The Laser Issue: PHOTOBIOMODULATION (Soup to Nuts)

Photobiomodulation and Skin Cancer: Summary of Current Evidence

INTRODUCTION- The Integrative Health Research Center/IHRC in NYC conducted a 2-year performance study in the use of various LED-based near-infrared light health devices.  The test was aptly named "Scan & Treat" whereby each model was tested on consenting subjects (as directed by its accompanying instructions and training programs). Brands ranged in frequency and design supporting various health claims.  All devices under review presented documentation and instructions based on each manufacturer's standard testing policies as approved by regulatory agencies for public market.

As part of any device research protocol, standard interest for user safety led to this micro-inquiry/survey of these devices, exploring the probability of injury and risk.  This, our evaluators seek any form of published evidence about the risks in applying radiative energy frequency and laser directly exposed to the skin within any close proximity.  Though designed for supposed therapeutic results, our challengers wish to explore any research concluding probable cause for concern or any form of negative effect.

Additional concern is PBMT's effects on cancers, especially skin cancers and melanoma where direct exposure of this 'light therapy' on an infected area may awaken or aggravate the cancer's  malignancy. Where PBMT is identified on the market (and with the brand's marketing claims) to reduce inflammation, an adverse concern is for the potential unknowns of a tumor's aggressiveness to be provoked by the device's exposure.

The following are statements and findings from a 2nd and 3rd level academic data search.  All references and expanded details are accessible by the links enclosed.

SAFETY INQUIRY/REVIEW (10-19-2024)
An academic research/report by:
Dr. Roberta Kline - editor, HealthTech Reporter / Women's Health Digest

Photobiomodulation therapy (PBMT) is the currently accepted term for the use of near (visible) or near infrared light to stimulate physiological processes in biological tissues. It is also often called low-level laser therapy (LLLT), which was introduced in the 1960’s. [De Pauli Paglioni, et al]

LED (Light Emitting Diode) is often included in PBMT and while around since the late 1920’s it is only since the late 1960’s that it has been used therapeutically. Its use is increasing in therapeutic applications as it is less expensive than laser. [De Pauli Paglioni, et al]

They both operate within defined spectrums of light, with visible red being 600-700 nm and near-infrared (NIR) being 700-1400nm. These wavelengths correspond to the maximal absorption of skin without creating heat.  [Torres, Angeli E et al.]

While there are differences between LLLT and LED, they have been found to be equally effective in many use cases, including wound healing, inflammation, and pain relief. [Torres, Angeli E et al.]

Table 1 source: Torres, Angeli E et al.

MECHANISM OF ACTION
PBMT works via absorption by mitochondrial chromophores including Cytochrome c oxidase and flavoenzymes, which facilitate electron transport and ATP synthesis. It also is involved in release of nitric oxide (NO) which is involved in mitochondrial antioxidant defense and would account for clinical and research observations that PBMT helps to mitigate oxidative damage from radiation or chemotherapy. Gene expression influenced to enhance regeneration and repair, including cell proliferation & migration, immune and angiogenesis. [Glass GE.]

Cells with higher concentrations of mitochondria appear to require lower doses for therapeutic effects, whereas cells such as fibroblasts and keratinocytes require more due to lower mitochondrial density. [Glass GE]

PBMT AND CANCER
Multiple cell culture and animal studies have shown that PBMT has little or no effect on cancer cell viability, nor does it induce neoplastic changes in normal cells. The rare studies that showed a possible effect were in animals with compromised immune systems. [Glass GE]

A large review published by Bensadoun RJ et al in 2020 showed that animal studies and clinical trials support the safety of PBMT related to tumor growth, and may even be beneficial for overall survival in patients with cancer. The conflicting results from a few in vitro cell culture studies were felt to be related to doses outside of normal clinical use, and thus not relevant to safety in humans.

In 2022, a position paper from the WALT Congress [Robijns J et al.] stated that PBMT has been shown to have a biphasic dose-response, with lower doses having potentially less effect and higher doses having potentially no beneficial or even adverse effects, that warrants further clinical research to clarity optimal dosage.

They also stated that the genetic variability of individual tumors, as revealed by the technology of precision oncology, may contribute to variable response to PBMT. Indeed, some tumors have genetic variations in genes that are targeted by PBMT, such as PI3K. One example is squamous cell cancers of the mouth, where up to 35% of tumors have alterations in the PI3K pathway. Thus, further research with this more individualized approach is needed and should replace one-size-fits-all approaches.

Their conclusion was that, although PBMT is generally safe for patients with cancer, there is a lack of definitive evidence regarding potential enhancement of tumor growth and long-term survival, thus more clinical trials and robust data regarding use with cancer are needed. They also specifically did not recommend direct treatments to the tumor, and advised that all patients should be fully informed of the potential benefits and risks.

 

References:

1) Glass GE. Photobiomodulation: A Systematic Review of the Oncologic Safety of Low-Level Light Therapy for Aesthetic Skin Rejuvenation. Aesthet Surg J. 2023 Apr 10;43(5):NP357-NP371. doi: 10.1093/asj/sjad018.

2) De Pauli Paglioni, Mariana, et al. "Tumor Safety and Side Effects of Photobiomodulation Therapy Used for Prevention and Management of Cancer Treatment Toxicities. A Systematic Review." Oral Oncology, vol. 93, 2019, pp. 21-28, https://doi.org/10.1016/j.oraloncology.2019.04.004.

3) Torres, Angeli E., and Henry W. Lim. "Photobiomodulation for the Management of Hair Loss." Photodermatology, Photoimmunology & Photomedicine, vol. 37, no. 2, 2021, pp. 91-98, https://doi.org/10.1111/phpp.12649.

4) Bensadoun RJ, Epstein JB, Nair RG, et al. World Association for Laser Therapy (WALT). Safety and efficacy of photobiomodulation therapy in oncology: A systematic review. Cancer Med. 2020 Nov;9(22):8279-8300. doi: 10.1002/cam4.3582.

5) Robijns, Jolien, et al. "Photobiomodulation Therapy in Management of Cancer Therapy-induced Side Effects: WALT Position Paper 2022." Frontiers in Oncology, vol. 12, 2022, p. 927685, https://doi.org/10.3389/fonc.2022.927685

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PART 2: HEALTH VISIONARY SPOTLIGHT

In our continued search for the next voice in support of Integrative and Functional wellness, our editors opted to follow the trail of innovative (or "alternative") healing technologies to the doorsteps of those who truly believe in their benefits.  In this case, an early report featuring Dr. Jennifer Stagg and her use of the THERALIGHT 360 prompted us to meet other therapists to get more insight in its clinical uses.

Meet Dr. Scott Schaeffer of Westchester Total Health (Mt Kisco, NY). His treatment approach, in addition to spinal manipulation includes a wide array of modalities and physiotherapy. In our discussion about the Theralight 360 device (and other near-infrared technologies), we covered his holistic and integrative approach to bringing full-body wellness to his patients. Dr. Schaeffer identified his commitment to researching for the latest proven innovations to address soft-tissue injuries, musculoskeletal dysfunction and other inflammatory conditions that his patients commonly present with. "There's so much out there", he started. Learning about these new healing concepts, "whatever I can use within my scope of practice to help people safely and 

non-invasively... I'm going to find it!" 

Transcript from the interview with Dr. Scott Schaffer (4/19/2023)

The Theralight 360 is one of the few full-body red light therapy units on the market.  Other common terms for red light therapy are photobiomodulation (PBM), low level laser therapy, cold laser therapy or near infrared red therapy (NIR).  In a nutshell, red light therapy is scientifically supported to benefit and treat conditions caused by the pervasive suffix “itis”, more commonly known as INFLAMMATION.  I purchased the Theralight 360 approximately 3+ years ago in search of more for my patients. I do a lot of good with conventional chiropractic work, but there's always evolving treatment options out there in the therapeutic and clinical world. You just have to do a little digging and climbing to find it.  I first learned about the growing use of red light therapy (light-emitting diodes and laser diodes) from an oral surgeon who used this technology to help expedite healing in post-surgical patients. He seemed to have great success with it, so I went on a red light therapy journey.  

Source: theralight.com

In an effort to find the best full-body red light pod on the market I traveled around the country experiencing the various units, their similarities and differences.  I landed on what I felt was the best unit on the market and with little leap of faith I committed to buying my first; they're not cheap as you can imagine. Fellow practitioner and my wife Dr. Lisa Cavaliere also agreed that this was the ONE!  So, we continued down the red light therapy path and we’ve been pleased ever since.  From arthritis to skin conditions, anxiety to depression, poor sleep to immune support, pre-workout boosts to post-workout recovery the 360 degree red light therapy treatment covers just about everything, literally.  Additionally, the Theralight 360 is non-invasive and safe, it’s comprised of some of the healthiest and most researched wavelengths of light in phototherapeutics. 

Comparatively the Theralight 360 is not an expensive treatment but it's not always easy to get people to try it since this treatment must be paid for "out of pocket".  So, in an effort to give a patient the experience of red light therapy I will offer them a "trial" so they can at least feel the positive effects of the healing light before making financial decision.  First and foremost, even if you don't see immediate results, it feels fantastic being in Theralight 360 (laugh). The 15-20 minute session is extremely comforting – what I would imagine being in the womb may feel like or a cocoon of warm light. Typically, the first thing people report is a “tingling” feeling during the session, this is because the body releases a substance called nitric oxide during the treatment causing your arteries to dilate thus improving circulation.  Another common bonus of being exposed to the red light is that clients will typically experience a very sound sleep that evening (yes, we treat people with difficulty sleeping also).

COVERING FULL-BODY RESULTS

Source: Westchester Total Health

In the past, I wouldn't have had much to offer to address non-musculoskeletal conditions like depression or anxiety, but now it's so prevalent, especially in the young population that it’s difficult to ignore.  In fact, it’s not uncommon that musculoskeletal discomfort creates or exacerbates an underlying depression or anxiety. 

Oftentimes, in the process of managing someone's back pain we have a dialogue about their life and what ails them. If it’s revealed that they are struggling with another condition like depression, anxiety, “brain fog”, sleep issues, lack of energy, etc. or their family members need help managing particular emotional stressor, then I may suggest that patient explore the Theralight 360.  Typically, these diagnoses are treated allopathically, but if red light therapy is a whole-body wellness solution that also benefits non-musculoskeletal conditions then of course I’ll suggest it – there’s nothing to lose.

Another popular condition that clients are finding great help with are disorders of the skin (psoriasis, eczema, rosacea, etc.). Again, this is a condition that I would never have expected to address in my office a few years back but have found that RLT is a successful treatment option for that as well.  I have patients that come in weekly to treat various skin ailments with the Theralight 360 often finding improvement.

*Coming up, check out our follow up story about our own Dr. Bard visiting Dr. Scott Schaeffer's health center in Mt. Kisco, NY to experience a full test drive of the Theralight360.  This meeting is part of Dr. Bard's pilgrimage to seek out and collaborate with innovative clinicians aligned with non-invasive therapeutic technologies. His mission is also dedicated to exploring the current non-invasive Bioenergy therapeutic solutions -including the science behind PEMF (Pulsed Electromagnetic Field therapy), Biofeedback, Radiotherapy, Neuro-stimulation and the varying options of light therapy - TBA

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RELATED ARTICLES

RED LIGHT THERAPY FOR TBI: by Dr. Jennifer Stagg

’Infrared’ refers to a type of light that is below the spectrum of visible light. The naked eye cannot see this type of light. Light is measured in wavelengths, and to further define infrared, there are near infrared (NIR) and far infrared (FIR) wavelengths. FIR is what is typically found in many of the devices sold to the general public like infrared blankets and saunas. (Although, saunas, combine heat with light so the effects of FIR are not comparable.) FIR offers some mild effects, but it doesn’t penetrate the body as much as NIR. As a result, most clinical research published to date is on visible red/NIR because these have been shown to be more effective. (See full review)

DEMO DAY WITH ASPEN LASER - PHOTOBIOMODULATION THERAPY: IPHA NEWS and HEALTH TECH REPORTER covers DEMO DAY at the Bard Diagnostic Imaging Center in NYC @ March 7, 2023.  National clinical trainer Mark Murdoch speaks in an interview about the Aspen Laser  technology while he treats registered patients suffering from various chronic disorders (including a rotator cuff tear & other MSK joint injuries,  psoriatic arthritis and psoriasis on the skin. (See full review)

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WHO IS CHARLES VORWALLER?

By: Lennard M. Gettz, Ed.D

Since 2021, I collaborated on a publishing project with Dr. Robert L. Bard (diagnostic imaging specialist) to conduct a tech performance review about AxioBionics wearable therapeutic device.  This was the impetus to our advocacy group and educational initiative aptly called HEALTH TECH REPORTER whose goals are to seek out and test drive the latest in non-invasive therapeutic solutions and publish reports on the validity of their claims and health advantages.  

In early 2023, we launched an event series called HEALTH TECH DEMO DAY in Dr. Bard's diagnostic imaging practice in NYC. This became the central ground for hosting manufacturers showcase of their latest devices where they provide actual case demonstrations directly to our reporters and Dr. Bard's patients.  

Our 2023 search brought us together with a remarkable advancement in red light therapy by a company called Aspen Laser (See event report on March 7, 2023) where a Demo Day with their rep was a great success. Shortly after the event, a heartfelt thanks and congratulatory letter was sent to CEO and founder Mr. Charles Vorwaller for a fantastic product.  A stunning surprise was granted us directly by Mr. Vorwaller who immediately booked a 

With a growing set of clues about the strength behind this company (and their truly fearless leader), his energy and enthusiasm to connect aligned with t

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FROM THE BRAIN HEALTH COLLABORATIVE

11/18/2022- RED LIGHT THERAPY FOR TBI (By: Jennifer Stagg, ND) Within the past decade, ads for Red Light Therapy (RLT) devices have exponentially appeared in the health, wellness and commercial markets- drawing significant attention to their claims and challenging their efficacy.  As with all technologies, many variables are to be considered as far as concluding on their proposed health benefits. Published reports from clinical (valid) studies detailing the utility of RLT in human health.  Encouraging reviews indicate that there is a growing body of evidence for the use of RLT in traumatic brain injury (TBI) and neurodegenerative processes, including Stroke and Parkinson’s disease. 

PHILOSOPHY BEHIND RED LASER THERAPY

Photobiomodulation is what we're actually doing when we look at red and near infrared light.  (it’s different from far infrared-that's a sauna creating deep heating in the tissue and sweating out toxins). Photobiomodulation is the application of red and near infrared light to tissue where there is disease or dysfunction.  The mechanism of action of light is very simple. It doesn't treat any specific disease or diagnosis, but it treats the underlying cause of all dysfunction in the body (all disease) and that is cellular health and wellness.

Within the cell, oxygen is supposed to flow into the mitochondria, which is the powerhouse of the cell, and that's supposed to produce adenosine triphosphate or ATP.  This is what every cell in the body uses for energy.  Due to exposure to via environmental toxins, lack of sleep, stress, injury and disease, lack of exercise, too much exercise, not enough sunlight, poor nutrition etc. oxygen flows in the cell and then it's bound by nitric oxide. That binding of nitric oxide with oxygen forms a deadly particle called a free radical.  This causes two problems: #1- that oxygen is now not free to go into the mitochondria- so our ATP production in the body drops.  #2- there's the abundance of free radicals is the root of every disease. It's the gene expression for things like cancer, heart disease and diabetes.  So what light does very simply is when we shine light in and we can get light into the cell at the right wavelength, dosage and power density, it simply unbinds the oxygen particle and the nitric oxide particle and the free radical is dissipated into the blood vessel walls. So now we have removed free radicals and inflammation inside the cell. Also, the oxygen respiratory chain starts up again and that oxygen particle is allowed to flow into the mitochondria, and the ATP now goes through the roof and rises again the body. 

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