LASER - heals. EGYM Solicite Información. By Lars Hode. Translated by Ellen heritage

Transcription

1 LASER - heals By Lars Hode Translated by Ellen heritage The intention of this little book is to summarize the experience that we have gained within SLMS (Svenska laser Medicinska Sällskapet), the Swedish Laser-Medical Society, regarding the treatment of diseases with low-power lasers, as well as to refer to the literature we as the most essential consider. Chapter 1 wendet at patients. We have tried to be as factual and easy as possible to write in the hope that all readers have benefited from it. Chapter 2 wendet itself to the reader, which is a little more familiar with laser. We go here a little deeper to the field of medical laser and its clinical application. Chapter 3 (For the advanced reader) Lars Hode, D. Sc. Chapter 1 Laser: the Aladdinslampe 20th Century? What is medical laser? What is treated with low-power laser? How big are the chances of a cure or improvement? How is it treated? You can feel pain? Duration of treatment What to look for after treatment? How much will it cost? Chapter 2 The electromagnetic radiation General radiation risk Are there any risks exist? Can you also take remedies laser treatment? How expensive is the treatment Laser in some detail Examples of usable medical laser Properties of the laser light Some aspects to laser instruments Bio stimulation Various parameters Risks and side effects Indications from A to Z Controversial indications 1

2 Veterinary use Contraindications Research in Sweden Chapter 3 Experiment 1 Experiment 2 A possible explanation Another possible explanation Experiment 3 Various mechanisms The cell membrane Summary Bibliography 50 positive double-blind studies Selection of books about laser therapy Contents Chapter 1. Laser: the Aladdinslampe 20th Century? It was in Dr. Endre Mester, a professor in surgery at Semmelweis Hospital in Budapest, was furnished with a new and exciting device: a ruby-laser! He had been made funds available to investigate whether one could use light from a laser to fight cancer. He therefore made a series of experiments, first in cell cultures, then to rats to be convinced that the laser light-this new and unknown type of light - not give rise to something dangerous or unexpected was. He shaved the fur on the back of a number of rats partially off and then applied different doses of laser light on half of the body shaved. The other half was left untreated for purposes of comparison. For small light doses nothing happened. With larger doses, the hair grew on the laser-treated half faster by - the laser light had a stimulating effect! In still larger doses, the effect disappeared and a further increase of the dose to obtain an opposite result: on the untreated half of the hair grew faster by - is now had caused an inhibitory effect. Dr. Mesters research group made several attempts. On a new group of rats was created on both sides of the body each have a surgical wound. One wound was illuminated with laser light, the untreated wound was used for comparison. Again, it was shown that certain doses of laser light were stimulated wound healing, while considerably higher laser light doses proven cure retardant. The results of these studies were published in Today - 30 years later - almost 2,000 different studies from over 80 countries have been published about the laser therapy on humans and animals in the medical literature. Light and sound Light is a form of energy which is generated in material and consists of waves. Light may have a long or a short wavelength. A light source is usually light with a broad wavelength range from - in other words, the light source has a spectrum of light. Some lamps give a lot of light of a certain color from, for example, Street lighting, fluorescent, light emitting diodes. White light is a mixture of several different colors. Also sound consists of waves that can have different wavelengths. High tones (treble) have short wavelengths, while low tones (bass) have long 2

3 wavelengths. Most natural sound sources give many different wavelengths simultaneously from - the noise of the wind, the trickling of water, thunderstorms, Wellengeplätscher. There are also sound sources that emit sounds from virtually a single wavelength, eg a whistle. What is a laser anyway? A laser is a light source which emits extremely pure light. Pure light is meant light which does not have a wide spectrum, but only a single wavelength. As an illustration, the following comparison may serve: the sound of a flute is 'pure' than the sound of eg a can filled with stones and shaken - the flute are sounds with a specific tone (of a certain wavelength) from. Just like the flute is a laser also long coherent waves. The light from a laser is very well-ordered, well-organized, while light from other lamps is completely disorganized. In technical terms, one says that the laser light is coherent (see page 8). The pure coherent sound of a flute can be both humans and matter in a different way influence than the impure sounds of traffic noise. A pure tone of the right frequency can, for example, to put a crystal in self-oscillation (resonance), which may even result in that the glass breaks into pieces. In the same way, coherent light in other ways affect our cells as incoherent light. There are hundreds of different types of lasers. They can be produced in strong or weak types (most are weak). The light may have any color or be invisible. The beam can be formed thin and parallel, or for the purpose of divergence (fan-like spread of the rays). What is medical laser? In the medical field there are many different types of laser, but they may be divided into two main groups: 1 Strong lasers, which can be used to cut tissue to coagulate or burn off. These lasers are often referred to as surgical lasers, because they can replace the surgeon's scalpel. Only physicians and veterinarians may use laser these species. 2 Weak laser that can be used for stimulation of cell functions. These are often called laser bio stimulation or low power lasers. Their biological effect is not based - as the surgical laser - strong heat, but that the pure light of the laser causes photochemical reactions in the cells. Neither sun nor lamplight cause the same types of reactions. How does laser therapy? There are very complicated processes in cells and tissues. However, it may be said briefly that the laser treatment is applied to the local immune defense, the circulation of blood and lymph vessels, the metabolism in the cells and on the excretion of various substances, such as Endorphins and prostaglandins, which, inter alia, Pain affect. Not always a stimulating effect. The laser can exert both a normalizing effect and inhibitory effects. The laser treatment is often curative processes in motion and therefore above all means to help themselves. What is treated with low-power laser? Various types of laser influence on tissue and cells of different species. What can be treated, therefore, often depends on which type of laser or which types of lasers have a therapist available. (See also page 10) How big are the chances of a cure or improvement? Not all patients respond to laser treatment similar. Usually a reaction within five treatments can be determined. Some patients react strongly and almost immediately, others need several treatments. Approximately one in ten 3

4 patients not responding or so weak that only remains to be stated that laser treatment for this person is not the right method. Examples of typical 'laser problems' are the following: herpes, shingles, facial paralysis, nerve inflammation, venous leg ulcers, wound lie, hand and foot warts (particularly in children), sensitive tooth necks, problems with back, neck, shoulders and knees, certain rheumatic complaints and sports injury. One calculates that approximately 75-90% of patients are symptom-free or improved strongly. However, this requires that the correct type of laser is used and that the therapist has good knowledge! Examples of problems that can be treated and where the chance of recovery at about 50%: hormonally induced hair loss, psoriasis, hand and foot warts in adults, sciatica, rheumatic pain, scars, wrinkles, stiff shoulder. Examples of problems where one has only occasional success (chance of recovery is less than 15%): Pigment stains, hemangioma (Gorbachev Male), alopecia areata (spot-wise loss of hair), herniated disc in the early stages. How is the procedure performed? For most instruments today the laser light comes from a probe (whose shape is similar to a spring). The treatment is carried out as follows: on the therapist to the laser device, and presses the end of the probe The importance of the tissue status Clinical and experimental experience shows that laser treatment has the greatest effect on tissues / organs, which have a generally deteriorated condition, eg in patients suffering from any disorder or to tissue damage. The wound of a young, healthy person heals about the same speed with or without laser treatment, however, difficult to heal open legs in a person with poor blood circulation plus of reduced immune defense with the help of laser treatment of a much more rapid healing can be supplied. You can feel pain? No, there are felt no pain; rather a pleasant sensation is perceived. The laser treatment is relaxing and many patients sleep while a. But it could be that an already existing pain increases, or that pain within 6-24 hours after treatment occurs, but usually only about holding a day. This is due to the fact that the laser light is healing processes in motion. Especially in case of problems chronic nature of this pain can occur when starting treatment. He usually wears off after a few days, but may persist in some cases longer. Duration of treatment The treatment at the beginning of intensive (usually every third to seventh day) and happens after the healing is under way, in increasingly longer intervals. Another five to ten treatments may be necessary, depending on the susceptibility of the patient and the type and duration of symptoms. Chronic disease states usually require oftmaligere treatments than acute symptoms. Are there any risks exist? Low-power laser, which is handled by trained staff only, is completely harmless. Safety glasses are not normally needed. Treatment with low-power laser can not cause cancer to worsen (see page 14). The laser light can not hurt either fetuses or vital body organs. However, it is important that you first consults a doctor for injuries or diseases for diagnosis, so you know exactly what is to be treated. Can you take medicines with laser during the treatment period? Yes. Previously remedies have shown in combination with laser treatment, no negative effects. Laser can even enhance the efficacy of certain remedies! 4

5 What to look for after treatment? The laser light may sometimes result in an almost immediate and direct pain relief. It is important to remember that pain is caused by damage often serves to prevent overloading. In such cases, can lead to the pain-relieving effect of laser, for example we can a tendon, a muscle or a joint overloaded, which would result in deterioration of the effect. It is therefore important not to burden the damaged area rather than to the therapist are the clear sign it. How much will it cost? A treatment generally costs between 10 and 100 DM, depending on the time it takes to complete. The first treatment costs due to the recording of data and information, and the investigation is often more. Chapter 2 (For the reader who wants more information.) The electromagnetic radiation The energy that we get from the sun is called electromagnetic radiation, and occurs in the form of waves. Examples of electromagnetic radiation with a long wavelength of radio waves (meters to kilometers) and microwave (millimeter to tens of centimeters). Heat radiation has a shorter wavelength. This is often referred to as the infrared radiation and has wavelengths between 800 nanometers (reduction: nm), and are 1 millimeter. Visible light has wavelengths between 400 and 800 nm, red light has a long wavelength ( nm). Shorter wavelengths have orange light ( nm), yellow light ( nm) and green light ( nm). Blue light ( nm) and violet light ( nm) have even shorter wavelengths. If the light has a longer wavelength than red light, it is, as mentioned above, as infrared light (shortening: IR) refers to (which means means 'outside red') and is then invisible. When the wavelength is shorter than violet light, it is used as ultraviolet (reduction: UV) and is also visible. Ultraviolet radiation with a wavelength between 320 and 400 nm is referred to as UV-A radiation and can contribute in large quantities to the early aging of the skin. The sun and tanning beds emit this radiation. The UVB radiation is more aggressive and has wavelengths in the interval nm, this radiation can, especially if they are exposed to high doses cause cancer, including Type the dangerous malignant melanoma. UVB radiation is present in sunlight, but may occur in solariums in only very small quantities. UVC rays (wavelengths shorter than 320 nm) is not in the sunlight at the soil surface available, but was part of the now banned for 30 years quartz lamps. Moreover, there are electromagnetic radiation having still shorter wavelengths, namely, X-ray and gamma radiation. These are more dangerous and topped with restriction measures. General radiation risk One must distinguish between the special conditions that apply to eyes (see pp ) and the risk of cells and other tissues. To what extent radiation or light from a source-the sun, a lamp, a laser, etc. - can be dangerous for our cells, is dependent on two things: some of the intensity of radiation and partly by the wavelength of the emitted radiation. The following general rule: the shorter the wavelength, the more dangerous is the radiation. When radiation contains wavelengths shorter than 320 nm, it is dangerous (here it is a question of dose), but not otherwise. Radiation which includes shorter wavelengths than 320 nm, is referred to as 'ionizing' and thus cause 5

6 cancer (carcinogenic). Warning: To what extent the radiation comes from a 'natural' or an artificial source, is without any significance. Crucial only their wavelength and intensity (strength), and also, as a large dose they are exposed (dose = intensity (Exposure time). Therapy laser give light with long and safe wavelengths (about 600 nm) from, and starches, which cannot cause tissue damage. Various light sources Different light sources have different spectra (the distribution of wavelengths in light). Most have a very wide range, but there are also many narrow-band, eg Fluorescent, and sodium lamps (the yellow street lighting). A laser having a very narrow spectrum, and are thus only light having a single wavelength. A light source which is to be mentioned here is the light emitting diode. A light emitting diode is a small semiconductor cheap lamp, which is often used as an indicator in tape recorders and radios. You are monochrome, but not coherent light (see page 8). The most typical light emitting diode emits red light with wavelengths around 660 nm, but there are also those that emit yellow or green light. In remote controls for television sets light emitting diodes with a radiation in the infrared range (950 nm, invisible) used. The laser The laser is the latest and most advanced of our light sources. The first working laser, a ruby laser, was from the Americans Theodor Maiman at a press conference in Los Angeles on 7 July 1960 demonstrated. The word LASER is a letter word (called acronym) for Light Amplification by Stimulated Emission Designation of Radiation, which reads in translation: 'light amplification by stimulated emission of radiation'. If you want to express yourself completely correct, a laser is thus a light amplifier. A laser its name often obtained from one of the substances that form part of the light-amplifying medium. Examples of usable medical laser Laser in medicine can be broadly divided into two groups. The table below shows the most commonly used laser in the medical field as well as their wavelengths are given. If more than a specified wavelength, can be chosen in the preparation of the wavelength. Strong laser: wavelength using 1. Rubin 694 nm Distance certain Tatuierungen, hair 2. Nd: YAG1064 nm coagulation of tissue 3. Ho: YAG 2130 nm surgery, tooth root sterilization 4. Er: YAG 3090 nm surgery, tooth drilling, leg hole 5. KTP nm Superficial blood vessels, Tatuierungen nm dye laser PDT, superficial vessels, kidney stones 7. Argon 514 nm dermatology, eye surgery 8. CO nm dermatology, gynecology, surgery 9. Excimer 193, 248, 308 nm sehfehlerkorrektur, coronary artery surgery 10. Low-power laser treatment areas: 11. GaAs 904 nm back, neck, shoulders, knees 12. GaAlAs 820 nm tendons, legs open 13. GaAlInP 635 nm skin and mucous membranes 14. HeNe 633 nm skin and mucous membranes 15. CO2 laser nm back, neck, shoulders, knees 6

7 Laser can be pulsed or continuous. (More about Low-power laser pages ) Properties of the laser light Laser light has four characteristics. Retrieved from 'ordinary' light is laser light differs mainly by: (1) Its very narrow bandwidth and (2) Its large coherence (see below). These two characteristics are the most typical for laser and are Laser light is always present. They are the ones who are in the laser therapy is most important, but as a surgical instrument have no meaning for lasers. The remaining two properties (3) Parallel beam of radiation and (4) High intensity Can usually get in a laser with appropriate geometric Shape of the laser medium and the resonant cavity taken lightly Be brought. Note, however: Laser light does not need to be even more strongly parallel. In surgical instruments, however, it is these latter two properties whose use is made, and at the same time, it is these two properties that can make the laser light dangerous to the eyes (see eye damage risk, pp ). Coherence If a matte surface is illuminated with visible laser light, is seen in a type of granularity light. This granularity is called 'Laserspeckler' (see pp ) and is caused by interference between rays of light. If the light is coherent light waves can in fact be added in the same way as when water waves meet, or if you tried different tones in a bathroom and a place that sounds very loud. This extra strength is caused by interference: Tones that are reflected from the walls, to be added if they meet and thus the effect of the resonance is called created. With coherence order is meant. Order in this case means that the light waves are related to long wave trains. The length of these waveforms, the coherence length can vary from light source to light source. An ordinary light bulb has a very short coherence length-only thousands of millimeters. A laser may have a very large coherence length, from centimeters to meters. With regard to the importance of coherence in laser therapy, see pp Some aspects to laser instruments The results are no better than the instrument that you use! In the technical area has during the last five years, a great places development. Tail laser and scanner lasers have been completely abandoned (for six years, those no longer produced), and indeed in large part because they had a bad dose control with these and large en loss of laser light by reflection against the skin ethyl. Met a hand-held probe, which is held in contact with the skin, you get a much larger share of light and reaches much deeper (see pp ). Similarly, the performance effects have increased significantly. The instruments have become smaller and cheaper and have received a better shape. New types of lasers have been added that allow a more effective treatment. In addition, we have now a much greater knowledge about treatment options and methods to achieve the best possible effect. 7

8 There are treatment instruments with only light-emitting diodes as a light source, often in a price range of 5,000 to 10,000 DM In comparisons were between light from lasers and light from light-emitting diodes, with otherwise identical parameters, made, laser performance was always the better effect (see p 21). Examples of LED instruments are Bio Light and Pretor. Many who have previously tried laser treatment, were disappointed, simply because the instrument, perhaps, was not so good in combination with the selection of dose and other parameters. However, as well as the drugs are constantly being developed, it is also the case with laser instruments. Bio stimulation The medical effects of laser light, as Endre Mester and many have observed after him, are often referred to as bio-stimulating effects. Of course, the treatment parameters must be chosen to match and suitable types of problems or illnesses are treated. The types of lasers used for this purpose are often low-power laser called because the light emitted by them is safe usually. The commonly used international term for this method of treatment is LLLT (Low Level Laser Therapy). In order to achieve a good effect, three things are needed: good knowledge on the part of the therapist, a good laser instrument of the right laser wavelength and a proper diagnosis. Unfortunately, there is often the therapist who lack not only of medical knowledge, but often do not even know what type of laser they possess what is meant by wavelength or power effect or what constitutes a treatment dose. Various parameters Upon treatment with a low power laser, it is important to choose the treatment parameters to some extent correct. Examples of such parameters are: laser wavelength, dose size, frequency of treatment, power density, and pulse frequency of treatment. These terms are explained in the following. 1 Laser type and wavelength The next in laser therapy, especially in question lasers are: Indium lasers (red light). This designation covers two different Laser: partly the helium-neon laser, HeNe shortened, partly the Gallium aluminum indium phosphide laser GaAlInP shortened. Both give red visible light in the wavelength interval nm from and are most effective in problems of skin and mucous membranes, including Herpes and shingles, with facial paralysis, inflammation of the trigeminal nerve, leg ulcers, varicose leg ulcers, bedsores, with sensitive teeth, hand and foot warts (particularly in children). Aluminum Laser (invisible). The full name is gallium aluminum arsenide, GaA1As shortened. The wavelength is nm, which laser usually continuously operating, but may be pulsed and has a penetration depth of 2-3 cm. He is best suited for tendons, but is also useful at leg ulcers, leg ulcers, herpes, shingles, and in the dental field. Gallium laser (invisible). The full name is gallium arsenide laser shortened GaAs. This laser emits infrared radiation of wavelength from 904 nm. He always works pulsed with extremely short pulses (supergepulst ns) of high intensity (10-50 W peak power), about how a flash lamp. The depth of effect is considerably larger than that of a laser with the same wavelength, which is not supergepulst. Measurements show that the penetration depth reached 3-5 cm, depending on the application technique and tissue type. This laser is best suited for deep-seated problems in the back, neck, shoulders and knees, with tendonitis, arthritis and myofasziellen pain. Carbon dioxide laser (invisible). The carbon dioxide laser is used to reduce CO2 laser. These lasers were once very large. Today, there are small, portable instruments, even with battery drive that arise up to 15 watts. When 8

9 treated with a CO2 laser man feels in contrast to the other types of laser-significant, in some cases quite strong, heat. Due to the large wavelength nm, the penetration depth is not greater than about 0.5 mm (the tissue type does not matter). Nevertheless, one has to observe effects of treatment of up to several centimeters in depth. This is hard to explain, but it is believed that the reason for the formation of transmitter substances in those cells where the absorption takes place, and that then distribute these substances into deeper tissues and exert the greatest effect. In biostimulation, the CO2 laser can be used for both external as well as low-lying problems. (See wrinkles, p 18) 2 Treatment dose The dose is an important parameter. The dose is measured in joules, and means that a certain amount of energy per cm? (J / cm?) Supplied: Dose = time x treatment laser power per cm2. Different laser wavelengths require different doses. The many disparate symptoms and disease states require different doses. Recommended doses are as follows: Indium-Laser: by over-bearing skin: 0.1 to 1 J/cm2 to mucous membranes and open wounds: from 0.01 to 0.2 J/cm2 Aluminum Laser: by over-bearing skin: 0.1 to 1 J/cm2 to mucous membranes and open wounds: from 0.01 to 0.2 J/cm2 Gallium laser: by over-bearing skin: 0.01 to 0.1 J/cm2 Carbon Dioxide Laser: Treatment: resting on the skin: 1-10 J/cm2. Treatment on open wounds: 0.1 to 5 J/cm2 At doses that exceed the highest values reported above significantly (5-10 times), we obtain a weaker biological effect (e.g. in wound healing and inflammation). At higher doses to reach the biosuppressiven area and can cause inflammatory effects in this case. Is the dose required for the treatment of mucous membranes of less based on the fact that mucous membranes in lower losses due to absorption and diffusion as in the horn bearing the skin in the treatment of skin or skin passing. 3 Performance effect The strength - or referred to more correctly the performance effect - a The laser is of particular importance for the length of treatment time. A certain specific dose is with a strong laser reached faster than a weak. The performance effect is for a good result is not decisive, but can be achieved with a strong laser sometimes a greater density effect (see below), which is sometimes convenient. 4 Density effect To effect density of the light effect per unit area is meant, this is used in W / cm? measured. Here, various lasers differ from one another; different producers have different effect density. A high effect density means high light concentration. One such example is obtained the focus of a burning glass. The bio stimulation based on cell interference. Too low or too high effect density result in a lower biological effect. 5 Pulse rate This applies only pulsed lasers. In a gallium laser (pulsed always) must be set the desired pulse rate. It is known that low frequencies ( Hz) exert a greater effect on pain and that high frequencies ( Hz) have the greatest effect on inflammatory conditions, while medium-high frequencies ( Hz) are best for edema and 9

10 swelling as well e.g. seem to be suitable for bone formation. It should be noted that some laser instruments have only one or two frequencies treatment while others undertake the entire frequency interval? 6 Eindringungsdichte, effective depth There is no exact limit to the penetration of light. Laser light spreads in all directions and is gradually absorbed in the tissue. The light intensity becomes weaker the further you walk on the surface from the meeting place. However, there is a limit where the light intensity is so low that the light does not cause any biological effect more. This limit is referred to as the effect depth. The effect of depth depends on several different factors: wavelength of light, tissue type (skin and fat are more transparent than the blood-rich muscle tissue), pigmentation, and dirt. Laser light penetrates through the bone (about as by muscle tissue). (See Reference [35]. Below is referred to the corresponding reference numbers in the bibliography in square brackets.) An important factor is the displacement of blood in the tissue. If you slightly pressed with a laser probe against the skin, the blood moves to the sides. The tissue directly in front of the probe and still a bit deeper will quite bloodless, and because the hemoglobin in the blood is the one factor that makes for the greatest absorption, the penetration of light increases significantly. Other factors of importance are the performance effect of the laser - whether it is supergepulst or not - the technical design of the instrument and the treatment technique (treatment by skin contact or at a distance). 7 Treatment methodology A distinction is made between local treatment and treatment system. Most common is local treatment, that is, the direct treatment of the problem area. Treatment system means that you treat locations that are remote from the actual problem area. An example of system treatment is the treatment of so-called trigger points (trigger points, whose touch cause pain and are located at sites other than the actual damage). Another example is laser acupuncture, whereby one or more acupuncture points illuminated with laser light, instead of insertion of needles. 8 Laser Acupuncture Acupuncture using laser is an interesting area. For a user with acupuncture training here opens up a broad field of activity. The method is sterile and free of pain and is therefore readily accepted by patients. Both laser acupuncture and conventional needle acupuncture affect the acupuncture points, but experienced therapist give aloud not the exact same effect. They are considered as one another komplettierend. An interesting variation of laser acupuncture, which is likely to result in a longer lasting effect you get when you burn acupuncture points on the surface with a CO2 laser. An example of laser acupuncture, the treatment of bronchial asthma with low-power lasers. A double-blind study, which shows that asthma by laser acupuncture with gallium laser (10 mw, 50 pulses / second) can be successfully treated, was conducted by Dr. Ines Vinge at the Karolinska Hospital in Stockholm. 9 Treatment intervals Professor Endre Master has shown early on that proper time intervals between treatments are more effective than too tight successive treatments. After it was also shown that the effect of laser treatment is cumulative (ie, the dose of treatment adds up to the dose of the next), it is important that the treatment is not carried out to 10

11 close succession. Usually selects one or two weeks to deal with during each few days, with 2-4 days between, and thereafter at longer intervals. Acute problems generally require fewer treatments and in these cases can be treated in more rapid succession. Herpes and acute shingles are usually treated daily for several days. Chronic ailments are usually treated best with longer intervals. Other factors of importance are the performance effect of the laser - whether it is supergepulst or not - the technical design of the instrument and the treatment technique (treatment by skin contact or at a distance). Risks and side effects Are there any risks with LLLT (Low Level Laser Therapy)? First to be noted that the 'radiation', with which we work, either visible light or heat radiation (infrared radiation) and nothing else is. The fact that the light has a high purity means no risk in itself, any more than that a pure flute tone would be more dangerous than, say, Noise of the same volume. The only real risk with low-power laser therapy, there is a certain risk for eye damage. Eye damage risk By laser with strong light intensities and narrow parallel beams could be produced, it has long been special requirements with regard to their application introduced. All lasers have been tested and therefore a laser class assigned: 1, 2, 3A, 3B or 4, wherein Class 4 contains the highest grade types. Laser with visible light are less dangerous than those with invisible light because the Zwinkerreflex protect you in case the light is perceived as strong. Previously durftennur treat (stronger laser therapy) Doctors, dentists and physiotherapists patients with laser class 3B. But since no cases of eye damage have been reported by laser therapy, this provision was abolished in Sweden in Today, it is therefore free to use instruments to laser class 3B. Question: Is it enough to close your eyes when you are treated with laser in the face or you have to wear goggles? Answer: Yes, it is enough to close your eyes, even if the laser is strong. You can even treat a style on the eyelid without risk. The reason for this is that the eyelids diverge the light, so that no focusing occurs. The light spreads over the whole retina. To avoid possible problems: the patient should always use safety glasses - many people place themselves under laser something dangerous before. Never leave a patient look rigid in a laser probe, which is directed against the eyes. Should this happen accidentally but for an instant, it typically draws fortunately no serious consequences. It is important to note that goggles that are tuned to a certain laser wavelength, can be of no use to a different wavelength. Warning: Ordinary sunglasses offer no protection but may instead increase the risk of eye damage. Cancer Many people do not know much about lasers and sometimes believe that a laser, a kind of mystical 'radiation' of this Agreement. And radiation can still be dangerous - yes, they may not even cause cancer? May cause cancer of the light therapy lasers? No, no way. (See also the section 'Contraindications Show,' pp ) In light of wavelengths above 600 nm at doses that are used in laser therapy, no mutagenic effects were observed. But what happens if you treat someone who unknowingly already has cancer? Can tumor growth are stimulated by laser light? No. Studies on the effects of laser light on cancer cells engineered have shown that certain doses of laser light can stimulate the growth of cancer cells. If cancer in a living being (in vivo) is growing, but other ratios, irradiated as if you have a cell culture (in vitro) apply. In experiments on rats with transplanted tumors to various sizes, it has been observed that small tumors that were treated with the laser, were smaller and even disappear owing to the fact that the laser is stimulates the local immune response to a greater degree than the tumor. Laser treatment had no effect on tumors that exceed a certain size. The same applies to bacteria cultures. This can be 11

12 stimulated by the laser light in suitable doses, whereas a bacterial infection by properly executed laser treatment cures faster. It is important that prior to the laser treatment, there is a diagnosis. An undiagnosed pain may be due to cancer. Response to the treatment Apparent health. It may happen that a pain disappears almost immediately after a laser treatment. In such a case, it is important that the damaged spot (for example, an inflamed tendon) is, which caused the pain, is not overloaded. It is very important that the patient is informed that such states of 'health certificate' may occur and that the patient bears the full responsibility for ensuring that no overloading occurs. Even if the pain disappears and the laser treatment shortens the healing process, the fabric an adequate time for healing and restoration must be granted. Fatigue. A 'risk' with laser treatment is that the patient feels large fatigue during or after treatment. This can, for example, be due to a pain subsides or that certain substances - type endorphin - into action. Pain response. It happens quite often that a patient on the day after the treatment experience pain, which is the case especially in chronic ailments. This is due to the fact that damage in a 'acute phase' occurs when the healing begins. The same sometimes also occurs in other forms of treatment, for example TENS (transcutaneous electrical nerve stimulation, that acupuncture analgesia) or acupuncture. The cause is not overdose usually. Patients have about these possible pain response always be informed, and also about the fact that this is to be regarded not only of a temporary nature, but also as a positive response to treatment. Otherwise, the patient can easily reach to the conclusion that 'laser damage' occurred. What can be treated with laser? Laser treatment may seem like a kind of panacea, appear against all possible complaints, and with a very large number of therapeutic indications. But if you know that lasers both (a) the local immune defense as well as (b) affects the blood circulation that (c) the treatment is anti-inflammatory, and that (d) can influence pain conditions, this diversity does not seem so very strange. If a patient should not respond to the treatment, keep in mind that the degree of treatment success based on a set of meaningful parameters. One has missed its effect can cause in an inappropriate type of laser in too low or too high dose, incorrect diagnosis, insufficient treatment, pulse rate, density, etc. have effect. Different people are also sensitive to the different dose and have different susceptibility to laser treatment: some may feel the laser 'to her toes', others seem to be completely unalterable. The more experienced the therapist is, the greater success he will achieve, among other things, due to the adaptation of the selection of the type of laser and the dose size to the type of the damage and of the person. There should be a clear that laser is only one tool among many. Indications from A to Z The indications listed below make a complete list, but are examples of complaints that laser treatment may be valuable to look at. 12

13 Acne. is best treated with indium or aluminum laser. Suitable dose: 0.5 J per point. The treatment is indeed a symptom therapy, but may fail the result still good. Aphthous ulcers. Aphthous ulcers are best treated with indium or aluminum laser. The dose is determined by the subjective analgesic effect. If the patient feels a clear improvement, one has come close to the 'right' dose. Often several treatments are necessary to keep the patient free of symptoms until the After is gone. Bacteria and viruses. What is the effect of laser light on bacteria and viruses? The fact is that laser light is capable of stimulating both grown bacteria and grown viruses. That, however, in the treatment of infections, the situation is not deteriorated but rather accelerates the healing, due to the fact that the stimulation of the immune response is greater than that of the microorganisms. Laser treatment must be combined with antibiotic therapy sometimes. Fractures. Treatment with gallium laser (700 Hz) locally over the fracture site, every third day during 1-2 weeks. Shingles (herpes zoster). The Norwegian and Danish words for shingles, 'Hellfire' are apt descriptions. Shingles can occur anywhere, not just on the fuselage. Even the trigeminal nerve kan be attacked. Indium or aluminum lasers have the best effect on the actual Zosterangriff, but can also be achieved in the post-herpetic pain, an effect wherein gallium or aluminum-lasers provide the best effect. It is important that the treatment is applied as soon as possible in order to achieve the greatest possible impact. A series of treatments reduced the suffering of the patient considerably. [51-58] Herpes simplex. Herpes is very suitable for treatment with low-power laser. The treatment outcome depends on the viral cycle in which stage one can engage. The later in the attack phase treatment is started, the worse the effect. Suitable dose: J per bubble with indium or aluminum-laser. Carpal tunnel syndrome, which is a very common symptom in people with monotonous work tasks-for example, Workers in auto plants-is, can be successfully treated with gallium laser. (See also under 'sports injury'.) Bone regeneration. The regeneration of bone tissue is associated with various interventions odontology of vital interest. Treatment with gallium laser volunteers a valuable addition here. Sinusitis (sinusitis). The treatment is done the nostrils along to the cartilage (2 J / cm?). The same dose is administered intra-orally in some places above the sinus floor. Sinus opening in the nose can also be illuminated with advantage. This treatment is a decongestant effect and comfortable for breathing. Acute sinusitis respond more quickly to treatment than chronic. Acupuncture points can be used with advantage. All three types of lasers can be applied. Nerve damage. Injured nerves heal slowly. Certainly works best in these cases, the indium laser. An indication of the effectiveness of the laser, when the patient is a non-specific feeling of restlessness felt in the treatment area. Open legs - wound healing. Open legs and bedsores are appropriate indications for indium or aluminum laser. In addition to improved wound healing is usually achieved a significant pain relief. Laser is always a complementary method; wound cleansing and dressing renewal shall be made as usual. One starts to handle the wound periphery by contact of the probe with the skin to give 1 J / cm? Administered. The treatment is carried out every other day, the healing process is to be evaluated. If there is no improvement, the dosage is increased by 50%. Rheumatism. Laser treatment can cure rheumatism, of course, just as medicine, but the symptoms often lessen. In addition to pain relief and greater mobility and reduced swelling can be achieved. Chronic cases often react with an initial increase of the pain, which is why the best starting with a low dose. The possible pain response 13

14 must be explained to the patient. Their eventual emergence is not an argument for the discontinuation of treatment. Pain. Laser treatment can affect pain conditions of various kinds. The positives with the laser treatment is that the pain relief in many cases can often adjust even during treatment. For example, listening to a tooth neck to draw, an open leg is pain free, a herpes blister is no more complaints, a jaw clamp can be opened. Often very high doses, however, are required to effect an immediate effect on acute pain. Thus, e.g. alveoli is for the purpose of pain relief up to 10 J with gallium laser claim. At less pronounced pain, such as with a herpes blister, a decubitus wound or a tooth neck, may be necessary to achieve analgesia 1-3 J. There is reason to believe that the high doses that are administered to alleviate severe pain, at the same time constitute an overdose in bio stimulating area, which has a slower healing result. Here, however, the choice is simple: the pain takes precedence. [1-6] Swelling, edema, effusions. Laser treatment has a antiödematischen effect which is based on an expansion of the lymphatic vessels and a decreased permeability of the blood vessels. If the edema is already a fact, high doses are required; J / cm? are not uncommon. Laser treatment also has a regenerative effect on both lymphatic and blood vessels. Tendinitis (tendonitis). Tendinitis and Tendalgie are often good for laser treatment. These states are sometimes difficult to diagnose. Acute tendonitis are much easier to treat than chronic. Aluminum and gallium laser to achieve the best effect. Sports and strain injuries. A thumb rule is that an ordinary sports injury heals well half the standard time when healing with laser is stimulated. A beach to Tends problem is that the subjective symptoms, resulting from the damaged site, quite rapidly disappear and the athlete then would like to resume the training. It is important that the damaged area rests and that the training comes only gradually in transition. Typical Industrial Injuries are the tennis elbow and pain in the shoulders and neck. Treatment is done locally with gallium laser. A tennis or golf elbow can often be 'wrong' - it may be Involve entrapment of a nerve (carpal tunnel syndrome). In this case, it does not help to treat only on and around the epicondyle. The treatment is therefore carried out with gallium laser in the area of the fifth and sixth neck vertebra. Dose proposal: 2-3 J at 700 Hz For the treatment of tendonitis, e.g. Achill tendinitis, one chooses like an aluminum laser in combination with gallium laser. Arthritis treated with gallium laser (5000 Hz). In these cases, a pain response is very common post-treatment. Trigeminusneuralgie.Gegen this pain condition, there is no completely effective treatment methods. Laser treatment is therefore no guarantee of success. However, since the method is painless and without side effects, they should be tried first. Indium laser is the primary choice. If this does not help, you try with aluminum or gallium laser. It will address the stimulus point, and 0.5 J per point is an appropriate starting dose. May pain points 1 J be administered? After that, the course of the main nerve is treated. A pain response is not unusual. The treatment is done twice a week initially, then with increasingly longer time intervals between treatments. Treatment should not be discontinued if and when pain relief is achieved, but should be continued, but in longer and longer intervals. [7, 8] Inflammation of the gums (gingivitis). Laser treatment is given as a supplement to conventional treatment and accelerated in this case, the cure. The postoperative pain is reduced. 14

15 Dental necks and sensitive. Pull in the tooth necks often respond favorably to laser treatment. This is fortunate, because so many people suffering from these ailments. Treatment is carried out locally at the neck of the tooth with indium laser, until the patient experiences a significant improvement. [59, 60] Controversial indications Fold... are the favorite theme of the critics. Scientific studies prove that low-power laser therapy can smooth wrinkles, it is probably not. A number of interesting examples shows that laser treatment effect on wrinkles has. In contrast, carbon dioxide laser has a surprisingly good effect on both wrinkled skin as well as acne scars. The treatment is done as follows: Using a scanner plug one burns superficial and evaporated to about 0.1 mm of the epidermis. This gives an approximately 0.5 mm deep burn, about forming a crust. If the crust has fallen off, the skin for 3-6 months is flushed. During this time, a new layer of collagen forms a bit deeper in the skin. At the same time, the skin stretched slightly and becomes more uniform and less wrinkled. Microscopic examination of the newly formed skin shows a rejuvenation. This is an effect of biostimulation. Spring depression. An advertising campaign in the Stockholm subway a few years ago regarding this disease gave rise to discussions in the press. In court, the advertiser had to back down because there is no scientific evidence that laser treatment achieved such an effect. However, it should be noted that it has been shown that sufficiently large doses may be influenced by white light (fluorescent tube light) winter and spring depression [9]. So there might be some justification for the assertion of the advertiser. Haarausfall. In one of the first attempts Endre Master in rats watching you that the fur shaved on the body that had been treated with ruby laser and HeNe laser, quickly grew back. The Finnish researcher Pekka Pöntinen has shown that laser light can increase the blood circulation in the scalp significantly in suitable doses. Other studies show that it is possible to achieve an effect on the growth of hair in humans. However, quite a few treatments are often required. A successful result can not be guaranteed. [10] Zellulitis.Dokumentierte results of low-power lasers for this indication have not been published, but can gallium laser sometimes achieve amazing effects. Veterinary use There are a large number of studies in which the effects of laser light have been studied in animals. Both gallium and aluminum laser having a good effect in horses, as well as dogs, provided that the corresponding laser sensors are shaped so that the light can be passed through the pelt and can come into contact with the skin. A laser that is intended for human consumption, is usually not indicated for treatment of animals with fur. By shaving the treatment site can, however, attach the laser light in general. Horses are sensitive to laser than man. At high local effect density at a gallium laser they react (often strong), when you come into the vicinity of damage or problem area with the probe. This is particularly true at high pulse rate. It may therefore be advisable to administer a while low pulse rate, before increasing the frequency policy. This reaction can also be used on horses to locate a possible damage. In open wounds indium laser is recommended. [11, 12, 13, 14] Contraindications Any absolute contraindications for treatment with low-power laser does not exist. In Sweden, however, applies the Kurpfuschergesetz, which prohibits the treatment against diseases in children under 8 years and which requires that certain diseases, such as Cancer, diabetes, epilepsy, may only be treated medically. In older laser literature is often mentioned that eg Pacemaker, pregnancy, epilepsy, heart attack, etc. Contraindications for 15

16 laser treatment. After pacemaker electronic, encapsulated by metal and light are entirely unalterable, the whole thing is a misunderstanding. Regarding pregnancy is normal medical assessment of the mother's condition. Laser light in itself does not affect the fetus, because so little light penetrates. For the fetus, it is certainly not a disadvantage that a sensitive tooth neck or a herpes blister the expectant mother is relieved. Regarding epilepsy it is known that pulsed visible light, especially with pulse frequencies in the range 5-10 Hz, can cause epileptic seizures. Therefore, one must, of course, with instruments that have flashing visible light, exercise caution. However, it is rare that low power lasers have pulsed visible light. There are no indications that pulsed invisible light could trigger epileptic seizures in the literature. In contrast, should you avoid it, to administer large doses of laser light on the thyroid gland. Spanish studies in rats [15] suggest that it could cause disorders in large doses. Could that laser light leads to direct damage, has never been proven, but because the thyroid appears to be sensitive to light, one should avoid to shed light on this gland until the research has made clear the limits. Cancer or suspected cancer should never be treated by others as specialists. The reason for this is not that laser treatment could have no positive effect on the cancer, but that the law's treatment of cancer no one else allowed as professionals. For patients who have received radiation therapy, it may be interesting to know that a number of investigations have shown that animals that were first treated with low-power laser, tolerated a subsequent X- rays better. [16] Research in Sweden Among the double-blind trials that have proven a significant positive effect of laser treatment, there may be mentioned the following. Vibrant and Fryberg at the Regional Hospital in Umea have studied the effect of gallium laser on medial knee osteoarthritis. Lögdberg-Andersson at the hospital = kersberga has in a double-blind trial stated a good effect of gallium laser Inflammation of tendons and myofasziellen pain. Hiker and Lundeberg at the Karolinska Institute in Stockholm have been studied in a double-blind study the effect of gallium laser on tennis elbow, stating: '. Irradiate laser treatment may be a valuable therapy in lateral epicondylalgia when it is executed as described in this study' Ines Vinge has at the Karolinska Hospital in Stockholm, also in a double-blind study investigated the effect of laser acupuncture with gallium laser in the treatment of asthma and found in the selected parameters have a good effect. Moreover, there are a greater number of unpublished pilot studies that have been conducted by various doctors and physiotherapists. Among them may be an attempt by Goran Restroom, well-known sports doctor from Boulanger, be mentioned, who analyzed gallium laser at 993 patients. Chapter 3 (For the advanced reader) This chapter explains a lot about what is going on in cells and tissues and why these reactions only occur when laser light is used. That the biological effects are laser-specific part is apparent from the research, some of the below-described experiments show that the properties of the laser light does not disappear when the light spread in the tissue. At the beginning... There are many studies which have been made on laboratory animals, where the biological effect of coherent light from a laser light of, for example Has been compared to light-emitting or other incoherent light source [17, 18, 19, 20, 21, 22, 23, 24, 25, etc.]. In this case, one has obtained a remarkable effect from the laser, but no effect or a much smaller effect - from the non-coherent light source. This clearly shows that laser light exerts a specific effect on cells and tissues. Speckle 16