Suppl 4: Low Level Laser Therapy (LLLT) for Neck Pain

Description of the Intervention

Various treatment strategies including low level laser therapy (LLLT) are used to treat neck pain [6, 7]. The term Laser is an acronym for light amplification by stimulated emission of radiation-a form of photonic therapythat is defined by the following characteristics: collimation &#; it has little beam divergence over distance; convergence &#; the light waves are all in phase; and monochromicity &#; it has a single or narrow band of a particular wavelength of light [8]. Proponents of LLLT note laser devices are either high power or low power. High power laser devices, having a thermal effect, destroy tissue and are used during surgical procedures and for thermolysis. Low power laser devices have little to no thermal effects, have a stimulative effect on target tissues and are used to treat an array of musculoskeletal conditions to decrease pain and inflammation, stimulate collagen metabolism and wound healing, and promote fracture healing [8-10].

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Lasers used therapeutically emit relatively low light energy [from a few milliwatts (mW) to 100 to 200 mW] for short periods of time (seconds to minutes) and produces insignificant changes in tissue temperature (measured to be around 1.0 °C). As such, this type of laser is often referred to as LLLT or photomodulation. The wavelength of the light emitted from lasers varies from >100 to > nanometer (nm) in the electromagnetic spectrum [8] so only wavelength above 193 are transmitted in the atmosphere. Lasers used to stimulate biological tissues were historically produced using a Helium-Neon (HeNe) gas mixture. Light is attenuated exponentially in tissue and the physical penetration depth is given by the distance over with the initial power or energy density dropped to 1/e or ~37% of its original value. The depth over which a sufficient dose can be delivered comprises multiple physical penetration depths and is more commonly quoted in the literature. Here we adopt the clinical usage of this term as the depth to which clinical affects can be achieved. HeNe has a wavelength output of 632.8 nm that is visible red light, is continuous and can penetrate 0.8 mm into tissue with indirect effects of up to15 mm [8]. Currently low level laser devices are commonly produced from semiconductor diodes composed of crystal compounds such as Gallium-Arsenide (GaAs) or Galium-Aluminum-Arsenide (GaAlAs), designed to emit laser energy at various specific wavelengths in the infrared range of the electromagnetic spectrum (730nm to 905nm). The infrared (IR)-laser light, GaAs, laser can penetrate up to approximately 5 cm into tissue with a wavelength of 904 nm and is pulsed [8]. The IR-laser, GaAlAs, laser has a wavelength of 830 nm [11, 12], is pulsed, and can penetrate approximately 2 to 3 cm into the tissue [10]. Hence, lasers with longer wavelengths penetrate deeper into the skin tissue than lasers with shorter wavelengths. There is experimental evidence to suggest that the biological effects and physical behaviour of lasers vary with the wavelength of light used [13-15]. The wavelength of red light has been consistently shown to biostimulate cellular responses including membrane permeability, intracellular calcium influx, and ATP production [14-16]. Laser driver technology considers the delivery of the therapeutic dose (J or J/cm2) either with a constant time average or as a pulse light source with low duty cycle but very high dose rate. The pulsed delivery of light allows higher dose-rates to reach deeper tissues, particularly for very short pulsed and low repetition rates. For example, a 905 nm continuous wave infrared laser allows 2.5 cm penetration of a clinically effective dose-rate, while a 905 nm super-pulsed infrared laser allows the same dose-rate even at a10 cm depth. Super-pulsed infrared laser allows high peak power (50 W) to be delivered in bursts of very short duration (200 nanoseconds). These brief pulses of light energy are delivered at frequencies of up to 10 kHz. Thus superficial tissues will not heat up due to the very short bursts. This (high peak power of short duration and high frequency) allows a therapeutic dose-rate to reach deep tissues. It is however important to note that the dose is not effected by pulsed delivery, only its rate of delivery during the actual emissions cycle of the laser. Dual channel lasers can combine both continuous and pulsed lasers to allow superficial and deep dose-rate delivery of laser energy. Thus laser drive technology allows penetration to deep tissues or more superficial tissue promoting acceleration of healing by reducing pain and inflammation while staying below the Maximal Permissible Exposure tolerance for tissue. Because of the relative ease of producing semiconductor diodes and the relative ability of infrared light to penetrate biological tissues, infrared lasers (GaAs; GaAlAs) are most often used clinically to treat musculoskeletal conditions involving structures located deep within the joint. Dosage of a laser treatment is calculated using the power output [milliwatts (mW)], the surface area of the laser beam (cm2) and the amount of time the laser beam is in contact with the skin (seconds) [8]. The wavelength of the laser device (nm) determines the quantum energy available for photochemical processes during laser exposure. Laser energy density is measured in joules per square centimeters (J/cm2) of tissue area and laser power emitted is expressed in mW.

Embodiment Construction

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[] Embodiments of the present invention are described in detail below, and the embodiments described with reference to the drawings are exemplary, and embodiments of the present invention are described in detail below.

[] In describing the present invention, it should be understood that the terms "center", "longitudinal", "transverse", "length", "width", "thickness", "upper", "lower", "left", " The orientation or positional relationship indicated by "right", "vertical", "horizontal", "inner", "outer", "axial", "radial", "circumferential" etc. is based on the orientation or position shown in the drawings The positional relationship is only for the convenience of describing the present invention and simplifying the description, but does not indicate or imply that the referred device or element must have a specific orientation, be constructed and operated in a specific orientation, and thus should not be construed as limiting the present invention.

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