#74 - Therapeutic Laser for Treating Pain, Part 2

[00:00:00] Hi guys, welcome to a new episode of the Factor podcast. I'm your host, Jessica Riddle. If this

[00:00:21] is your first time tuning in, welcome and thank you for listening. When you're a healthcare provider with doubts about wearable laser technology, stay tuned. We'll give you the lowdown on red flags to watch out for and how to assess the veracity of the technology you might be considering. So whether you currently use laser therapy in practice or, or just kind of intrigued

[00:01:40] enough to want to learn more, this you're talking about area, you need to have an estimate of how much tissue you're

[00:03:01] going to treat so that you can put in the right amount of energy.

[00:03:04] If you put in a thousand joules of energy into say a low back versus a thousand joules are energy and that is watts times time in seconds. So basically the more power you have the more watts the less time you need to deliver the same amount of energy. So it just goes to show if you had a one watt laser and you wanted to dose that forearm that 300 centimeter squared at 10 joules per centimeter squared it would take 50 minutes of treatment versus if you had a

[00:04:20] 10 watt laser you could cut that treatment time down to five minutes. So

[00:04:24] that's a real important concept higher power when you're treating that person. So just remember power is watts and energy is joules.

[00:05:42] So dose and power are slightly different,

[00:05:46] but they are interrelated. recently. We're going to talk about one of those here in a second, but exciting to see that literature is really starting to support the use of laser for a number of different things. So last year, the CDC put out a draft report on opioid reduction. And what was interesting is that they recommended the use of laser, LLLT, among several other therapies to help reduce the need

[00:07:01] for opioids. And the thing that was pointed out just that there's not enough access to these tools in our health system. So they really were trying to support health insurers and health providers and systems to try to get these modalities so that they can apply them to patients because they are

[00:08:21] successful and they work fairly well and there's very low risk.

[00:08:24] But because of the reimbursement problems that they're generally not reimbursed, there's with Pedro, which is the database out of Australia that looks at rehab papers. And they looked at carpal tunnel treatments with both high power and low power lasers. And what was great about this paper is they were starting, you're starting to get a sense that people are really getting how this works. So they basically treated,

[00:09:40] they had four different categories

[00:09:41] in addition to control group where they said,

[00:09:42] hey, let's do a high power laser with low dose

[00:09:46] and a high power laser with high dose. They basically were stating on a strong recommendation not to use opioids upfront. They state that most of these patients are gonna get better on their own, regardless of what intervention is, but they like the idea of using heat. And the class IV laser does create some superficial heat. That would seem to be a good choice as well. In addition to the thought of what we were talking about earlier about how it impacts pain

[00:11:00] with the C fibers for chronic pain,

[00:11:02] as well as the A Delta fibers for acute pain,

[00:11:05] it would also sort of lend to think

[00:11:07] that it might have far as cold goes, similar findings. They didn't recommend it for any category

[00:12:23] of low back pain. So whether it was acute,ocaine to inject, they didn't create the same amount of relief. As far as neck pain with radiating pain, they also recommended a laser for that person. So your radicular patients, as well as intermittent traction for your chronic patients.

[00:13:41] What they didn't support was use of a semi rigid collar.

[00:13:44] Again, continuous traction,

[00:13:46] thought that it could put too much stretch But especially with lower power devices, they just have a tough time getting enough light down to that three or four centimeters of depth at the nerve roots. And then neck pain with movement coordination that was not supported in JOSPT. But those are people that are more like fearful of motion. They're people that need more pain counseling and muscular reeducation as far as how to reintroduce normal patterning.

[00:15:03] So it didn't surprise me that that that as far as that slide goes. As far as like incorporating the manual therapy,

[00:16:20] there's benefits to use the laser before you do manual

[00:16:22] therapy just because it can help basically quiet down

[00:16:26] muscle guarding and splinting and spasm. So generally, how do you combine the laser? You just need to think about what you're trying to address. So you're trying to address pain. You're going to be trying to focus on a specific nerve path. They have a radicular complaint or for other factors that might be involved. When you're targeting the nerve, make sure you're just dosing that nerve properly and that you're traveling the path of that nerve, the more of it you innervate or excite

[00:17:40] with the light, probably the better result

[00:17:41] you're going to get.

[00:17:42] If you want to address the capsule and the synovium

[00:17:45] because you're trying to address the pain or tightness

[00:17:46] around a joint, make and you wanted to do your best to get pain relief, you'd probably want to treat with higher power. If you had a really acute, like a post-op patient, you're trying to just help overall address some of the acute circulatory issues that are present. In those cases, you might want to use lower power and lower dose because you wanted to reduce the chance of maybe some rebound pain or something that can happen

[00:19:00] sometimes when you treat with higher dose and higher power for an acute condition. So you have

[00:19:05] to have your thinking cap on. You got to understand what. If I've piqued your interest, you should be sure to click on the Factor 5 Things Friday link in our show notes. Simply give us your contact details and start getting our weekly Factor 5 Things Friday email in your inbox. It's a simple bullet point style format with no fluff, just tons of great

[00:20:20] content and resources you can use for continual professional word out. And then as far as coaching up your therapists or your clinicians on how to have these discussions with the patient and how to set up an introductory session with someone so they can experience it and how you can maximize revenue. Generally it's a cash transaction with those patients.

[00:21:42] So it is a special type of conversation.

[00:21:44] I noticed in the chiropractic space,

[00:21:46] you guys are excellent at talking to patients about cash for a single visit, but with your problem, I'm recommending six. So if you were to purchase the whole package today, we could discount that by 10% or 15% when that usually works out great. Wonderful. And I think I'd imagine you would echo the sentiment that once a patient has the treatment, they see the benefits of it, they see that pain relief. It's a lot easier for them to

[00:23:01] kind of realize that even though this may to be able to give a two hour

[00:24:21] talk on it, but you need to have at least enough information to talk about how it impacts

[00:24:25] pain and circulation and tissue repair. have extenders in most cases provide this treatment and get people feeling a lot better. So it's a really nice add to a lot of clinics where you might as the clinician, the lead doc do the initial treatment just to make sure you get the outcome you want. Maybe I'll explain it, answer the questions. And we generally recommend that because it's important for them to get the buy-in and have

[00:25:40] all those boxes checked.

[00:25:41] But then once you set up the protocol or the treatment parameters, you can usually hand assist them with utilizing laser in practice. So different companies have different levels of training anywhere from here's your box, good luck with a instructional manual to like what we do, which is more white glove, full service. So we understand that it's complicated. A lot of companies have sales forces that maybe sell a lot of different products

[00:27:00] and they're not experts in this space.

[00:27:02] And it's quite technical when it comes down

[00:27:04] to getting good outcomes for all the different conditions

[00:27:07] that you have that support and you have that team that can kind of help answer those questions as they inevitably will come up. When it comes to the conditions that are really effective and can have really great results when treating with laser therapy, if you had to kind of name getting support from these different groups like the APTA. They support it for plantar fasciitis heel pain, achilles tendinopathy, ankle sprains. Shoulders is one of those ones that's sort of a tweener. Like if you are using the right equipment and you know what you're doing and it's for a pathology that isn't something that requires surgery or isn't something

[00:29:43] like a frozen shoulder that is going to just require time because of the nature of the journals, there's a lot of that. But the next, because it's not as deep, that's where the JOSPT endorsement comes for treating neck problems, because you're dealing with tissues that are maybe two centimeters deep, as opposed to two to three fold when you get in the lower back. So I would say for the average outpatient person, if you're using it to help with neck pain patients,

[00:31:04] anything in the periphery, and if you had going too slow. It also vibrate to, it's got haptic feedback. So it helps the clinician know, hey, I got to speed up or slow down basically. Cause you don't want it to be so fast that you're not getting enough light to penetrate and you don't want it to be too slow because it gets too hot. So that was from feedback we got from users over the years. They were always like, how fast should

[00:32:21] we do it? This sort of helps take care of next question. We've heard a lot in the healthcare industry about wearable laser technology, about treated home laser technology. You'll go to any healthcare trade show and see tons of vendors out there

[00:33:40] selling different patches or booties you can wear or things of that nature.

[00:33:45] What are some things to look for when you see something like that, it or they're using things that are shorter. Like I've seen these patches that have blue or yellow wavelengths and purporting the greatness of that. Like for example, like in the, in the 430 range, which is in the blue range, there's been some studies that have shown that that helps with bacterial infection can help with bacteria.

[00:35:02] So everybody goes, Oh gosh, that'll be great.

[00:35:03] Put that all over everything.

[00:35:07] But the downside of that is that that blue range gets absorbed

[00:35:08] almost completely at the skin. There are certain thresholds that need to be reached for those to be effective. And the analogy you can think of is that if you sit out on the beach, get in the suntan for several hours, you're getting thousands of joules of energy put onto your skin, but because the intensity of that light is low and you're getting barraged with all sorts of wavelengths in the visible spectrum, it's not just say

[00:36:23] 810 or 980. Generally not creating any phot continue on our mission to deliver the best cutting-edge education

[00:37:40] to healthcare providers.

[00:37:42] And of course, be sure to check out the show notes for a link to the full webinar training