EXTENDED EXPERIENCE IN GaAlAs DIODE LASER THERAPY (LLLT) FOR PAIN ATTENUATION, AND THE IMPORTANCE OF STAFF EDUCATION AND CLINlCAL ENVIRONMENT ON LLLT EFFICACY

Abstract

The Shiroto Ciinic in Goshogawara has been studying the efficacy of low reactive-level laser therapy (LLLT) in pain attenuation using the 830 nm GaAlAs diode laser since 1984, and the authors and colleagues have presented regular updates in this journal and at various national and international congresses, including the last three ILTA meetings. The current study covers the period from April 1984 to February 1993 (106 months) and details 15,641 cases in 8,844 patients with a follow-up period of over 1 year. The clinic currently uses the Luketron® laser therapy system, researched and developed by the Japan Medical Laser Laboratory and Matsushita Electric Company, and marketed by Mochida Pharmaceutical Company. Laser energy at 60 mW, 830 nm in continuous or switched wave is easily delivered by a hand-held probe used in contact with the target tissue, with usual exposure times per session varying from 5 to 30 seconds, although treatment times of up to 3 minutes may sometimes be used. Our average effective rates are consistently around 84%, but in common with other reports it is noted that the efficacy varies, with some pain entities resistant to LLLT. 3 years ago the principal author (CS) opened an annexe to his main Goshogawara clinic in Nakasato, about 30 minutes away by car. The overall efficacy rate in 1992 with the same LLLT techniques as the main clinic was surprisingly poor, however, at 75%. The therapists' attitude and level of enthusiasm were reviewed and improved by more careful staff education, and after a further year the overall efficacy had risen to 89.7%. In spring of 1993, in the main hospital, a former in-patient ward area was remodelled to provide a new laser therapy facility with an open, spacious and warm environment, and a decor relying on natural wood and greenery in which 6 laser therapists can work to a selection of appropriate back-ground music (BGM). In addition to laser therapy, another 3 types of conventional pain attenuation system are used, thus employing patients’ waiting time to the maximum efficiency. Although LLLT remains the treatment method of choice by a large majority of the patients, a questionnaire completed by over 100 patients 3 months after the remodelling shows that the pleasant environment combined with the use of appropriate conventional methodologies can enhance the efficacy of LLLT, so the psychosomatic aspects of the therapy area must also be taken into account in addition to careful staff training and patient education.