Cold Laser Contraindications and precautions:
There are no absolute contraindications for Cold Laser Therapy (CLT). However, it is always better to be cautious when treating ones self or patients in high-risk categories. Laser therapy should be avoided or given with special caution or under medical supervision in the following cases:
Patients with pacemakers
Pacemakers are electronic devices and are well protected inside a cover and insensitive to light. Most therapy lasers have an EMC approval (Electro Magnetic Compatibility) and therefore should not interact with pacemakers.
Side Note: The TerraQuant Laser uses a healing technology to enhance microcirculation called magnetic induction and some writings suggest that because of that, the TerraQuant laser should probably not be used over a pacemaker.
Patients with a history of cardiac arhythmias or unexplained chest pain
Laser therapy applied to mid-thoracic area (Th4-7) para spinally may induce transient coronary spasm and/or arrhythmias in rare occasions.
Patients who are pregnant
Laser therapy should not be applied directly over the fetus. The same applies to the so-called forbidden acupuncture points (e.g. Hegu (LI4), Sanyinjiao (SP6), and points in lumbosacral region) to avoid uterine contractions. However, nausea and vomiting (hyperemesis gravidarum) may be treated through Neiguan (PC6) point.
Patients with labile epilepsy
As pulsing light (especially with 5-10 Hz frequency) can induce epileptic attacks. Laser therapy using visible low frequency pulsed emission should be avoided when treating these patients. Note! Remember to use eye protective goggles!
According to Spanish studies thyroid gland seems to be sensitive to light. Therefore laser therapy over the thyroid gland should be avoided unless there is a need for activation of thyroid function. The thyroid gland is located in the front of the neck, below the larynx (voice box). The small, two-inch gland consists of two lobes, one on each side of the windpipe, connected by tissue called the isthmus.
Patients with tumors
Laser therapy has not induced or accelerated tumor growth in any of the reported in vivo studies. However, laser therapy should not be directed over the tumor tissue as the precise reactions of existing tumors to laser therapy is unknown.
Patients with prostheses
Although laser therapy does not increase the temperature of deeper tissues (muscles, cartilage, bone) or that of materials used in prostheses markedly, some very sensitive patients may react to laser therapy over the prosthesis by temporary increase of pain due to increased circulation or release of toxins.
Risk of eye injury
As the cornea and lens focus radiation onto the retina, the power density may increase to more than 100,000 times higher than the primary energy density on the skin or cornea. The cornea, aqueous humour, lens and vitreous humour are more conductive of radiation with a wavelength of 450-900 nm. The risk of retinal injury is reduced if laser therapy is given in a bright light when the pupil size is at the minimum. IR lasers are more dangerous than those emitting at visual wavelengths, as the invisible beam does not provoke an eye-blink reflex.
To date, few to no retinal injuries have been reported during or after laser therapy. Due to the individual characteristics of each laser beam (parallel, focalized or divergent) and in order to avoid any future discussions of possible eye injuries, it is recommended that patients always wear goggles unless the laser is of the particular variety that uses purely diffused laser technology such as the Scalar Wave Laser. On the contrary, laser therapy may be applied through the lids and eyeball to alleviate inflammatory reaction after high power laser irradiation to correct retinal detachment or even retinal lesions from accidental direct laser beam exposures.
Patients with solar eczema or hypersensitivity to sunlight
may react to laser therapy when high photon densities are used. Avoid photosensitizers when laser therapy is given over the newly abrased skin, especially in the face.
Note! Discoloration due to pigment reaction is possible. Radiation over dark skin or tattoos may cause thermal reactions.
There is no evidence that CLT could induce either thrombosis or prolonged bleeding time. Instead CLT is indicated for its anti-inflammatory and pain relieving effect in acute injuries from fresh wounds and bruises to joint injuries and fractures. Increase of microcirculation and lymphatic flow prevents stasis and reduces existing oedema, and forms a basis for fast recovery.
Note! When adequate CLT provides only a short lasting relief of pain and dysfunction and this response is not getting better with repeated treatments, the underlying disturbances in homeostasis (e.g. systemic disease, infection, tumours) or interactions with medicationshould be taken into account.
Use with Certain Drugs
There is clinical evidence that cholesterol lowering drugs like fibrates and statins (e.g. serivastatin) may induce muscle pain and fatigue in about 1-2 percent of patients, in rare cases increase of S-CK and rhabdomyolysis leading to myoglobinaemia, myoglobinuria, kidney failure and death. More common is poor response to adequate pain therapy with any form of peripheral stimulation including CLT. Increased muscle pain and fatigue 1-2 months from beginning of statin medication is a clear sign of this side effect. The normal response to CLT may take some 2-4 weeks after cessation of medication. Statins provide valuable protection against cardiovascular accidents and should be terminated gradually and not stopped abruptly. Other drugs that may interact with statins are macrolides (e.g. erythromysin), cyclosporins, konazoles, nicotinic acid and fibrates.
Pekka J. Pöntinen, MD, PhD, FICAE, FASLMS
Assoc. Prof. Tampere University
For a free consultation with Laser Specialist - Kalon Prensky - Call 808-870-048