LASER (Photobiomodulation)

Photobiomodulation (PBM) therapy
Photobiomodulation (PBM) therapy

PBM therapy using low level laser for treatment of lymphoedema

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Post Laser
Post Laser

Results post laser (6 treatments) following radiation therapy. Source: "The Laser Therapy Handbook" by Tuner and Hode

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Photobiomodulation therapy
Photobiomodulation therapy

PBM therapy using low level laser for treatment of lymphoedema

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THOR LLLT presentation at United Nations – Global Health Impact Forum

THOR LLLT presentation at United Nations – Global Health Impact Forum

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Source: "The Laser Therapy Handbook" by Tuner and Hode

What is Laser?

Laser is an acronym for 

 

L - Laser

A - Amplification by

S - Stimulated

E - Emission of

R - Radiation

 

The correct internationally recognised term for low level laser is now Photobiomodulation (PBM). It is a therapeutic class of laser which is non thermal (no heat is produced). This is quite different from laser used in general and eye surgery, which are very high powered units designed to remove or "cut" tissue.

 

Different types of lasers will produce different types of light or wavelengths.The units used in lymphoedema management and musculoskeletal treatments produce wavelengths of laser between 632 and 904 nanometers. Some lasers such as the scanning units used in our clinic use 2 wavelenghts of light at the same time. Different wavelengths have different depths of penetration and can have slightly different effects on the tissue.

 

Scanning units cover large areas of tissue (up to 10cm x 10cm) in a session.Hand held units are also frequently used by lymphoedema practioners as they are much cheaper to purchase, and there is reduced risk of eye damage if there is accidental beam irradiation into the eyes. They can also be used at home. They have a small aperture and so treat small areas at a time (1cm x 1cm).


Handheld units are becoming more accessible for purchase for home use, although they generally have smaller output aperturesand so treat a smaller area.

Early Use

Lasers were first used for wound healing in Europe in the 1960's, and there is a large body of research to illustrate how laser light enhances healing and reduces pain. Research papers have been published indicating positive effects can be achieved in many areas, such as healing diabetic ulcers, reducing pain associated with shingles and reducing plantar warts.

Use in Lymphoedema

Its use however in the management of lymphoedema was pioneered at this clinic in 1988 on the basis that previous research had shown that laser increases lymphatic function and regeneration.(Lievens, 1985)

 

The first clinical trial in 1995 (Piller et al, 1995) showed that laser alone caused an average volume reduction of 19% in 10 women with 

breast cancer related lymphoedema. A randomised double blinded trial was then performed in 2003 using a hand held unit (Carati et al, 2003). No immediate changes in volume occurred, but at 1 and 3 month follow ups, 31% of subjects had at least a 200ml reduction compared to only 4% of those who did not receive laser (control subjects). Significant softening of hard fibrosis was also measured. 

How is it used at our Clinic?

Our laser treatments consist of about 45 minute sessions in which several segments of up to 10cm x 10cm areas of a limb are treated directly with the laser light. In this way much of an arm or leg can be treated in one session. Hand held units can be used concurrently, particularly on areas of fibrosis and tightness as these further obstruct lymphatic return.

 

There is usually no sensation during laser treatment and it produces no ill side effects when used by experienced practioners. Many of 

our clients report immediate softening of hard areas and will describe a reduction in symptoms such as heaviness, aching and tightness.

This improvement can continue for several weeks in many individuals and further treatments appear to have a cummulative effect so that treatment times can be extended to 4-6 weekly or even longer as conditions stabilise.

 

There is no such thing as one treatment plan fits all, as we seek to encompass individuals differing needs and social situations.

References

Baxter et al , “Low Level Laser Therapy ( Photobiomodulation therapy) for breast cancer related lymphoedema :a systematic review”   BMC Cancer ( 2017) 17:833

Carati CJ, Anderson SN, Gannon BJ, Piller NB (2003) Treatment of post-masectomy lymphoedema with low level laser therapy: a double blind, placebo controlled trial. Cancer 98(6): 1114-22 

Censabella et al , “Photobiomodulation for the management of radiation dermatitis : the Dermis Trial, a pilot study of MLS laser therapy in breast cancer patients”  Support Care Cancer (2016) 24: 3925-3933

Cialdai et al , “ In vitro study on the safety of near infrared laser therapy in its potential application as a post-mastectomy treatment “ J of Photochemistry and Photobiology B: Biology (2015) 5: 285- 296 

Kaviani A, Fateh M, Noooraie RY, Ataie-Fashtami L, Alinagi-Zadeh MR (2006) Low-level laser therapy in management of post mastectomy lymphedema. Lasers Med Sci 21: 90-4

 

Lievens PC (1991) The effect of combined HeNe and I.R. laser treatment on the regeneration of the lymphatic system during the process of wound healing. Lasers Med Sci 6: 193-9

 

Lievens PC (1985) The influence of laser-irradiation on the motoricity of the lymphatic system and on the wound healing process. In: Proceedings from the International Congress on Laser In Medicine and Surgery, Bologna, 26-28 June: 171-4

Oman M et al (2010) Treatment of postmastectomy lymphoedema with laser therapy: double blind placebo control randomised study. J Surgical Research Vol 10 1016

 

Piller NB, Thelander A (1995) Treating chronic postmastectomy lymphoedema with low level laser therapy: a cost effective strategy to reduce severity and improve the quality of survival. Laser Therapy 7: 163-8

 

Piller NB, Thelander A (1998) Treatment of chronic postmastectomy lymphoedema with low level laser therapy: A 2.5 year follow up. Lymphology 31: 74-86

 

Tilley S (2009) Use of Laser therapy in the management of lymphoedema. 

J Lymphoedema Vol 4, No 1: 39-43

Zecha et al , “Low Level Laser Therapy /Photobiomodulation  in the management of side effects of chemoradiation therapy in head and neck cancer “  Support Care Cancer ( 2016) 24: 2781-2792