WALT - World Association of Laser Therapy

Report from the Scientific Secretary 2007-8

The period from the 6 th congress in Cyprus has been busy and we have worked on putting our strategy for disseminating scientific information and about Low Level Laser and Light Therapy (LLLT) onto action. Key elements in the strategy have been:

•  To perform a “watch-dog”-function when LLLT misinformation or lack of knowledge about LLLT contribute to the development of false myths about LLLT
• To promote dissemination of scientific information in congresses, and to challenge censoring of new and important LLLT research findings
• To bring bring forward scientific information about LLLT to makers of national or international guidelines for specific diseases
• To establish LLLT as a therapeutic tool within the boundaries of mainstream medicine and dentistry where scientific evidence is of sufficient quality

During this period the following achievements have been reached:

The recommended dosage tables are evidence-based and both laser-type specific and location specific and according to the visitor statistics they appear to be a success. The WALT guidelines have been cited in several scientific articles during the past two years. The Cochrane Library have now started using WALT dosage recommendations in their latest LLLT review on low back pain.

WALTs website

An increasing number of visitors have visited our website www.walt.nu and it peaked in 2007 with an average of 372 visitors daily. This is now down to about 200 daily visitors. The website was refurbished at the beginning of 2007 which brought down the visitor numbers. The latest summary statistics of the visits to the refurbished website are shown below.

Popularity of WALT web pages

LLLT in Medline/Pubmed

The output of scientific LLLT papers in Medline is increasing with now a total number of 1688 hits for the Mesh term “Low-Level Laser Therapy”. The most popular study type is animal studies which contribute with 418 studies. The Hottest topic in the last two years 2007 and 2008 were wound healing (74 studies), pain treatment (72 studies) and bone regeneration (44 studies), while nerve injury, tendinopathy and arthritis stands for a handful of studies each. In terms of medical domains, dentistry, dermatology and physiotherapy are the most popular areas. The annual output of studies have risen abruptly from the turn of the decade, and the number of scientific articles have in fact doubled since 2004. At the Pedro database of physiotherapy studies in Sydney, Australia there are now listed 121 randomized controlled LLLT trials. 62 of them have methods scores of 6 or above on the 10-item scoring list.

Numbers Low-level laser therapy publications in Pubmed

Internet links to WALT and LLLT

The Scientific Secretary has also contacted Wikipedia –the internet encyclopedia- and provided scientific information about LLLT and a link to the WALT website from Wikipedia. This also seem to increase the number of visitors to the WALT website. “Low level laser therapy” and “photobiomodulation” are now terms listed in Wikipedia. Still, Wikipedia seem to change both listings and the contents in their feature of LLLT irregularly, but Wikipedia is now the largest single link for recruiting vistors to our website.

Inconclusive Cochrane reviews about LLLT in low back pain

There are strong forces who would like that LLLT remains as a mythical and obscure therapy, and not a serious alternative to conventional medicine. Consequently, a lot of misleading information have been distributed about LLLT and it seems like a never-ending story to challenge second and third party repetitions of these misleading statements. As described in my latest report, there is an ongoing debate with the Cochrane Collaboration about misunderstandings in LLLT reviews. The low back pain review is now published in a new version, after it was withdrawn because of criticism regarding misclassification of studies from WALTs Scientific Secretary. This review, where 6 out of 7 studies of acceptable methodology show better effect than placebo or similar effect as other Cochrane-recommended interventions, still express non-positive conclusions. Typically for their negative attitude WALTs scientific secretary has found it necessary to file a comment to the review clarifying that I strongly disagree with the review conclusion. This must be the only Cochrane review with 6 studies (86%) of acceptable methodology and partly or wholly positive results, where the review conclusion does not give the slightest hint in a positive direction. Typically, and contrary to other leading medical journals which offer immediate publication of responses, the Cochrane Library did not publish my comment on their website until 5 months after it was submitted to them. Their answer also points out that they think that:

•  The patient sample was too heterogeneous, although 97% of the included patients were classified as non-specific low back pain,
•  The comparisons were heterogeneous, but what does different comparison scales matter when the overall combined results of them are positive?
•  The Cochrane Library editors also do not seem to comprehend that the effects of LLLT on inflammation is a “class effect” independent of wavelengths similar to that of the drug class non-steroidal anti-inflammatory drugs (NSAID). The editors also seem to neglect the string of references we have provided them with where anti-inflammatory effects were reported for all investigated wavelengths between 600 and 1100 nm which we have provided for them.

Links: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005107/frame.html

As a consequence of this negligence we cannot recommend the Cochrane Library as a source for objective information about LLLT at the time being.

Review about LLLT in neck pain

A more positive attitude can be found in the published neck pain review of the Bone and Joint Decade 2000-10 Task Force (Hurwitz et al., Spine. 2008 Feb 15;33(4 Suppl):S123-52.) They were only able to identify five out of the existing 17 randomized placebo-controlled LLLT trials in neck pain. In this systematic review the results showed that LLLT was one of three effective therapies for other than whiplash-associated neck pain. Still, the conclusion manages to miss out this important finding and only mentions the other two interventions. So again, two steps forward and one step back.

Back Pain Guidelines

The recent period has also been a challenge in the sense that several guidelines have been developed. The new American guidelines for the treatment of low back pain published by American Pain Society and American College of Physicians, have also failed to address the scientific literature on LLLT and drug treatment adequately. The scientific secretary of WALT and his research team commented upon this to the Annals of Internal Medicine editors. Annals of Internal Medicine is rated among the top five medical journals in the world. This response first lead to an erratum where the evidence for drug treatment with acetaminophen (paracetamol) was downgraded. The guideline authors were also forced to address the criticism of their handling of LLLT evidence, which followed the same inadequate understanding as the abovementioned Cochrane review on low back pain. We choose to interpret this as a small step forward as the scientific findings in the LLLT literature are now being discussed on a scientific basis in a mainstream medical journal.

Link: http://www.annals.org/cgi/content/abstract/147/7/492

Scientific Progress for methodological quality in clinical LLLT – studies

On the clinical side, a marked quality improvement has been seen in the clinical publications appearing in the Journal. We have seen that the number of randomized placebo-controlled double blinded trials seven in both 2007 and 2008. There are also 121 randomized controlled clinical LLLT trials have now been listed in the Pedro database of controlled physiotherapy trials at University of Sydney. 62 of them have been awarded a method score of 6 or more on the 10-item scoring list.

Scientific Progress: LLLT – studies gain awards in mainstream medicine on a national level

Another positive development on a national scale is that LLLT science in some cases are competing well with more established therapies. One example is the recognition of the work from WALTs president dr. Farouk Al-Watban and his group in Saudi-Arabia. In issue 3 of the journal Arab Health, their work with rat diabetic and burn ulcers and 633 nm red laser is described as a medical breakthrough. In their dose-finding study the optimal dose of red laser healed the diabetic wounds 35% faster and the burns healed 53% faster than controls.

Dr. Farouk Al-Watban (right) and his team working

Another research team involving WALTs scientific secretary Jan M Bjordal, and fellow WALT members Roberta Chow, Rodrigo Lopes Martins and Jon Joensen have won both the Musculoskeletal Award 2008 and the Neck and Back Pain Award 2008 in Norway for two separate papers involving LLLT. So at least in some countries, LLLT is beginning to be recognized as a valuable therapeutic tool.

Another advance towards acceptance of LLLT in a broader medical audience was opened, when the Scientific Secretary was invited to present his views on LLLT and drugs in osteoarthritis management to the 900 participants at OARSI World congress 2008 in Rome, Italy. Under the title “Is best evidence the best?” WALTs Scientific Secretary told the audience about the basic science and clinical evidence behind LLLT and the negative publication bias which LLLT characterizes the LLLT literature.

Private Hospital & Healthcare Europe also presented a feature on the latest advances for LLLT in tendinopathies with an article from the Scientific Secretary (picture). The latest animal and clinical studies were presented in this feature.

Travel and networking activities

Another important issue is to make visits, join forces and build network with researchers interested in LLLT. The main purpose with these visits has been to increase collaboration and to stimulate LLLT research within prestigious academic institutions.
Much of the travel activity of the Scientific Secretary has been made possible by a travel grant from the Grieg Foundation in Bergen, Norway. The grant amounts to $ 18.000 for 2008 and has been made available through Bergen University College, where the Scientific Secretary is affiliated.
With the good help of board and council members several opportunities have been offered to promote LLLT and WALT. The Scientific Secretary was invited to give a keynote lecture at Swiss Association for Laser Therapy in March, and together with scientific advisor dr. Lopes- Martins at North American Association of Laser Therapy, in West Palm Beach, FL, USA in early June. Visits and guest lectures have also been held at several universities in Brazil.

And last, but not least we would like to remind our members of the upcoming congress in South Africa. Take advantage of the opportunity to see a new LLLT continent and visit the website:

http://www.technoscene.co.za/walt2008 and make your registration to participate.