Editor's Note: Part 1 of this article appeared as a digital exclusive in the September issue.
NIR Therapy for Pain
A 2015 study by Michael R. Hamblin and James Carroll (two pioneers in low-level laser therapy and photobiomodulation research), with co-authors Roberta T. Chow and Howard B. Cotler, concluded: "LLLT is beneficial for pain relief and can accelerate the body's ability to heal itself. LLLT has a long history and strong basic science evidence, which supports its use in pain management."14 More specifically, they determined that laser therapy can effectively treat all causes of musculoskeletal pain:
"The overall positive short term clinical studies in addition to strong laboratory studies should give the clinical confidence that LLLT may be beneficial for many individuals suffering from musculoskeletal pain, regardless of the cause."15
Like any effective therapy, NIR / LLLT can produce benefits that are short, medium and long-term. In the short-term, pain relief may occur within minutes of applying NIR therapy, while in the medium-term, there can be a decrease in inflammation and a reduction of pain within hours to days.
Results can last far longer: "The long term effects of LLLT occur within a week or two and can last for months and sometimes years as a result of improved tissue healing."16 For example, "A review of 16 randomized clinical trials including a total of 820 patients found that LLLT reduces acute neck pain immediately after treatment, and up to 22 weeks after completion of treatment in patients with chronic neck pain." Dr. Shelley [introduced in Pt. 1] reports that the majority of his patients realize improvement within the first two weeks.17
NIR Therapy for Acute and Chronic Conditions
Although they recommended that further randomized, controlled studies be completed to confirm their positive assessment, a German study published in November 2017 concluded: "LLLT shows potential as an effective, noninvasive, safe and cost-efficient means to treat and prevent a variety of acute and chronic musculoskeletal conditions."18
An extensive list of chronic and acute conditions respond well to NIR therapy, allowing your practice to extend into niche market areas, such as peripheral neuropathy, fibromyalgia, carpal tunnel syndrome, and plantar fasciitis:
"Acute orthopedic conditions such as sprains, strains, post-surgical pain, a whiplash injury, muscular back pain, cervical or lumbar radiculopathy, tendinitis, and chronic conditions such as osteoarthritis, rheumatoid arthritis, frozen shoulder, neck and back pain, epicondylitis, carpal tunnel syndrome, tendinopathy, fibromyalgia, plantar fasciitis, post tibial fracture surgery and chronic regional pain syndrome are amenable to LLLT ... Neuropathic pain conditions can also be treated, such as post herpetic neuralgia, trigeminal neuralgia, and diabetic neuropathy."19
Multiple pain issues can be treated simultaneously using several pads during a single treatment session. With its ability to effectively reduce pain and discomfort in so many conditions, NIR therapy should be considered an essential part of any chronic pain program.
Keys to Success
1. Tailor Your Program: When it comes to treating chronic pain, treatment should always be based on individual patient need. "We tailor the therapy to what is most beneficial for the patient," says Dr. Shelley. "We get a feel for what they are looking for and what they want."
2. Create a Corresponding In-Home Program: Dr. McKay [also introduced in Pt. 1] brought NIR therapy into his clinic specifically to give his patients a way at home to advance their healing progress between office visits. Patients self-administer NIR therapy daily using systems purchased from Dr. McKay for in-home use. They also have an exercise routine.
He has found that "homework" helps his patients take a vested interest in their own healing. In-clinic, he will explain NIR therapy and instruct patients on how to use their system, but clinic visits are for adjustments and other therapies. Dr. McKay feels that NIR therapy preps the body for chiropractic adjustment, explaining that "if the patient's body is prepped, then I can do more for them during each clinic visit."
3. Make Systems Easily Available for Purchase: Drs. McKay and Shelley both sell NIR therapy systems to their patients. Although it is not standard procedure at Dr. Shelley's clinic, "In a percentage of cases I will recommend in-home purchase of an NIR Therapy system when it looks like the patient needs more than just in-clinic treatment." Make it easy and convenient for patients to acquire their own systems. This will not only benefit your patients, but provide an extra source of revenue for your clinic, as most manufacturers allow chiropractors to purchase systems at wholesale to resell to patients at a profit.
4. Create a Streamlined Option for Lower- or Fixed-Income Patients: When a patient cannot go forward with the prescribed therapy plan due to financial reasons, offer them a partial package option. Allow them to buy their own NIR therapy system, as well as receive guidance on diet and exercise, at a lower price point, with in-clinic adjustments if covered under their insurance.
Practice Pearls
NIR therapy has the potential to not only bring quick and effective pain relief to your chronic pain patients, but also substantial benefits to all your patients, while offering a fast ROI. You can start out with only a few NIR therapy pads and a controller for a modest purchase price that will make a big difference in your clinic.
The addition of NIR therapy to your treatment menu may allow you to greatly extend the list of conditions you treat, attract a greater range of patients, and provide more accelerated, enhanced and effective pain relief for acute and chronic conditions – a win-win for both you and your patients. Dr. Shelley reports that NIR therapy "has allowed us to expand and treat peripheral neuropathy effectively. And it has been really pivotal also in getting results for our difficult chronic spine cases." Dr. McKay succinctly sums it all up by stating that NIR therapy has brought "better results; happier patients."
References
14. Cotler HB, et al. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol, 2015;2(5):7.
15. Ibid, p. 6.
16. Ibid, p. 5.
17. Chung H, et al. The Nuts and Bolts of Low-level Laser (Light) Therapy. Ann Biomed Eng, 2012 February;40(2):516-533.
18. Baltzer AWA., et al. Low level laser therapy: a narrative literature review on the efficacy in the treatment of rheumatic orthopaedic conditions. Z Rheumatol, 2017 Nov;76(9):806-812. doi: 10.1007/s00393-017-0309-1, p. 2. [PubMed: 28466181]
19. Cotler HB, et al., Op Cit: p. 4.
