Contraindications are generally based on prudence rather than empirical or anecdotal data, and are presented as precautions for overall safe and effective treatment and care. Please note that the information contained herein should not be construed as empirical medical scientific data; contraindications/indications will vary according to individual cases.
TYPES OF CONTRAINDICATIONS TO LASER THERAPY INCLUDE:
ABSOLUTE CONTRAINDICATIONS FOR LASER THERAPY INCLUDE:
• Eye exposure
• Over cancer or tumor
• Over gravid uterus (see below: fact versus fiction)
• Over thyroid (see below: fact versus fiction)
• Malignant neoplasms of any location
• Benign with a tendency to progression
• Systemic blood diseases, leukemia
• Pregnancy in all terms, hyperplastic processes in the uterus, benign genital tumors
• Acute infectious diseases
• Infectious processes caused by anaerobic bacteria
• Severe uncompensated endocrine pathology;
• Severe diseases of the cardiovascular system
• Acute stroke; lung disease with symptoms of pulmonary disease
• Stage III liver and kidney failure decompensation
• Fever of unknown etiology;
• Photodermatitis and photodermatosis, porphyrin disease, discoid and systemic lupus erythematosus, rosacea
• Mental illness in the acute stage
RELATIVE CONTRAINDICATIONS FOR LASER THERAPY INCLUDE:
• Autoimmune disorders
• Encephalopathy
• Hypersensitivity to powerful light energy
• Treatment Over tattoos
• Patients using IR photosensitizing medications
• Patients using steroids
• Renal failure (severe)
UNPROVEN CONTRAINDICATIONS FOR LASER THERAPY INCLUDE:
• Epilepsy - flashing lights at 5-10 Hz may induce seizure, when treating someone epilepsy always use pulse mode 30% duty cycle or less with frequency over 40 Hz
• Multiple Sclerosis - laser therapy is proven to be beneficial when treating almost all types of nervous system disorders - this should not be considered a contraindication
• Patients with Pacemaker - see below, Fact Versus Fiction
• Systemic infections - laser therapy has proven to be beneficial in dealing with systemic infections, as laser energy is inherently antimicrobial
• Un-united Epiphyseal Plate • Un-united Fontanelles
PRECAUTIOUS CONTRAINDICATIONS FOR LASER THERAPY INCLUDE:
• Dark skin
• Hairline sensitivity
• Iodine treated wounds
• Patients using anticoagulants
• Steroid therapy
• Through dark clothing - laser energy is ‘pigment oriented’, darker clothing will absorb laser energy at a faster rate, leading to possible thermal hazards.
Contraindications are presented as precautions for overall safe and effective treatment and care; An adequate history should be taken from the patient to determine if any contraindications to treatment are present. Following CORRECT treatment protocols for laser dosage will prevent some, if not all of the potential adverse responses to treatment; mild adverse reactions with normal treatment protocols may occur.
Some patients may report increased pain after the initial treatment or within 24 hours; mild bruising also may occur from pressure of the laser wand into cutaneous tissues using the laser tip in conjunction with deep tissue myofascial techniques. Mild temporary dizziness may rarely occur, most likely from the peripheral vasodilatory effect and a mild drop in blood pressure.
Laser therapy is commonly utilized for symptomatic treatment, and is contraindicated when analgesia may mask progressive pathology. Laser therapy should not be employed in certain situations when the clinician would normally avoid the use of any other analgesia in order to retain the beneficial aspects of pain.
Class IV lasers are potentially harmful to the retina, though accidental retinal damage is highly unlikely. Both patient and practitioner must wear laser safety eyewear appropriate for the NIR wavelength. Do not employ laser therapy over the pregnant uterus; it may be used elsewhere as indicated for conditions commonly treated by laser therapy (may be considered relative contraindication, see below). Laser therapy should not be applied over the thyroid gland (may be considered relative contraindication, see below).
Laser-mediated vasodilatation may worsen an existing hemorrhage (may be considered relative contraindication, see below).
LASER THERAPY AND DRUGS
I. Patients may suffer an increase of symptoms after treatment in conjunction with a recent steroid injection; consequently, laser therapy should not be employed within 7-days of a recent steroid injection at or near the injection site. In addition, research has suggested that it is a net zero gain for laser therapy and steroid use, because both suppress prostaglandin E-2. In addition, vasodilatation from laser treatments may cause release of the steroid from the localized injection site. Laser therapy can also accelerate the inflammatory process in a chronic condition, which is counter-productive to the use of steroids.
II. Photosensitivity reactions from certain drugs (including many antibiotics), may be heightened by laser therapy treatments. It is recommended that patients with a history of such reactions be patch-tested for the minimum recommended treatment time.
III. Laser therapy can stimulate immune system function; immunosuppressant drugs may be counter-productive and may minimize the beneficial effects of laser therapy.
IV. Anti-inflammatory medications taken by mouth may potentially decrease the effectiveness of laser therapy; therefore, the reduction or discontinuation of anti-inflammatory medications may need to be considered to allow for the full benefits of laser treatment. In addition, patients using topical or systemic steroids or N.S.A.I.D's for pain or skin conditions may experience mild exacerbation of their symptoms; if such a reaction occurs, laser therapy should be discontinued, or applied at lower dosages.
V. Some clinical evidence suggests that certain holistic remedies, such as St. John's Wort, may elicit hypersensitivity to laser therapy; consequently, smaller laser doses should be initially applied, with a gradual increase in dosage over the next several treatments.
VI. Iodine based products may also make tissue more sensitive to light when treating wounds, requiring a lower dose.
INDICATIONS FOR LASER THERAPY
• Inflammatory Conditions
• Bursitis
• Carpal Tunnel Syndrome
• Edema
• Effusion
• Epicondylitis
• Inflammation
• Muscle Spasms
• Myofasciitis
• Paresthesia
• Plantar Fasciitis
• Primary Diagnosis Pain
• Radicular Pain
• Restricted Rom / Stiffness
• Rheumatoid Arthritis
PAIN MANAGEMENT
• Bursitis
• Cervical/Neck Pain
• Edema
• Effusion
• Fasciitis
• Fibromyalgia
• Inflammation
• Low Back Pain
• Muscle Spasms
• Myofascial Pain
• Myofasciitis
• Primary Diagnosis Pain
• Restricted ROM / Stiffness
CONNECTIVE TISSUE INJURY / DISORDERS
• Edema
• Effusion
• Inflammation
• Muscle Spasms
• Myofasciitis
• Primary Diagnosis Pain
• Radicular Pain
• Restricted Rom / Stiffness
• Sprains
• Strains
• Tendon Ruptures
• Tendonitis
MUSCLE INJURY / DISORDERS
• Edema
• Inflammation
• Muscle Bruises, Contusions
• Muscle Contractures
• Muscle Ruptures
• Muscle Spasms
• Myofasciitis
• Myositis
• Primary Diagnosis Pain In Joint
• Restricted ROM / Stiffness
JOINT INJURIES / DISORDERS
• Dislocations
• Edema
• Effusion Of Joint
• Inflammation
• Ligament Injury
• Osteoarthritis
• Primary Diagnosis Pain In Joint
• Restricted Rom / Stiffness
• TM Disorders
NEUROLOGICAL INJURY / DISORDERS
• Crush Injuries
• Decreased Rom / Stiffness
• Edema
• Inflammation
• Muscle Spasms
• Myofasciitis
• Neuritis
• Paresthesia
• Primary Diagnosis
• Prolapsed Disk
• Radicular Pain
• Ruptured Disk
SKIN INJURIES / CONDITIONS
• Burns
• Edema
• Inflammation
• Joint Pain as Primary Diagnosis
• Scars, Restricted Range of Motion
• Skin Grafts
• Skin Ulcers
• Surgical Incisions
LASER THERAPY CONTRAINDICATIONS – FACT VS. FICTION Of the relatively few contraindications for the use of therapeutic laser, many are relative rather than absolute and a skilled clinician, together with careful patient selection, should minimize any risks. While I have written a number of articles over the past years discussing the benefits of utilizing therapeutic laser for a variety of conditions, I would like to take the opportunity to discuss contraindications in greater depth. While laser therapy has relatively few contraindications associated with it when compared with some other therapeutic modalities, some cautions are worth noting. Likewise, it is also worth noting that some contraindications are assumed when they are not—or are relative rather than absolute.
Pacemakers:
The use of therapeutic laser over internal pacemakers is mistakenly considered to be contraindicated. They are encased in metal and cannot be influenced by photons. The only exception is any light therapy device that also uses electrical stimulation.
Pregnancy:
Pregnancy is an anecdotal/unproven contraindication largely because extreme caution has historically been exercised with any modality during pregnancy—especially during the first trimester. It would be prudent to avoid large doses over the pregnant uterus. However, there is no evidence to support the idea of there being any risk in treating isolated regions of the body relative to the uterus. While researchers observed cell damage in chicken embryos after irradiation with a HeNe laser through an opening in the egg, it is important to keep in mind that the dosage represented a very high dose of laser irradiation for the size and weight of the chicken egg compared with a human fetus inside a pregnant abdomen of an adult female. Nevertheless, it would be wise to note that if any complication occurred subsequent to the use of a therapeutic laser, it would automatically be suspect and leave the clinician with the burden of proof.
Epileptic Seizures:
It is known that pulsing visible red light in the 5–10 Hz range can trigger epileptic seizures. Many light therapy devices utilize flashing visible light so it should be used with extreme caution in epileptics. There is nothing in the scientific literature on the subject of pulsing invisible light therapy such as infrared—except for one study by Simunovic. He observed a patient that could only tolerate frequencies below 800 Hz with a GaAs laser.
Thyroid Gland:
The thyroid gland is considered to be a delicate structure. It may be prudent to avoid treating over the thyroid with therapeutic laser. Rat studies have demonstrated the development of thyroid disorders in rats treated with large doses of light radiation. Hernandez found that GaAs laser therapy reduced mRNA levels of thyro-globulin, changes in the cytoskeleton of thyroid cells and a reduction in thyroid hormone plasma levels. This was associated with an increase in thyroid-stimulating hormone (TSH). Mikhailov performed an interesting study in which he utilized an 890 nm infrared laser in treating 42 patients with autoimmune thyroiditis. Each patient received 10 treatments at 2.4J/cm2. The thymus projection, vascular junction, and thyroid itself were irradiated. A control group of similar size was given 100mg of L-thyroxin. The clinical effect in all laser-treated patients was a decreased feeling of squeezing in the field of the thyroid, as well as a decrease in facial edema. The thyroid gland became palpably soft and decreased in size as observed on ultrasound. The number of winter colds decreased. The immunoregulatory index (Th/Ts) normalized decreasing from 7.5 to 4.2%. These effects were still observable in 78% of the patients after four months.
Children:
Children There is concern over the treatment of children with therapeutic laser, especially over bone growth plates. Cheetham irradiated healthy growth plates in young rats. One knee of each animal in the experimental group was irradiated three times/week at 5J/cm2. The animals were examined histologically after 6 to 12 treatments. There were no observable differences between the treated group and the control group. Renstrom successfully treated 30 children with Osgood Schlatter disease (aged 11 to 15). Their knees and lower legs were treated with a 60 mW GaAs laser at 30 Hz and 0.1J/cm2 dosage. Paolini also successfully treated 15 children with Osgood-Schlatter disease with 30 sessions of GaAs laser. These patients were compared with 15 patients who underwent conventional care including surgery. The laser group obtained the best results.
Cancer:
Cancer should not be treated by anyone but an oncologist or other appropriate specialist because of legal regulations, especially in the United States.10 Laser therapy is commonly considered to be contraindicated in patients undergoing radiation therapy yet recent scientific research paints a more positive view. Tamachi studied the effect of therapeutic laser on cytoxin, 5-florouracil (5-FU) uptake in various experiments on rats. The rats received 6J/cm2 of HeNe laser. They demonstrated a greater uptake of cytoxin, 5-FU than a group that only received cytoxin, 5-FU. The laser irradiation caused blood vessel to dilate allowing more chemotherapy to accumulate in the lesion. This may allow lower doses of anti-cancer drugs. Podalskaya has used an HeNe laser on post-radiation reactions and injuries on lips and oral mucosa. This treatment has had better results than any previous treatment approaches. Soldo studied the effect of GaAs laser irradiation on murine sarcoma. There was an anti-tumor effect on small tumors probably due to increased immune defense. Funk investigated cytokine production after HeNe laser irradiation to cultures of human PMN cells, which were irradiated for various periods at selected intensities then stimulated with various mitogens. When these cells were stimulated after irradiation at 18.9J/cm2, significantly higher levels of all cytokines were observed. Cells that received 37.8J/cm2 of laser irradiation showed significantly decreased cytokine levels.
Diabetes:
There has been debate about whether or not diabetes is a contraindication for therapeutic laser. Several studies have shown positive results in diabetic patients. Radelli performed an experiment on rats utilizing a 904nm GaAs laser. There was no observable affect on insulin-glycemic balance. Schindl carried out thermographic studies on patients with microanginopathic disorders. Blood flow began to improve within 15 minutes after the initiation of laser therapy and persisted for 45 minutes after ending the treatment session. A maximum temperature in-crease of 2.5 degrees was observed.
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