Healed by the Light
By Jeffrey M. Nelson, MD and Karen P. Nelson, MA
The cell is a machine driven by energy…In every medical tradition before ours, healing was accomplished by moving energy. Albert von Szent-Györgyi (1967)
Light energy has been used for healing
since the earliest recorded medical history, but has gone out of favor
in Western medicine with the advent of the existing paradigm of a more
surgical and pharmacological basis. Recently, a shift in thinking has
been emerging with an explosion of research, exploration and
utilization of energy medicine modalities such as micro-current
stimulators, bone growth stimulators, broad-spectrum multiple frequency
Tesla coil devices, and low-level or cold lasers.
Despite
years of research demonstrating the benefits of low-level laser therapy
(LLLT) as a modality for wound healing, Western medicine, and its
adjunct professions, have been slow to adopt this technology. LLLT has
been an essential part of therapy for practitioners around the world
for almost 20 years, but it is only recently catching on in the United
States. Still, the vast majority of students of medicine and allied
health practices in this country are not being taught its efficacy and
use. It's time we opened our eyes to the light.
One of my
first eye-opening experiences with LLLT in wound recovery was with a
burn patient. As a plastic surgeon and medical director of a burn and
wound center, I see large numbers of acute and chronic burn injuries as
well as wounds of various etiologies. One particular gentleman had a
home fire that melted his carpet and he was forced to walk across it in
bare feet to get out of his home. He presented with very deep foot
burns and severe pain. He was on chronic narcotics due to an old back
injury, so I knew his pain would be difficult to manage. At
presentation his pain was exceptionally severe and the bottoms of his
feet were purple, swollen and sloughing skin. Within two minutes of
treatment with the 635nm Erchonia® cold-diode laser his pain decreased
by a self-reported 75%, and his skin went from blue and purple to pink
right before our eyes! As you can imagine, our jaws dropped and this
particular laser therapy has been a part of my practice ever since.
How it Works
The
exact mechanism of action of LLLT is not completely understood;
however, there are several theories based on cellular research
conducted over the last two decades or more. The basic premise is that
LLLT stimulates cell activation processes which, in turn, intensify
physiologic activity. Healing is essentially a cellular process and
light energy initiates a cascade of reactions, from the cell membrane
to the cytoplasm, to the nucleus and DNA. This is called cellular
amplification; a phenomenon whose demonstration earned the Nobel Prize
in Physiology or Medicine in 1994.
There are many biological
processes that take place in tissues that have been shown to respond to
LLLT in the 630-640 nanometer wavelength range. One of these processes
is the enhancement of ATP production in the mitochondria, which
provides more energy substrate for cellular healing and tissue recovery
post injury. This wavelength has also been shown to decrease
inflammatory mediators in wounds and increase endogenous endorphin
release.
When one considers that wounds have varying degrees
of cellular and vascular damage, the wound site can be in a potentially
anaerobic state. Cells deprived of oxygen or blood supply have a
potential to increase lactic acidosis and therefore amplify local
cellular damage. Normal physiologic healing requires growth factors and
cytokines to be released at the wound site. These cell mediators call
inflammatory cells to the wound which clean up damaged tissues, fight
bacteria, and stimulate fibroblasts and vascular cells to grow to try
to heal the zone of injury. The physiologic concept is that LLLT
improves cellular metabolism and accelerates the process of debris
cleaning, improves neutrophil bacterial clearing and hastens cellular
division. Therefore, all stages of wound healing; hemostasis,
inflammation, cell proliferation and migration, collagen synthesis,
wound contraction, and wound remodeling proceed more rapidly and more
efficiently.
A key issue to understand is that LLLT, as a
category, covers a broad range of wavelengths. Individual wavelengths
have individual physiologic results. The 635 nm wavelength is the
monochromatic output that has been shown to be the best wavelength for
improving cellular metabolism and therefore, improving wound healing.
Another
important property of an effective laser is that it be a true laser,
which, by definition, produces the emission of coherent light,
generated at a precise, stable frequency, in a focused direction.
Products that use Light Emitting Diodes (LEDs) are not true lasers.
They produce non-coherent or random light, generating random
frequencies. Coherent light energy is critical when treating the human
body.
One more consideration is the optimum power necessary
for bio-stimulation. The Arndt-Schulz Law of photo-biological activity,
essentially states that "less is more" when it comes to energy for
improved cellular physiology. The Erchonia® LLLT provides the best
wavelength (635 nm) for cellular physiology at very low energy (2-5
mill Watts) to stimulate cells to function better. If the stimulation
is too intense, there may actually be an inhibitory effect, or possibly
degeneration or destruction of cells.
Healing Research
Our
research with burn patients demonstrates several advantages to the
635nm LLLT in burn/wound management. The most immediate advantage is an
average of 70% decrease in pain at the wound site within 5 minutes of a
two-minute treatment per 4% total body surface area (TBSA). Other
research has shown that LLLT increases natural endorphins in patients.
This increase in endorphin release would explain why we often see
decreased pain for days at a time. I believe we are also seeing an
immediate decrease in sensory nerve stimulation and a decrease in
sympathetic stimulation. This decrease in sympathetic tone and sensory
nerve stimulation provides the decrease in pain within minutes. During
our studies with burn patients we noticed that they had less swelling
in their wounds, visibly improved perfusion (blood supply) to the
tissues and faster healing. When patients have continued LLLT and we
follow them post-healing, they have less scar formation and less
purritus (itching) in their scars. Currently, we are undertaking a
multi-center, double-blinded trial that will explore the potential of
LLLT in healing burn injuries and decreasing their late complications.
Our
success with the burn-injured patient led us to apply LLLT to the
management of other complex wounds. Some of the wounds we have treated
include diabetic wounds, decubitus ulcers, post-orthopedic surgery
wounds and skin and myocutaneous flaps. We use the laser to decrease
inflammation, improve tissue perfusion and decrease pain at the wound
site; each a tremendous advantage to the patient and the treating
practitioner.
Complementary Advantages
The
Erchonia® laser's first FDA approval was obtained for the management of
neck and back pain. The advantages in improving musculoskeletal pain
carry over to the physical therapy and occupational therapy arenas. We
have found in our clinical work that patient's stiffness and sense of
tissue tightness greatly decreases after LLLT treatments. Typically, an
improvement of 30-50% occurs with just one treatment. Many extremity
wounds have long periods of immobilization associated with them; from
splinting, surgery, or just a protective mechanism of pain control.
LLLT treatments increase the patient's recovery of range of motion
(ROM). This mechanism of improved ROM is separate from pain control and
protective issues. Later, after a burn or wound injury, many patients
will report no pain, but have problems with tightness and stiffness.
Within minutes or hours of LLLT treatments they report significant
(>30%) improvement in the tightness. We have also found that many
patients may have a functionally normal ROM by goniometer measurements,
yet feel very tight or stiff. The LLLT greatly improves their
subjective assessment of tightness, however their ROM may remain the
same.
Basic Mechanics
The Erchonia® laser
is a very portable, user-friendly, hand-held unit. Treatments take
about 5 minutes total on average, so it fits easily into a clinical
treatment schedule. Erchonia® laser can be used with full contact with
the patient if needed, but most treatments are done about 6-12 inches
away from the surface area so there is no cross-contamination if the
patients' wound is colonized with resistant bacteria. LLLT can be used
in the setting of open wounds, burns, tissue injury, surgical recovery,
neuropathy, deep tissue injury or active infection. There is no known
"tissue problem" that is a contraindication; however, I would not
suggest treatment of a known active cancer until more studies are done
specifically in cancer cells. To date, there is no evidence that LLLT
converts normal cells to cancer cells.
LLLT can be used near
and over hardware such as artificial joints. Pregnancy is not a
contraindication, but it is suggested that a pregnant patient not be
treated due to medical/legal issues. Though there are no known problems
with the use of LLLT on a patient with a pacemaker, it is not suggested
that it be used directly over the pacemaker or pacemaker wires.
LLLT
can be applied through dressings and clothing, though, in my practice,
I like to observe the areas when treated. In the physical therapy
setting this is important because dressings or garments don't always
have to be removed. The number of treatments depends on the problem
being addressed and may be as little as one and as many as 20 spread
over several months.
There can often be increased exudate in
an open wound for LLLT increases tissue perfusion which can increase
wound fluid. Pain at the treatment site is rare, but can occur on
occasion with a mild increase in pain that then significantly resolves
in 1-2 hours.
As a plastic surgeon in charge of a burn and
wound center for many years, I have had the opportunity to assist
multiple patients with pain management, wound healing and physical
recovery with the use of 635 nm LLLT. This modality has been the best
new technology I have had to offer my patients in the last decade. It
is my hope that others will latch onto this technology and bring it
forward, for it is a completely non-invasive option that provides so
many physiologic advantages with no apparent side effects.
Dr.
Jeffrey Nelson is a plastic surgeon who has been involved in wound
healing for more than 20 years and is currently the Medical Director of
the burn and wound center at St. Mary's Hospital in Tucson, Arizona.
Karen Nelson has an advanced degree in physiology and is working as a medical writer in Tucson, Arizona.