An Overview of Low Level Laser Therapy & Acupuncture as Adjunctive Treatment in an Outpatient Clinical Setting
BY ELAINE WALSH, M.AC.
, LIC.AC.
Copyright
2005
Over the past 35 years, low-level laser therapy has been used effectively to treat a variety of medical conditions, seen in the outpatient clinical setting, which cause chronic and acute pain, numbness, paralysis and tissue damage.
These conditions can be divided into five major categories in the adult, aging and disabled population: Chronic degenerative disorders such as osteoarthritis (1,2), spinal stenosis, degenerative disc disease (3); Neurological disorders such as paralysis due to stroke, brain or spinal cord injury (4); diabetic neuropathy (5); entrapment neuropathies such as Sciatica, CTS(6), cervical radiculopathy(7); Nerve inflammation such as Bell’s palsy (8); Chronic neuropathic pain, RSD (9), post-herpetic neuralgia(10), headaches (11) and insomnia (12). Acute and Chronic musculoskeletal injuries (13,14), tendonitis (15,16), myofacial pain (17,18), chronic low back pain (19); Acute and chronic inflammatory disorders such as fibromyalgia (20 ), Rheumatoid arthritis(21,22); Wound healing of both superficial wounds and deep, non-healing wounds(23,24).
The positive clinical trials referenced above, as well as numerous case studies and clinical studies of this author and others, support the clinical use of non-invasive low level laser therapy and acupuncture to help accelerate the healing process in a wide variety of conditions.
The combination of laser therapy with needle acupuncture and other treatments has been shown in many cases to increase efficacy and reduce the number of treatments required to effectively decrease pain, inflammation, numbness, swelling and to increase ROM and tissue repair more rapidly (25,26).
Recent reports of the adverse effects of long term NSAID use and revelations of increased risk of mortality in Cox-2 inhibitor clinical trials have called into question the current medical recommendations for the use of NSAIDS in the treatment of patients with chronic musculoskeletal pain, osteoarthritis and inflammatory conditions (27). Both low level laser therapy and acupuncture offer a safe and effective treatment alternative for this population.
Low level lasers and acupuncture are proven to be safe and have no negative side effects when contraindications are followed. Their safety has been well documented in clinical use over the past 35 years (28). Low level, Class 3b, lasers have a low power output of 5-500mW and are in the red to near infrared range of the electromagnetic spectrum (600 – 1000nm). Unlike surgical lasers, these “cold” lasers are non-thermal. Low level lasers do not destroy tissue and promote tissue repair. There are only a few contraindications with low level lasers; avoid use on cancers, benign tumors and thyroid, do not laser over the unclosed fontanelles of infants, over the abdomen in pregnant women and do not shine laser into the eyes.
Red beam lasers (600-700 nm) have shallow penetration of a few millimeters below the skin and may be used to treat acupuncture points, superficial areas of the hands, feet, face, small joints and shallow wounds. Infrared lasers (780-1200 nm) have deeper penetration of a few centimeters up to 2 inches and may be used to treat deep tissues and large joints.
Low level laser therapy is known to stimulate a variety of biochemical changes which initiate complex physiological interactions at both the cellular and systemic levels. These changes depend on laser light’s unique properties of being coherent and monochromatic. This ultimately results in reduced inflammation, tissue regeneration and pain relief in both acute and chronic conditions.
Recently, highly sophisticated electron microscope videography has demonstrated that macrophages actually “ingest” or phagocytize a beam of laser light and direct it into the mitichondria of the cell. Laser light stimulates cytochromes, the electron and proton transfer proteins in the mitochondria, to increase ATP synthesis for enhanced cellular repair, nerve function and circulatory improvement (29).
Cellular regeneration in the presence of laser light is shown by local increases in the numbers of mast cells, epithelial cells, fibroblasts, T-lymphocytes as well as local collagen production (30).
Low level laser light has an anti-inflammatory effect by reducing serum levels of C-reactive proteins and Interleukin 1 which has been implicated in the pathogenesis of rheumatoid arthritis and other inflammatory conditions. Laser light also stimulates increased prostaglandin synthesis, especially PG12, which has an anti-inflammatory effect similar to Cox-1 and Cox-2 inhibitors.
The unique pain reduction ability of low level laser light has been extensively researched (31). This occurs via a combination of local and systemic reactions which are modulated by laser light.
Low level laser-mediated pain reduction occurs by increasing beta-Endorphins and encephalins, blocking depolarization of afferent nerve C-fibers, increasing nitric oxide and acetylcholine neurotransmitter production and increasing nerve cell action potential as well as nerve repair (32).
Traditional needle acupuncture has been used for centuries to treat many acute and chronic internal medical conditions, pain, neurological and musculoskeletal conditions. Until the past 30 years, most of the positive evidence had been either anecdotal or unavailable to American healthcare professionals. In the 1970s, acupuncture began to be put to the test using the western scientific standard, the Randomized placebo-controlled Trial.
In 1997the NIH Consensus Conference on Acupuncture recognized many high quality, positive studies showing acupuncture’s efficacy for the following conditions: nausea, dental pain, addiction, stroke rehabilitation, headache, fibromyalgia, myofacial pain, osteoarthritis, menstrual cramps, tennis elbow, low back pain, carpal tunnel syndrome and asthma. The NIH Committee concluded that in these conditions “acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program”.
In the past ten years there has been a quantum leap in numbers of high quality RCTs which elucidate not only the efficacy of acupuncture but also its possible physiologic mechanisms.The energetic web of acupuncture meridians may also involve the liquid crystalline collagen matrix (33). This matrix may be the mechanism of photon communication from cell to cell in the body as well. Acupuncture and low level laser therapy administered within the same treatment may work in synergy to enhance the treatment’s efficacy. A decrease in the number of treatments required in individual cases supports this view. Acupuncture provides the “root treatment” to balance the body’s energy along with local points and laser therapy provides both local and systemic biostimulation.. Both acupuncture and low level laser therapy have been shown to be viable alternative and complementary treatments which can be integrated into a comprehensive healthcare management program in the outpatient clinical setting.
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