In recent years, there has been a lot of discussion about the benefits and efficacy of photobiomodulation, also known as low-level laser therapy (LLLT). Current research supports its benefits in the treatment of post-surgical and neuropathic pain, lymph vessel regeneration, lymphatic fluid motility, prevention of tissue fibrosis, fibroblast proliferation, and neovascularization1,2,3. Though there is scientific evidence encouraging the use of LLLT, it is underutilized by healthcare practitioners. Some of the reasons for the underutilization of LLLT are lack of knowledge of this modality, lack of standardization regarding the treatment parameters for different conditions, and lack of reimbursement from Medicare. The United States Food and Drug Administration approved the use of LLLT as an adjunct treatment for chronic pain4. However, as mentioned above, LLLT is beneficial for other medical conditions such as lymphedema and diabetic ulcers. These types of patients present pain, inflammation, edema, and fibrosis, affecting their functional status and quality of life. Using a contributory modality that facilitates their healing is not only beneficial but necessary to improve their quality of life and decrease health-related costs associated with ongoing treatment.
What is low-level laser therapy?
LLLT is non-invasive, light intensity phototherapy providing a photochemical, no thermal effect on the tissue. This type of photobiomodulation uses wavelengths of light in the red or infrared region, which is between 650 and 905 nm triggering biochemical changes at the cellular level, specifically in the mitochondria. The way it works can be compared to the process of photosynthesis in plants; photoreceptors absorb light facilitating the chemical changes within the plant cell. LLLT wavelengths can penetrate the skin and soft/hard tissues promoting tissue repair, decrease pain, and inflammation. This modality has been used mostly for musculoskeletal conditions for its pain management benefits. Nevertheless, patients with other chronic diseases can be treated with LLLT.
How does LLLT help patients with lymphedema and diabetic foot ulcers?
Lymphedema patients present several impairments such as pain, increased circumference in the affected limb due to edema and decreased range of motion associated with the amount of fluid in the extremity. As reported in the literature2, LLLT can be effective in the reduction of limb volume and circumference, movement in the affected limb, and pain relief.
Diabetic foot ulcers are a serious complication in patients with diabetes. Statistics from the Department of Health indicate that 15% of these patients will likely develop foot ulcers during their lifetime and 6–40% of them may require an amputation4. Since diabetic foot ulcers can result in such a burden for the patient, family, and the healthcare system as a whole, it is imperative that practitioners incorporate effective treatments to facilitate the healing of these ulcers.
LLLT assists with diabetic foot ulcer healing by increasing granulation tissue formation, fibroblast proliferation, collagen synthesis, neovascularization, and early epithelialization5. In addition, the healing time and wound contraction are improved with the use of LLLT as a supporting modality in the treatment of these ulcers.
Conventional lymphedema management includes compression treatment, manual lymphatic drainage, exercises, and skincare. In the case of diabetic foot ulcers, common treatments include debridement (as indicated), specialty dressings, and off-loading. Should practitioners incorporate LLLT in their toolbox as an added modality to treat lymphedema and diabetic foot ulcers, these patients will benefit tremendously with outcomes that possibly include faster and cost-effective results, since the patient will not revolve in the healthcare system for impairments and functional limitations related to these chronic conditions.
We owe it to our patients to include evidence-based vanguard treatments that ultimately will improve their lives. Even if the LLLT treatment is not reimbursed by Medicare, the practitioner may find creative alternatives to cover the cost of this treatment. Having lymphedema and diabetic foot ulcers decrease the patient’s mobility, increase healthcare costs and affect their independence. Our goal should be to facilitate a good quality of life for our patients. Low-level laser therapy improves these conditions and that my friends, is priceless.
1.Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low-Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5):1-10.
2. Baxter GD, Liu L, Petrich S, et al. Low-level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review. BMC Cancer. 2017;17(1):833.
3. Rashidi S, Yadollahpour A, Mirzaiyan M. Low-Level Laser Therapy for the Treatment of Chronic Wound: Clinical Considerations. Biomed Pharmacol J 2015;8(2):1121-1127.
4. The United States Food and Drug Administration. 510 Summary: (as required per 2LCFR; §807.92) Excalibur Light Therapy System-Summary Report 2004. https://www.accessdata.fda.gov/cdrh_docs/pdf4/k041530.pdf Published October 2004. Accessed February 26th, 2020.
5. Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of low-level laser therapy on wound healing in patients with chronic diabetic foot ulcers-a randomized control trial. Indian J Surg. 2012;74(5):359–363.
Dr. Nilma Elias Santiago, PT, DPT, WCC, CLT, OMS, is the owner and Physical Therapist at Integumentary Physiotherapy Clinic. She is Board Certified in Wound Care, Ostomy Management and Certified in Lymphedema Management. She can be reached at firstname.lastname@example.org.