low Reactive-Level Laser Therapyin the Treatment

This art ic lc is based oD.1 le. ture Eiven,t the 8 , ,1-S Auturr/r S{: ielni i i ( Meet i igltcld ,11 th€ llaval Sa.i-.ty at tr1e.li( ine in Octobcr 1991

SutnfiatyThe physi(al prapcft icsnt ecl i c a I L t ses r:f ,t 1tp I i ecl

Th-. ner.tropatholotv ai hcrpcs zosler an.l theretioloBy oi posthctpctic Dcunl a IPHN) dt-.sLtntntarised, and thc various Ire.t!nt-onl appro;tchesare r/rscusscd. By rnat.hit i t the knotrn healingprcpettics al ltcilic laser Lr';ve/er3ths and theunclerlying ncurcpathalaly oi Pl lN, a lni i le offherapv has bccn dt-vt-loped ior ttirl itt thosepatients suff ir inB l iot11 iDlra.lable PHN, !ef id.ttr ') t()ca n vc n I ion a I I rc.11 t t te t ) L

Key wordsHcrpes zosleL lr-se/ /)h),51c-\, NeLtrcpathalag.v, Posthcrpetic Deurdlgi;.

Elsewhere in this rssuc (patc 2J"A revi-.\r al Iotr-powet Iaser pain rclievint controlled .linical trials"is pr,"sented. Unfortunatc' ly th s othcrwise excel entand delni le(l review is lookint at ar inei le. l ivea\p-ocl of Inser therapy. Trc fact th. l t low fea.l v-"1 . , . - | , l l l - h ^ ' " . r r

9 . r " r -parl ir) most Cont nental hea th scrviccs srnae l lrelal," 'aros - not ior the a lev atior oi pain, bul Lo.r.c-., .r.rte lhe healing of dam.lgcd l issle isscarcely rnenlio|1ed. l t s also sigri icaIt thal thelnlcrnaliolra Lasef Therirpv Association l lLTAt, at i lsLo rdon mee t ing i n Sep te f rbc r 1992 . €e .L - "d DrNlafy D),son as President. signi l icanl h,".ause ILTAen)bmces ir I nrodes oi ascr appl cal ion innledi( ine, Le. high por,vcr, destru.l ive laser iorsLrrgerv; mid powcr ophthalm c laser; ancl lovr-po!!er non thernral therapy. Dr Dysof h,"a.ls lheTiss!e Repa r R..search Ufh al Cuv's Hospital,wh ich has c l ca r , v dcn rons t ra led tha t t he p r i nc ipaeiiects oi lo\\, rcacl ive level laser are nc{ elerat on otu,ouncl heal rg and repair oi darrraged t issue l7Jl.An1, rel iei of pa r is .r sccondary ei iecL.

t is c early lnisg! clcd to use ou po\t-er nser ns nnacLrpunciL fc irstr-Lrrefl . There is nothing morecilcct vc thar a n-"edle in the right hancJs. At thcsamc t imc, i t is unjusti l j .rble Lo crit cise lo\\ ' po\\ 'cfascT as n l l 'eaLmenl \yslenr \\ ,hen it is being applicd

I , ln ) , r )9 , i , i t / l No. /

oi Laser and th-a pt-rsen!phatobtolo cal enetty arc

inappropriatelv, at th€ sarne t me ignoring theabundan t acadcmic l l e ra lu re on the t i ssue hea l r fE iand repJir effects of ight enerBy f7,721.This nft ic e seeks to rcslore Lhe balnnce.

Physics and photobiologyWhile i t is Lrn rcccssaTy ior l l)e cl n cian to have adeep knowicclgc oi Lh," scienti i ic bass ol taseractrons, t s importanl lo Lrnderstand some oi t feparanretcrs, in order Lo Lrse the availab c systemsmo e safelv and ci ie.Livelv in the treatment ol oulpatents. l t s also i l l l lorttnt ior !s lo bc afi le 1oinlofir our aol engLres as well as our patiet) ls - thntLh i s s no l j L rs t nn e \pens iVe p laccbo l

lhc word LASER is an . lcronym ior LiShtArnp ir i .aLion by the Stimulatccl Em ssron otRadiatiorr. Light has been Lrscd ior i ts healing ei iectslor aeflLrr ies. Pants cannot srlrvive !vi lhoLtt ightipholos),nlhesis is essential iof plant metabol sm.There is a recent fcport on lhe benefits of l ightthernl)y fo seasoral dcpres<iolr - ior people whosri ier irom clepressior during the w,inter. (But \!enlLrsl also remembe trc rv.rrnings about erposure oflhe skin to sunlight, and the dangefs of increasedLrl l f ,r-violet rrdiatron duc to ozon-o dep etion in thce.rf ih's nimosphere.)

Visib e ight occupies on11, a smal portron ol theelectro magnctic spealrLrf ir, \ 'vhere the wavclen€ith is' ' r . r i ' o r ^ o . J . ' r ' . \ , ' b n ' r n nFii jLrfe l , t l i€s bellveef Camrn, a!,s and Radjorvaves. Thc invi5ible parls of the l ight spcctrum .rrethe ultfa violcl ($avelength less thar 200fanomctrcsl an.l l l )e infr ir red (grcaler lhan 700ranomelres). One ninometre (1nN,1) is one mil l ioniho l t o t e . t r 6 z - . , , . , e r , t , ^ l a r , - , J , . p i \

corcef fed wi th in f ln tc 's lmal ly smai l c l is tances,

t l

."'--lP#:�: L,"nfff'ff.?"--

^cupun.tua ln Me.I.ine

on 19 May 2018 by guest. P

rotected by copyright.http://aim

.bmj.com

/A

cupunct Med: first published as 10.1136/aim

.11.1.11 on 1 May 1993. D

ownloaded from

compafed with the much larger radio and TVwaveJengths. Laser l iSht does not occur in nature-An analogy can be drawn between Light and Sound.lf Ordinary l iBht = Noise, then Laser = A pLrremusical note.ln 1960 the Hungarian physicist, Mester f7l devised

an apparatus that ernitted pure, singie wavelengthsof l iBht (monochromatic) in f ine, paral lel beams bystimulatinB the emission of l ight part icles (photons)and then focusing the beam to differ€nt energyoutputs, depending on the medium through whichthe photons arc being "pumped". Ten years later fB)he described how wound heajing coulcl beaccelerated by using a ruby as the lasing medium.q ,1, p t l_p1. the room-- z"d origin. "ppdr"rJ. l_d-gradually been miniaturised, sol id state electroniccircuits afe buil t in, and th€ uses of laser energyhave diversif ied as different media nave oeenexptorlecl.

Laserc in MedicineApart from the application of lasers in industry andspace, and for mil i tary purposes, there is a fast-growing f ield of use in medicine. There are 3principal types of medical lase( (Fi+ure 2).

fypical patten af Gau$ian suryi.al laser bean in tissue. with.on.:enttic zanes oidecreasing power densilv and concomitantdecrcasing themal effect. Note rhe twa niain arcas al ircvercible phatodes.tructlan (HLLT) and revesiblep hatoactl vati a n ( L LLI).

Relationship between tissue Gnpetatute and biolaBical ef(ts.Please note that all values are approxinate, and ate also d6e

The electrcnagneti. spectrun (limited to nedical appiicatianrange, in logatithnl.: prcBrcssbn: units as shown) sho||ing thechanle in nnle.Ltlat efiect. Note the incrcase in phaton energylevel (ev) with decrease i!) wavelength value.

1. High powered, heat-producinB lasers are used tor"destructive" surgety (Fig.ures 3 and 4), e.gr. excisionof cancer in the mouth and pharynx. For instance,carcinoma of the tongue can be cleanly dissectedout, with effective haemostasis and far moreaccurately than with the tradit ional scalpel andforceps. A commonly used example of this type isthe CO, laser, of very high frequency, vaporisingcells at 500 Watts.2. Short application of medium-power, thermalla,.ers are u.pd tor.Frtdin, ondir io'rc in. ioe Ll-e eye,

Acupurcture in Medicine

e.g. small ret inal detachment. An example is thesolid crystal Neodymium-Carnet laser, transmitt ingpower levels of 15-100 Watts through a f ibre opticsystem.3. Low-power, non thermal lasers are used toirnprove the quali ty of t issue repair by acceleratingthe physiological process of healing. An exampJe isthe Call ium-Aluminium-Arsenide (Ca Al As) diode(10), wilh a power output of less than I00mW (thatis 0.1 Watt).I t is this type with which this paper is concerned-

Low Reactive-Level Laser TherapyWith this system, the energy ernitted is in the form ofl jght, and not heat.Because l ight therapy is not so dramatic as

destructive laser surgery it has never hit theheadlines of medical news. Helium-Neon lasershave been in use on the Continent for more than 20years in the treatment of a wide range of disorders;but the healing professions in the UK have been

*-'lfliil--

tu1)

| | F| | lt t lI r

ro'� -.1I

12 Mat ta, t ) Vol l l Na. t

on 19 May 2018 by guest. P

rotected by copyright.http://aim

.bmj.com

/A

cupunct Med: first published as 10.1136/aim

.11.1.11 on 1 May 1993. D

ownloaded from

slow to nccept so diff idefi a method of lreatment -rvhich cannot be felt, \ \ ,hich is invisible ( ir the inira'red bancls), ancl lvhich has ro side ei iects or dangers$,hen usecl !vith nornral laser prccaLrt ions.

Dr Dyson's fesearch team at Cuyt Hospital hasbeen carrying out sophisi icated academic lr ials intolhe hiologica effects of LLLT during the last 10years. The papefs that have enrerted frorn th€ TissueRcp.rir Research Unit (and from the considerableaccumulal ior 'r oi international l i teraturc of thesubjecl) cleafl), demonstrate the bcneficial el iecls oiiow-po\\,er aser irradiation on discased t issue andind i .a le the $ , i c l en ing range o f c l i n i ca i app l i ca t i onsai LLLI 11-13).

henl. This t inre can be accelerated to 36 hours:nracrophages arc energised to produce the enzymethat st imLrlates f ibroblasls lo produce f ibrin, thcbasic material of scaf t issue.Micfo-anSiography shows a mass of capil lar), loops

beint aitracted into the irradiated area, and this inits turn promotes the nutri t ion of the t issue. Thcobviolrs aFrp icat ons here arc ior delayed hea ing inskin ulcers, bedsores, etc.l f lra-red laser (/00 I000nM: specil ical y B30nM)

is not \," 'ater-absorbed and can thus penetrate todeeper l issuesr joint sudaces, nerve roots, mLrscle,e1c. Chfonic arthrit is, muscle injury and neuropath),are q,pical incl ications for this $,avelength l-?,4,56).

Herpes ZosterThere is nearly al lvays a history of previoLls yarice//ainfection, Lrsral y in chi ldhood. Lare in the init iai l lness, the virus is presumed to efler the sensoryner\,e i ibres and is thence caff ied to the tr igemir]al,Beniculate and dorsal root ganll l ia. l f ofe or moreof these sites the vifus nray remair] dorrfant loryears. As a result of declinifg irnrnunity withndvancing ate, of when lhal im|nlrnitv becomescompf,rfr ised, thc virLrs re-erupts in the sensoryganglia. The Hcfper \, irus lhLrs takes up residencespecif ical ly in the central fervoLrs system, choosiIgthe ccl l statior)s oi AB and Ad f ibres rn the postsriorrool ganElin and the substantia gclatrfosa of thespina cod gfey matter, i .e. mcchanoreceplor andnocicepfive neurones. The precise localion oi theinlecl ion in facial Hepes zostcr can only beguessed:apart irom the tr igeminal ganglion, i t couidalso be the descencling nucleus oi thc tr igemifalnefve. This woulcl be a logical exlension of the otherspinal sites. The virus fc erupls in these sensoryneurone sites afd is assumcd to give r ise to a haenrorfhaEic inf ammatory reactioir, spreadinS lo nefverool, rneninges and spinal cord. EveflLral ly theini lamed t issues beconrc l ibrosed, leacl ingsornetimes to de€jencration in lhe ipsi lateralposterior column and atrophy oi lhe dorsa hotn,which rvi l l then coftajf hypersefsit ive and dea#erented neurones.

_lhe precise rr icro-pathology oithe aclrte state is oniy assumed, since it has neverbeen possible to peform an in vivo exarnination ofthe spinal cord. Retrospeclive Buessworl( trom postmoftem microscopy oi the spin.r l cord in suiferersfrom PHN can only provlde a rouBh gLride to theoriginal pathology. Aparl iror. the previous chtckcnpox, i t t lc more is knolvn of the aetiolog\r. Thchistory feveals that the erLrption is oiten tr iggefed bytfaumat c, enrol ional or psycho ogical strcssoccuffences Ihal tend to recl!ce the efiectivefess ofthe immune svstem.'fhe

iniLial symptoms are similaf to other vir lrsinfccl iofs: acLrte onset of general malalse nndlassitude. Pain in the spine and I the ctennnlonesprecedes the segmental eruptiof of vesicles. Of al lthe areas attacked, herJres ophrhalnl ic!s inl l icts themost devastating arfav of syrnptoms, often afiectingthe conjlrnctiva and comea as weli as the s<in ofthe

3 o ss

Ab<vptionl'p.n€tretbn ralDes plitire tu )rareien\th tin nr):ia) Mah biala]i.al pigneDt .bs.nptb1 .u^c5t tb) Watclabso4nbn ttrc (nn far \,isible eDd ne,n.rR, lm k\ nkl lR)li) a;aphiL .onparison at relet;!,e pene!LtLntt depths.f.urent

To summarise the i indings a/21 oi the Cuy'sHospita Research Unit:Red i ight laser (600-700nM) is absorbed by $/atcrand therelore cannot penetrate beneath thc skin iormore than 4-5mm (FieJre 5).I le str iking eifecl oilas-"r at this wavelength is thc acceleration olhealinS. A skin rvound normal v takes 5 days to

t la r l9L)J v . ] I I Na. I 13 Acupu ncture in M..licine

on 19 May 2018 by guest. P

rotected by copyright.http://aim

.bmj.com

/A

cupunct Med: first published as 10.1136/aim

.11.1.11 on 1 May 1993. D

ownloaded from

t r i geminn lde mr tome.There s no s.rt islactory treatnrc'f t egrme.

Corticosteroicls, a(.v(layir, antantidine, levodap,1rnd ;rdenosine nonqllosphate havc' al l had the '

advocates, \ ' i th persuasive results irom cloublc bl rclt ' . b u " r o l r i I r . ^ l . ' . , Crefc.nal rate oi PHN sufierers constitutcs 3{l; l{ l 'X, oin l P . n C l i n i c re fe ra l s tT i r l (Roya l O ldhnm Lase rCent e l6' ' ,1,; Poole Cene al Hospital 35o1,). This\\,ould a})perr to incl icate inc'f fective primafv ca c atthe acrte stage oi t re nfectof.

Post-herpetic NeuralgiaNlost patents i |1 thc ,vourgcr agc group rccovcrco|npletelv ironr the acLrte staite of shing cs .1nclsLrf ier no iLr iher pain, n,r more than just an. ' i u r ' r l i r . r , o i n \ ' i l ' . r n r . .Ch ron ic ncu r . l l g i a con t ru i rg a iLe r t he sk in e fup t i o Ihas he.rlcd is morc commor in thc clclcrlv (.rgcrange j j 35 imea f / 01 .Tr.. aVcfai le afatonr cal dist butior i / i ' l is: l funl i1T-l Ll) tr3'1,; Face 22' i t Linbs I 5' i .

P.l t icrG dcscr bc a spcctfL nr oi di i ierent painrroclcs: Lrurningl, rching or ralv, !vi l l r .r cor' lslanlunderl,ving dysaesLhesia pLr|rcLLr.ted b\ " -.p i l - .pt i -t-omr " i lashing sl.rbs oi unerdureble pain. O al-"fpal icnts, oi lef elderly lr, idows (ienrnie nre ai iectealmor 'e o iLen l h : l mn le l , who a re l eac l i ng so l i t a r l ,l ives, ten(l to with(lr.rw ironr a I socia contact. Th..y(annot be ie!,e that anyone e se ca r srr i ier similar _v;, rnd son re a re d r i ven to su i c de as the on l y mean5 o iesc ipe f rom !n re rn i t t i f g and rn to e rab le pa in tha tno-on-A seenrs nb e to el eve. Thc' orger theneLrragia has been presc.nt as a LrL'srstent anclt c'atnrent refft ictofy s)ncl ornc, thc morc thc s! l icfcr$i I adopt .1 dcspair i fg and ncElati ! ,e .1lLi l !de t.)tcatmcnt: \ \ 'h ch tLrscl l l l ,v Ior rcscarch prlposesl. I i ' - r . ' 1 . - r . \ p , h . I ' . . . ) , ^afd untl icd t rcft1p) ll i s i r t c f cs i i ng t l r . 1 t PHN i s V i r l r a l l y L rnknown in

Cr fa i l4l. AcLrlc shifglcs is l fei led l)y TC]V aconrbincd herbal afd i .Lrp!r icLLrre,/nroxbLrstrorlr p r . ' 1 . l l , " . . r r r ' ls,vslenr cnough 1o ifaati \rnLe Ll le virLrs. 5if ir i ar res! tsafe rcporfccl in lhe lrealmefl oI pal iot i ty-r l i l is,srowin!l .1 owcr rncidcnce oi paralysis io lcxvingllr-" a.LrLe inie.l iv," sLaBe. There is a sinri lar Virrsspecii iciLy i .rf spin.l l (o(l neLrones, pol o .rf iectingn roLor r l eL r fo r l es i r l l he nn te r i o r ho rn .

Developrnent of a Trcatntent SysternA med ic . r l ncup ! | r ( l u fe c l i n i c h . r s been one o i t heNHS provlslons oi Pooe Ceneral H,rspital since1977 ancl vc1 ihcrc afe st l l paticrts bcing fclcrrcd"as a last rcsart". Adiclcs r CP iournals ancllcclurcs to rncdica groLrps locally, natona lv anclintcmatioDal y havc ovcr thc \rc.1rs improvcd thcselective reierri l rate. Evcf so, mosf ol lhe PHNsuiierers usecl Lo com-o ironr lhe Pa I R-"l iei Clinicorl ly al ier the conventiorral Lfenlment regimes hndbeen tr ied - ancl hacl ial ed. At this "-.t id-st, ise",

aclrpunctLrfe is unlikel),to be of mrch nvni , though

thcrc ravc l)ccn a lcw dramaLia suac-.sses, pnrt icu-la y r thosc paticr)ts $ho har,e be,"n helperl bvTENS,Aitcf . l t tcncl int trc I rst laser svnrposiunr nt Cluy's

H ^ i I l . h " l , p h 1 . . 1 . " ' . , " ,Brl l ish mnd," O/))-.8n - lMl nppnr.t!s \ ' \ ,hich hassigr)i i ic. lnLly erlended the c,rp;bi l i ty oi the Cl nic,part icularly in thc tfcatmenl () i PHN. Th-" resLrl lshavc bccn so cncoLrraging lhal nrosL p.r l ients nfenorv bcing relerrecl directly lhrough Lhe Pain Clinic,bciorc corVenllonal Lf,oalnrefls, ir)c uding TENS,have been tr ied. Thjs is a st-"p in the righr orrecron,| ^ o r r . r , r L . r , . h . I r | r . , r ) u r I r - , r r 1 . , ,paticrts h.rve sLri iered their oriB rr,r l z.rs/er inlection2 ycars or morc heiofe alLefdifB iof trentrnent(range: l j months l2 ycaf<). l t shoulcl be comr'rroI(no\\, lcdge lhnl Lhe longer the clelay iol lolving the.1.Lrle rorler .r l l .(k before trentment is insti tutc'd,Lhcn the less l ike y lhnt svnrptomnlic rel iei rvi l be.1 tL1i fcd.l n es tab i i shed PHN, l o . . r l app l i c . r t i ons , such r s'I iaxa'.rr gel are unlikey tc pr.^, i . le more th;]n n

plar:ebo ei iect because oi distorted skin sensation.Opintes nre n so inefiective, since lhe ce I gfoupsthnt h.rve been "destroye(|" by the virus afe thoscllrnl normnl v morl! l i r te nociception via theenkephaline gic nterneu one gating systenr. Fof thcsrnre reasor ac!purcture carrot opcft l tc i i .rppl icdscgrlrcntal ly. lhc onl) ' means by !vhr. lr lhesl mulat or lherapies (.raLrpL naLLrr,., T[NS, ! l |n-souncl, ctc.) can possibly inLcn'r pl the .onsLafl i lo\,rrof pain is b,v applying thc sl imulLrs al). ,e {.,"phaledtol thc aiicctcd scgrlcnts, "rL//-r'oordlr)B Ill-. dr,lSon',or contft i atcral y, u\ irg "Dtinor ini.rge" poinls.a)c.nsionnll ,v brain st-onr sLir l lLr at ior l)v plfnnlaLrf i .Lrl ,rrt a.upLrnclLre hds been iound efiectlve.Th," orl,v possibl-" \ 'v.y, nf presel] l t avai able, oi

reaching lhe diseased area s.r ielv, p,r inless v .rnd!\ irh ben,"i iL, is ro use laser-procluced l.rhoton ene gyal .r penelr,r l f8 $'nvelefgth: there h.pl)ens to be n.onVefienL LissLre '11,irdo11," irt Bl0 B.+0nN.1 n the

A Profile of Laser Treatment for Post-herpeticNeuralgiaThe ai iected derm.tomes cnf be inadiated \ ' \ ' i th anrixture oi wavelengths: supe f ic al ly at 66t)nM, .1ndcleeper l :reretration Lrsing the inif tr rccl bands, rvhichnre not absorbed b,v lvatef and thcrclore car rc. lchtarget t issue 5 6cm irom lhc skin suriace.The a)rre8a JAI is thc on y LLLT insLr!nrent lvhich

sLrplrorts a c u5tef head, coflaining.16 "/.rser" hcadsoi wavclcngirs v.r lyrng beLlveen a)00 an.l 900nN,1.'Jhc

circular iace oi the clustef head with .r dianrelefoi 7cm i5 ideal ior tre;t irg larye i:reas of skin.Oll l i r .Unr photo-l l iologica ei iec-ts are achievccl

!sinEi lh,".of la. l rnode lthe ldser toLrchifg Lhe skir))wiLh a power densitv of around l\ \ / /crn'. Afi f f .rdiat ion t ime of B 10sec provides ar) eferg,vdensity oi 2.1 30 Joules/cm' ior encl) larBeL poif l .The same "dose" is given tor t l)e i f ler\, ,"f1-.brapoints, ainring at the posterior rool EarrBliorl ard

Acupu}.xre n) Medi(ine 14 I,l.rr l tl9r' fb/ // Nr./

on 19 May 2018 by guest. P

rotected by copyright.http://aim

.bmj.com

/A

cupunct Med: first published as 10.1136/aim

.11.1.11 on 1 May 1993. D

ownloaded from

dorsal horn at each ofthe affected spinal levels, anclalso at two levels above and belolr, to provideadequate co\,erage- A single laser probe, with awavelength of B20nM, a power outpLrt of 50mWand an ernission freqerency o{ 60-70H2, whenpressed aSainst the skin to reduce the vascularity ofh r u r d e r l r i r ; . . . 1 - \ i l " , h i - r - m a ' m : m

penetrar on.ldeally these patients shoLrld be treated twice a

week unti l some measure of symptomatic control isSained, but this has been loSistica ly irnpossible: 1.5cl inics a week is the maxirnurn the aLrthor has beenable to wfinB out of the managers after 15 yearsl lnorder to deal with this part icular group, we haveevolved a "c/iric within a clinic". The Staff NLrrsehas been trained in laser techniqLres and pe#onnsall the laser treatments, after each patient has beenassessed. A tfeatment is relatively shot a matter olseconds for each target so i t is possible for theconsultant to see up to B PHN patients at 15 minute

inte^,als; and sti l continue to handle the otherpatients attending the cl inic. At this frequency oftreatment once a rveek real symptomatic controlis at last bcin€l achieved-

n.rcaring number ol te.rnenb

continuous wave B30nM beam with a constantpower output of 60mW The overalJ effectiveresponse rate was 7170, in that this number oipatients had such signif icant reduction in theirsymptoms that they required no medication ot anysort. In 30% pain rel ief had been maintained forover a year since the last treatment 45, /0,7 7, /3).With these signif icant results, but frorn only a few

reports, what is needed is a mult i-centre tr ial toassess the real eff icacy of laser therapy comparedwith other therapies in the al leviation of postherpetic neuralgia.

AcknowledgementMy thanks are due to Dr Kevin Moore ior muchvaluable inlorrnaLion obtained from his publishedanicles and papers presented at various meetings. Inpart icular, I am most gratelul for his pefmission touse FEU,"es -2-5 which appeared in The Internationalloutnal of Optoelecttunics (10).

Dr Keith Clennie-Smith TD FFARCSHanorary Consu lta nt An aestheti st

Poole Ceneral Hospital

A dd ress fo r co r respon d en ce17 Spingfield Crescent

Parkstone, Poole, Dorset BH14 0LL

I Mester E , L !dar i c , seye i M er r / . ( l ' l a ,8 t Th- - s r n ru l . t ingeirects of lo\! power aser ra),s on bnrl.Bi.r eystehs. lrse.

2 . K . rL T 1198/ ) Pho lob io og ca l lundamcnta s o i low power laserthe)apy. L)ur1.|ot Quant. Electrcn. 2J:1A

rl. Or5hr() I Cilderread RC (1988) Lory /evei laser thcrapy: Apattnnl intorludn)n. lohr \Niley & sors, chichester

.,1. \ /a ker i (1t88) Low evel l.s--r therapy lor fain man?gcment.rn: Ohshiro T and ca derhead Rc, eds Low /eve/ /.rJer t/rp€/rrjA practi.alintro.lu.tian. )ohn Wile! & Sons, Chi.1e(€r

5 . Moore KC, l ' l i ra N, K lmar P5, layakunrarC5. Ohsh i ro I ( l988)A dolble blind cro$over tria oi ow lclcl aser therap! in rherrentment oipost-h--rper c reua)Eia. Lasetfheftpl. Pilal isae:7

6 . Ros .hk nd S, Rousn) M, N$.n M, V i l ln re . l M, EarNea L ,Rees DC {1989) SJ,\len,ti.: --lle.rs oI low power laseri f tad ia ton o f the per iphef ! rnd .en t ra l nervoas sys tem,.utaneo!s wounds and borns La\ett Sugety Me.licine 9: )14

/ . K ing PR 11989) Los eve l las . r iherapy : a rev ies . L ,5er tM--dn:.1 5.:i. 1: 141

8. Mest-"r F, Meste. A (1989) Wo! r.l fea in8. Laser lherapl /:79. Ohnr ftr T (1990) row fe.r.iive lercl laset therapy: tuactical

rppl,.21,oni.lohi wilq, & sons, Chichestefl0 Moor . KC, Ca derhead RC (1991) The c l in ica app l ica t ion o f

low ncldent powef density 830nM Ca-Al As diode las€rrad al of in the th€fap! ol .hroni. intra.rable pain.hitetn.tional lournal of Oploelecttonics. 615): soi 20

l l . Moore KC (1992) l . Cos t e f fec t i vc bene l ts o f the ase or rase ftherapy in the treannent ol ntractable post herpetic neurale a.2. Cli,ricil patterns of symptom rcliei d!r ns l.ser ther.py IdLephali{: posr-herpetic .eutalEia Papers prc\ented at LandanLaset 1992, the 2nd deeinB of ILIA

12. Dyson M (1992)A fe l iew o t cur ren t sc ien l f c research in LLLTand phoiobioactivation. Prcsidential addre$ at the 2tu1

I3. Calderhcad RC (1990) On the cotrect repon ns o1 pnrinreteFand consistent !se termino ogy in reponing i iri.al .rd erp--ri-menta LLLT proced!res. Lrse, ibe.,pt l

14. Liahtang He Persan.l CahnlLrni.itian. Depaftmenl oAcup!nct!fe R€seafch, ShanBhai Uf i!efsit!

As th," nunbet oi trcetmenl. in.feases, synpt.rnsirnprNe in the ot.let e|n||n.

The most usefrl indication that a measure of conlrolis being achieved is the patient 's admission that hersleep pattern has improved. Next, the l ighteningf ashes of pain occur less often and, when the areaof skin pain is mapped out, i t is found to be gett in8smaller. When the patient 's measurement of herpain, using the visual analogue scale, shows aconstantly reduced level, then one can confidentlyclaim to have restored the patient to a reasonablequa ity of l i fe f ir irJ. A serendipitous benefit of thiscl nic is the measure of comfort that the patientsgain from meeting each other. At last they eachrealise that they are not alone in their sufferin:1.Recent ResearchAt the recent 2nd ILTA (lnternationa Lasef TherapyAssociation) Congress, held in London in r.rd-\ e p t . - h a a r c r c r " l p a p e r . ^ n I l l I i 1 t l atrealrnenl of PHN were presented. Concerned wrthlarger numbers oi patients over a longer period oft irne than at Poole, these papers offered corrol lora-t ive evidence of the advantages of LLLT over exist ingconventional therapies, with support ing statist icaianalyses.Dr Kevin Moore, Consultant Anaesthetist, is one of

three pain special ists at O dham. He init iated andnow directs the Royal Oldham Laser Centre. Thelaser used for al l treatments in his several siudies is aprototype Ca Al As diode system developed by theJapan Medical Laser Laboraiory, Tokyo. l t del ivers a

May 1993 Val 11 Na. l

trequen.v oi ex..erbalio r re.lu.ed

slnr ned redrcuon i'r VAs

15 Acupunctue in Me.licine

on 19 May 2018 by guest. P

rotected by copyright.http://aim

.bmj.com

/A

cupunct Med: first published as 10.1136/aim

.11.1.11 on 1 May 1993. D

ownloaded from