Low level laser therapy

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Low level laser therapy

In the low level laser therapy is an alternative medical and -veterinärmedizinische treatment by means of laser light - that is monochromatic and coherent light - is performed. The aim of treatment is to reduce pain , accelerate wound healing and combat inflammation . The effectiveness has not been scientifically proven.

Naming

Low-level laser therapy is known by different names. In addition to the outdated name of soft laser therapy , the terms cold light laser therapy, laser bio-stimulation and laser bio-modulation are also used. The name low level laser is actually misleading as the therapy can also be carried out with high power lasers . Scientists in this field therefore use the name Laser Photo Therapy , but this name has not yet caught on everywhere (even in scientific literature).

history

The first medical applications of laser technology were already a few years after the invention of the laser in 1960. For example, Endre Mester investigated the influence of laser radiation on tissue in 1963 at Semmelweis University in Budapest, particularly with regard to a possible carcinogenic effect of laser radiation . To do this, he irradiated mice on areas of the skin that had previously been made accessible by shaving their hair. He interpreted the results of his experiments to mean that the lasers examined had no carcinogenic effect, but also that the hair of the mice in the treatment group regenerated significantly faster than in the control group. In further investigations he claims to have found improved epithelialization of poorly healing wounds. Mester published his results in several publications from 1967. These studies are now seen by some authors as the starting point and first evidence of the LLLT, a scientific reception or even experimental verification of its results has so far not been available.

Hypotheses on the mechanism of action

The photochemical processes triggered by laser light in living cells are the subject of numerous scientific and pseudoscientific speculations and have not yet been clearly clarified. The protagonists of this therapy assume that the influence of light on the mitochondria is of central importance . These cell organelles are essentially responsible for providing the cell with energy in the form of adenosine triphosphate (ATP). This happens in the respiratory chains on the inner cell membrane , which finally synthesize ATP from adenosine diphosphate (ADP) and phosphorus through the process of phosphorylation via several redox reactions . Despite a few individual studies by their protagonists, these speculations have so far not been received in the medical and scientific discourse; reputable secondary literature on the mechanism of action of low-level laser therapy is not yet available.

application

The recommendations for use are primarily aimed at superficial inflammation of the skin and mucous membrane as well as signs of wear and tear, inflammation of the locomotor organs and joints, as well as allergies (e.g. house dust, animal hair, hay fever).

There is no standardized form of application for therapy. Just like the device performance, the application parameters vary from therapist to therapist. Soft laser devices can be found u. a. in practices of naturopaths, orthopedists (especially sports doctors) and ENT doctors.

The soft laser treatment is considered painless and free of side effects. The laser beam penetrates the subcutaneous layers and, according to its users, acts as a beneficial “biostimulation” on the metabolism in the connective tissue. This leads to the regeneration of the auditory cells, to the stimulation of the immune system, to the acceleration of cell division and to the activation of certain defense molecules. There is no scientific evidence for this.

Depending on the therapist's training, either painful areas of the body are irradiated over a large area, or specific acupuncture points are treated ( laser acupuncture ). A rarely offered variant is laser blood irradiation ( blood acupuncture ), in which green light is supposed to act on the blood via a catheter in a vein .

Therapeutic value

The therapeutic value of soft lasers is viewed differently and mostly critically in the literature. The effectiveness has not been scientifically proven.

A systematic review article on the use of neck pain comes to the conclusion that there is a pain-relieving effect in the short and medium term. Controversially, Edzard Ernst states that this indication does not have any effects beyond the placebo .

Several randomized, controlled studies are available specifically on the use of the low-level laser for tinnitus , but each with a small number of patients. While some of them produce positive results, others cannot prove the effectiveness of low-level laser therapy for tinnitus. A corresponding study on the medium-power laser (450 mW, 830 nm) from 2013 also found no effect of the treatment above the placebo effect .

When evaluating laser biostimulation, the German Society for Dental, Oral and Maxillofacial Medicine came to the conclusion that the means used are comparable to laser pointers in view of their low power density . Based on numerous double-blind studies, it can be assumed with a high degree of certainty that laser bio-stimulation has no substantial effect and that therapeutic effects are based on the placebo effect.

Device technology

There are three types of lasers:

  • Hard laser with powers between 30 and 180 watts (use in surgery)
  • MID laser with emission strength in the double-digit milliwatt range
  • Soft laser with very soft emission in the low milliwatt range

So-called MID lasers are usually used in physiotherapy. The radiation output is around 70 milliwatts.

Low-level laser therapy is only performed with soft lasers.

literature

Web links

Individual evidence

  1. ↑ Endre Mester, B. Szende et al .: The effect of laser beams on the growth of hair in mice. In: Radiobiol Radiother. 9/1968, pp. 621-626.
  2. ↑ Endre Mester: About the effect of laser beams on bacterial phagocytosis of leukocytes. In: Acta biol. Med. Germ. 21/1968, pp. 317-324.
  3. ^ Endre Mester: Clinical application of laser beams. In: Lyon Chir. 65/1969, pp. 335-345.
  4. ↑ Endre Mester: Effect of laser rays on muscle fiber regeneration. In: Acta Chir. Acad. Sci. Hung. 13/1972, pp. 315-324.
  5. ↑ Endre Mester: Laser - induced stimulation of the vascularization of the healing wound. In: Separat.Exp. 30/1974, pp. 341-345.
  6. ↑ Chow et al .: Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. In: The Lancet . Volume 374, Issue 9705, December 5, 2009, pp. 1897–1908 doi: 10.1016 / S0140-6736 (09) 61522-1
  7. ^ Edzard Ernst : The Desktop Guide to Complementary and Alternative Medicine . 1st edition. Harcourt Publishers Limited, London 2001, ISBN 0-7234-3207-4 , pp. 323 .
  8. ↑ A. Gungor include: Effectiveness of transmeatally low power laser irradiation for chronic tinnitus. In: Journal Laryngol. Otol. 5/2008, pp. 447-451. PMID 17625032
  9. ↑ D. Cuda, A. De Caria: Effectiveness of combined counseling and low-level laser stimulation in the treatment of disturbing chronic tinnitus. In: Int. Tinnitus Journal. 2/2008, pp. 175-180. PMID 19205171
  10. ^ H. von Wedel, L. Calero, M. Walger, S. Hoenen, D. Rutwalt: Soft-laser / Ginkgo therapy in chronic tinnitus. A placebo-controlled study. Adv Otorhinolaryngol. 49, 1995, pp. 105-8. PMID 7653340
  11. ↑ T. Nakashima, H. Ueda, H. Misawa, T. Suzuki, M. Tominaga, A. Ito, S. Numata, S. Kasai, K. Asahi, JA Vernon, MB Meikle: Transmeatal low-power laser irradiation for tinnitus. In: Otol Neurotol. 23 (3), May 2002, pp. 296-300. PMID 11981384
  12. ↑ F. Mirz, R. Zachariah, SE Andersen, Nielsen AG, LV Johansen, P. Bjerring, CB Pedersen: The low-power laser in the treatment of tinnitus. In: Clin Otolaryngol Allied Sci. 24 (4), Aug 1999, pp. 346-354. PMID 10472473
  13. ↑ R. Teggi, C. Bellini, LO Piccioni, F. Palonta, M. Bussi: transmeatally low-level laser therapy for chronic tinnitus with cochlear dysfunction. In: Audiol Neurootol. 14 (2), 2009, pp. 115-120. PMID 18843180
  14. ↑ CF Ngao, TS Tan, P. Narayanan, R. Raman: The effectiveness of transmeatal low-power laser stimulation in treating tinnitus. In: Eur Arch Otorhinolaryngol. Apr 19, 2013. PMID 23605244
  15. ↑ K. Dejakum, J. Piegger, C. Plewka, A. Gunkel, W. Thumfart, S. Kudaibergenova, G. Goebel, F. Kral, W. Freysinger: Medium-level laser in chronic tinnitus treatment. In: Biomed Res Int. 2013, p. 324234. PMID 24294604
  16. ↑ Lasers in Periodontology Joint statement of the German Society for Oral, Dentistry and Maxillofacial Medicine and the German Society for Periodontology. DZZ 60 (6) 2005 (PDF; 186 kB)
  17. ↑ AK Røynesdal, T. Bjorn country P. Barkvoll, HR Haanaes: The effect of soft laser application on postoperative pain and swelling. A double-blind, crossover study. In: Int J Oral Maxillofac Surg. 22 (4), August 1993, pp. 242-245. PMID 8409569
  18. ↑ S. Fernando: A randomized double blind comparative study of low level laser therapy following surgical extraction of lower third molar teeth. In: Br J Oral Maxillofac Surg . 31, 1993, pp. 170-172. PMID 8512911
  19. ^ S. Taube: Helium-neon laser therapy in the prevention of postoperative swelling and pain after wisdom teeth extraction. In: Proc Finn Dent Soc. 86, 1990, pp. 23-27. PMID 2385579