High Power Laser Therapy (HPLT) Revolutionizing The Non-Surgical Treatment of Neuro-musculoskeletal Pain and Wound HealingPHYSICIAN SEMINAR
Presented by: Bruce R. Coren, DVM, MS Cofounder, Chairman and CEOJoseph Costello, DC. DABCO Chief of Clinical Services Avicenna Laser Technology
What is High Power Therapeutic Laser Medicine -HPTLM• HPTLM is a new medical discipline that combines the fields of High Power Laser Therapy(HPLT), pain management, non-surgical orthopedics, neurology, biomechanics, kinetic chain dysfunction and podiatry to treat patients non-invasively and without drugs surgery or side effects• Before we get into the clinical aspects of HPTLM we will discuss the Biophysics of High Power Laser Therapy (HPLT)
HPLT – High Power Laser Therapy• HPLT was first introduced to the medical field in 2002 by Avicenna Laser Technology, Inc. The company invented and developed the first High Power Therapeutic Laser to receive FDA clearance in 2003.• The therapeutic laser system developed was capable of delivering healing laser energy to depth’s never before achieved and to offer physicians of all medical disciplines the capability to heal injuries previously refractive to traditional medical care.• Up until that time only low power therapeutic or cold lasers where available. The problem with the lower power lasers where that they had no ability to penetrate and thus only at best treated superficial pathologies.
The Design of the Avicenna Laser• The Avicenna laser was designed from the ground up to be a therapeutic medical laser.• It was developed using research by our own biomedical engineers and clinicians as well as collaboration with a major medical school and university optics department.• We investigated important criteria such as wavelength, power and power density, optics and beam delivery in order to afford the greatest penetration and delivery of a therapeutic dose capable of stimulating tissue healing in deep seated pathologies.• All of our lasers have there own research to support our claims as well as being tested in our patient treatment and R&D center.• No other laser manufacturer can make that statement.• They typically use studies done with other lasers and then make a great leap of faith to make the claims they do without any of their own research.• The world of laser therapy is unfortunately buyer beware!
LASER— an acronym for: Light Amplification by Stimulated Emission of Radiation
Lasers in MedicineSurgical Lasers:• Are used to cut, coagulate,and evaporate tissues.• This type of laser replacesthe scalpel of the surgeon.
Lasers in MedicineTherapeutic Lasers:• Are used for the stimulation of cellfunction.• The biological effect isphotochemical not thermal, as is thecase with surgical lasers.
Who is using Avicenna (HPLT)• Pain Management Specialists, Orthopedists,• Neurologists, Interventional Pain Management• Doctors, Physical Medicine and Rehab,• Physiatrists and Family Practice Physicians• Chiropractors and Physical Therapists• Podiatrists, Naturopaths and DOM’s• MLB, NBA, NFL and College Sports Teams• Medical Colleges• The United States Military and VA Hospitals• Veterinarians –Equine and Small Animal
Comparison of “Class IV” Surgical and Therapeutic Lasers• Surgical lasers collimate high amounts of laser energyinto a beam of high intensity resulting in tissuedestruction• High Power Therapeutic Lasers take a high amount oflaser energy but instead of beam collimation you getbeam divergence resulting in tissue stimulation
Properties of Infrared Laser Light•Laser Energy is just another form of energy on theelectromagnetic spectrum. Depth of penetration isdetermined by wavelength and energy density. In generalThe higher the wavelength the greater the depth ofPenetration. The high power laser delivers infrared light.
Biological Effects of Therapeutic Lasers• Laser therapy aims to bio-stimulate injured anddysfunctional tissues.• Clinical studies and trials of Class III & IV lasertechnology indicate the following beneficial effectsof light therapy on tissues and cells.
Cellular Effects of Laser Energy• Chromophores are components ofmolecules which absorb light.• The stimulation of chromophoreson mitochondrial membranes incitesthe production of ATP.• Leading to a biological cascade of events.
Cellular Effects of Laser Therapy Continued:• Increased Growth factor responsewithin cells and tissue as a result ofincreased ATP and protein synthesis.•Accelerated cell reproduction andgrowth leading to faster repair ofdamaged tissues.•Increased metabolic activity- via increase in enzymeoutputs, oxygen and nutrient availability.
Wound Healing Effects of Laser Therapy• Faster Wound Healing- Laser significantly increases fibroblastand collagen production which are essential for tissue repair.•Improved Vascular Activity- Increased capillary productionleads to faster wound closure.• Greater Tensile Strength – Surgical repaired wounds healwith greater tensile strength, including skin, tendon, ligamentand fascia.•Scar Tissue Reduction- Wounds heal with less scar tissueformation.
Anti-inflammatory Effects of Laser Therapy: Anti-inflammatory via an anti-edemic effect as it causes vasodilatation and activation of the lymphatic drainage system.
Analgesic Effects of Laser Therapy:•Via increased endorphin release.•Anti-inflammatory via less edema as aresult of lymphatic system activation andless swelling.•Via Suppression of nociceptors.
Immune System Effects of Laser Therapy• Strengthening the immune system response via increasing levels of lymphocyte activity and through a newly researched mechanism termed photo-modulation of blood.• Documented evidence of Tumor size reduction in animals. Mechanism of action unknown.
Miscellaneous Effects of Laser Therapy• Improved Nerve Function via increased nerve cellreconnections• Trigger Point Resolution• Acupuncture Point Stimulation•Dermatology, Respiratory, GI and OB-GYN cases also beingtreated by numerous Avicenna clinicians in the field.(Corporately We stick to neuromusculoskeletal and wouldhealing claims.)
Summary of LT Biological Effects •Accelerated Tissue Repair and Cell Growth •Faster wound Healing •Reduced Fibrous (Scar) Tissue Formation •Anti-Inflammation •Anti-Pain (Analgesia) •Improved Vascular Activity •Increased Metabolic Activity •Improved Nerve Function •Immunoregulation •Trigger Point Resolution and Acupuncture Pt. Stimulation
Laser Safety Safety protocols must ensure sufficientprecautions are taken toprotect the health and safety of employees and patients.
All Lasers are Not Created Equally• Although all therapeutic lasers bio-stimulate tissue, that is where the similarities end.• Laser Therapy is all about Physics!
Therapeutic Laser Classifications• Class IIIa = lasers 1 to 5mw of power (laser pointers)• Class IIIb = lasers 6 to 500mw in power (typical cold laser youread about)• Class IV = lasers above 500mw of power• Avicenna AVI HPLL-12 = 12,000mw maximum output
Therapeutic Laser Classifications• Therapy lasers are classified based on their power output•Class IIIa = lasers 1 to 5mw of power (laser pointers)• Class = lasers 6 to 500mw in power (typical cold laser or Low Level Laser)• Class IV = lasers above 500mw of power
Therapeutic Laser Physics• The therapeutic dosage of laser energy is measured in Joules• 1 Watt = 1 Joule / Second - For every one watt of laser power output, one joule of energy is delivered per second of time, for a continuous laser. - For a pulsed laser the energy delivery depends on the duty cycle, which tells us what percentage of time the laser is on or actively firing. If the duty cycle is 50% then the laser at 1 watt only delivers 0.5 Joules / Second. - For any given time period a continuous wave laser delivers twice as much energy that a pulsed laser with a 50% duty cycle• From this we can see that high power lasers can deliver considerably more energy than low power or their cold laser predecessors
How Light Penetrates Tissue• As light energy hits the surface of the skin and subsequent deeper layers, some of it is scattered and some of it is absorbed• At each tissue interface less energy is available to pass further through to the next layer because of the effects of absorption, reflectance and transmission
Absorption Curves980 nm: Low melanin, low water, low hemoglobin absorption thus an optimalwavelength to choose when designing a therapy laser for stimulating tissue at greaterdepths of penetration.
Physiological Effects Light – Tissue Interactions • 65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption: • Hemoglobin in blood • Melanin in skin, hair, moles, etc. • Water (present in all biological tissue) • In order to overcome those factors one most start with large quantities of energy on the skin
Therapeutic Laser Penetration• Prime Determinants of Laser Penetration andConcomitant Tissue Stimulation are: • Power – measured in Watts or milliwatts • Wavelength – measured in nanometers • Power Density – measured in mw / cm2 • Frequency – continuous wave versus pulsing
Importance of Power Density• Approximately 65% of the energy delivered is lost in the epidermis• If you don’t start with enough energy there will not be enough to stimulate cell healing• If you do not have sustained power density over a long enough period of time treatments may be ineffective• Too much power density can also be detrimental (surgical lasers that have been converted to therapy lasers.)• Collimated beam vs. Divergent Beam
Multiple Wavelength Lasers vs.Avicenna Single Wavelength Continuous Wave Laser• A laser with two or more wavelengths only has the ability to penetrate as deep as each individual wavelengths allows• Lasers that pulse or have a high duty cycle coupled with multiple wavelengths of energy emission will not penetrate as deep as CW lasers of a single wavelength• Continuous wave lasers = 100% duty cycle, laser is always delivering energy which is needed to overcome absorption in the superficial layers
In Laser Medicine 1 + 1 Does not = 2• Dual wavelength lasers onlypenetrate as deep as each wavelengthindividually. The penetration is notadditive, even our competitorsagree, and there is no real benefit tothis scenario.• It is more advantageous to have one wavelength of greater powerthat stimulates cell metabolism and tissue regeneration at alltissues in its pathway. We knew this going into the formation ofour laser system unlike our competitors who relied on other lasermanufacturers incorrect theory of wavelength and biostimulation.
Sponge Theory• In order to get penetration you must create significant energy density toovercome absorption in the superficial layers of the skin. With low powerdensity and even with pulsed class iv lasers it is like pouring small amounts ofwater onto a large sponge (the dermis and subcutaneous tissues) andexpecting the water to leak through. In order to to do so you must saturatethe superficial layers of the sponge- with enough water-energy to soak thesponge, so as you pour more water-energy over the sponge it will start topenetrate or leak through. This it what is needed and why it is important todeliver the energy in a continuous manner.• Low power or pulsed class iv lasers just cannot provide the energy necessaryto overcome the absorptive capabilities of the superficial skin layers and thatis why they fail to deliver a positive outcome when trying to reach deepseated pathologies.
How Much is Enough • 49-73 mw/cm2 for cell stimulation1 EFFECTS OF INFRARED LASER EXPOSURE IN A CELLULAR MODEL OF WOUND HEALING Mark D. Skopin and Scott C. Molitor, Department of Bioengineering, University of Toledo, Toledo OH• This study shows an optimal wavelength (980 nm) and power density range for wound healing and tissue stimulation
Laser & Tissue Powers Tissue Layer Max Power (mw/cm2) Epidermis 206 Dermis Layer 182 Dermis Plexus Super. 135 2nd Dermis Layer 115 Dermis Plexus Prof. 93 Muscle Tissue 9.7Power Setting 5 Watts, 3.0cm spot size, 980nm(This is a snapshot in time. Calculated using computer models by U of Toledo).Translation – As laser light or energy penetrates through the body more andmore energy is absorbed so by the time you start reaching deeper structuresthere is not enough therapeutic energy to cause adequate tissue stimulationand thus the reason why low power lasers as well as pulsing lasersCannot effectively treat deep seated pathologies.
Translation of Previous Two Slides• Translation – It is important to comprehend thatas laser energy penetrates through the body moreand more energy is absorbed at each tissueinterface, so by the time you start reaching deeperstructures there is not enough therapeutic energy tocause adequate tissue stimulation. This is thereason why low power lasers as well as pulsinglasers fail to deliver when treating deep seatedpathologies.
Other Factors Affecting Lasers Penetration • Duty Cycle – 100% • Laser is firing continuously • Duty Cycle – 50% • Laser is firing 50% of the time. This will not only cut energy delivery but it will also affect ability to penetrate. • Pulsing – Lasers that pulse also do not emit continuous energy • Avicenna is 100% continuous wave energy
Why Therapeutic Lasers Fail• Under-dosage – The typical low level or cold laser does not deliver enough energy to adequately stimulate deep seated inflammatory conditions• Under penetration - The typical low level or cold laser does not concentrate the laser energy sufficiently to allow for adequate penetration
High Power Therapeutic Laser Medicine (HPTLM)A New Medical Discipline that Allows Physicians to Successfully Treat Medical FailuresPHYSICIAN SEMINAR
HPTLM• High Power Therapeutic Laser Medicine is a new discipline in Neuromusculoskeletal Medicine created by Avicenna Laser Technology’s Team of Physicians• It revolves around using the Avicenna High Power Laser in conjunction with numerous areas of medicine such as:
The Success of HPTLM Revolves Around Creating the Best Environment for Tissue Healing• High Power Laser Therapy• Non-surgical orthopedics• Neurology• Foot pathology• Biomechanics, gait and kinetic chain dysfunction• Orthotic intervention• All of the above are critical components in achieving a successful outcome.
Avicenna Philosophy• Avicenna’s goal has always been to build the most efficacious laser available to deliver the best outcomes.• Our lasers are built from the ground up and are designed to get patients who have failed traditional therapy better• Our competitors lasers are built based on economic factors• There is a hugh difference between making a patient feel better vs. actually getting them better.• There are no shortcuts to treating real pathologies
“The Key to Better Outcomes”• Higher the power output of laser energy•The Greater The Penetration•The Faster the Therapeutic Outcome•The Quicker the Patient Returns to Normal•This is one of the reasons we developed our new technology the AVI HPLL-12
Goal of Pain Management Using Laser Therapy• Relieve Pain and Reduce Inflammation • Promote Tissue Healing • Minimize Side Effects • Restore Active Range of motion
Lasers vs. Standard Modalities Currently Used to Treat Neuromusculoskeletal Pathologies
Applications of Laser Therapy•Disc Pathologies, Spinal Stenosis, Radicular Pain,spondylolesthesis, and sacroiliac dysfunction•Failed surgical back syndrome• Accelerated Post Surgical, Soft and hard Tissue healing•Arthritis (Degenerative Joint Disease)•Foot Pain and Neuropathies•Muscle, Ligament and Tendon Injuries•Ulcerations and Open Wounds
Clinical Translation of the Previous Slide as it Pertains to the Spine • Decreased inflammation of disc, nerve roots and the cauda equine • Increase microcirculation of spinal structures • Accelerate healing of annular defects • Decreased formation of abnormal/non functional scar tissue • Decreased scar tissue and non-osseous hypertrophic changes • Reduce pain associated with prolotherapy injection • Decrease or even eliminate need for epidurals
Clinical Translation of the Previous Slide as it Pertains to the Lower Extremities• Decreased inflammation of nerve tissue• Accelerated Reinervation of nerve fibers• Increase blood flow and microcirculation of tissue structures• Accelerate healing of open wounds• Decreased formation of abnormal/non-functional scar tissue
Clinical Translation as it Pertains tothe Lower Extremities Continued…• Increase synovial fluid and cartilage production• Increase collagen and fibroblast production• Increase osteoblastic activity and fracture healing• Decreased bony edema – osteochondral bone bruise• Decrease in pain associated with epidural, prolotherapy or other invasive injections
Clinical ResearchAssessment of Laser Therapy for Late Postoperative Pain after Lumbar Fusion Surgery and For Pain And Wound Healing After Acute Traumatic Injury - Preliminary Results Ashok Biyani, MD Martin Skie, MD Despina Ciocanel, MD
Other Research Studies• Cornell University – Weill College of Medicine• Investigating the Effect of the AVI-HP 7.5 Therapeutic Laser on Post Thoracotomy Syndrome
Evidence Based Medicine•Avicenna clinicians all subscribe to the theory of EBM•Clinicians measures results with outcome assessment tools: • Pressure Algometer • Inclinometer , Goniometer • Thermal Imaging and Doppler Studies • VAS, PDQ – Pain Disability Questionnaire•These tools are vital to document outcomes whichultimately lead to adequate reimbursement
Avicenna Laser Therapy Protocols• Developed by Clinicians for Clinicians• Proprietary to AVI HP –7.5 and AVI HPLL-12•Utilizes Texas Back Institute Protocols in conjunction with laser• Will not work for LLLT or other Low Power Lasers as they cannot create significant power (energy density) to over come tissue saturation to reach deep structures in the disc, joint or areas of deep seated inflammation
—HPLT —A New Trend in Pain Management• Profound anti-inflammatory and analgesic effects• Pain relief typically immediate• Non-invasive and no side effects• Profound tissue regeneration of all tissue types• Overall contraindications minimal
Avicenna’s Clinical Advantage• Avicennas training incorporates the teachings of multiple disciplines including non-surgical orthopedics, physical medicine and rehab, neurology, podiatry, bio-mechanics and kinetic chain dysfunction.• Combined with our revolutionary technology we have brought to the field of medicine a new discipline: "High Power Therapeutic Laser Medicine”• Regardless of your medical discipline or level of experience we will train you to outperform anything in medicine when it comes to treating neuromusculoskeletal pain.• The training you will receive will not only be second to none, you will receive it complimentary for life, along with unlimited phone consultation services!• As good as our laser is, without proper training you may fail when treating difficult conditions• With our training, when it comes to pain management you will now be able to outperform anything in medicine, safely and without the potential for side-effects.
Avicenna Philosophy• Avicenna’s goal has always been to build the most efficacious laser available to deliver the best outcomes.• Our lasers are built from the ground up and are designed to get patients who have failed traditional therapy better• Our competitors lasers are built based on economic factors• There is a huge difference between making a patient feel better vs. actually getting them better.• There are no shortcuts to treating real pathologies
Introducing the AVI HPLL-12• A technological advancement in energy output and delivery• The AVI HPLL-12 is the world’s most powerful and advanced therapeutic laser system• But: As good as this technology is, without the appropriate training when it comes to treating medical failures your results will be marginal at best• As a physician based company we have treated or will know how to treat any condition you are confronted with the ultimate result being a better outcome• With the superior training and clinical support we provide physicians the above goal will readily be achieved
Avicenna’s Turnkey Marketing Program• Proper marketing is critical to assure financial success, whether it is internal within your clinic or external via various media outlets, news print, radio, tv, etc.• Avicenna provides each physician with a 32 inch LCD-DVD TV player to play its patient video to stimulate interest within the clinic.• Proven newspaper ads, along with radio and TV commercial scripts are also provided.• PowerPoint presentations to promote public awareness of the capabilities of HPLT to patients and other physicians. (This is the not only the most economical way to promote the laser it is also the most effective).• Free marketing consultative services. We will help you get up and running.• Free Website Listing – Each Clinic using our laser is listed under find a care provider.
The Key to Financial SuccessEffective Marketing
The Barrier to Better Patient Care is Always the Doctor (You?) Seminar Results Dollars spent including Ads and entertainment• Number of attendees 135, with 5 patients booking appt. prior to seminar.• Appointments book first week 20. (Still calling another 40 patients to confirm)• Income First 4.5 days post seminar $ 22,475
The Barrier to Better Patient Careand financial Success is Always the Doctor (Is that You?) • The first step in implementing a successful cash laser practice is recognizing that you need help and it is ok! • You didn’t go to medical school to get a business degree • Implementing our turkey program, which means duplicating what we do and consulting with Avicenna, will be the key to both clinical and financial success • The Future of Avicenna— “Licensing and Marketing Strategy”
Changing the WayPhysician’s Manages Pain Thank You For Attending Feel Free to Ask Questions www.AvicennaLaser.com 561-882-1430