Noninvasive, Low Level Energy Laser Treatment Calms Carpal Tunnel Syndrome

By Christine McLaughlin

Carpal tunnel syndrome has become an occupational scourge of the '90's-largely due to the increased use of computers and higher job demands. In fact, millions of workers throughout the United States have experienced the repetitive strain injury, which also has resulted in millions of dollars lost in productivity, and few options for effective treatment.

Conventional treatments for carpal tunnel syndrome include the use of splints, massage therapy, ultrasound, medication and even surgery to relieve or correct the problem-many times with limited success. Yet a new treatment is beta:, investigated that is conservative in nature but is progressive as far as treatments go, which is promising for patients and clinicians alike.

Called low level energy laser or “cold laser” treatment, it allows patients to experience the benefits of laser therapy to treat their CTS without feeling a thing. The modality involves a laser output of 100 milliwatts or less. By using a lower wattage of power than conventional lasers, it has no thermal effect on tissue, which allows the device to penetrate deeply into the skin without pain.

As noted by Lasermedics Inc. of Sugar Land, TX, the manufacturer of the investigational laser, the Microlight 830T 1 uses the process of photobiostimulation to treat repetitive strain injuries like CTS. The company stated that most light has some penetration properties, however, it is often absorbed by the outermost layers of the skin. Traditional thermal (hot) laser light can penetrate the skin but frequently destroys tissue along with it. Because damaged cells benefit from light, the objective of the Microlight 830 was to be a nonthermal and safe, deep-tissue penetrating treatment that could be used with no painful effects.

The low-energy laser, which is a portable, battery-operated unit that resembles a household flashlight, emits an infrared beam into tendons, muscles, blood vessels and other tissues when scanned over the injured area. Once the device is used on the area, the light energy promotes the process of photobiostimulation.

The positive effect of photobiostimulation on animal cells is similar to photosynthesis in plant cells whereby a chain of chemical reactions is set in motion. According to Lasermedics, in human tissue, the resulting photochemical reaction produces an increase in the cellular metabolism rate which expedites cell repair and the stimulation of the immune, lymphatic and vascular system.

Consequently, there is a reduction in pain, inflammation, edema and an overall reduction in healing time, as observed in clinical trials.

The technology was developed by a team of doctors and engineers in Denmark and Houston, and is based on more than two decades of research documenting the ability of certain laser frequencies to activate endorphins-the chemicals produced by the body to reduce pain.

For the past three years, a total of 20 clinical sites nationwide have been testing the Microlight 830 for the FDA, and it’s still awaiting approval hr the federal agency to treat CTS. Therefore, the only health professionals permitted to use it are the ones involved in the FDA clinical trials.

One of the participating clinical researchers has noticed profound improvements in his patients' CTS condition after using the laser therapy. "In my experience, the first thing people notice getting better [in their CTS] is the tingling that wakes them up at night," said Alan Lichtbroun, MD, FACT, FACR, assistant professor of medicine at Robert Wood Johnson Medical School, New Brunswick, NJ, and a private practicing rheumatologist, in East Brunswick, NJ.

He told Advance that he heard about the treatment four years ago from podiatrist Garry Sherman, DMD, of Cedar Knolls, NJ, who used it to treat tarsal tunnel syndrome in athletes, who found it to have "dramatic success" in curing the syndrome.

Dr. Lichtbroun got involved with the FDA study when it began about three years ago. Eve- since, he has documented the effects of the lowlevel laser on several of his patients and has discovered that most "do very well." Two of Dr. Lichtbroun's patients, who were scheduled for surgery, underwent the laser treatment first and were cured completely.

According to a recent CNN Interactive article, Mark White, a guitarist with the pop/alternative band the Spin Doctors, experienced CTS that almost cost him his job but was "rejuvenated" following laser treatment. After White visited Dr. Lichtbroun and underwent about 16 routine sessions of the low-energy laser treatment, his CTS problem resolved and surgery was avoided. The article quoted White as saving, "It's like having a hand again ... It's pretty amazing."

Not only can it prevent surgery in some patients, but the Microlight 830 is especially helpful for easing the weakness and tingling experienced by patients who have undergone surgery, noted Dr. Lichtbroun.

But because the laser device still lacks FDA approval, many patients must pay out-of-pocket for the $25 per treatment services, particularly Medicare patients because Medicare does not cover non-FDA approved procedures. "The cost of the treatment barely covers the cost of the very expensive instrument," explained the physician. "But I usually advise people to try four treatment sessions and see how they feel. If they Jon i notice any changes at that time then they have the option to stop, but the protocol is up to 16 sessions to notice a change."

What is particularly interesting, he commented, is that the modality is widely used in Japan and Europe-about half of PT practices in Scandinavian countries are believed to use low energy laser treatment in their practices. "I think the modality ~could be perfect for PTs [once it's FDA approved] in the United States, because they would be able to know exactly its place in treating patients with CTS among the other modalities they use,” said Dr. Lichtbroun, who added that it's more powerful than ultrasound-penetrating much deeper into the skin.

The only disadvantage that Dr. Lichtbroun could identify with using the low-level laser was that if patients look directly into the laser, it can burn their retina. "So we have people wear special dark polarized tenses that prevent them from damaging their retina."

Finally, he noted that he hopes the FDA will approve the treatment soon because of its potential of helping millions of people. Already, the Microlight 830 is classified as lowrisk by the FDA. One reason the FDA may be holding up approval is because it is not effective in curing every patient of CTS, noted the rheumatologist.

No reason exists to not use it on patients with carpal tunnel syndrome because there are virtually no side effects found after years of research on both humans and animals, said Dr. Lichtbroun. "In some of the studies on animals that have gotten the treatment many times more than is considered 'therapeutic,' there were no abnormalities-not even electromicroscopic abnormalities. So it doesn't appear to affect bone or cartilage at all no matter how often w it's used.

"As far as we know, it can only help."