a chance for relaxation and I find it is a good way to get to know my patients while we chat.
Since starting SNVHS, I have offered cold laser therapy for my massage clients and now my patients. The class of laser currently utilized is class 2 with deep penetration abilities of 808nm. I have helped folks struggling with tooth infections, surgical wound healing, musculoskeletal pain, post-herpetic neuropathy, and peripheral neuropathy. Most recently, I treated a young woman struggling with developing carpal tunnel syndrome (CTS) in both wrists. She came to me seeking help as her mother and aunt suffered with the same issue that is genetic in their family; and treated it with cold laser years ago. After the first treatment, she returned with a gleam in her eye as she was finally able to sleep through the night without the numbness and tingling that robbed her of sleep for the last 6 months.
If this type of treatment is or has been a consideration for you, or you are interested in more information, please give me a call.
Pietrangelo, A. (2018, July). Is Cold Laser Therapy Right for You? HealthLine. https://www.healthline.com/health/cold-laser-therapy
United States Department of Labor, Occupation Safety and Health Administration (OSHA). (n.d.). Use of Medical Lasers. https://www.osha.gov/SLTC/etools/hospital/surgical/lasers.html