NIR Class 4 Laser Therapy
How to obtain Class 4 laser treatment
Class 4 laser treatment is obtained at clinics
You can search the web to find a provider near you.
How many treatments required?
Depends on type of condition:
- Acute conditions.
Can be treated more frequently and require fewer visits - typically 4-6 treatments
- Chronic conditions.
Typically require 10-15 visits over 2-4 weeks. Treatments can be 2-3
times / week for short duration, or 1-2 treatments / week with longer times
The effects of class 4 laser treatments are cumulative.
Pain relief is typically achieved before healing occurs.
It is therefore necessary to stay with the therapy if you want complete healing
that deals with the cause of the problem
How long does each treatment take?
Treatment times are just a few minutes
Does it hurt?
Class 4 laser therapy is painless.
Although the patient may feel some slight, relaxing warmth
Cost?
Cost is around $55-75 /treatment
(2019 prices)
Contraindications
The class 4 laser should not be used:
• Directly over the eyes;
• Directly over the uterus of a pregnant
woman;
• Directly over a known cancerous tumor;
• Directly over thyroid tissue
Drug Interactions
One should wait at least seven days after having a cortisone
(corticosteroid / steroid)
shot. Since both steroids and Class 4 laser therapy suppress prostaglandin E-2 (which
otherwise has a hormone-like effect to promote inflammation in its local area)
Light sensitive medication may be affected by laser therapy.
Class 4 therapy lasers are safe to use over metal
implants. Tissue warming occurs from the outside-in.
FDA and safety
A Class 4 therapy laser is used by someone trained to understand and
practise safety precautions for handling this powerful device.
The FDA requires wavelength-specific safety goggles for
everyone in the treatment room to protect eyes. SInce infrared lasers are outside the
visible spectrum, the blink reflex will not register. The Nominal Hazard
Zone (NHZ) is defined as "the space within which the level of the direct,
reflected, or scattered radiation during normal operation exceeds the applicable
MPE." The NHZ for Class 4 therapy lasers is about 21 feet.
The FDA also requires that one
person be designated as the "Laser Safety Officer" for the treatment facility.
Treatment dosage
Dosage refers to the
amount of energy per unit area of tissue
surface exposed to laser beam . Measured as Joules / cm2 .
The power of a laser is the rate of energ y
being delivered (usually measured in watts) 1 watt is 1 Joule / second, so
a laser operating at 8 watts power level, with a continuous wave would deliver
480
joules in 1 minute, and 240 Joules/min in pulsed mode (with 50% duty
cycle). In 1 minute, a treatment area of 50cm2 (~8 inches2 ) would
therefore receive a dose of 9.6 J/cm2 (480 J /50cm2 ) in continuous mode, or 4.8
J/cm2 in pulsed mode.
Required dosage is affected by
several factors: including wavelength of beam, tissue type /condition, whether problem is acute or chronic, skin pigmentation, treatment method.
There's a "Goldilocks" dosage
window. Below this window, biostimulation does not occur, and above
the window, it is inhibited or can cause damage to tissue. This has been
easily observed in wound healing and hair growth (Tuner &
Hobe, 2004). Biostimulation is
reported in the dosage range of 0.001 to 10 J/cm2.
• Photobiomodulation has been extensively used for many
years on sports injuries, arthritic joints, neuropathic pain syndromes, back and
neck pain. Over 700 randomised clinical trials have been published on
photobiomodulation, half of which are on pain.
• Irradiation of in vitro rabbit articular chondrocytes with 4-6 J/cm2 demonstrated
substantial biostimulation compared to control cultures.
(Jia & Guo, 2004)
• 13 J/cm2 increased
the number of chondrocytes and the thickness of the articular cartilage in
immobilized rabbit knees. (Bayat et al, 2004)
When treating with a GaAlAs diode laser, the current accepted dosage for
deep-lying pain is 4-10 J/cm2. (Ibid Tuner & Hode, 2004) .
Output wattage. A deeper target requires a higher wattage to enable sufficient photons
to reach the target to yield the primary effects of
photobiomodulation. Examples (adjusted by clinical laser therapist according to his or her
judgement):
• 2 watts for tennis elbow (lateral
epicondylitis);
• 5 watts for cervical pain ( i.e. wear and tear
of cartilage / bones connected to the neck, especially spinal disks as in
cervical spondylosis /osteoarthritis, mostly seen in older people)
• 7 watts for lower back (lumbar) pain.
Much of the beam energy is
reflected, or scattered into none-targeted areas. An
estimate of at least half of the energy is lost when targeting an area
well below the skin.
Treatment methodology
Applying a combination of continuous wave
and various frequencies of pulsation
is the best treatment approach. Using different pulse frequencies
prevents the body from getting immune to and
becoming less responsive to any steady stimulus.
(Blahnick & Rindge, 2003)
The treatment wand is kept in motion during the
continuous wave phase, and is pressed into the tissues for several seconds
during laser pulsation.
Empirical evidence provides a guide for which
pulsation frequency ranges
to use for specific problems and tissues:
• 2-10 Hz for an analgesic effect;
• Around 500 Hz is biostimulatory;
• >2,500 Hz has an anti-inflammatory effect;
• > 5,000 Hz is anti-microbial and anti-fungal.
(Ibid Tuner & Hode, 2004, p 78) .
Ideally - Class 4 laser therapy combines several of
these pulsation frequencies to provide an analgesic effect, inflammation
reduction, and biostimulation.
References
Practical pain management
Bayat M, Ansari A, and Hekmat H (Sep 2004) Effect of low-power helium-neon laser
irradiation on 13-week immobilized articular cartilage of rabbits. Indian
Journal of Experimental Biology. 42(9): 866-870.
Blahnick J and Rindge D. Laser Therapy, A Clinical Manual. 2003. Healing Light
Seminars, Inc. Melbourne, FL. p 27.
Jia YL and Guo ZY (2004) Effect of low-power He-Ne laser irradiation on
rabbit articular chondrocytes in vitro. Lasers in Surgery and Medicine. 34(4):
323-328.
Moore P, Ridgeway TD, Higbee RG, Howard EW, and Lucroy
MD (2002) Effect of wavelength on low intensity laser irradiation — stimulated
cell proliferation in vitro. Lasers Surg Med. 36(1): 8-12.
Tuner J and Hode L (2004) The Laser Therapy Handbook.
Prima Books. Grängesberg, Sweden. pp 72-74.
