Oct 15, 2018Knowledge is All the Power You Need for Laser Therapy Success
by: Douglas Johnson, ATC, EES, CLS | Chris Carraway DC,DIBCN, CLS
The use of light as a physical modality continues to gain popularity. The beneficial effects on pain and tissue repair make it an ideal adjunct to pain management care. Everyone can agree, that light therapy works. However, there is a great deal of confusion on “what” type of device is needed to produce photobiological effects in the tissue. The most confusing issue revolves around laser power.
Is there anyone reading this that doesn’t want more power? Just the sound of it is exhilarating! Imagine more horsepower, or even a more powerful horse. Bigger, Better, Faster, Stronger — the more power the better!
Of course that translates into medicine, right? If a small dose of medicine works, then a more powerful dose has to be better. If an intraocular implant at 23.0 diopters is the right power, then a more powerful 28.0 diopter lens will definitely improve vision. In stroke recovery, if stimulating the brain with a low current of electricity assists recovery, then a more powerful current must provide a quicker and better recovery.
If any of these examples sound absurd, then why would anyone think that MORE POWER from High Powered Class IV Therapy Lasers would provide better results, when it is Low Level Laser Therapy that has all of the documentation and validation? In recent studies by one Class IV manufacturer, they documented that only 2.4% of their light made it beneath the skin barrier1, and in another, that their laser actually down-regulated mitochondrial function.2 That’s not a good thing! How can their laser produce ATP as they claim, if their own research shows they are actually decreasing mitochondrial function?
In sharp contrast, Multi Radiance Medical has already been published in peer-reviewed journals 6 times this year, bringing its total compendium of research to 20 peer-reviewed research papers, with 17 more in submission, preparation or data collection. In addition, with over 30 clinical research projects underway, Multi Radiance is publishing more peer-reviewed data than all of its competitors combined.
The Price Paid for More Power
Ironically, for years the Class IV technology has become increasingly more expensive while producing little to no convincing clinical evidence that it works. But there are also other more subtle prices to be paid when owning a Class IV Laser. In classifying the hazards of Medical Lasers, the American National Standards Institute (ANSI) Z 136.3 states: “A Class 4 laser system (high-power) is a hazard to the eye or skin from the direct beam, and sometimes from a diffuse reflection, and can also be a fire hazard. A Class 4 laser system may also produce laser generated air contaminants (LGAC) and hazardous plasma radiation.”3
This hazard classification creates a potential risk for your patients, your employees and you. Have you ever had a bad day? You’re driving to work and someone ahead of you slams on their brakes and you spill coffee all over your brand new shirt. Worse yet, the car in back of you slams into you and now you might be liable as well. Now can you imagine having a bad day, or your CA having a bad day with a Class IV laser? There are documented potential eye and skin hazards that require warning signs, kill switches and special treatments areas defined by federal, state and local regulations.4
While we’re on the topic of liability, it is the manufacturer’s responsibility to at least guide the clinician into understanding the federal, state and local requirements and regulations about operating a Class IV Laser in their practice. There are strict Occupational Safety and Health Administration guidelines that need to be complied with on a federal level,5 and each state has its own requirements such as registering the laser with the state’s health services or radiation safety department,6 along with paying hundreds of dollars in fees for continuing the license for as long as you own the laser. It is also a good idea to consult with your malpractice insurance company as annual premiums to cover laser therapy, if you can find someone to insure you, can be in the thousands of dollars per year. The clinician never has to worry about these things with a Class 1M laser, because they are exempt from all of these hazard restrictions and will never cause harm if the clinician or CA has a “bad day.”
Changing Perceptions with Facts
According to ANSI Hazard Classifications: “A Class 1M laser system [Multi Radiance] is considered to be incapable of producing hazardous exposure conditions during normal operation unless the beam is viewed with an optical instrument such as eye-loupe (diverging beam) or telescope (collimated beam). It is; therefore, exempt from any control measures other than to prevent potentially hazardous optically aided viewing.”7
Laser Therapy is not and was never meant to be a thermal modality. The definition of Photobiomodulation, a term Class IV lasers shouldn’t use, was developed and adopted by the Board of The North American Association for Photobiomodulation Therapy as “a form of light therapy that utilizes non-ionizing forms of light sources, including LASERS, LEDs, and broad-band light, in the visible and infrared spectrum. It is a non-thermal process involving endogenous chromophores eliciting photophysical (i.e. linear and non-linear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.”8
For years, clinicians have been told that more power is necessary to achieve positive patient outcomes, but the research proving that is scarce or non-existent. This “increased” need for power Class IV companies cite was derived from the early days of light therapy where the outputs of power were under 5 mW. Just saying something doesn’t make it so. Repeating the same misconception over and over again may make you think something correct, but it’s not. Perception, correct or not, becomes “reality” and changing that can be challenging.
However, facts beat fiction every time. Multi Radiance has the facts, including a published dosimetry curve, a cytochrome C oxidase peak activation time profile, a depth of penetration time profile, a thermal time profile, and a peer-reviewed, published comparison against Class 3B and Class IV lasers showing superiority in managing pain (DOMS). Before purchasing any laser, the clinician should demand to see the peer reviewed evidence and understand the hazard restrictions of integrating the laser into their practice.
Most recently, Multi Radiance launched two new products for athletic trainers and medical professionals. The first is the MR5 ACTIV PRO, the latest generation of Multi Radiance technology which underwent rigorous clinical testing to be not only validated, but optimized. Additionally, the MR5 ACTIV PRO with LaserStim™ is the world’s first and only FDA registered multi wavelength laser with electrical stimulation. The ACTIV PRO with LaserStim has TARGET© and DOSE© technology, which allow the clinician to locate areas of treatment and then provide the proper dose with audible and visual cues.
Both lasers in the MR5 ACTIV PRO series are cordless, battery-operated and allow the clinician freedom to treat patients almost anywhere and anytime. The MR5 ACTIV PRO line is unrivaled in the industry with a peak power of 50W and a mean output of power over 450mW, all while maintaining the safest hazard classification level of 1.
In fact, Multi Radiance has always led the way in supporting customers with monthly educational webinars, newsletters, and by providing live clinical support. MRM is also a Platinum Sponsor of Laser Therapy University which houses over 60 hours of videos, nearly a hundred protocols and hundreds of research papers.
If that wasn’t enough, Multi Radiance is now leading the industry forward with research and clinical studies that transcend pain management, rehabilitation and sports performance fields as the company is exploring exciting opportunities in neurology, cardiology, ophthalmology and de novo submissions for MSK, which will never be realized by Class IV laser companies.
With thousands of Lasers in practice and dozens of published papers and ongoing clinical research, Multi Radiance Medical is truly Peer Reviewed and Practice Proven.
1 In Vitro and In Vivo Optimization of Infrared Laser Treatment for Injured Peripheral Nerves Juanita J. Anders, PhD,1 Helina Moges, BS,1 Xingjia Wu, BS,1 Isaac D. Erbele, MD,1 Stephanie L. Alberico, BS,1 Edward K. Saidu, BS,1 Jason T. Smith, PhD,2 and Brian A. Pryor, PhD Lasers in Surgery and Medicine 46:34–45 (2014)
2 Photobiomodulation Therapy Comes of Age Juantia Anders, Uniformed Services University of the Health Sciences BioPhotonics March, 2017 https://www.photo ics.com/a61531/Photobiomodulation_Therapy_Comes_of_Age#Comments
3 AMERICAN NATIONAL STANDARD Z136.3-2011 page 3
4 AMERICAN NATIONAL STANDARD Z136.3-2011 pages 20-22
5 OHSA Technical Manual; Section III, Chapter 6, VI. Control Measures and Safety Programs
6 Laws and Regulations of Laser Operation in the United States Catherine M. DiGiorgio, MD and Mathew M. Avram, MD, JD Lasers in Surgery and Medicine 50:272–279 (2018)
7 AMERICAN NATIONAL STANDARD Z136.3-2011 page 3
8 https://www.naalt.org Home Page: Terminology: The recent adoption of a MeSH term “Photobiomodulation Therapy” symbolizes the unique nature of this therapy.
* Data on file