hello and welcome this is laser lessons from dr phil i am dr phil harrington and welcome to everything you wanted to know about laser therapy in less than 15 minutes today's topics are my vision the definition of photobiomodulation the mechanisms and treatments are scientific and proven the optimal parameters of photobiomodulation conditions that respond to photobiomodulation and patient appeal my vision is this class iv laser therapy will be an integral modality in all fields of healthcare in 2015 a worldwide panel of experts came together and agreed upon the definition of photobiomodulation the everyday term that we use is laser therapy but realize that if you go to pubmed google scholar or any other online research source the term in the library of congress medical subject headings list is photobiomodulation which is abbreviated pbm pbm is the application of red and infrared laser light to biological tissue with the goals of stimulating cellular processes and enhancing the activation of biochemical mechanisms which induce activation of specific processes that contribute to healing pain relief reduction of inflammation and tissue regeneration i give credit to this slide to dr pravin irani of the university at buffalo in the last few years we have gained much in the understanding of the mechanisms for photobiomodulation or laser therapy those mechanisms can be broken up into three main categories intracellular the photoreceptors on the cell membrane and extracellular anyone who attends a lecture on laser therapy will hear about the effect on the cytochrome c oxidase the terminal enzyme in the respiratory chain this is where the increase in energy production production happens in the mitochondria there are also photoreceptors in the cell membrane so that we can have an influence on the exchange of ions across the cell membrane and thereby improving cellular health there are extracellular effects in photobiomodulation treatments also as we gain more knowledge of these understanding of these mechanisms it is important for three main reasons one to gain greater acceptance from the health care community at large two so that we can optimize parameters for further studies and three to guide equipment manufacturers in building better equipment for laser therapy treatments what is happening during laser therapy we can describe it in these ways the physiological effects of laser therapy treatments are to induce better blood circulation in the tissues to increase the levels of tissue oxygenation and as a result we see the production of more cellular energy which is in the form of adenosine triphosphate atp the energy that is produced by the mitochondria the mitochondria being the energy the engine of the cells what are the overall physiological effects they are pain management resolved inflammation and enhanced tissue healing it is important that we say resolution of inflammation because photobiomodulation does not reduce inflammation such as how non-steroidal anti-inflammatories and other drugs do rather it is better to say that laser therapy helps the body progress through the stages of inflammation proliferation remodeling and maturation more efficiently this is important because yes we can and we should be applying laser therapy as soon as possible after acute injuries after sports injuries after any sort of injury we should be applying therapeutic laser this is also important when it comes to the regenerative medicine procedures such as prolotherapy platelet-rich plasma or stem cell injections yes we can and we should be applying therapeutic laser after those procedures in the last few years there has been an immense growth in the number of pbm studies appearing in high impact journals such as the lancet circulation the science of translational medicine and so on we see an exponential growth in the number of articles introduced into the photobiomodulation research some of these studies included are studies on peripheral nerve regeneration the effect of laser therapy in the treatment of bell's palsy the effectiveness of laser therapy for non-specific chronic low back pain pain control in chronic pain and osteoarthritis and so on when it comes to delivering the optimal laser treatment there are many parameters involved and they include power power density whether that light is delivered in continuous wave or in pulse frequencies the wavelengths or the colors of the light that are used the wavelength power distribution the total dose delivered the dosage to the tissues and the handpiece that delivers that laser treatment the complete discussion of these is beyond the scope of this particular presentation but realize that all of the these parameters are being studied and bar and are being implemented into the latest laser therapy equipment the important thing for us to know is this if we are going to successfully deliver therapeutic laser treatments to our human patients we must be doing class 4 laser therapy this paper from 2019 states an important advance in photobiomodulation therapy was the recognition that optimization of transcutaneous therapeutic parameters should be based on the photonic dose reaching the target tissue and that often requires higher doses of light at the skin surface to reach deeper tissues this is something that i have been saying for 15 years or more class 4 therapeutic lasers are required in order to do effective therapeutic laser treatments here we see an example of a class iv therapeutic laser treatment treatment being done this patient has diabetic neuropathy and peripheral arterial disease and here we can see before during and immediately after the treatment look at the benefits to that patient's tissues their pain and symptoms associated with their diabetic peripheral neuropathy were relieved significantly laser therapy treatments are able to help patients with inflammation pain and tissue damage any patients suffering from any one of these conditions and more that involve inflammation pain and or tissue damage should be getting therapeutic laser treatments photobiomodulation with a class iv therapeutic laser these treatments are safe and non-invasive there are virtually no side effects these treatments are effective for both superficial wounds and deep neurological conditions these treatments are appealing to patients it is a high-tech solution for their pain and it is an in clinic service look at this here we see a happy patient getting treated with his uh with two class iv therapeutic lasers for his diabetic peripheral neuropathy so there we showed it the definition of photobiomodulation we talked about the mechanisms of laser therapy the optimal parameters conditions that respond and patient appeal my name is dr phil harrington i welcome questions and comments on this video or email me email me your questions to laser lessons from dr phil gmail.com