Laser acupuncture: Practical guidelines

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Laser acupuncture: Practical guidelines

  1. 1. Laser acupuncture Dr/ Shimaa A Essa Ph.D , P.T, Laser applications in Physical therapy, NILES, Cairo University, Egypt.
  2. 2. Research Scope 1. Traditional Chinese Medicine Concepts 2. Scientific explanation of acupuncture points 3. Physiological effects of needle acupuncture 4. Physiological effects of Low Level Laser therapy 5. What laser puncture means 6. Advantages of laser puncture over needle puncture 7. Characteristics of laser devices used for laser puncture 8. Technical considerations for laser puncture application 9. Precautions and contraindications for Laser puncture application
  3. 3. 1. Traditional Chinese Medicine (TCM)Concepts [1] For every yin, there is a corresponding yang. For example, light is yin and dark is yang. In the human body, the tendons and bones are yin and the skin is yang. Harmony and good health occur when the yin and the yang are perfectly balanced, whereas unbalance results in dis-ease. All TCM techniques aim to restore the balance of yin and yang. Behind the theory of acupuncture ( Acu [Pronounced Ako]= needle, Puncture= penetrate) are the basic underlying theories involving yin, yang, and qi (pronounced “chee”). According to TCM concepts, everything in nature can be classified as either yin or yang.
  4. 4. 2. Scientific explanation of acupuncture points [2] 1- Skin resistance: (Not proved) Acupuncture points can be identified by decreases in electrical skin resistance 2- Correlation with motor points: (Not Proved) 3- Correlation with trigger points: (Not proved), acupuncture is not limited to trigger points.
  5. 5. 3. Physiological effects of needle acupuncture [3] 1- Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. 2- Stimulation by acupuncture may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. 3- Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented.
  6. 6. 3. Physiological effects of needle acupuncture [4] Figure 1. Brain single photon emission computed tomography (SPECT) images demonstrating cerebral blood flow changes in the brain between the baseline state with pain and post-acupuncture, when the pain was relieved. Red indicates the highest activity level, followed by yellow, blue, and black (in descending order). With pain (ie, baseline), thalamic activity is initially asymmetric, with activity on the left side greater than on the right. After acupuncture, the thalamic activity has shifted, with activity on the right side now greater than on the left.
  7. 7. 4. Physiological effects of Low Level Laser therapy [5] 1. Stimulates cell growth: Increase ATP production 150 X 2. Increases cell metabolism 3. Improves cell regeneration 4. Invokes an anti-inflammatory response 5. Promotes edema reduction 6. Reduces fibrous tissue formation 7. Stimulates nerve function 8. Reduces the production of substance P 9. Stimulates long term production of nitric oxide 10. Decreases the formation of bradikynin, histamine, and Acetylcholine 11. Stimulates the production of endorphins.
  8. 8. 4. Physiological effects of Low Level Laser therapy [6] A pilot study (2000) on 15 adult subjects showed specific changes in blood flow velocity in cerebral arteries both during stimulation with light as well as during acupuncture. These changes were more pronounced with needle acupuncture than with laser puncture. Also this study reported that laser puncture can elicit reproducible and measurable bioelectrical effects in the brain. These changes may have their origin in the thalamus or hypothalamus.
  9. 9. 5- What does laser acupuncture mean? [7] Low-level laser acupuncture involves the application of photonic energy to acupuncture points/tissues with the objective of augmentation of the normal healing process and/or pain relief.
  10. 10. 6- Benefits of Laser acupuncture over traditional needle technique? [8] 3) Consistently applied at any time (the results are replicable). 1) Laser acupuncture is beneficial for patients whom are apprehended by needle application or in a very weak health condition. 2) Shorter treatment times (5-12 Sec/ point)
  11. 11. 7. Characteristics of laser devices used for laser puncture [7]
  12. 12. 4) Gallium-Arsenide Laser (904 nm) Greatest depth of penetration, deeper than gallium-aluminum-arsenide. This is due to a much longer wavelength and because they are pulsed, forcing the laser light deep into the tissues. Useful for reaching deep acupuncture points and for the treatment of pain. Continuous wave lasers are now also available (Figure 2). 1) Helium-Neon Laser (632.8 nm) Helium-neon gas mixture. Visible red light. Relatively shallow depth of penetration. Very useful for laser acupuncture, superficial applications, and wound healing. Absorbed by mitochondrial cytochromes (Figure 2). 2) Indium-Gallium-Aluminum-Phosphorus Laser (633-635 nm) Now replacing helium-neon lasers. Visible red light, smaller and portable, inexpensive; higher power than the helium-neon, more durable. Same applications as helium-neon (Figure 2). 3) Gallium-Aluminum-Arsenide Laser (780-890 nm) Deeper penetration. Near infrared, invisible light. Many applications, inexpensive, very useful for the treatment of pain, but also effective in healing. Most popular therapeutic laser. Valuable to reach very deep acupuncture points or deep Ah Shi points (Figure 2).
  13. 13. Figure 2. Relative depth of various lasers commonly used in acupuncture
  14. 14. Models of laser acupuncture devices
  15. 15. Models of laser acupuncture devices
  16. 16. Models of laser acupuncture devices
  17. 17. Models of laser acupuncture devices
  18. 18. 8. Technical considerations for laser puncture application
  19. 19. Using cold lasers or electric stimulation requires supervision or collaboration with a physician acupuncturist or a licensed acupuncturist knowledgeable in the use of these modalities. [9] The applied laser dosage is determined by the manner of the intended effect, which is generally characterized as to stimulate or to sedate acupuncture points, Ashi Points, and Trigger Points. According to the Arndt-Schultz Rule, it can be understood that low dosages will stimulate and that higher dosages will sedate. [8]
  20. 20. Dosages of 0.5 to 2.5 J/cm2 are reported to be effective in the stimulation of superficial acupuncture points, With 2.5 to 5.0 J/cm2 being effective for deeper points and myofascial trigger points. Higher dosages (8 - 12 J/cm2) are effective for the sedation of points. [8]
  21. 21. For optimal biostimulation, use lower dosages per point with more treatment points and for optimal bioinhibition, higher dosages per point with less treatment points. [8] Visible red wavelengths (~620-690 nanometers) have shallow penetration and are used for superficial treatment such as facial rejuvenation, acne, scars and other skin blemishes. [8] Infrared wavelengths (~760-1260 nanometers) penetrate deeper for subdermal tissue treatment in musculoskeletal injuries, sports therapy and wound healing. [8]
  22. 22. Laser therapy works on the principle of inducing a biological response through energy transfer, in that the photon energy delivered into the tissue by the laser will modulate the biological processes within that tissue, and those within the biological system of which that tissue is a part. [8] Laser energy at or near 800 nanometers is particularly effective as this is close to the biophotonic emissions of cells. [8] Infrared diodes of 810 nanometers and 150 milliwatts were the most popular. Red diodes of 680 nanometers and 50 milliwatts ran a close second. [13]
  23. 23. 2 Hz Nerve regeneration, neurite outgrowth 7 Hz Bone growth 3-20 Hz Pain 700-2500 Hz Stimulatory effect >2500 Hz Inflammation, edema >5000 Hz Most lasers may be used in all instances for which moxibustion is indicated. There is no reducing or tonifying technique when performing laser acupuncture. [7] Low-level lasers when used in pulsed mode have significant effects that may correspond with central bioresonances. The following frequencies are suggested from prior research studies. [7]
  24. 24. Acute/chronic pain TMJ dysfunction Paresthesias Cervical/lumbar spine syndromes Neuralgias Dermatitis Allergic rhinitis/sinusitis Asthma Frozen shoulder Phantom pain Arthritis/arthrosis Fibromyalgia Bursitis, tendonitis Nerve regeneration Carpal tunnel syndrome Wound healing The following is a partial list of conditions that have shown promising results with laser acupuncture. INDICATIONS [7]
  25. 25. 9. Precautions and contraindications for Laser puncture application
  26. 26. Contraindications for Laser therapy [10], [11] 1) Irradiation Of The Eyes 2) Pregnancy (over the pregnant uterus), cancers (over the tumor site). 3) Over the Thyroid gland 4) Over pediatric joint epiphysis. 5) Transplant patients, or other immuno-suppressed patients. 6) Hemorrhage, Laser is believed to increase blood flow and hence, increase hemorrhage. 7) Patients using anticoagulants (susceptible for bruising due to over pressure by the laser probe. 8) Steroid Injections Patients may suffer an exacerbation of symptoms after laser therapy in conjunction with a recent steroid injection.
  27. 27. Precautions for Laser therapy application [10], [11] 1) Photosensitivity, Patients who have a photosensitivity disease, using photosensitizing drugs (Antibiotics, Antihistamines, Cancer chemotherapy ,Diuretics, Anti-depressants, Diabetic drugs, photodynamic therapy for skin cancer [ALA]). 2) Anti-Inflammatories Patients taking anti-inflammatories (NASIDs) for acute soft tissue injuries may not respond as quickly to laser therapy as those who are not. Ideally, we would suggest a combination of ice and laser therapy without the use of an anti-inflammatory. 3) Tattoos and Other Pigmented Tissues Dark pigments, such as tattoos and melanin, may absorb light at the wavelengths used in laser therapy. Where probes with high power densities are in use, the absorption of laser energy by these pigments may cause localized heating, and subsequent discomfort or injury, of the irradiated tissue.
  28. 28. Contraindications for Laser puncture [12] The vast majority of contraindications for acupuncture are relative rather than absolute contraindications 1- Sepsis and overwhelming infection. 2- Unexplained and/or unstable syncope or seizure. 4- Pregnancy (abortion risk) 3- Local contraindications of acupuncture include active infection, skin lesions, or malignancy at the application sites.
  29. 29. References 1- Nestler G (2002). Traditional Chinese medicine. In Lee B, LaRiccia P, and Newberg A. Acupuncture in Theory and Practice Part 1: Theoretical Basis and Physiologic Effects. www.turner- white.com, April 2004: 11-18 http://turner-white.com/memberfile.php?PubCode=hp_apr04_theory.pdf 2- Ramey D. Acupuncture points and meridians do not exist. The scientific review of alternative medicine , Summer 2001 ; (5) 3 :143-48 http://sram.org/media/documents/uploads/article_pdfs/5-3-03-Ramey.pdf 3- How Acupuncture works. Retrieved April 6th 2013 from ohttp://www.medicinenet.com/acupuncture/page3.htm 4- Lee B, LaRiccia P, and Newberg A . Acupuncture in Theory and Practice Part 1: Theoretical Basis and Physiologic Effects. www.turner-white.com, April 2004: 11-18 http://turner-white.com/memberfile.php?PubCode=hp_apr04_theory.pdf
  30. 30. References 5- Johnson D. Phototherapy 101. Sports and Industrial Rehab (Self Published).2006: 8 6- Litscher G, Wang L, and Wiesner-Zechmeister M. Specific Effects of Laser puncture on the Cerebral Circulation. Lasers Med Sci 2000, 15: 57- 62 http://www.nupen.com.br/port/odontologia/od_bibli/maio_2007/LASERACUP UNTURA/Litschercirculation2000.pdf 7- Vargas J. Low-Level Laser Acupuncture. Medical Acupuncture J, 2005; 16(2): 38-41 http://www.medicalacupuncture.org/aama_marf/journal/vol16_2/article_6.ht ml 8- Block E. Low-Level Laser Acupuncture Treatment In The Clinical Application Of The Five Shu Points. J Bioelectromagnetic Med 2010; 22. http://www.diamondhead.net/p22.htm 9- Fargas-Babjak AM, Pomeranz B, Rooney PJ. Acupuncture-like stimulation with codetron for rehabilitation of patients with chronic pain syndrome and osteoarthritis. Acupunct Electrother Res 1992;17:95-105.
  31. 31. References 10- NAALT Standards. Toronto Canada. 2006 11- Jenkins P . A concise introduction to Laser therapy. Retrieved April 4th, 2013 http://www.spectra-medics.com/llltinfo.html#Contra 12- Lee S. Contraindications of Acupuncture. Retrieved April 1st , 2013 http://acupunctureinmedicine.info/contraindications-of-acupuncture.html 13- Rindge D. Understanding Laserpuncture, Laser Needles. Retrieved April 4th , 2013. http://www.healinglightseminars.com/laser-articles/understanding- laserpuncture-laser-needles/

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