The use of lasers in surgery and to treat diabetic retinopathy is well known. A different type of laser, low-level laser therapy (LLLT), is now making news in medical circles.

Unlike high-power lasers that use heat and destroy tissue, low-energy (cold) lasers (through infrared, red and helium-neon (HeNe) light emissions from diodes) affect the cellular energy of the underlying tissue.

"LLLT promotes healing in many conditions because it penetrates the skin, in-creases ATP [adenosine triphosphate] and activates enzymes in the targeted cells," says Andreas Schindl, MD, PhD, Austrian laser researcher.

Different wavelengths are used for different conditions, and are sometimes used in combination. The intensity and length of application of the laser may also vary. Using the incorrect protocol for the specific ailment may result in the treatment having little or no efficacy.



Benefits of LLLT Treatment

When Val Volkov, MD, president of the New Zealand Laser Therapy Association, was asked about the uses of LLLT for diabetes, he responded without hesitation.

"My father had diabetic gangrene while living in Uzbekistan, and my application of LLLT saved his life."

This wouldn't surprise Schindl, who states that clinical experience and published research support the use of LLLT in diabetes for ulcerations, neuropathy and bone conditions. He describes a hospitalized diabetes patient with an ulcerous lesion on his toe that was complicated by edema, advanced infection and osteomyelitis. After the patient was given antibiotics and 16 laser treatments, the ulcer completely healed.

Schindl states in a September 1999 issue of Dermatology that because LLLT has been used successfully in various dis-orders of microcirculation, it should be considered as an alternative therapy prior to surgery in patients with diabetic gangrene.

"There are no known side effects and it may be used concurrently with any other therapy," he says.

A double-blind study on humans with diabetic ulcerations should be completed in Vienna by December.

LLLT was used concurrently with topical hyperbaric oxygen in an Israeli study of 100 consecutive diabetic foot-ulcer patients who had not responded to prior therapies. According to the March 2001 issue of Yale Journal of Biology and Medicine, 81 percent were healed in an average of three months.

Although LLLT can work remarkably well for diabetic ulcers, Dr. Les Johnson, a podiatrist from New Zealand, cautions, "LLLT is no panacea. One patient may respond dramatically, and another not at all." Yet, when the public health service would not allow him to recover the cost of a laser, Dr. Johnson had no trouble persuading a local support group, Diabetes Wairarapa, to raise grant money to fund the device.



Laser Acupuncture

Published studies show that LLLT is often used on both acupuncture and trigger points. According to a August 1996 issue of Journal of Clinical Laser Medical Surgery, a Swiss laser center applied LLLT on trigger points and observed that the effect on shoulder and arm pain, as well as other conditions, exceeded expectations. Improvements occurred in both microcirculation and the oxygen supply to the trigger-point areas.

In addition, a study in the February 1999 edition of the Journal of Alternative and Complimentary Medicine concludes that when a combination of low-level laser acupuncture and transcutaneous electrical nerve stimulation (TENS) was used in the treatment of carpal tunnel syndrome, it reduced pain by more than 50 percent in 33 of 36 hands, including 14 that had failed to respond to surgery.

Laser acupuncture was also used in diabetic patients with angiopathies of the lower extremities. Among the results were pain reduction, increases in peripheral circulation and better functioning, according to Lik Sprava in October 1992.



Intravenous Laser Irradiation

Journal articles written in Russian publications report success using intravenous laser treatment, an invasive procedure that treats the blood directly with laser light. A study appearing in the January 1999 issue of Vestnik Oftalmologii reports that diabetic retinopathy was reportedly effectively treated by intravenous laser irradiation and heparin inhalations.

In another study that appeared in the October 1998 issue of Voenno-Meditsinskii Zhurnal, non-invasive LLLT and intravenous infrared laser therapy were each found to improve blood lipids in people with diabetes, although the latter had the greater effect.



Organizations

Clinical use of laser therapy often outpaces techniques reported in pub-lished journals, as practitioners are working out pro-tocols for each condition and ex-panding the number of ailments effectively treated. Meetings of laser researchers and practitioners offer an oppor-tunity for partici-pants to exchange information on new techniques and present papers on various related topics.

In the United States, the American Society for Laser Medicine and Surgery (ASLMA) is an organization that encompasses the use of all types of medical lasers, in contrast, the North American Association for Laser Therapy (NAALT) focuses specifically on LLLT. A number of different professions are represented in NAALT, including physicians, physi-cal therapists, scientists, chiropractors, acupunctur-ists, nurses and veter-inarians. FDA approval in the United States is one of the stated objectives of NAALT.

Worldwide organizations also flourish, and some have recently splintered into different factions. At Laser Florence, an international trade fair and medical congress scheduled to take place in November, organizers are planning a four-hour course of particular interest to those in the diabetes community. Petridev Ramdawon, MD, of Mauritius will present the course on "Laser Dia-betology." Dr. Ramdawon will teach the use of LLLT and other quantum tech-niques for type 1 and 2 diabetes, which produce a long-lasting hypoglycemic effect.

Noting the appropriateness of the setting for the conference, Leonardo Longo, MD, president of Laser Florence, states, "The use of the laser in medicine, surgery and the human sciences is a Renaissance, of sorts, in medical treatment."

Note: In the United States, the FDA has not yet approved low-level laser therapy for general use, although it is classified as a "non-significant risk device." Practitioners may apply for permission to use it for investigative pur-poses. Most published studies on humans have been done outside the USA. Intravenous LLLT therapy is not generally available in most western countries.



Pauline Lathram, a freelance writer, lives in Memphis, Tennessee. She is interested in innovative medical treatments. Her daughter has type 1 diabetes.