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1. Is laser therapy scientifically wellquestions_poster.gif documented?

2. How is laser used?

3. How deep into the tissue can a laser penetrate?

4. Can LLLT cause cancer?

5. What happens if I use a too high dose?

6. Does LLLT cause a heating of the tissue?

7. How long does a treatment take?

8. How many treatments are needed?

9. What about the negative effects of radiation?

10. What is the difference between Thermal Laser and Low Intensity Laser Therapy?

11. Why use Low-level Laser Therapy over conventional physiotherapy?

12. How effective is laser therapy for smoking cessation?

13. Are there any harmful side effects, precautions or contraindications?

1. Is laser therapy scientifically well documented?
Basically yes. There are thousands of published studies that describe the positive effects of laser therapy. These studies range from studies on individual cell types to in vivo double blind crossover studies. The areas of study range from wound healing to musculoskeletal conditions and have been conducted on different types of laser devices. 'Medline' is a very good medical database search engine that can provide abstracts and can sell literature. There are also many books on the subject. One very good text is "Low Level Laser Therapy - Clinical Practice and Scientific Background", written by Jan Tuner & Lars Hode.  

2. How is laser used?
Laser may be used in three different ways:

  • To stimulate acupuncture points - Laser is used to stimulate acupuncture points using the same rules of point selection as needle acupuncture. Laser acupuncture may be used solely or in combination with needles for any given condition over a course of treatment.
  • To treat trigger points - In some musculoskeletal conditions, higher doses of laser may be used for the deactivation of trigger points. Trigger points may be found in muscles, ligaments, tendons and periosteum. Direct irradiation over tendons, joint margins, bursae etc may be effective in the treatment of conditions in which trigger points may play a part. Children and the elderly may require smaller doses. Areas of thick or dark skin, or muscle may require higher doses for penetration than finer skin areas e.g. ear.
  • To promote healing - The bio-stimulatory effects of laser on open and closed wounds have been widely investigated both in vivo and in vitro.

3. How deep into the tissue can a laser penetrate?
The depth of penetration of laser light depends on the light's wavelength, on whether the laser is super-pulsed, and on the power output, but also on the technical design of the apparatus and the treatment technique used. A factor of importance here is the compressive removal of blood in the target tissue. When you press lightly with a laser probe against skin, the blood flows to the sides, so that the tissue right in front of the probe (and some distance into the tissue) is fairly empty of blood. As the haemoglobin in the blood is responsible for most of the absorption, this mechanical removal of blood greatly increases the depth of penetration of the laser light.

There is no exact limit with respect to the penetration of the light. The light gets weaker and weaker the further from the surface it penetrates. There is, however, a limit at which the light intensity is so low that no biological effect of the light can be registered. This limit, where the effect ceases, is called the greatest active depth. In addition to the factors mentioned above, this depth is also contingent on tissue type, pigmentation, and dirt on the skin. It is worth noting that laser light can even penetrate bone (as well as it can penetrate muscle tissue). Fat tissue is more transparent than muscle tissue. If you are working in direct contact with the skin, and press the probe against the skin, then the greatest active depth will be achieved.

4. Can LLLT cause cancer?
The answer is no. No mutational effects have been observed resulting from light with wavelengths in the red or infrared range and of doses used within LLLT. The effects of LLLT on cancer cells in vitro have been studied, and it was observed that they could be stimulated by laser light. However, with respect to a cancer in vivo, the situation is rather different. Experiments on rats have shown that small tumours treated with LLLT can recede and completely disappear, although laser treatment had no effect on tumours over a certain size. It is probably the local immune system, which is stimulated more than the tumour.

The situation is the same for bacteria and virus in culture. Laser light in certain doses stimulates these, while a bacterial or viral infection is cured much quicker after the treatment with LLLT.

5. What happens if I use a too high dose?
You will have a bio-suppressive effect. That means that, for instance, the healing of a wound will take longer time than normally. Very high doses on healthy tissues will not damage them. Research studies show that there may be a dose dependent response, so it may be more effective to treat at lower doses at multiple intervals then to treat a single time with a high dose.

6. Does LLLT cause a heating of the tissue?
Due to increased circulation, there is usually an increase of 0.5-1 centigrade locally. The biological effects have nothing to do with heat. GaAlAs lasers in the 300-500 mW range will cause a noticeable heat sensation, particularly in hairy areas and on sensitive tissues such as lips.

7. How long does a treatment take?
A treatment plan can vary in time from seconds to minutes, depending on the condition. For instance, an acute soft tissue injury or open wound may require multiple short treatments initially, and then the interval between treatments will lengthen as the condition improves. On the average, musculoskeletal treatments are typically no more than 15-20 minutes in duration, depending on the type of condition and the length of time the condition has knowingly been present.

8. How many treatments are needed?
The number of treatments will vary with regard to the patient's presenting problem. Just as every medical condition varies, so will the individual response to therapy. By affecting and reversing the offending pathology at the cellular level, low-level laser therapy optimizes the restoration of normal cellular morphology and function; therefore, as logic dictates, symptoms disappear. The beneficial effects of laser therapy are cumulative over the course of a series of treatments. In a recent clinical report summarizing over 1000 patients treated, patients had averaged slightly less than twelve treatment sessions to reasonably resolve their condition.

9. What about the negative effects of radiation?
Low Intensity Laser Therapy (LILT) produces radiation as 'photon' energy in the visible and near infrared regions of the electromagnetic spectrum. Worldwide research conducted over the past thirty years indicates that this type of irradiation does not adversely affect normally functioning cells. Unlike other forms of radiation, i.e. x-ray, etc., this process is beneficial rather than harmful to tissue.

10. What is the difference between High Intensity Thermal Laser and Low Intensity Laser Therapy?
High power or thermal lasers (ClassIV and higher) can produce a substantial amount of heat. This destructive potential makes high power laser a key component in industrial applications such as cutting and welding. Thermal laser combines power and precision and therefore has many beneficial uses in surgical and ablative procedures.

Unlike thermal lasers, the low intensity laser (Class III) beam is 'soft power'; athermal (non-heating) and can stimulate cellular regeneration and natural healing. Red and infrared lasers with power outputs in the range of 10 to 250 mW belong in this category, in addition to superluminous diodes up to the 2000mW level.

Low intensity laser energy stimulates cellular function at many levels including metabolism; in essence it promotes the initiation of multiple physiological and beneficial effects in the repair and function of human cells. Low-level laser therapy (LLLT) is widely used in the medical and cosmetic fields, principally because it is non-destructive to the target tissue, while positively affecting many functions such as collagen formation, cellular metabolism, angiogenesis, lymphatic flow, etc.

There are two types of diodes used in low intensity laser therapy: 1) Superluminous Diodes (SLD) are designed for the treatment of a large surface area. Less powerful than laser diodes, these diodes are however applied safely in larger numbers over a wide area and for a longer period of time on the average. These include red and near infrared diodes. 2) Laser Diodes (LD) have higher power output and narrow beams, making them ideal 'laser probes' for deeper penetration and for targeting localized, focal pathologies. These laser diodes require substantially less therapy time in order to to achieve the required results. Again, this includes both red and near infrared diodes.

11. Why use Low-level Laser Therapy over conventional physiotherapy?
For many years, rehabilitation therapies including ultrasound, interferential current and TENS have been used extensively throughout the world to treat pain and stimulate the healing process. Unlike low-level laser therapy (LLLT), the healing effects of these treatments have been disappointing as they appear to modulate symptoms only. In contrast, LLLT is able to influence the pathology directly at the cellular level, resulting in therapeutic benefits that are more profound and indeed restorative. Frequently at times, alternative therapies act as counter-irritants, creating a transient increase in arterial circulation and the release of endorphins, providing temporary symptomatic relief only.

12. How effective is laser therapy for smoking cessation?  
International clinical studies have shown success rates between 72% and 80% in treating nicotine addictions. Laser therapy has been successful for total smoking cessation -- in many instances after just one treatment.  

When treating nicotine addiction, laser therapy is designed to help your body cope with the overwhelming urges and cravings but does not take over your mind. The international success rates of 72 to 80% have shown clearly that laser therapy, when given serious commitment, does have a remarkable, positive effect on the health and lifestyles of thousands of people.

13. Are there any harmful side effects, precautions or contraindications?
Unlike many pharmaceutical options, LLLT is non-toxic; unlike surgical procedures, it is non-traumatic and most important, it is non-invasive. Pacemakers are electronic and do not respond to light. There are normally no adverse effects that have been documented from low-level laser therapy; however, the following cautions are advised:

  • Patients may experience mild discomfort/ache after treatment. This is due to a re-stimulation of the inflammatory phase and should settle down after 24 to 48 hours.
  • Low-level laser therapy can be used over bony prominences, metal pins, plates and pacemakers.
  • Laser light can be potentially damaging to the retina. When used near the eyes, safety goggles must be worn by both patient and practitioner.
  • Laser light is contra-indicated for use over the pregnant uterus, or within the first trimester of pregnancy. It may, however, be used on the pregnant woman as an adjunct to other modalities used for the treatment of back pain or other complaints.
  • Do not use laser light on primary of secondary lesions associated with carcinoma. It may be given for pain relief in the terminal stages of the illness, with the full consent of both patient and attending physician. 
  • Do not use laser light over the thyroid gland.
  • Laser treatment is not recommended for use on children.
  • Laser therapy should not to be used in the case of haemorrhage.
  • Laser light is contra-indicated for patients on immune suppressant and light-sensitve drugs and topical agents.
  • Laser light is contra-indicated for treatment over sympathetic ganglia, the vagus nerves and cardiac region in patients with heart disease.
  • Laser therapy should not be used within 2-3 weeks of a recent steroid injection on or near the same site.
  • Patients using topical or systemic steroids or NSAID's for pain or skin conditions may experience a mild "flare up" of their symptoms. If this should happen, discontinue use, to allow the reaction to settle. Laser treatment can be recommenced at minimum or half-minimum treatment times, building up to an "effective dose" if the patient does not respond to the lowered treatment times. If the reaction persists, discontinue treatment.
  • Laser treatment may cause bruising on patients taking anti-coagulants.
  • Patients taking anti-inflammatory medication for acute soft tissue injuries will not respond as quickly to laser therapy as those who are not. Ideally, use laser and ice, without an anti-inflammatory.
  • Lasers should not to be used around the head or neck areas of patients suffering from epilepsy.
  • Laser treatment is not to be used on patients with pacemakers.

Laser therapy promotes cell growth repair, so studies are inconclusive on the effects for the above situations. Appropriate clinical factors vary and treatment protocols must always be considered and followed in the best interests of a patient's health and well-being.

** We cannot treat anyone who is pregnant, has a pacemaker, has had an organ transplant, is taking immunosuppressant or light-sensitive drugs and topical agents, has cancer or is receiving radiation or chemotherapy treatments for cancer **

** Laser therapy is not intended to replace medical health care. We recommend that you consult your health practitioner for a professional diagnosis of your health condition and the appropriate formulation of a treatment plan.  Consult your doctor or therapist before making any changes in your regular treatment regime **

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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.

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