Light Touch

There are two kinds of light - the glow that illumines, and the glare that obscures.

~James Thurber

I have spent the past several months researching everything I can find on “Low Level Laser Therapy” or “Cold Laser.”

The amount of information is vast, the quality is confusing, conflicting and difficult to sort through. I managed to talk a few reps into letting me play with demo models, and I sorted through enough information to justify purchasing a machine. So now my task is to try to make sense of all of the information available, and squeeze it into a nutshell that is easier to handle. I am NOT an expert, and my experience is limited. (That was my disclaimer). I hope this helps, but if you decide to seek light therapy for any condition, please discuss it thoroughly with your health professionals.

First – it is perfectly safe. The machines on the market available to clinicians will not burn you. We are all familiar with the concept of surgical lasers, and have seen Hollywood lasers burn through metal, glass, people, even mountains. The class “3” or “3b” lasers, which are the light frequencies used in rehab, will not burn holes through your body or damage tissue.

The treatment has been approved by the FDA for temporary relief of minor muscle aches, joint pain and stiffness, relaxation of muscle spasm and increasing local blood flow.

At this point, I know of no insurance companies that will pay for cold laser treatment. Part of this is secondary to the type and quality of research available. There are foreign studies that are better, mostly Russian, but they are not the studies that insurance companies look at. I reviewed the abstracts on many of the studies cited by some of the insurance companies, and I understand the justification for denial. Even those reviews admitted that “further study” is warranted. They are not ruling out the possibility of payment, they just want tightly controlled, well-designed studies. And here-in lies the problem. Most of the studies available in the US are funded, in fact, PERFORMED, by clinicians with a monetary interest in the companies that make or sell machines, creating an inherent bias. Many of the abstracts I looked at were small samples, or had multiple, uncontrolled variables, and were, in short, not very well designed. There is not a lot of incentive for really good studies. Practitioners are using them, patients are paying out of pocket (and getting results) so there is not a lot of financial incentive to have better studies: if people will pay out of pocket, and the FDA has approved it, do we need 3^rd party payor blessing?

Does it work? We all know the benefits of sunlight. We know that light can be extremely powerful. We know that even tiny laser pointers can span great distances through air, glass, and some plastics. If you hold a flashlight to your hand in a dark room, you see the dense silhouette of bone surrounded by eerie red as the light penetrates your blood vessels. Better yet, put the flashlight in your mouth and puff up your cheeks – sorry, inner child moment. Light can penetrate, and these lasers are fairly powerful.

But how does it work? The theory is that laser therapy increases your metabolic process by exciting the mitochondria. Uh-oh, 8^th grade biology flashback! Mitochondria is the powerhouse of your cells, they produce energy for your cells, and keep everything running. They love light. In fact, it is partially the mitochondrial response that makes sunlight so good for you. It also increases protein synthesis, promotes efficiency at the cell membrane to normalize pressure, and improve exchange of nutrients and wastes. All of this activity on the cellular level is supposed to decrease swelling, inflammation and pain, promote healing and generally make things work better.

But – does it really work? Well, I have only been using the machine for a couple of months, and, again, I am not an expert. The results have been strong enough for me to purchase one. I am still playing with protocols and parameters. Some of my patients have had truly phenomenal results. I am hoping that those that did not have such positive results will benefit from my increased proficiency. When a treatment effects the cellular metabolism, there is risk of temporarily increasing symptoms, especially in the chronic pain population. I tend to error on the very conservative side of caution. My patients that did not get better, also experienced no increase in symptoms. As I get more comfortable with the therapy, I will probably treat (slightly) more aggressively.