LASER THERAPY WITH 10600 NM
DEFOCUSED CO2 LASER
Y. Ben Hatit* and J. P. Lammens
'European Laser Academy and Study Club, Brussels, Belgium; Private practice, Genval, Belgium
Two hundred cases of acute and chronic articular, muscular and spinal pathologies have been treated with a
defocused CO2 laser and with conventional treatment, representing in total 1515 treatments. The patients were then
followed for 20 months.
In evaluating the results the following parameters were considered: Average number of treatments; speed of
improvement; assessed as totally cured, improved, little or no change and poor.
KEY WORDS Chronic
and acute pathologies Defocused CO2 laser (defocused) Low Level Laser Therapy, LLLT
Introduction
In the last 20 years, laser beams have been introduced
into the medical field. Low level laser therapy (LLLT)
seems to have a beneficial effect on inflamed tissues.!
The high powered, focused laser beam has a cutting
effect and so is used as a laser scalpel, in high level laser
treatment, or HLLT. The CO2 laser (10 600 nm) usually
belongs to the HLL T laser family. It has been used very
successfully in laser surgery. In the last 10 years some
clinicians have observed the anti-inflammatory and
analgesic effects of the CO2 laser when used in the
defocused mode.2,3 Studies in this field are few and
quite contradictory. It is obvious that the rise in the
temperature of the irradiated tissues cannot explain the
biostimulating effect of the laser energy. It is known that
according to its wavelength (10 600 nm) the beam of the
CO2 laser is well absorbed by water. The question is
how does the laser beam act on· the biological tissues.
The theoretical and experimental data proving the
photochemical dependence of the biological mechanism
of laser radiation led to the development of the so-called
laser photochemotherapy, using laser energy and photosensitizers, in which the target molecules are capable of
absorbing light and then passing the energy to the other
surrounding and deeper molecules.
Actually there are several different explanations of
the biostimulating effect of low level laser therapy. One
of these hypotheses is the so-called 'theory of resonance
stimulation of the biological processes in the tissues'. 4
The Russian biologist Gurvich observed that cell
division is accompanied
by the emission of low intensity radiation, causing a
resonance effect in the neighbouring cells which are not
in the process of division. He proves that dividing cells in
one culture influences nondividing cells in another
culture through the emission of low intensity radiation.
This type of communication between cells has been
called biological induction by Gurvich.4
An original hypothesis explaining the mechanism of
laser biostimulation was proposed by Injushin in 1975. 5 It
is based on the presumed presence of electromagnetic
fields and free electrical charges in the cells and tissues,
which are redistributed under the influence of the
incident laser photons. Thus, the resonance stimulation of
the biological processes in the tissues is realized. It seems
that the basic matrix, which resonates in tune with the
monochromatic light beam is the bioplasm. There is
another hypothesis which assumes the presence of a
photoregulatory system in animals, similar to the
photochromatic regulating system in plants and
microorganisms which includes photoreceptors on the
skin. Low laser intensity stimulates the synthesis of
collagen and many enzymes. It is known also, that the
photoregulatory systems control the synthesis of RNA
and proteins.6
So, the biological effects of laser radiation can be
defined as molecular and tissue-based consequences,
resulting from laser energy absorption by the cells. 7,9,1l,12
They can be divided into three major categories:
(1) Trophic or growth effect by cellular biostimulation:
The laser energy acts by stimulating the
intracellular components such as mitochondria,
improving the cellular respiratory metabolism and
phosphorylation,
by accelerating collagen
synthesis.8,10,12
Addressee for correspondence: Dr Ben Hatit, Bd L. Mettewie 47,
1080 Brussels, Belgium.
0898-5901192/040175-04$07.00
© 1992 by John Wiley & Sons, Ltd.
Received 30 September 1992
Revised 8 November 1992
175
(2) Anti-inflammatory effect.
(3) Analgesic effect.
Materials and Methods
Two hundred patients of both sexes, between 30 and 65
years of age, suffering from a variety of chronic and
acute pain types: Shoulder periarthritis, tendinitis,
sciatica, lumbago, cervicalgia, tennis elbow, dorsalgia,
ankle strain and knee arthritis were treated with the
following methodologies: A defocused CO2 laser alone;
laser plus mesotherapy; laser plus manipulative
medicine; and laser plus other medical treatment such as
drugs.
Most of these patients had been referred to us by
other physicians after failed treatment.
There were acute (45.5%) pathologies and 54.5%
chronic.
We used a defocused CO2 laser manufactured by
Electronic En. Florence, with a maximum output power
of 25 Wand a maximum energy density of 99.9 J/cm2•
All laser procedures were performed with protective
eyewear on the patient, physicians and assistant.
The patients were randomly divided into four groups:
A,B, C and D.
The patients in group A underwent only defocused
CO2 laser therapy twice a week.
Group B were treated with a mixture of defocused
CO2 laser associated with a technique treatment called
mesotherapy, involving subdermal and intradermal
application of chemotherapeutic agents.
Group C underwent a combination of defocused CO2
laser therapy and manipulative medicine.
Group D were treated with a defocused CO2 laser
combined with oral anti-inflammatory and analgesic
drugs.
The frequency of laser treatment was twice a week
for all groups. The energy density was situated between
40 and 70 J/cm2. The time of every treatment was
somewhere between 10 and 15 min combining
continuous mode and frequency modulation mode,
using 300 Hz. The distance separating the laser beam
from the patients was between 70 and 80 em. The target
site was chosen depending on the pathology, but we
tried to use always a comparatively small surface not
exceeding 600 cm2•
The skin was cleaned before every treatment with an
antiseptic solution (non-alcoholic). Eighty per cent of
the patients received less than 10 treatments, 20%
underwent more than 10 treatments. The average
number of treatments per case was 7.6 (Figure 1).
The average age of the patients was as follows: 51 %
of the total treated patients were more than 50 years old
and 49% were less than 50 years old. Forty-three per
cent belonged to the male sex and
176
57% were female; 45.5% of the total pathologies were
acute and 54.5% were chronic. The percentage of the
pathologies is listed in Table 1.
Results and Discussion
The following parameters were considered when
evaluating the results (Table 2): Period of treatment in
weeks; total number of treatments per case; speed of
improvement and related efficacy rates, including an
evaluation scale ranging from total improvement, to
noticeable improvement, little or no improvement, and
exacerbation of the complaint (excellent, good, no
change and poor, respectively), detailed in Table 2 and
Figure 2.
Table 2 and Figure 3 show the results obtained after
laser treatment. We can see in the case of laser
treatment alone, a high percentage in the 'excellent' or
cured patient group (70%), 22% improved and only
7.4% of little or no improvement treatment. The second
method of therapy used in this study (laser plus
mesotherapy) gives us a better score of improved cases
but less score of cured patient and a higher percentage
of insufficient and failed treatment, and a similar score
is seen in laser therapy plus manipulative medicine.
The laser plus other medical therapy gives also
approximately the same score with a high percentage of
insufficient treatment. There is, really, a considerable
difference between group A and the other groups with
92% of cured and improved cases in group A and only
71 % to 72% for the other groups.
Analysis of the results shows no evidence of a
significant difference between group B, C, and D.
Forty-five per cent of the total pathologies were
analysed separately: 14% shoulder-periarthritis; 19%
lumbago and sciatica; 12% tendinitis.
Analysis of the obtained results (Table 3 and Figure
4) shows a high score of cured and improved patients
when treated with laser alone: In the tendinitis and
lumbo-sciatica patients, laser therapy
Y. B. HATIT AND J. P. LAMMENS
Table 1. Trial statistics
Number of patients treated
Sex
200
Male = 86 (43%), female = 114 (57%)
M:F ratio = 1:1.33
Under 50 = 49%, 50 and over = 51 %
20 months
1515
Acute = 45.5%, chronic = 54.5%
Average age
Trial period
Total treatment sessions
Pain types
Pathologies treated, and relative percentage
Shoulder periarthritis
Tendinitis
Sciatica
Lumbago
Cervical pain
Tennis elbow
Intercostal neuralgia and dorsal pain
Ankle eversion injury
Arthroses of feet, hands and fingers
Arthritis of the knee
Miscellaneous others
14%
12%
11%
8%
7.5%
4.5%
4%
4%
4%
4%
27%
Table 2. Total results of treatment with laser therapy alone, compared with the combination
of LLL T and other therapeutic modalities
Modality
Laser alone
Laser plus mesotherapy
Laser plus manipulation
Laser plus medical Tx
Percentage
of patients
Grade
Excellent
Good
Little change
No change or worse
Excellent
Good
Little change
No change or worse
Excellent
Good
Little change
No change or worse
Excellent
Good
Little change
No change or worse
70
22
3.7
3.7
39
32
19
9
38.4
34
16.4
11
35.5
35.5
25.8
3
Overall
efficacy
92
71
72.4
71
Mean overall efficacy rate = 76.6 ± 10.3.
by itself shows 100% of cured and improved cases
but in shoulder-periarthritis laser therapy shows a lower
score, only 75% of cured and improved cases when
treated with laser alone.
The average number of laser therapy sessions was
less than the total average number of treatments in the
tendinitis cases (6.9 tx./case).
We can assume from Tables 3, 4, 5 and 6 that the
combined treatment does not offer always the best
results, when compared to the laser therapy used alone.
Conclusions
Following this study and other studies which have been
done in this field, we can actually confirm
LLLT WITH DEFOCUS ED CO2 LASER
Figure 2
177
2.
1.
Table 3. Overall efficacy rate (excellent plus good) of
LLLT in treatment of shoulder periarthritis (17% of total
pain entities), lumbo-sciatica (19%) and tendinitis (12%)
compared with combination methodologies. Average
treatment sessions = 8.7, 7.9 and 6.9 respectively
Shoulder Lumboperiarthritis
sciatica
(%)
LLLT alone
LLLT plus
75
(%)
100
Tendinitis
(%)
100
meso-
therapy
LLLT plus manipulation
LLL T plys medical
Tx
74
63
effects of the defocused CO2 laser can sometimes be
superior to the conventional therapeutic methods and can
replace a number of interventions that can be unpleasant
for the patient. This therapy has many advantages. It is
non-toxic, painless and has no negative side-effects.
Actually, there is frank scepticism among doctors as to
believability of the reports that laser energy radiation acts
directly on the organism at the molecular level. This,
because of the lack of the quantitative information on this
subject.
We do believe that laser as a light source offers many
benefits for medical applications. The use of such a laser
(defocused CO2), due to its high incident power density,
which gives a uniquely high photon density, allows a great
reduction of application time. Further research and
experimentation will allow improvement indications
especially in the treatment of some pathologies against
which the practitioners are relatively helpless at the present
time.
87
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178
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Y. B. HATIT AND J. P. LAMMENS