RE: Laser therapy update -OBCE

[Guest guest]

Minga;

Congratulations to you and the rest of the Board on this

terrific win for chiropractic in Oregon!

S. Feinberg, D.C.

From:

[mailto: ] On Behalf Of AboWoman@...

Sent: Thursday, December 28, 2006 11:59 AM

Cc: Dave.MCTEAGUE@...

Subject: Laser therapy update -OBCE

Listserv,

The following article will be published in the Back Talk

publication put out by the OBCE. I decided to send it ahead of time to the

listserv as a courtesy and to update anyone interested in laser therapy. You'll

get this and many other pieces of work done by the board sometime in January

2007.

Minga Guerrero DC

Laser/Light Therapy

Approved

Winter 2007 BackTalk

A variety of low-level laser and light therapy (LLLT a.k.a

phototherapy) is available to Oregon chiropractic physicians as a standard

treatment for NMS conditions. Western States and other chiropractic colleges

have current core curriculum on this subject. In addition, WSCC is continuing

work on future curriculum to cover advances and new applications in technology

of this field. LLLT has been used to speed wound healing, stimulate

tissue repair, reduce swelling and edema, and reduce acute and chronic pain.

LLLT has been popular in Europe and Asia. More recently, in 2002, the United

States FDA granted 510 (k) clearances allowing for healing and pain relief with

various soft tissue disorders including carpal tunnel, rheumatoid arthritis,

bursitis, tendonitis and more.

Following recommendations from the OBCE ETSDP committee

(a.k.a. Examinations, Tests, Substances, Devices, And Procedures), the OBCE

approved and reaffirmed as standard use of Class I-IIIa lasers/phototherapy for

use by chiropractors (as well as certified chiropractic assistants!) as a

physiotherapy modality.

The OBCE also approved use of Class IIIb & IV " hot " lasers for

use by chiropractic physicians to treat NMS conditions. (Class IIIb &

IV laser therapy for cosmetic purposes is still under discussion.)

Chiropractors must be properly trained for use of all LLLT,

especially Class IIIb & IV. Training is usually available from the vendors

of these devices. Class IIIb for NMS conditions does not require detailed

special training other than provided by vendors, however use of Class IV

devices requires strict adherence to safety protocols. Minor surgery

training, of course, should be more extensive.

Phototherapy involves the application of specific wavelengths of light energy

capable of penetrating into tissue and being absorbed by cells. Light energy

can be produced by low level laser and/or super luminous diodes (SLDs).

Sufficient energy must be delivered to target tissue to trigger a response.

Light is absorbed by irradiated tissue where the light energy is transformed

into biochemical energy, which is then available for photochemical cell

activities.

The FDA has classified lasers into six categories based on their potential

damage to the eye. They are:

Class 1: Safe to human eye or contained within device, no labeling required.

Class 2: Low power lasers with output less than 1 mW. Labeled,

" CAUTION - Laser Radiation: Do not stare into beam "

Class 2a: Eye damage can occur if laser enters eye more than 1,000 seconds.

Labeled: " CAUTON- Laser Radiation: Do not stare into beam "

Class 3a: Power output up to 5 mW. Direct eye contact for short periods is not

hazardous, but viewing laser through magnifying optics such as eyeglasses can

present a hazard. Labeled: " CAUTON- Laser Radiation: Do not stare into

beam or view directly with optical instruments. "

Class 3b: Involves certain risk. Laser output 5mW to 500 mW. Labeled

" DANGER - Visible and/or invisible laser radiation - avoid direct exposure

to beam. "

Class 4: High power lasers with output greater than 500 mW. Involves definite

risk. Labeled " DANGER - Visible and/or invisible laser radiation - avoid

eye or skin exposure to direct or scattered beam. "

According to Western States instructor Agresta PT, DC,

a patient treated with Class IV must wear goggles. " Class IV lasers have

great benefits if handled properly and can deliver more energy in less time,

but proper training and understanding of the contraindications is imperative.

As far as I understand, the manufacturers (i.e., K-Lasers and Avicenna) issue

specific protocols that keep these lasers safe for NMS conditions. These

protocols have some degree of safety built into them. By their nature

they do require a higher level of safety precaution, but when following the

programmed protocols it appears that they are safe. "

He also said by law, Class III and above must be stored in a locked

cabinet. Dr. Agresta says that " photobiostimulation " stimulates

or speeds up the inflammatory process and resultant healing when lower doses

are used. However, he says that at higher doses starting around 100 to

200 Joules/cm2 (Joules/cm2 = power/beam area x time) inhibitory or negative

effects may occur.

The ETSDP Committee and the OBCE reviewed a wealth of published clinical

literature which documents many therapeutic applications of LLLT.

(Many thanks to Dr. Agresta for his expert advice on this subject.)

Submitted by Minga Guerrero DC

president, OBCE