- Literature Watch for October 2013 with 35 new papers
- LLLT Training courses:
- USA: Miami, Atlanta, San Francisco, Los Angeles, Scottsdale
- UK: London, Oxford, Cambridge, Edinburgh, Glasgow
- Singapore: Singapore
- Australia: Perth, Melbourne, Sydney
- Conferences: 4 in USA
- Rant and praise - Class IV misdirection but NICE to see you
35 papers for you this month: a trial on oral complications in patients with H&N cancer, a meta-analysis of LLLT for oral mucositis, an LLLT neck pain systematic review, a review of laser in orthodontics, a clinical trial on hair growth with LED and laser, and finally another attempt to big up "class IV laser" by misleading readers about parameters. See my Rant and Praise at the end of this email.
About this image: TMJ pain is multifactorial, for best results treat the joint, trigger points, nerves and lymphatics.
THOR Training dates and cities:
We study LLLT relentlessly (had you noticed?). We use our knowledge to develop our training, treatments and products. Come see what we have learned since your last training. Now available with Continuing Medical/Dental Education credits.
- What is the difference between the anti-inflammatory effects of LLLT, the healing and the analgesic mechanisms?
- Have you thought about treating lymphatics?
- Are you de-activating trigger points (and how does that work!)?
- How much LLLT is enough, how much is too much?
- Joules or J/cm2 - which is the right way to express dose and how is it calculated?
- Lasers or LEDs, red or infrared wavelengths, high or low power density, pulsed or continuous?
- Treatment times and treatment intervals and when to expect a result.
- Safety, contraindications, adverse effects, regulations and reimbursement
It seems like a lot to learn in one day but we use videos, cartoons and a 50 page illustrated book to help you so very little note-taking is required. A certificate of attendance is provided.
Discounts for groups, repeat attendees and early registration.
|Sat, 7 Dec 2013
|Sun, 8 Dec 2013
|Sat, 14 Dec 2013
|Sun, 12 Jan 2014
|Sat, 18 Jan 2014
|Sun, 19 Jan 2014
|Mon, 3 Feb 2014
||San Francisco CA
|Tues, 4 Feb 2014
||Los Angeles CA
|Sat, 15 Feb 2014
|Mon, 17 Feb 2014
|Tues, 18 Feb 2014
|Wed, 26 Feb 2014
|Sat, 15 Mar 2014
|Sun, 16 Mar 2014
|2014 Feb 1-6
||BiOS - SPIE Photonics West 2014
||San Francisco, CA
|2014 Apr 2-6
|| ASLMS Annual Conference
|2014 Jun 14-18
||American society for Photobiology
||San Diego, CA
|2014 Sept 8-12
||WALT 2014 Congress
Rant and praise - Class IV misdirection but NICE to see you
In October a paper was published claiming that class IV laser is more effective than class 3B for oral mucositis. The authors attempt to con the reader by asserting they used a "standard" 3B laser protocol, but instead they set up a weak protocol delivering just 15% of the recomended energy in order to make a "class IV laser" product appear more effective.
As you know the marketing claim for class IV devices is that they have more power so should go deeper, should reduce treatment time and should be more effective, well guess what, most of their power is using wavelengths that do not penetrate (970-980nm) . All the evidence on dose consistently shows that over treatment reduces effectiveness  , treatment times are longer due to the scanning technique  and when you look at the small handful of clinical trails done with class IV lasers they use the same irradiation parameters used by 3B lasers anyway!
Such misinformation is intended to direct a doctor / therapist away from what is proven to work in favour of something more expensive. If you see a manuscript with "HILT" or "class IV laser" in the title watch out for the marketing spin.
Here is my letter to the journal editor.
Significant errors and misdirection in "Effect of Class IV Laser Therapy on Chemotherapy-Induced Oral Mucositis"
There are errors in this paper and the subsequent conclusions are misleading.
This paper claims to demonstrate that a 5W 970nm Class IV high power laser is more effective than a "standard low-power laser therapy protocol".
Ottaviani et al compared a 5Watt 970nm laser with a 2.5mW 635nm laser delivering 0.45J per point. This is not a "standard protocol" for oral mucositis and could not possibly have any clinical effect.
Ottaviani et al referenced a systematic review of LLLT for oral mucositis by Bjordal et al 2011 in which a careful analysis of effective parameters are reported. The paper concludes that the effective treatment regime for a 635nm laser is a 10mW - 60mW laser and 3J per point. The laser power used by Ottaviani et al was only 25% of that recommended and the energy delivered was only 15% of that recommended.
As well as the beam being under powered, the 635nm laser "was taken 1 to 3 cm from the affected areas, and a rotator motion was applied". This further distributes the already weak (low irradiance) beam over a larger area. In the clinical protocol it is stated that the 635nm laser was pulsed at 2Hz which would reduce the energy further.
It has been consistently shown in LLLT dose rate studies that irradiances in the range 5mW/cm2 - 100mW/cm2 are more effective at reducing inflammation and repairing tissue than high irradiances. Huang et al 2011, Lanzafame et al 2007, Gal 2009.
Ottaviani et al misdirect the reader by asserting they used a "standard protocol" when, in fact, they have merely set up a weak protocol to make a "class IV laser" product appear more effective.
Yours sincerely James Carroll, THOR Photomedicine
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NICE to see you
The good news is I received an invite from NICE to go see them.
NICE are the UK's National Institute for Health and Clinical Excellence. Their guidance helps British health professionals deliver the optimal care based on the best available evidence. It seems they like what we do and want me go show them LLLT. Watch this space.
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