Authors:Dr. Puneeta Duggal

ABSTRACT:

Laser Acupuncture is now by far the third most popular method for treating pain in the world. A complete health system of acupressure points and meridians has been documented for use in treating over 3000 conditions. It has proved to be an effective option for the existing treatments and as a supplement to the current treatments as well. Acupressure with Lasers is a proven, natural and cost effective professional and self care system of treatment that can improve the quality life of the patients.

INTRODUCTION AND HISTORICAL ASPECT

Acupressure has been practiced as a healing art for around 5,000 years now. By using pressure or Laser Light instead of needles, acupressure works to stimulate (tonify or sedate) specific reflex points located along the lines of energy which run through the body, called Meridians. There are 14 main meridian lines, each of which corresponds to an individual organ of the body. When the vital energies are able to flow through the meridians in a balanced and even way the result is good health. When pain or illness is experienced, it is an indication that there is a block or leak in the energy flow within the body (1)

Acupuncturists first began experimenting with soft lasers during the 1970s. (2) In laser acupuncture low intensity lasers are used to stimulate the trigger points thereby curing many medical conditions. The use of this is called Low Level Laser Therapy (LLLT).

The earliest experimental application of lasers in acupuncture was by using Low Power Laser (LPL). In medicine, its use was first reported by Endre Mester in Hungary. He described the use of Ruby and Argon lasers in the promotion of healing of chronic ulcers and from there the use of terms like "Needleless Acupuncture" and “Pain Attenuation” started.(3)

LASER, an acronym for Light Amplification by Stimulated Emission of Radiation, was developed in the early 1960s. It is a form of electromagnetic radiation, in the visible or infrared region of the light spectrum, generated by stimulating a medium, which may be solid or gaseous, under inert conditions.(1) The laser machines are used widely by physiotherapists, dermatologists, ophthalmologists, medical acupuncturists as well as practitioners of alternate therapy (and now gradually even Dentists). (2)

MECHANISM OF ACTION:

This professional acupuncture Laser is a true red light laser with an effective 50 mW, 660 nm run beam. Acupuncture lasers such as the 660 enhancer probe delivers 6.3 Joules of energy to an acupuncture point every 3 minutes. (4) To tonify an acupuncture point only 1-3 Joules is needed and to sedate acupuncture point use 4-8 Joules. Using an acupuncture laser will enable an acupuncturist, dentist or therapist to treat 1-6 acupuncture points during a 3 minute cycle at a time. Laser Acupuncture is a non-invasive therapy for wound healing, neurologic recovery, and pain reduction. The laser acupuncture broadly has the following functions:

1. Stimulation of acupuncture points: Laser is used to stimulate acupuncture points using the same rules of point selection as needle acupuncture. Laser acupuncture may be used solely or in combination with needles for any given condition over a course of treatment.

2. Treatment of trigger points: In some musculo-skeletal conditions higher doses of laser may be used for the deactivation of trigger points. Trigger points may be found in muscles, ligaments, tendons and periosteum. Direct irradiation over tendons, joint margins, bursae etc may be effective in the treatment of conditions in which trigger points may play a part. Children and the elderly may require smaller doses. Areas of thick skin or muscle may require higher doses for penetration than finer skin areas e.g. ear.

3. Promoting healing: The bio-stimulatory or healing effects of laser have been widely investigated both in-vivo and in-vitro. Bio-stimulatory effects of laser are governed by the Arndt-Schultz Law of Biology i.e, weak stimuli excite physiological activity, strong stimuli retard it. The implication of this for wound healing is that, as treatment of a wound is continuing and there appears to be a slowing down of healing, a reduction of the laser dosage may be needed. By virtue of the Arndt-Schultz Law and the changed responsiveness of the tissues, what was originally a stimulating laser dose may have become an inhibitory dose of laser. The optimal energy density for bio-stimulation, based on current clinical experience, is 4 J/cm2. Dose must be adjusted according to individual response.

A) PHYSIOLOGY OF LASER ACUPUNCTURE:

Laser acupuncture relies on the absorption and scattering of light within tissues in contrast to needle acupuncture, in which input begins with the micro-traumatic mechanical effects of the needle on local tissue. Photons from the laser create a stimulating, bio-modulatory effect. Physiologic changes include: increased phagocytosis, vasodilation, increased rate of regeneration of lymphatic and blood vessels, stimulation of enzyme activity at the wound edges, fibroblast stimulation, keratinocyte and fibrocyte proliferation, scar and keloid reduction, increased ATP and DNA synthesis, and stimulation of muscle, tendon, and nerve regeneration. The functional Magnetic Resonance Imaging (MRI), has shown that, Laser acupuncture activates specific regions of the brain that releases Endorphins and Enkaphalins and hence promote healing.

B) What is Gaussian Beam Mode and Alpha Phenomenon?

The Laser working in the Gaussian Beam Mode has a healing effect. In this mode, the power of laser is highest at the centre of the beam with the power then falling off, with the weakest power at the periphery of the beam diffusing out into the undamaged tissues. This phenomenon was called the "Alpha-Phenomenon". (3, 4) Thus the "Low Power" segment of the beam was postulated to be responsible for the decreased pain and inflammation and promoting healing activity in the wound/ lesion. Laser devices were manufactured in which power densities and energy densities of laser were lowered to a point where no photo thermal effects occurred but the photo-osmotic, photo-ionic and photo-enzymatic effects were still present. And hence, the use of "cold" laser "soft" laser, as it was first came into being.(4)

C) MECHANISM OF ACTION AT THE MOLECULAR LEVEL:

1. Neural: Laser causes in-vitro changes in nerve action potentials, conduction velocities and distal latencies. Experimental evidence has demonstrated significant pain relief following low power He-Ne and infra-red laser stimulation of acupuncture points. Increased levels of serotonin in chronic pain patients after treatment with low power Helium-Neon laser(8)

2. Photo-activation of Enzymes: one photon can activate one enzyme molecule which in turn can process thousands of substrate molecules (3). This mechanism provides a theoretical framework in which a very small amount of energy can cause a significant extent of biological effect. Primary photo-acceptors, which are activated by laser, are thought to be flavins, cytochromes (pigments in the respiratory chain of cells) and porphyrins (9,10). They are located in mitochondria. They can convert laser energy to electro-chemical energy.

Low doses of laser stimulation cause the ATP in mitochondria to be activated causing further activation of the Ca++ Pump, release of Ca++ in the cytoplasm (via ion channels), cell mitosis and cell proliferation. Higher doses of laser stimulation cause hyperactivity of the Ca++/ATPase pump and exhaust the ATP reserves of the cell. This results in failure to maintain osmotic pressure within the cell and it explodes.

3. Vibrational and Rotational Changes In Cell Membrane Molecules: Infra-red radiation results in rotation and vibration of molecules in the cell membrane leading to activation of the Ca++ pump as in the cascade above. Different wavelengths may stimulate different tissue responses which may be synergistic and thus produce better clinical effects. (10)

GENERAL USES OF LASER ACCUPUNCTURE:

      Bio-inhibitory effects of laser may occur at higher doses e.g. 8J/cm
2
    . Treatment of keloid scars has been successful at these doses. The promotion of healing of wounds e.g. venous and arterial ulcers, burns, pressure sores. Treatment of skin infections such as herpes zoster and Labialis. Laser may have an enhancing effect on healing wherever inflammation is present. A wide range of conditions are amenable to management by Laser. Many of these include conditions not amenable to or unresponsive to current drug or physical therapies such as Osteoarthritis, Back Ache, Post-Herpetic Neuralgia, Chronic Pelvic Inflammation and Rheumatoid Arthritis.



USES IN DENTISTRY:

The uses of Laser acupuncture in dentistry are not completely established other than in management of Pain and Dental surgery related neurological complications.

1.Pain Management:

      The most frequent complaint among the dental patients is Pain. Laser Acupunture can reduce or eliminate pain of various origins (6). Low level stimulation of the acupuncture points with 1-2 Joules of energy lead to release of Endorphins and Enkaphalins and reduce the nociception at the cerebral level by binding to the opioid receptors. Post operative pain especially after the extraction of mandibular third molar is managed well using auricular acupuncture before the effect of anaesthesia wears off (12).


2.Management of Paresthesia:

      After oral surgery paresthesias may occur as a result of the surgery, in particular in the mandibular region. Laser Acupuncture has been used to reduce the effect of such complications (12).


3.Trigeminal neuralgia:

      Apart from being extremely debilitating, trigeminal neuralgia can sometimes make dental treatment impossible. While no miraculous cure is possible, dentists can offer a great deal of comfort to these patients, and with a non-invasive method of Laser Acupuncture (12).


4.Controlling the Gag Reflex:

      A series of 37 cases were evaluated for controlling severe Gagging Reflex (GR) during dental treatment (requiring an upper alginate impression). All patients were first evaluated before acupuncture, and a second upper alginate impression taken immediately after acupuncture of point CV24. The Gag Reflex assessment was undertaken using the Gagging Severity Index (GSI). Prior to acupuncture, all 37 patients were unable to accept the impression taking. An improvement of around 53% for the three stages of impression taking was noticed. Thirty patients (81%) were able to accept the impression taking. (11)


5.Pain Anxiety:

    A case series that examined the effect of acupuncture given prior to dental treatment on anxiety. The cases were evaluated using the Beck Anxiety Inventory (BAI) score. The assessment was made before and after the acupuncture treatment. All patients received acupuncture treatment for 5 min prior to the planned dental treatment. There was a significant reduction in median value of BAI scores after treatment with acupuncture with a score of 26.5 reduced to 11.5, and it was possible to carry out the planned dental treatment in all 20 cases after acupuncture treatment. The researchers therefore concluded that acupuncture prior to dental treatment has a beneficial effect on the level of anxiety in patients with dental anxiety and may offer a simple and inexpensive method of treatment (13).



ADVANTAGES OF LASER ACUPUNTURE:

The advantages of Laser Acupuncture are many. The following are to name a few (9, 10):

-Pain-free treatment

-Non-surgical,

-Non-pharmaceutical

-Safe and effective

- Treatments generally last less than 20 minutes

-No requirement to stop or modify work/activities

-Long-lasting results

-Effective rate more than 80%.

COMMERCIAL MACHINES AVAILABLE:

Fig 1: Showing a type of Laser Acupuncture Delivery Pen



Acupuncture Pen is a dual-purpose handheld device for both clinic and personal healthcare use that provides acu-point location as well as electrical micro current therapy. It applies a painless stimulation to perform electro acupuncture includingauricular and hand acupuncture and acupressure. It emits a low-intensity electric current (micro current) to stimulate the acupuncture points, which makes this method especially simple, clean, painless, gentle and ideal for people sensitive to acupuncture needling No piercing of the skin is required while stimulus is conducted by simply touching the button. Acupuncture Pen measures electrical resistance of the skin to accurately detect and locate major acupuncture points of the human body with an acoustic signal through special sensations of the skin and body tissue. The approximate location of an acupuncture point is detected and scanned with Acupuncture Pen. The simulation time is either individually selected or preset to15 seconds or 30 seconds with the working current of 5-10 mA.

Fig 2: Showing a type of Laser Acupuncture Delivery Pen



CONCLUSION:

It can be therefore concluded that laser is a healing light that can be used to alleviate pain with minimal side-effects. This low-power laser (LPL) treatment can also provide safe and cost-effective treatment and hence it emerges as a new modality to relieve patient of pain that is unresponsive to conventional mode of treatment.

REFERENCES:

  1. Thermographic Study of LLLT for Acute-Phase Injury. Yoshimi Asagai, M.D.1, Atuhiro Imakiire, M.D.2, Toshio Oshiro, M.D.3, 1. Shinano Handicapped Children's Hospital Shimosuwa, Nagano, Japan 2. Department of Orthopedic Surgery, Tokyo Medical University Shinjuka, Tokyo, Japan 3. Japan Medical Laser Laboratory Shinanomachi, Tokyo, Japan.
  2. Aurelicio N. Silva Junior, Antonio L.B. Pinheiro, Marilia G. Oliveira, Ruben Weismann, Luciana Maria Pedreira Ramalho, Renata Amadei Nicolau. "Computerized Morphometric Assessment of the Effect of Low-Level Laser Therapy on Bone Repair: An Experimental Animal Study." Journal of Clinical Laser Medicine & Surgery. April 1, 2002, 20(2): 83-87. doi:10.1089/104454702753768061.
  3. Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. "A Systematic Review of Low Level Laser Therapy (LLLT) with Location-Specific Doses for Pain from Chronic Joint Disorders." Section of Physiotherapy Science, University of Bergen, Bergen, 5020 Norway. Aust J Physiother 2003;49(2):107-16.
  4. Research Institute of Pediatric Oncology and Hematology, Russian Oncological Scientific Center. L.A. Durnov, A.Y. Grabovshchiner, L.I. Gusev, S.A. Balakirev.
  5. Fund DT, Ng G, Leung MC, Tay DK> "Therapeutic Low Energy Laser Improves Mechanical Strength of Repairing Medial Collateral Ligament." Lasers Surg Med. 2002; 31:91-96.
  6. K.R. Byrnes 1, R.W. Waynant 2, I.K. Ilev 2, B. Johnson 1, Pollard H. 1, Srivastava M. 1, Edelman O. 1, Huang W. 1, Anders J.J. 1. "Light Therapy (LLLT) Alters Gene Expression After Acute Spinal Cord Injury." World Association for Laser Therapy. 1. Department of Anatomy, Physiology and Genetics, Uniformed Service University, Bethesda, MD, USA; 2. Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD, USA.
  7. Kevin C Moore MB Ch B FRCA, Naru Hira, Parnswanath Kramer, Copparam Jayakumar, Toshio Oshiro. Department of Anaesthesia, Royal Oldham Hospital UK. "Double Blind Crossover Trial of Low Level Laser Therapy (LLLT) in the Treatment of Post Herpetic Neuralgia." Laser Therapy. 1988; 1:7.
  8. Muxeneder R. Soft laser in the conservative treatment of chronic skin lesions in the horse. Der Praktische Tierarzt. 1987;68:12-21.
  9. Pöntinen PJ. Chapter 17, “Low-energy photon therapy” in Schoen AM and Wynn SG (eds.): Complementary and Alternative Veterinary Medicine, Principles and Practice. St. Louis: Mosby, 1998. pp. 247-274.
  10. Laor Y et al. The pathology of laser irradiation of the skin and body wall of the mouse. Am J Pathol. 1965; 47:643. Cited in: Pöntinen PJ. Chapter 17, “Low-energy photon therapy” in Schoen AM and Wynn SG (eds.): Complementary and Alternative Veterinary Medicine
  11. Rosted P et al. The use of acupuncture in controlling the gag reflex in patients requiring an upper alginate impression: An audit. British Dental Journal 2006; 201: 721-25
  12. Tavares MG et al. Electro-acupuncture efficacy on pain control after mandibular third molar surgery. Braz Dent J 2007; 18: 158-62
  13. Karst M et al. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg 2007; 104: 295-300.