DOCUMENT 14 FOI 25/26-0524
Research Request – Cold Laser Therapy (Low Level Laser Therapy)
Access matter for an Applicant who is a 62yo woman with the following diagnoses:
− Spondylolisthesis − Osteoarthritis − L5 Sciatica/radiculopathy − Osteopenia − Gluteal tears − Hip bursitis − Fibromyalgia Brief − Chronic fatigue syndrome − Multiple chemical sensitivity?
What is cold laser therapy?
What is the evidence base for use in Chronic pain?
Is this therapy likely to be available to the applicant who is a NSW resident, ie are there any practitioners who offer this therapy in Sydney?
Date 02 July, 2020
s22(1)(a)(ii) - irrele Requester Susan (Senior Technical Advisor – TAB)
s22(1)(a)(ii) - i Researcher Craig (Tactical Research Advisor – TAB/AAT)
Please note:
The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making.
Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters they are to call the TAPS line for advice.
The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters.
Contents Related TAB Research …………………………………………………………………………………………………………….. 2
Overview ………………………………………………………………………………………………………………………………. 2
What is Cold Laser Therapy? ……………………………………………………………………………………………………. 2
Efficacy …………………………………………………………………………………………………………………………………. 3
Chronic Pain ………………………………………………………………………………………………………………………. 3
Fibromyalgia ………………………………………………………………………………………………………………………. 4
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Osteoarthritis …………………………………………………………………………………………………………………….. 5
Osteopenia ………………………………………………………………………………………………………………………… 5
Clinics offering Cold Laser Therapy in Sydney ……………………………………………………………………………. 6
References ……………………………………………………………………………………………………………………………. 6
Related TAB Research
• RES HWB Group Based pain management programs 2019/2036 • RES HWB Multiple Chemical Sensitivity 2019/0058
Overview
• There are various terms for “Cold Laser Therapy”. The most common term appears to be “Low-Level Laser Therapy” (LLLT).
• Research on the subject is plentiful.
• Research indicates there is evidence that Cold Laser Therapy has positive outcomes for those suffering from chronic pain.
• Research on cold laser therapy as a treatment specifically for Osteoarthritis, Osteopenia and Fibromyalgia is also plentiful, and indicates positive outcomes for those suffering from these conditions. This paper briefly comments on the research in these conditions.
• Cold Laser Therapy treatment is readily available from numerous health clinics in Sydney.
What is Cold Laser Therapy?
Cold laser therapy is low-intensity laser therapy that stimulates healing while using low levels of light.
The technique is called “cold” laser therapy because the low levels of light aren’t enough to heat your body’s tissue. The level of light is low when compared to other forms of laser therapy, such as those used to destroy tumors and coagulate tissue.
Surgical and aesthetic lasers heat the tissue being treated. True to its name, cold laser therapy does not.
Cold laser therapy is also known as:
• low-level laser therapy (LLLT)
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• low-power laser therapy (LPLT) • soft laser biostimulation • photobiomodulation
The most common term appears to be low-level laser therapy (LLLT).
During this procedure, different wavelengths and outputs of low-level light are applied directly to a targeted area. The body tissue then absorbs the light. The red and near-infrared light cause a reaction, and the damaged cells respond with a physiological reaction that promotes regeneration.
Superficial tissue is commonly treated with wavelengths between 600 and 700 nanometers (nm). For deeper penetration, wavelengths between 780 and 950 nm are used.
The procedure is painless and noninvasive. There is no sound or feeling of vibration or heat. Each treatment typically takes only a few minutes. [1]
Efficacy
Chronic Pain
A 2015 research paper suggests that the use of LLLT has been shown to reduce inflammation and edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies for over 40 years.
The paper reviewed the use of LLLT for pain, the biochemical mechanisms of action, the dose response curves, and how LLLT may be employed by orthopedic surgeons to improve outcomes and reduce adverse events. The paper states that according to the more than 4000 studies on pub.med.gov, it can be concluded that the majority of laboratory and clinical studies have demonstrated that LLLT has a positive effect on acute and chronic musculoskeletal pain.
The paper concludes that “LLLT is beneficial for pain relief and can accelerate the body’s ability to heal itself. LLLT has a long history and strong basic science evidence, which supports its use in pain management. It has few side effects and is well tolerated by the elderly. A laser or LED does not correct situations involving structural deficits or instabilities whether in bone or in soft tissue”. However it suggests that “LLLT should only be used as an adjuvant therapy for pain relief in patients with neuropathic pain and neurologic deficits. Successful outcomes, like all medical management, depend on good clinical skills linked with an understanding of the nature of injury, inflammation, repair, pain, and the mechanism of laser and LED effects”. [2]
The focus of a 2014 research paper was to highlight the physiological aspects of LLLT, and to discuss its application for those suffering from chronic pain, alone and in combination with exercise. It also provided justification for the use of LLLT using specific data and case studies from the existing literature which have resulted in positive outcomes for those suffering from chronic pain.
The paper found that data suggested an increase in endorphin production and opioid-receptor binding via opioid-containing leukocytes with LLLT. LLLT may also mimic the effects of anti- inflammatory drugs by attenuating levels of prostaglandin-2 (PGE2) and inhibiting cyclooxygenase-2 (COX-2). In addition, data found has suggested that LLLT may augment levels of nitric oxide, a
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powerful vasodilator, which would in turn act to increase blood flow and assist with healing, and that whilst the mechanisms have not been completely explained, it is clear that LLLT may have an analgesic effect.
The paper concluded that studies have demonstrated that LLLT may have positive effects on symptomology associated with chronic pain, and it is clear that LLLT may be effective in treating chronic pain in many individuals and should not be overlooked as a treatment modality. [3]
The findings of a 2014 literature review suggests that LLLT is an excellent therapeutic resource for the treatment of skeletal muscle injuries in the short-term. The review found the main effects of LLLT were a reduction in the inflammatory process, the modulation of growth factors and myogenic regulatory factors, and increased angiogenesis. The studies analyzed demonstrate the positive effects of LLLT on the muscle repair process, which are dependent on irradiation and treatment parameters. [4]
LLLT has been found to be effective with nonspecific chronic lower back pain (NSCLBP). A 2015 Systematic Review and Meta-Analysis. MEDLINE, EMBASE, ISI Web of Science and Cochrane Library were systematically searched from January 2000 to November 2014. Included studies were randomized controlled trials (RCTs) written in English that compared LLLT with placebo treatment in NSCLBP patients. The study concluded that “findings indicate that LLLT is an effective method for relieving pain in NSCLBP patients. However, there is still a lack of evidence supporting its effect on function”. [8]
Another 2015 study of meta-analysis of randomised controlled trials conducted an updated review to determine if LLLT (including laser acupuncture) has specific benefits in chronic non-specific low back pain (CNLBP). Electronic databases were searched for randomised trials using sham controls and blinded assessment examining the intervention of LLLT in adults with CNLBP. The study demonstrated moderate quality of evidence to support a clinically important benefit in LLLT for CNLBP in the short term, which was only seen following higher laser dose interventions and in participants with a shorter duration of back pain. The paper suggested that rigorously blinded trials using appropriate laser dosage would provide greater certainty around this conclusion. [9]
A recent 2019 blind randomised clinical trial which looked at the combination of physical exercise and LLLT evaluate the effects of each intervention on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis. The groups consisted of a Control Group (CG), untreated; Laser Group (LG), treated with laser at 808 nm, 5.6 J; Exercise Group (EG), treated with exercise; and Laser + Exercise Group (LEG), treated with laser and exercises. At the end of the trial “The group treated only with exercise showed improvement in WOMAC questionnaire scores. Regarding the gait variables, all groups undergoing the interventions showed increases in the gait speed compared to the CG. The laser and exercise combination therapy provided the best results for the other gait variables (cadence and duration of right limb support and duration of single right limb support). [10]
Fibromyalgia
A recent 2019 systematic review and meta-analysis focused on Low-Level Laser Therapy for fibromyalgia. The study suggested it provided the most up-to-date and relevant evidence regarding the effects of LLLT in fibromyalgia and concluded that LLLT is an effective, safe, and well-tolerated
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treatment for fibromyalgia where the data indicated that LLLT is an emerging, non invasive, well- tolerated treatment for fibromyalgia to relieve discomfort, particularly in patients who do not exercise regularly. [5]
A 2014 randomized clinical trial was carried out with the aim to evaluate the effects of LLLT in patients with fibromyalgia. It concluded that LLLT provided relief from fibromyalgia symptoms in patients and should be further investigated as a therapeutic tool for management in fibromyalgia. [6]
A 2014 placebo-controlled, randomized clinical trial aimed to evaluate the effects of LLLT in patients with fibromyalgia. All fibromyalgia symptoms showed significant improvements after LLLT compared to placebo. [11]
Osteoarthritis
Authors of a 2017 study conducted a literature review to investigate the potential for prolotherapy and LLLT to be used adjunctively to manage chronic osteoarthritis. A review of the literature revealed good clinical results in the use of prolotherapy and LLLT separately to manage chronic musculoskeletal pain due to osteoarthritis and other chronic conditions. “ The authors suggest that practicing health care providers consider utilizing LLLT and prolotherapy together as a supplementary method in the management of chronic pain due to osteoarthritis, to minimize the long-term prescription of opioids and emphasize a less invasive treatment for this debilitating condition“ [12]
The purpose of a recent 2018 literature review was to present a summary of the possible pain management benefits of LLLT with regard to chronic pain and osteoarthritis. The study concluded that “the utilization of LLLT for pain management and osteoarthritic conditions may be a complementary strategy used in clinical practice to provide symptom management for patients suffering from osteoarthritis and chronic pain”. [13]
Osteopenia
Research into the use of LLLT as a treatment for Osteopenia is recent and most studies are focused on LLLT in combination with other treatment modalities. Much of the controlled research uses rats.
A recent 2019 systematic review aimed to review and analyze the scientific literature regarding the use of Photobiomodulation therapy (LLLT) in the process of bone defect repair. Electronic searches were carried out in PubMed/MEDLINE and Web of Science databases with combination of the descriptors low-level laser therapy AND bone repair, considering the period of publication until the year 2018. The paper concluded that many studies have shown that LLLT has positive photobiostimulatory effects on bone regeneration, accelerating its process regardless of parameters and the use of biomaterials. However, standardization of its use is still imperfect and should be better studied to allow correct application concerning the utilization protocols. [7]
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Clinics offering Cold Laser Therapy in Sydney
Cold Laser Therapy treatment is readily available in Sydney. Below is a small selection of clinics offering the treatment.
Clinic/Practitioner Link to website Quantum Pain Management Website Sydney Laser Health Solutions Website Balmain Osteopaths Website Sydney City Chiropractic Website Artarmon Musuculoskeletal & Laser physiotherapy Website Optimum Health Essentials Website The Physiotherapy Centre Website Spinal & Sports Care Website Renude Laser Clinic Website References
(1) “Cold Laser Therapy: Procedure, Purpose, Pros/Cons, and More.” Healthline, 17 July 2018, https://www.healthline.com/health/cold-laser-thera
(2] Cotler, Howard B., et al. “The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain.” MOJ Orthopedics & Rheumatology, vol. 2, no. 5, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743666/
[3] Kingsley, J. Derek, et al. “Low-Level Laser Therapy as a Treatment for Chronic Pain.” Frontiers in Physiology, vol. 5, 2014. https://www.frontiersin.org/articles/10.3389/fphys.2014.00306/full
[4] Alves, Agnelo Neves, et al. “Effects of Low-Level Laser Therapy on Skeletal Muscle Repair: A Systematic Review.” American Journal of Physical Medicine & Rehabilitation, vol. 93, no. 12, Dec. 2014, pp1073-1085. Link
[5] Yeh, Shu-Wei, et al. “Low-Level Laser Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis.” Pain Physician, vol. 22, no. 3, 2019, pp. 241-54. https://www.painphysicianjournal.com/current/pdf?article=NjMWNA%3D%3D&journal=1 20
[6] Ruaro, J. A., et al. “Low-Level Laser Therapy to Treat Fibromyalgia.” Lasers in Medical Science, vol. 29, no. 6, Nov. 2014, pp. 1815-19. https://link.springer.com/article/10.1007/s10103-014-1566-8
[7] Escudero, Jose Stalin Bayas, et al. “Photobiomodulation Therapy (PBMT) in Bone Repair: A Systematic Review.” Injury, vol. 50, no. 11, Nov. 2019, pp. 1853-67. https://www.sciencedirect.com/science/article/abs/pii/S0020138319305492
Research Request — Cold Laser Therapy Page |6
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[8] Huang, ZeYu, et al. “The Effectiveness of Low-Level Laser Therapy for Nonspecific Chronic Low Back Pain: A Systematic Review and Meta-Analysis.” Arthritis Research & Therapy, vol. 17, Dec. 2015, p. 360. https://pubmed.ncbi.nlm.nih.gov/26667480
[9] Glazov, Gregory, et al. “Low-Level Laser Therapy for Chronic Non-Specific Low Back Pain: A Meta-Analysis of Randomised Controlled Trials.” Acupuncture in Medicine: Journal of the British Medical Acupuncture Society, vol. 34, no. 5, Oct. 2016, pp. 328–41. https://pubmed.ncbi.nlm.nih.gov/27207675
[10] de Matos Brunelli Braghin, Roberta, et al. “The Effect of Low-Level Laser Therapy and Physical Exercise on Pain, Stiffness, Function, and Spatiotemporal Gait Variables in Subjects with Bilateral Knee Osteoarthritis: A Blind Randomized Clinical Trial.” Disability and Rehabilitation, vol. 41, no. 26, 2019, pp. 3165–72. https://pubmed.ncbi.nlm.nih.gov/30324827
[11] Ruaro, J. A., et al. “Low-Level Laser Therapy to Treat Fibromyalgia.” Lasers in Medical Science, vol. 29, no. 6, Nov. 2014, pp. 1815–19. PubMed, doi:10.1007/s10103-014-1566-8. https://pubmed.ncbi.nlm.nih.gov/24801056
[12] Tieppo Francio, Vinicius, et al. “Prolotherapy and Low Level Laser Therapy: A Synergistic Approach to Pain Management in Chronic Osteoarthritis.” Anesthesiology and Pain Medicine, vol. 7, no. 5, Oct. 2017, p. e14470. https://pubmed.ncbi.nlm.nih.gov/29696113
[13] Dima, Robert, et al. “Review of Literature on Low-Level Laser Therapy Benefits for Nonpharmacological Pain Control in Chronic Pain and Osteoarthritis.” Alternative Therapies in Health and Medicine, vol. 24, no. 5, 2018, pp. 8–10. https://pubmed.ncbi.nlm.nih.gov/28987080
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