Better wound healing and less postoperative pain with laser procedures compared with the same procedure performed with the cold scalpel or with electrothermy were reported by those who first used the surgical laser in the late 1960’s and early 1970’s, which was an added beneficial component associated only with laser surgery compared with conventional methodology. This was obviously a photo-mediated effect rather than purely thermal or electrothermal and was first termed the ‘α-effect’ in the early 1990’s, was then classified by the author as simultaneous laser therapy in the mid 1990’s, but is now more accurately classified by the author in his latest classification of laser treatment as part of the auto-simultaneous aspect of laser treatment, whereby a number of different reactions can be obtained at the one time with a single laser. Laser/tissue reactions fall into three broad groups. Irreversible and destructive photoreactions in the tissue is classified as high-reactive-level laser treatment (HLLT), as in laser surgery for incision, excision, vaporization and tissue coagulation. If some irreversible damage occurs together with reversible photodamage, as in tissue welding, the author refers to this as mid reactive-level laser treatment (MLLT). If the level of reaction in the target tissue does not cross the survival threshold of the cells making up the tissue, then this is called low reactive-level laser therapy (LLLT). All three of these classifications can occur simultaneously in the one target, and fall under the umbrella of laser treatment (LT). Auto-simultaneous laser treatment (ASi-LT) is used to describe a treatment situation whereby 2 or more tissue reaction types are achieved simultaneously in tissue with the one laser, and accounts for the successful surgical application of the laser in many fields compared with conventional modalities, such as in laser full face resurfacing, nonablative skin regeneration and tissue welding, due to the beneficial actions on the wound healing process of the zone of photobiomodulated cells at the periphery of any such surgical beam.

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Alzheimer’s disease presents a major problem as far as successful treatment is concerned, which is exacerbated by the ageing of the world’s population, and the increasing number of elderly in the ‘at risk’ age groups. Low reactive-level laser therapy (LLLT) has been reported as having beneficial effects on the blood vascular and neurological systems, including the regeneration of degenerated axons. The present study with 154 AD patients examined LLLT used as a monotherapy (intravenous HeNe laser irradiation) as well as magnetic field therapy (MFT), light chromotherapy (LCT) and conventional AD pharmacotherapy all as monotherapies, compared with a placebo control group. A further group received a combination of LLLT, MFT and LCT (the LMLCT group). Patients were assessed using the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) before treatment and at the end of the 18-month treatment regimen. LLLT and MFT significantly slowed down AD-related deterioration compared with controls (p‹0.05), but theLMLCTgroup was even more significantly effective (p‹0.001). Of all the monotherapies, LLLT was the most effective compared with the others, but the differences were not statistically significant. This may have been a factor of the low statistical power of the study due to small group numbers. Pharmacotherapy was the second most efficacious approach, but is associated with severe side effects particularly in elderly patients, and is often contraindicated. The results of the sudy suggest that combined LLLT, MFT and LCT is a safe, effective, easy-to-deliver, well-tolerated and side effect free therapeutic approach for slowing down the deterioration associated with AD.

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Treatment of sports injuries in top class athletes should be as fast and effective as possible, to enable the athlete to return to training or competition as quickly as possible so as to maintain as much of their preinjury muscle tone as they can. Laser therapy has offered an effective modality, particularly with deep-penetrating wavelengths in the near infrared around 830 nm, but the treatment of a major muscle injury requires multiple point applications of a hand-held unit, and is very therapist intensive. A new hands-free operation system based on multipanels of near IR light-emitting diodes (LEDs, 830 nm, 180 mW/cm²) has been developed designed for applications in rehabilitation and physical therapy. The present study was designed to test the efficacy of this IR LED rehabilitation system (Omnilux Rehabilitation System, Photo Therapeutics, Ltd., Altrincham, UK) in a variety of sports injuries, both acute and chronic. Twenty-eight subjects were enrolled in the study with a variety of conditions: Joint Pain and Dysfunction (n=8), Tendinopathies (n=7), Muscle Pain and Dysfunction (n=4), and Back Pain (n=9). In 17 of the 28 subjects the results were excellent, and varied in the others. However, prudent doses of 54 and 108 J/cm² (5 and 10 min exposure times, respectively) were chosen. Higher doses may give better effects. Both acute and chronic pain types responded well to IR LED therapy. There were no adverse side effects, and all subjects were happy with the treatment. Practitioners were also pleased with the ease of use of the system, and found it safe and effective. Further controlled, double blind studies are required with larger populations and a greater range of pain entities to further examine efficacy with statistical analysis, but the results of the present efficacy study are very promising.

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Low reactive-level laser therapy (LLLT) is a safe and easy therapeutic modality and now utilized in the treatment of inflammatory conditions. However, the clinical evidence base for such application remains sparse. This study was designed to examine the effects of LLLT on production of interleukin-8 (IL-8) by human neutrophils. Neutrophils, separated from blood drawn from 10 healthy volunteers, received laser irradiation (150 mW/cm2) for 30 or 60 sec at 60 min prior to or just before the stimulation with opsonized zymosan. These conditions had different effects on production of reactive oxygen species by neutrophils. After the incubation at 37 °C for 3 and 9 hours, the concentration of IL-8 was measured by ELISA. The concentration of IL-8 was higher when neutrophils were incubated longer. However, the levels of IL-8 production by irradiated neutrophils did not differ from those of unirradiated neutrophils even under the conditions whereby both the period of irradiation and the duration from irradiation to stimulation were different. IL-8 production by neutrophils may not play a role in the therapeutic effects of LLLT in inflammatory conditions.

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Mastectomies can sometimes be associated with prolonged pain and discomfort. Low reactive-level laser therapy (LLLT) at 830 nm has been reported as effective in pain attenuation. A new generation of quasimonochromatic light emitting diodes at a nominal 830 nm has offered the clinician an alternative IR phototherapy source for the hands-off treatment of large areas. The combination of the LED therapy over a large area combined with punctal application of laser therapy is an interesting concept. The present study evaluated this combination phototherapy in a patient with comparatively long-term postmastectomy pain. A 44-year-old female had suffered from postmastectomy pain and discomfort for over 3 months, despite taking a nonsteroidal anti-inflammatory drug at high doses. A GaAlAs diode laser (60 mW, CW, 20 sec and 60 J/cm² per point) in punctal application was combined with an LED array (830 nm ± 5 nm, 20 min/irradiation, CW, 60 J/cm²) in the dermatomal approach. Three consecutive daily sessions were given at the above parameters. The Hospital Anxiety and Depression Scale (HADS) was administered one day before and one day after the treatment regimen. Range of movement (ROM) and pain relief scores were recorded. The pre- and posttreatment HADS scores for depression and anxiety were 14 and 9, and 4 and 4, respectively. Pain and discomfort decreased somewhat after the first session, and more rapidly with the subsequent 2 sessions. At 24 hours after the third session, the patient was completely pain free with a full ROM. After an 8-week follow-up, ROM was still good, but mild discomfort was noted around the right breast, and a single ‘top-up’ session with the LED array alone was required, which was effective. The combination of punctal laser and area LED therapy at 830 nm over three consecutive daily sessions improved postmastectomy pain and restored full ROM in this one patient, with good latency which was extended with a single ‘top-up’ IR LED session. Further controlled studies with larger patient populations and longer follow-ups are warranted.

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