Low intensity laser therapy

Laser therapy low intensity also called laser soft (soft-laser), laser therapy or low level lasertherapy (LLLT) is a relatively recent area of science. It has a wide use in current medical practice, and there are a large number of acute or chronic conditions that can be treated with this therapy, with encouraging results, far superior to those obtained with the use of conventional therapy.

Table of Contents

Summary

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1 Introduction of Laser therapy in Cuba
2 Effects of Laser therapy on the body
3 Contraindications, side effects and precautions
4 Diseases that can be treated with Laser therapy
5 Shapes, frequency and dosimetry in the application of the laser
6 CEADEN in Laser Therapy
7 Cuban equipment installed in the national health network
8 See also
9 Sources

Introduction of Laser therapy in Cuba

Cuba has not been isolated from the introduction of laser therapy in medicine, and is currently at the forefront of Latin America and many third world countries in research and development of technologies in this area. The laser was instituted in the 70s of the last 20th century, when the first commercial devices for medicine and scientific research emerged. In that same decade, steps began to be taken in the construction of gaseous lasers. Currently there are therapeutic laser equipment in all the provinces of the country.
In 1990, a series of new devices were presented, and after being evaluated with positive results, the State assigned the necessary funding to MINSAP for the introduction of other models in the National Health System. Work continues to this day on the design of the most modern, economical, and high-quality equipment for entry into the national and international market, until achieving at CEADEN the FISSER 21 model, which exceeds in power and performance the previous equipment manufactured and it is currently installed in many of our health institutions.

Effects of laser therapy on the body

Low-power laser treatment offers a restorative and beneficial effect on nervous tissue, skeletal muscle, soft tissue and skin. From the biochemical point of view, its fundamental action lies in the modulation of oxidative phosphorylation at the mitochondrial level, where the synthesis of adenosine triphosphate (ATP), which is the fundamental form of energy of the cell, is stimulated.
Hence, normalization of cellular functions occurs in those diseases in which there are cellular and / or functional disorders. The remote effects of this low-power laser lie in promoting microcirculation and cellular trophism.
In microcirculation, the laser acts both at the level of the precapillary sphincter, causing vasodilation and reabsorption of exudates, as well as the blood stream, increasing the speed of circulation and the fibrinolytic system and eliminating microthrombi. In addition, it produces an increase in phagocytosis due to an increase in the number of macrophages and oxygen, and therefore, normalizes the injured tissues without causing deterioration in neighboring areas.
Laser radiation has physical properties that produce therapeutic effects on living tissue, such as analgesia in the irradiated area, since it interferes with the electrical message locally to inhibit the transmission of the painful stimulus, balances the membrane potential at rest and it avoids the lowering of the painful threshold and the anti-edematous or anti-inflammatory action, since it favors capillary vasodilation, accelerates the regeneration of lymphatic vessels, increases drainage of the inflamed area, favors fibrinolysis, and interacts with partitioning processes; as well as acting on the repair of wounds or trauma in various tissues, since it increases the rate of cellular mitosis, activates protein synthesis, and therefore cellular function, thus stimulating epithelialization processes,
The laser has a biostimulant effect based on hyperpolarization at the cell membrane level, accelerates metabolic processes and increases the exchange of nutritional substances, which contributes to strengthening the action of defensive cells. Its antibacterial, anti-edematous and stimulating action on the immune system is used.
Laser radiation, due to its photochemical effect, has a direct action on the precapillary sphincter. Capillary and arteriolar vasodilation occurs, with 2 consequences: the increase in nutrients and oxygen, which, together with the elimination of catabolites, contributes to improving trophism in the area and increases the supply of defensive elements, both humoral and cellular.
After laser irradiation, a primary response occurs, which is part of a biochemical behavior that is triggered after the absorption of the energy charge. The laser is a stabilizer of the sodium-potassium pump, and generally acts as a promoter in the exchange processes at the cellular level, as evidenced by the different studies carried out.

Contraindications, side effects and precautions

This therapy is indicated in diseases of any system that occurs with inflammation, pain or disorders of tissue repair. Any therapeutic procedure, however innocuous it may be, will always have its contraindications, which can be divided into absolute and relative.
The retina is in the first group of the absolute ones, since if the irradiation passes through the transparent medium of the eye, it is absorbed and deposited at the retinal level, producing a degenerative process that can lead to irreversible blindness. All this, if the irradiation were punctual and directly affected it. If it were through the optical fiber, or at a distance, the damage would not occur. Taking into account the indicated protective measures, there is no danger of eye damage for the patient or for the therapist.

Within the second group, the relative ones are the neoplastic processes: the biostimulatory effect of the laser occurs through the acceleration of cellular mitosis, that is, by increasing the number of cells, which is unknown if it happened irradiating neoplastic diseased cells, so that there are various criteria in this regard.
It is recommended not to use it on tumors, but distant processes can be treated, and not related to the primary lesion. It should not be used in acute septic processes: there are in vitro tests that show that irradiating bacterial foci can cause an acceleration and extension of the problem, but in in vivo experiments there is nothing categorically demonstrated, therefore, it can be used without antibiotic therapy with results positive.
It is recommended not to use it in generalized septic processes. In pregnancy it seems unlikely that it may affect the fetus, but the pregnant belly should never be irradiated and abortive acupuncture points should not be used. It can be used in affected areas far from the abdomen.

In the world literature there are other medical criteria for the non-use of such therapy. Without scientific support, the possibility of heating metallic prostheses or metallic IUDs has been raised, in the same way with epileptic patients and those who use pacemakers, which has been ruled out at present. It should always be taken into account that the patient is compensated for his underlying disease.

The use of photosensitizing drugs is not a risk, although some drugs such as steroids, quinacrine, and antimalarials may increase the absorption of laser radiation; therefore, low doses must be managed in these cases.
Internal organs cannot be directly treated with a therapeutic laser, only organs that have external cavities or by acupuncture points related to these organs. It can be applied intracavitary by using the fiber optic of a red laser.

Diseases that can be treated with laser therapy

In otorhinolaryngology (ENT): infectious or allergic sinusopathies, allergic rhinitis, pharyngitis, tonsillitis, sudden hearing loss and deafness, vascular tinnitus, otitis media and trauma to the ear.
In gynecology: cervicitis, ectopias, bartolinitis, vulvitis, vulvar ulcer, raffia, mastitis, mammary dysplasia, pelvic inflammation and genital herpes.
In neurology: facial paralysis, trigeminal neuralgia, intercostal neuralgia, and postherpetic neuritis.
In caumatology: burn ulcers and friction burns.
In angiology: vascular ulcer, venous thrombosis and poor plantar perforator.
In proctology: anal fissure, hemorrhoidal thrombosis, external hemorrhoids and operated pilonidal cyst.
In stomatology: gingivitis, alveolitis, canker sores, postimplantation of teeth, temporomandibular joint syndrome (TMJ), periodontal abscess and trismus.
In surgery: dehiscent wounds, foreign body granuloma, recent scars and keloids, post-cosmetic surgery skin and scarring, pressure ulcers, boils, abscesses and paronychia.
In orthopedics and traumatology: epicondylitis, epitrocleitis, tendinitis, cervicalgia, cervicobrachialgia, bursitis, painful shoulder, sacrolumbalgia, gonalgia (plantar fasciitis, calcaneal spur, post-fracture syndrome, carpal ganglion, carpal tunnel (STC), spring finger , Dupuytren’s disease, sprains, trochanteritis, piriformis syndrome, back pain, muscle strain or tear, and many other conditions of the osteomyoarticular system (SOMA) that cause inflammation and pain.
In urology: balanitis, orchitis, epididymitis, Peyronie’s disease and genital herpes.
In traditional medicine (laser puncture and laser ear puncture): migraine, neuralgia, bronchial asthma, stress, Bell’s palsy, SOMA conditions, ENT conditions and eye conditions (glaucoma, myopia, diplopia, conjunctivitis and optic nerve conditions).
In dermatology: herpes simplex, herpes zoster, inflammatory acne, acne rosacea, superficial mycosis, dermatitis, eczema, pyodermitis, boils, abscesses, recent alopecia areata, scleroderma and pemphigus vulgaris.

The absence of side effects and the fact that it is an effective, innocuous, painless, and aseptic method, places the therapeutic laser in the first line of treatment for many diseases that are presented to the Family Doctor and other specialists in the daily consultation.

Shapes, frequency and dosimetry in the application of the laser

Surgical lasers are applied directly to the region to be operated on. In therapeutic lasers in medical practice there are 3 ways of applying
Locally
Directly to the affected area, which according to its extension will require one or more application points. Local application is made in direct and perpendicular contact between the applicator device and the affected tissue.
The only cases in which direct contact should not be applied is when the lesion is wet (herpes simplex, varicose ulcers, fistulas, etc.) or when the affected tissue is a mucosa (pharyngitis, gingivitis, rhinitis, etc.). In these cases it is enough to separate the applicator a few millimeters from the tissue to be treated.
Laser puncture
That is, application of the laser to the acupuncture points considered by traditional medicine.
Trigger Zones are areas of the human body endowed with a particularly rich innervation and that reflect pain from a distance. Generally, in daily practice, the 3 forms of application are combined according to the clinical conditions that need to be treated.
The frequencies with which the laser applications are carried out will vary according to the pathology to be treated; Initially, laser treatment has been shown to be more effective in consecutive sessions (3 per week, in moderate doses). Then they can distance themselves in time, reaching 15-20 sessions on intercalated days, depending on the results.
Today, therapeutic lasers are applied more and more in different medical conditions, either as the only treatment or in combination with other physical or medicinal methods. These lasers emit energy in 2 forms: continuous and the other intermittently (pulsed)

When the laser is going to be applied, it is necessary to know what energy the equipment emits, the area where it is going to irradiate and how much energy has been deposited or is to be supplied to obtain a good therapeutic response. For this, the energy density (DE) is the relationship between the energy provided by the equipment and the surface of the spot (depending on the diameter of the fiber).

CEADEN in Laser Therapy

CEADEN is a research center located in the Playa municipality, which has a multidisciplinary team of researchers who for 20 years have been dedicated to the development, production and repair of laser equipment in the country, as well as to the training of personnel who work with this technology, located in the rehabilitation rooms and some hospital centers in the country and in other parts of the world.

Cuban equipment installed in the national health network

Fisser III: continuous emission gaseous helium-neon (He-Ne) laser equipment, with a wavelength of 632.8 nm (red) and a maximum output power of 25 mW. It is located in hospitals for use mainly on the skin and mucosa.
Lasermed 401 M: pulsed emission gallium arsenide (AsGa) semiconductor laser diode with a wavelength of 904 nm (infrared) and a maximum average power output of 7 mW, which is located in pain clinics, polyclinics and hospitals, for use in laser puncture, orthopedics, traumatology and sports medicine.
Fisser 25: continuous emission semiconductor laser diode with a wavelength of 650 nm (red) and a maximum output power of 20 mW. It is located in polyclinics and hospitals. It is used in the regeneration of tissues, in stomatology, in cosmetics and in laser-puncture treatments, mainly in skin and mucosal conditions (Figure 3).
Fisser 21: Continuous emission semiconductor diode with 2 applicators, 1 has a wavelength of 650nm (red) and maximum output power of 20mW, and the other of 780nm (infrared) and maximum output power of 40mW , to be used at analgesic, anti-inflammatory, tissue regenerating and laser puncture doses. It is also available in stomatology, in polyclinics and hospitals.
Lasermed 101 MD: continuous emission He-Ne (gas laser) laser equipment, with a wavelength of 632.8 nm (red), with a maximum output power of 2 mW, mainly used for laser puncture and laser puncture, in stomatology and skin and mucosa conditions. It is located in pain clinics, dental clinics and hospitals