photobiomodulation

Photobiomodulation and Pain Management

Chronic pain is defined as pain persisting longer than 3 months, and based on Pain Canada, 8, 000,000 people in Canada live with chronic pain. Chronic pain affects the mental and physical health of those experiencing it and can inhibit their ability to be active in their lives - this includes enjoying time with family and friends, working, and their quality of life.

Based on a study done in 2011, done by Dr. Schopflocher, et al; Alberta had the second-highest prevalence of chronic pain in Canada in 2007 with 20.6% reporting persistent pain, while British Columbia reported 21.8%. This was a while ago, and it would be reasonable to assume that this number has increased since. 35.5% of surveyors experiencing pain reported lower back pain, making it the most common area of pain, followed by upper back with 15.4% and knee with 14.9%. Of those surveyed, 22.5% reported that they have been experiencing chronic pain for 20+ years with their last pain flare-up being at least a 5/10 (10 = worst), and 40% of the surveyors had experienced pain for 2-10 years.

With the amount and duration of pain experienced, there’s no doubt that these people have tried anything and everything in their power to decrease their pain. Unfortunately, the most common prescription for pain is opioid drugs - which are highly addictive and have contributed to the opioid crisis. As a result, alternatives are being sought after as a way to decrease pain without causing addiction. Photobiomodulation (PBM) is one of these therapies that are of interest.

Photobiomodulation has many different mechanisms of action that can lead to a decrease in pain, and it is a very safe therapy, with few side effects. This makes PBM a very promising therapy to use for pain management. It is able to create more ATP energy in the cells by interacting with cytochrome C oxidase in the mitochondria increasing membrane potential. It also reduces swelling and inflammation, increases circulation, increases nerve regeneration, increases collagen and cartilage production and increases bone formation. This last one is particularly helpful with fractures, while the other are extremely helpful for healing in general.

In acute cases, the sooner and more regularly you can come for PBM, the better it is for outcomes. That being said, it can help with chronic pain or difficulty healing as well, it is common for more chronic concerns to take longer to heal than the typical 5-10 treatments. Treatment time is depended on the area being treated, with most areas requiring between 30 or 45 minutes.

If you are interested in learning more about PBM, I have linked additional blogs below for you to enjoy. Otherewise, if you want to book an appointment for PBM, click the link below to book with Dr. Charmagne.


~Dr. Charmagne

Other Blogs:

Photobiomodulation (AKA Low-Level Light Therapy)

Laser Therapy and Concussions

Citations:

Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag. 2011 Nov-Dec;16(6):445-50. doi: 10.1155/2011/876306. PMID: 22184555; PMCID: PMC3298051.

Li BM, Zhang CK, He JH, Liu YQ, Bao XY, Li FH. The Effects of Photobiomodulation on Knee Function, Pain, and Exercise Tolerance in Older Adults: A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2023 Jul 5:S0003-9993(23)00375-1. doi: 10.1016/j.apmr.2023.06.016. Epub ahead of print. PMID: 37419235.

Chow RT, Armati PJ. Photobiomodulation: Implications for Anesthesia and Pain Relief. Photomed Laser Surg. 2016 Dec;34(12):599-609. doi: 10.1089/pho.2015.4048. Epub 2016 Jul 15. PMID: 27419354.

Alayat MSM, Battecha KH, Elsodany AM, Alzahrani OA, Alqurashi AKA, Jawa AT, Alharthi YS. Effectiveness of Photobiomodulation Therapy in the Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Systematic Review and Meta-Analysis. Photobiomodul Photomed Laser Surg. 2022 Oct;40(10):661-674. doi: 10.1089/photob.2022.0056. Epub 2022 Oct 10. PMID: 36219747.

Barbosa LM, de Luna Gomes JM, Laureano Filho JR, do Egito Vasconcelos BC, Dantas Moraes SL, Pellizzer EP. Does the use of low-level light therapy postoperatively reduce pain, oedema, and neurosensory disorders following orthognathic surgery? A systematic review. Int J Oral Maxillofac Surg. 2022 Mar;51(3):355-365. doi: 10.1016/j.ijom.2021.06.006. Epub 2021 Jul 6. PMID: 34238645.

Huang Z, Ma J, Chen J, Shen B, Pei F, Kraus VB. The effectiveness of low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther. 2015 Dec 15;17:360. doi: 10.1186/s13075-015-0882-0. PMID: 26667480; PMCID: PMC4704537.

Laser Therapy and Concussions

Concussions are considered a type of Traumatic Brain Injury (TBI), and it is common in car accidents and sports. They occur when the head receives an external impact that causes the head and brain to shake rapidly (CDC, 2019). This can cause chemical changes within the brain, inflammation, bruising, and can cause damage to brain cells. While most people recover from concussions on their own, others have long-term consequences where they experience changes in mood, and cognition (eg. slower mental processing, worsening of memory, etc.). Those who experience multiple concussions may notice that it takes them longer and longer to recover, and others may find that some symptoms stay after months or years.

Some signs and symptoms that can be experienced with concussions are:

  • Amnesia of events before or after the head impact

  • Mood, behaviour, or personality changes

  • Being dazed or stunned

  • Uncoordinated movements (eg. balance problems)

  • Loss of consciousness

  • Headache or pressure in their head

  • Nausea or vomiting

  • Dizziness, blurry vision, or seeing double

  • Light or noise sensitivity

  • Confusion, difficulty concentrating

  • Memory problems

  • Difficulty with sleep (sleeping too much or too little, difficulty sleeping)

  • Fatigue (CDC, 2019, Mayfield Clinic, 2018)

These signs and symptoms may show up minutes after the injury or can take hours or days to occur. So it is important to observe the person who was injured and support them if needed. The number one recommendation for concussions is to rest for the first few days after the injury. This will be enough for the majority of people, with their symptoms resolving in the next few weeks. However, based on some studies, 5-22% of people with concussions will experience persistent cognitive problems after the first few weeks (Gustavo, et al; 2022). These symptoms can persist over a month, and they may continue to experience these symptoms for months or years. So what are they supposed to do?

There aren’t currently any great treatments available for those experiencing post-traumatic symptoms. However, Photobiomodulation (also known as Low-Level Light Therapy, Cold Laser Therapy, or Laser Therapy) has been a tool of great interest since it is a non-invasive way to support those with post-traumatic symptoms. Photobiomodulation (PBM) is a wonderful therapy to use for TBI because it has many ways it helps support the healing of the brain. These include:

  • Increasing the ATP (the energy currency of the cell) production in the mitochondria through cytochrome C oxidase’s ability to absorb the photons from red light

  • Increasing regional brain flow by releasing the Nitric Oxide that tends to bind to the mitochondria and cause vasodilation

  • Anti-inflammatory and anti-oxidant effects by inhibiting the microglial activation (chronic activation causes neuronal degeneration)

  • Increases neurogenesis and synaptogenesis (new formation of neurons and improving their ability to communicate with each other) (Gustavo, et al; 2022) - this is particularly important for the recovery of the brain after TBI.

Studies have shown that PBM has been able to improve verbal memory, depression, executive function, headache, sleep disturbance, cognition, mood dysregulation, anxiety, irritability, work performance, blood flow to the brain, reduced swelling, inflammation, excitotoxicity, reduction in post-traumatic stress disorder in those with TBI (Naeser, et al; 2014, Gustavo, et al; 2022, Chao, et al; 2020). The amount and frequency of treatments varied between the studies, but it averaged 18 sessions over 7 weeks.

If this treatment interests you, you can click the link below to book an appointment.

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Photobiomodulation (AKA Low Level Light Therapy)

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Photobiomodulation, also known as Low-Level Light Therapy or Laser Therapy (LLLT) is a way to utilize light and it’s healing properties to accelerate healing. It is a pain-free, non-invasive therapy that can be used to treat a number of different conditions. This may sound far-fetched - “light healing” - but it’s true! The medical profession has used light therapy to help treat various conditions. For example, using phototherapy (literally meaning light therapy) to treat babies with jaundice, or UV Therapy to treat eczema. More recently, there are studies looking at using Light Therapy to treat people with alopecia and Alzheimer’s Disease. So it’s not as far-fetched as you may have thought.

The photobiomodulation that I do in the clinic uses a combination of different wavelengths to treat a patient. It uses Red LED (wavelength of 630-680 nm range) for more superficial layers and infrared (810-840 nm) to treat the deeper musculoskeletal layers. These two wavelengths prep the area so that the laser can penetrate deep into the areas that are needing treatment (eg, within the knee joint). After these two types of light, I use an infrared laser probe. This can penetrate the deepest and can reach the bony layers to promote healing.

Video from BIOFLEX

Image from BIOFLEX

The reason photobiomodulation works is because it reaches the mitochondria in the area being treated, and allows them to create more ATP. ATP is the energy currency of the cell, and it is used in every process in the body - including healing. When a tissue is injured, the mitochondira’s ability to make ATP is impaired, causing the area to take a longer period of time to heal. So helping the cell create more energy, accelerates that area’s ability to heal. As a result, photobiomodulation can help treat a number of different conditions including:

  • sciatica

  • arthritis

  • fractures

  • keloids

  • sprains and strains,

  • plantar fasciitis

  • nerve pain

  • joint pain

  • burns, etc.

Treatments are generally recommended to be 2-3 x week or more in acute cases. The number of treatments can vary depending on the patient and can vary from 1-30, with a minimum of 10-15 treatments being recommended. In most cases, there can be some change in symptomology after 3-5 treatments; however, this is not always the case. Acute problems generally respond faster than chronic problems, and each person is different, so this makes it difficult to predict how many treatments you may need. My goal will always be to minimize the length and number of treatments you need, but know that even with that, you will require multiple treatments (especially if a chronic condition flares). Be patient with yourself and the treatments.

To read more about the laser system and science behind photobiomodulation, click here.

~Dr. Charmagne

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Laser Therapy

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Summary

Light therapy is a non-invasive therapy that works by increasing the ability of the cell to create energy (ATP) to heal the area being treated. As a result, it can decrease inflammation, swelling, and pain in the area. Research in this area is expanding, with more in-depth research papers linked below for those who would like to learn more.

HIstory

Light therapy has been around for thousands of years and has been practiced in India and is seen in the Hindu texts (News Medical, 2018). In modern days, we still use light therapy, in cases like jaundice for babies, when they receive blue-green light spectrum therapy to help eliminate the excess bilirubin (Mayo Clinic, 2020). There is even evidence that shows that ultraviolet light therapy works on conditions such as eczema and vitiligo (Berthold E, 2019).

History of low-level light therapy

Experiments were testing Low-Level Light Therapy (LLLT) - or photobomb modulation as it is often referred to now - after the invention of the ruby laser in 1960. In the first experiment, Dr. Endre Mester, used shaved rats and observing how the laser affected their ability to grow hair compared to the group that was not receiving LLLT. He found that the group of mice receiving LLLT were able to grow their hair back more quickly than the group of mice that didn’t receive LLLT (Hoon C, et al; 2012). In a separate experiment involving mice, he also noticed that LLLT helped to stimulate wound healing. Dr. Mester started to apply these LLLT findings on humans, for nonhealing skin ulcers.

mechanism of action

The word Laser came about as an acronym for Light Amplification by Stimulated Emission of Radiation. The energy released from the photos in light is referred to as electroluminescence - most of which is absorbed by the tissue and is responsible for the effects (Hoon C, et al; 2012). Though the mechanism of action is poorly understood; what the research has shown is that LLLT works in the cell’s mitochondria to generate more energy or ATP, modulate Reactive Oxygen Species (ROS) (which can cause damage to cells), and induce transcription factors (Hoon C, et al; 2012). It has been observed the LLLT has a wide range of effects at the tissue, cellular, and molecular levels, causing an increase in cell number and movement, modulation of cytokines, growth factors, and inflammatory mediators, and an increase in tissue oxygenation (which is different from creating ROS) (Hoon C, et al; 2012).

Basically, LLLT has been seen to speed up healing by creating more energy in the cells, which affects molecular, cellular, and tissue processes by giving them fuel; and increases the body’s ability to decrease inflammation, swelling, and decrease pain through its ability to interact with messengers in the body.

Low-Level Light Therapy (LLLT)

This therapy is termed this way to differentiate the difference between the lasers some professions use to cut (eg. in surgeries, or dental procedures). Low-level light therapy is painless, non-invasive treatment. It is used to decrease inflammation, swelling, and chronic joint disorders, reduce pain and accelerate wound healing of nerves and tissues (Hoon C, et al; 2012). In more recent literature, they have changed the term to photobiomodulation therapy, but I’ll be using LLLT for this article.

LLLT has a biphasic response, meaning that lower doses are generally seen to be more beneficial than higher doses. That being said, doses higher or lower than the optimal dose doesn’t affect (Hoon C, et al; 2012). For this reason, it can be difficult to have studies on LLLT with so many parameters. However, what has been seen is that wavelengths between 600-1200 nm have shown benefit in the studies (Thunshelle C, Hamblin M.R; 2016; Huang Z, et al; 2015). So it becomes important to know if the machine that is treating you is providing these wavelengths.

It has also been shown that LED treatment with similar wavelength and parameters to low power lasers produced similar results to LLLT (Hamblin M.R; 2016). Migliario M, et al (2018) noted that red and near-infrared portion of the light spectra can be used for biostimulation, and promote cell survival and multiplication. This was awesome news because that means a larger area can be treated, than just the narrow space that a laser can treat at a time. Some companies combined the two (LED and laser) to provide a more well-rounded treatment since lasers can penetrate deeper than LED and infrared light (Norman Doidge, The Brain’s Way of Healing, 2015).

During treatment, the area that is being treated is exposed to LED light from a BioFlex Laser, which is at 660 nm wavelength, followed by infrared light at 830-840 nm wavelength. Our naked eyes do not see infrared light, so it looks like the machine has turned off - but it hasn’t (fun fact: your cellphone camera can see infrared light). These wavelengths are important because these wavelengths have been seen to be absorbed more by our mitochondria.

LLLT has been used for various conditions, and some awesome studies are displaying their benefits for certain conditions. Below, I will list what has been studied, along with the link to go to the actual study if you wanted to read more about it. Note that there are most likely other conditions that can be treated, and haven’t yet. The research is still expanding!

Happy LASERING!

~ Dr. Charmagne

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