Pavel Kuna
GP for adults, Jaromer, CZ

Patients visit their doctors with a request to get their pain off, or at least to alleviate it. General Practitioners (GP) meet the phenomenon of pain in their consulting rooms every day, for pain as a somatic sign and a subjective feeling in a part or parts of human organism ranks with the most frequent causes why patients see their doctors, provided it is not for a regular treatment of hypertonic or cardiac patients etc. The interest of a GP in LLLT is motivated especially by efforts to provide a quick and effective help in cases of suddenly emerging painful and badly bearable affections (herpes, mucosal aphtae, distortions, neuralgias etc.). Another reason for application of LLLT is also a solution of long-term deranging pathologies (badly healing scars, chronic tonsillitis, tennis elbows, vertebral complaints, neuralgic pains, ulcus cruris etc.).

Acute pains in vital organs are the most serious ones. These are mainly pains of vascular origin, incidental to infarct myocardium, pulmonary embolisms, vascular encefalic emergency and others. Acute colic pains caused by spasms of glabrate muscles, pains accompanying coeliac emergencies, neuralgias, acute dorsalgias comprising the whole of the object, as well as other pains distinguished by the localization of origin, such as dental pains, ophtalmic, otogenous, dermatologic and complex traumatic pains, ranging from plain contusion to poly-traumas are also very predicamental.

In GP`s consulting room acute pain conditions, falling under dentistry, dermatology, orthopaedy, surgery, neurology and gynaecology, are the most frequent indications for application of LLLT. Treatment of aphtae on mucose of oral cavity and tongue, as well as of acute herpetic bloomings on lips and their surround is rewarding very much. Painful aphtae, hamperring intake of food and liquids, remit already after first irradiation with a biostimulation laser. To treat these complaints we apply 50 Hz frequency, energy density 2 to 5 J/cm2, irradiating aphtae usually three times in 24 hours interval, bloomings of herpes simplex usually three to five times. We obviously irradiate surrounding healthy tissue, several milimeters limb is enough. However, having enough time it is practical to apply laser on the whole of the lips. In this case early relapses have not been noticed. Treatment of herpetic affections on genitals, on glans penis and preputium as well as on labia. We have repeatedly relieved women, treated with Zovirax and analgesics, from extreme pain and oedemas on little pudic lips, they have been healed of these complaints in 3 or 5 days. According to our experience treatment is successful also in the period after the appearance of vesicles.

In case that neighbouring dentist has not got his own non-invasive laser, it is possible for us to speed up healing of tooth socket after extraction or alveolitis as well as to provide first aid in case of atrocious pulpitis. However, LLLT is not the proper method for treatment of pulpitis. Anguli infectiosi also react to laser therapy very well. Repeated treatment (3 to 5 times) with energy density 1 - 2 J/cm2 and frequency 8 - 10 Hz is enough. Usually very perseverant afections of school-age children can be obviated by LLLT with sufficient saturation with vitamins, and in many cases relapses do not appear. Laser lightguides provide for irradiation in the throat area, especially in cases of tonsillitis resistant to antibiotics or relapsing.

LLLT is very efficient with I and II grade burns in various localities. LLLT has especialy positive impact on burns in face. We start exposure as soon as possible, however LLLT has good results in any stage of treatment of burns. We irradiate every day with frequency 8 - 10 Hz and energy density up to 2 J/cm2. 5 to 15 applications are recommended according to extension and seriousness of burns.

Therapy of various distortions of joints and muscle contussions accompanied with oedemas of wounded tissue. On superficial applications usually a red laser is more effective.

Chronic pain lasting for months and years is a permanent problem in general medicine. It has negative influence on psychic balance of the patient and can lead to disbelief in doctor`s ability, patients look for help elsewhere, change physicians, haunt folk healers and are even able to ruin themselves financially in order to achieve alleviation of their ordeal. Painful conditions at GP`s are prevailingly treated with medicaments, meaning usually considerable risk with side effects in gastro intestinal tract or in haematogenous organs for the patients, as it is widely known. In the event of a well equipped surgery and a more knowledgeable physician, such a treatment can be complemented, even fully substituted by efficient methods of physical therapy.

Patients suffering from ulcus cruris, belonging aetio-pathogenetically to internists, however whose therapy usually falls with dermatologists, are very frequent visitors of GP`s. Application of LLLT can heal defects formerly incurable for 20 - 30 years. It is obvious that we cannot treat these patients, sufferring usually also from mental aberration, only with LLLT (energy density 1 - 2 J/cm2 , frequency 8 Hz). LLLT of well treated ulcers with proper application of unguents and powders, with an overall therapy and systematic bandaging brings astonishing results, which can never be achieved without laser. However, hyperpigmentations are resistant in the area of defect even after this complex therapy, and relapses, which are significantly postponed, can be significantly avoided, especially in case of proper complex therapy and bandaging.

Orofacial acne or eczema is a relatively frequent complaint of young women, where combination of LLLT in moderate dosages with classical dermatological therapy bring acceleration of healing and prolongation of time, necessary for a possible relapse. Positive therapeutic effect has been also noticed with sinusitis.

Soft laser is also very well healing post-operative skin sutures, healing per secundam, often due to various endogenous causes (diabetes mellitus). Especially scars in abdominal area after surgical or gynaecological operations are very rewarding. We irradiate three times a week with energy density 2 J/cm2 and frequency 8 - 10 Hz. It is advisable to start irradiation in shortest possible time, even though patients are comming usually later after a failure of classical surgical treatment, which can be sometimes found out whet checking patient`s disablement. LLLT leads to significant shortening of working disablement and brings patient`s satisfaction. We are also successful in softening relatively fresh keloid scars, i. e. approximately up to one year since their origination. We treat them 2 - 3 times a week with energy density 2 - 5 J/cm2, frequency 8 - 10 Hz, total 10 - 20 applications, according to magnitude of the keloid.

We have been able to influence positively pain in case of calcar calcanei, five applications a week, twenty applications in total, with changing frequency of 30, 50 a 70 Hz and energy density around 1 - 5 J/cm2. The treatment course is sufficient to eliminate pain for the following one to two years. Similar scheme we utilize when treating pain of patients with hallux valgus. Obviously, the deformity cannot avoid an orthopaedic surgery, but the pain after LLLT is significantly lower. An application of a laser brings also remission of acute access of gout.

In case of epikondylitis, in our particular conditions LLLT accompanied with a local and general antalgic treatments seems to be less efficient. However, presumed reason of our nonsuccess is insufficient dosage of energy of IR laser. Orthopaedic operations do not bring ultimate solutions and thus the need of antalgic procedures is still high. Application of LLLT is befitting for tendovaginitis and carpal tunnel syndrome. In the event of tendovaginitis the anti-inflammatory and anti-oedematic affects can be noticed after five expositions, whilst treatment of carpal tunnel syndrome is longer and requires 10 to 15 irradiations. We apply time-proven energy dosage 2 - 4 J/cm2 with 8 Hz frequency.

In GP`s consultation rooms we can meet tinnitus auris very often. In order to be able to achieve significant relief it is necessary to apply sufficient dosage of energy. We use an IR laser, frequency 50 Hz and the application lasts 20 minutes. One half of the time we apply LLLT on processus mastoideus whilst the other half is applied into auditory canal, the energy density reaches 20 - 80 J/cm2. Relief is reported not earlier than after 10 applications, usually we irradiate 15 - 20 times. Total elimination is rare, but our patients are very grateful even for reduction of murmurs.

LLLT has been successfully used for treatment of neuralgia trigemini and of paralysis n. facialis. The number of our patients is insufficient for exact conclusions, however we are convinced of positive effect of LLLT. We apply laser not only on the area of outlet of particular ramus of cephalic nerve but on its course. It is also possible, and very convenient, to apply acupuncture with the use of laser or fitting needles apart from classical antalgic therapy with vitamins and medicaments.

When choosing patients for LLLT, GP must take into account not only medical indication, but also specifications of his/her laser device. In a short time GP learns that it is necessary to have at least two types of therapeutic lasers:

1. laser with a red beam, with optimum power output in the range between 5 and 25 mW for treatment of skin and mucosa
   

2. and a laser in infrared area, with minimum power output 25 mW, preferrably higher, for treatments of articulations lesions and some applications in ENT, especially tinnitus which a number of elderly people suffer from.

However, within the frameworks of necessary saving, a GP can manage with only one IR laser with sufficient output power, preferrably 50 mW and more. Such a laser can handle not only some of skin and mucosa treatments, but it can also enable us, in relatively short exposures, to treat effectively even those cases where we have to penetrate tissue in order to hit target structures. We have to add that it is an advantage for a GP to use also a laser scanner to make his/her work easier when irradiating large scale defects. 

Our experience with the use of non-invasive lasers in a consulting room of a GP have proven that a therapeutic laser definitely belongs in the hands of a GP. Laser widens the offer of therapeutic possibilities, and insertion of LLLT into therapeutic index speeds up treatment and shortens the time of necessary working disablement of patients. However, LLLT is not a panacea and therefore it is only favourable if it can supplement other methods of physical therapy.

October 5th, 2000