Defense & National Security Practice

Newsletter Winter 2020 - Why Photobiomodulation Might be the Answer to the Opioid Crisis

Why Photobiomodulation Might be the Answer to the Opioid Crisis (cont.)


What is photobiomodulation (PBM), and how does it help solve the opioid crisis?
PBM is something you have seen on Star Trek. 
On Star Trek, when somebody was injured, the doctor would aim a low-intensity laser beam at the injury, and the wounds would heal instantly! That is photobiomodulation (PBM). The effects are not as fast as shown on TV, but the idea is the same: light is shone on people, and they get better more quickly. 
PBM is a non-thermal light therapy that reduces the underlying causes of pain: trauma, inflammation, degenerative joints, and neuropathies. PBM utilizes low-intensity lasers and LED devices in the red and near-infrared spectrum (600–1000 nm) to stimulate mitochondrial function, which leads to increased ATP production, reduced oxidative stress (which leads to less inflammation), and better tissue regeneration.
There are no known side effects, though occasionally there are some mild short-term treatment reactions. It is cleared by FDA, Health Canada, Europe, and Australia for muscle and joint pain, and it is widely used in the US.

Evidence for PBM
There are over 6,400 published academic papers indicating that PBM, when correctly delivered, reduces musculoskeletal pain (back pain, neck pain, degenerative joint diseases, and tendinopathies), neuropathic pain (shingles, postherpetic neuralgia, trigeminal neuralgia, and diabetic peripheral neuropathies), dental pain (post-tooth extraction, burning mouth syndrome, and other neuropathies), and other postsurgical pain (hip replacement, total knee replacement, and open heart surgery).
There are over 700 randomized controlled clinical trials (RCTs) on PBM. Additionally, there are more than 4,000 laboratory studies looking at the mechanism of action and dose-response. It appears in more than 200 systematic reviews. In 2018, 443 papers on PBM were published.
PBM was previously known as Low-Level Laser Therapy (LLLT), but now the National Library of Medicine has adopted “photobiomodulation” as the official medical subject heading (MeSH) [2].
PBM is a recommended treatment for oral mucositis (a side effect of radiotherapy for cancer) by the National Institute Health and Care Excellence (NICE) in the UK and the Multinational Association for Supportive Care in Cancer (MASCC) [3, 4].
The American College of Physicians Guidelines for Noninvasive Treatments for Acute, Subacute & Chronic Low Back Pain includes PBM as a “strong recommendation” [5].
The British Journal of Sports Medicine published a systematic review of the effectiveness of conservative and surgical interventions for frozen shoulder and found “strong evidence” for the effectiveness of PBM in the short term [6].
The Lancet published a systematic review and meta-analysis of RCTs for neck pain. It concluded that PBM is "non-invasive, painless, and can be easily administered in primary-care settings." It also stated, "The incidence of adverse effects is low and similar to that of placebo, with no reports of serious events, and the results contrasted with those for drug therapies for which the effect ends rapidly when drug use is discontinued" [7].
The British Medical Journal (BMJ) published a systematic review and meta-analysis on the efficacy of PBM on pain and disability in knee osteoarthritis, concluding that "the positive effect from PBM seems to last longer than those of widely recommended painkiller drugs. It is important to note that no adverse events were reported by any of the trial authors, and the dropout rate was minor, indicating that PBM is harmless" [8].
The British Medical Journal (BMJ) published another systematic review with meta-analysis, this time on the efficacy of PBM for chronic non-specific low back pain. The meta-analysis suggests that PBM, when used by itself or in combination with other modalities, may achieve a useful reduction in pain for up to 3 months in chronic non-specific low back pain with few adverse effects [9].
How does PBM work?

Primary effect (absorption)
There is a consensus that cytochrome c oxidase (CcO) in mitochondria is the primary photo-acceptor of PBM light, with a cascade of molecular events following such absorption [10–12]. There are some additional mechanisms, but the CcO pathway explains most of the benefits seen from PBM.
Secondary effects (mitochondrial)
Following light absorption by CcO, there is increased oxygen consumption by mitochondria, with a corresponding increase in ATP production, a burst of reactive oxygen species (ROS) and nitric oxide (NO), followed by a reduction in ROS (i.e., superoxide, hydrogen peroxide) [13–15].
Tertiary effect (intracellular)
The changes in ROS, reduced oxidative stress (and subsequent increase in ATP followed by more cAMP), resets NF-