Photobiomodulation with Low-Level Laser Acupuncture in Pediatrics

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As evidence mounts supporting the safety and effectiveness of pediatric acupuncture, increasing numbers of pediatric health professionals are looking for ways to incorporate non-needle acupuncture point stimulation as a treatment option for their patients.

Photobiomodulation with laser acupuncture (LA) offers a feasible way to stimulate acupuncture points because it is quick and painless. LA can be applied to the acupuncture point for 15 to 60 seconds per point. Patients do not typically feel any sensation, although some children report a pleasant tingling feeling during application.

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Clinically, I’ve used LA for the same health conditions that I have used needles for including:

  • Asthma
  • Allergies
  • Anxiety
  • Eczema
  • Earache
  • Digestive problems
  • Poor sleep
  • Pain
  • Headaches

One of my first cases using LA exclusively was a three-year-old girl with recurrent pneumonia. She had pneumonia 3 times within 5 months and had been hospitalized twice. After many rounds of antibiotics and other medications, her symptoms failed to improve.

Since the first bout of pneumonia, every cold seemed to go straight to her lungs. The stress of frequent hospital visits was taking its toll on her parents, and they were looking for a natural approach that worked with the body.   

At the first visit, it became clear that needles were not an option as she was highly sensitive to any stimulation. In their place, I used a red Ito laser at 635 nm on the same points I would have needled: CV 17, LU 1, LU 9, ST 36, ST 40, and KI 3. Over the course of three months, I saw her twice weekly in the beginning and then the sessions tapered to once weekly and then every other week.

Within that time, her immune system became balanced and she was no longer contracting illnesses as easily. There were no further bouts of pneumonia from that point forward and that continued for a full year after she was released from treatment.

How Laser Acupuncture Works

LA works through the mechanism of Photobiomodulation, the term for the regenerative effects of light on our cells, particularly cytochrome C oxidase. It was coined in 1995 by biologist Tiina Karu, head of the Laboratory of Laser Biology and Medicine of the Russian Academy of Sciences, in order to describe the effects of light stimulation on our bodies and cells.

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Despite hundreds of years of use, light therapy and Photobiomodulation have been considered pseudoscience and lacked acceptance in the mainstream medical community. This is beginning to change. According to the Natural Library of Medicine, there have been

8,175 studies on low-level laser therapy and 1,089 studies on laser acupuncture. 

In the last 10 years, applications of Photobiomodulation have expanded to include dermatological conditions, mental health conditions, seasonal affective disorder, pain, arthritis, dental applications, neuropathy, and much more.

Naturally, there have been skeptics of laser acupuncture, especially for children. Without a thorough understanding of the physiological effects of Photobiomodulation, it can be easy to dismiss. But, as you will see shortly, there is an overwhelming amount of evidence that pediatric LA has a place in medicine.

Laser Acupuncture Provides Benefits With Fewer Side Effects

With LA, only light penetrates the skin at the acupoint so it has fewer adverse effects than needle penetration, thereby completely eliminating any potential for organ penetration, pneumothorax, bruising, swelling, and bleeding. These adverse effects with pediatric acupuncture needle penetration are generally limited and mild due to the incredibly small needles and gentle techniques used.

The adverse effects of LA are minimal and include transient dizziness, headaches, and fatigue, which subside quickly upon cessation of treatment. 

LA can be safely combined with medical procedures and medications as necessary for pediatric patient care. For example, LA can be combined with bronchodilators to help increase oxygen saturation and reduce tachypnea.


What Laser Acupuncture Helps

Research on laser acupuncture has shown it is a promising treatment option for:

  • Nocturnal enuresis (bedwetting)
  • Nausea and vomiting (post-operative and after chemo)
  • Allergic rhinitis
  • Headache
  • Post-operative pain
  • Asthma
  • Speech and social interaction in children with Autism Spectrum Disorder
  • Amblyopia (lazy eye)
  • Controlling gag reflex

While the mechanism of action is not clearly understood, animal models and fMRI studies show that LA has the following physiological effects: 

  • Anti-inflammatory
  • Modulation of peripheral and central nervous system activity
  • Activation of various brain regions
  • Increased cytochrome c oxidase and ATP production
  • Improved cell redox potential
  • Reduces oxidative stress

The neuromodulating effects of Photobiomodulation with LA are perhaps the most compelling. Could Photobiomodulation have a role in the treatment of stress and mental health issues such as anxiety, depression, ODC, and autism?

According to an article published in PLOS ONE titled The Brain Effects of Laser Acupuncture in Healthy Individuals:

“Many of the acupoint laser stimulation conditions resulted in different patterns of neural activity. Regions with significantly increased activation included the limbic cortex (cingulate) and the frontal lobe (middle and superior frontal gyrus). Laser acupuncture tended to be associated with ipsilateral brain activation and contralateral deactivation that therefore cannot be simply attributed to somatosensory stimulation.”


The Future is Bright

The biggest issue with LA is the lack of guidelines on the proper use of wavelength, power output, and energy dose to get the desired effect. All of these factors affect the level of light scattering and penetrating through the skin.

Bigger is not always better and that includes low-level laser therapy. Emerging research suggests that Ultra Low-Level Laser Therapy (ULLLT) can benefit our patients as well.

According to a journal article published in Lasers in Medical Science, “A growing number of laboratory and clinical studies over the past 10 years have shown that low-level laser stimulation (633 or 670 nm) at extremely low power densities (about 0.15 mW/cm(2)), when administered through a particular emission mode, is capable of eliciting significant biological effects.”

What does this mean for clinical practice?

The use of cold, Class IV lasers on acupoints is a viable option based on the evidence supported in ULLLT as well as my own clinical experience. While Class IIIb lasers, which have a higher power density, can be used, they are not necessary in the pediatric population in my clinical experience.

laser-box-set

For pediatric acupuncture applications, LA can be done with the handheld device held above the skin or applied directly to the skin. Based on my experience using different lasers, I recommend the Qi Pulse red and blue handheld lasers.

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LA is a great tool to use in the clinic but doesn’t translate as well for home care. Thanks to emerging technological advances, Photobiomodulation can be done at home creating similar biological effects yet in an affordable and cost-effective manner for patients.


References:

Chon TY, Mallory MJ, Yang J, Bublitz SE, Do A, Dorsher PT. Laser Acupuncture: A Concise Review. Med Acupunct. 2019 Jun 1;31(3):164-168. doi: 10.1089/acu.2019.1343. Epub 2019 Jun 17. PMID: 31297170; PMCID: PMC6604908.


Quah-Smith I, Sachdev PS, Wen W, Chen X, Williams MA. The brain effects of laser acupuncture in healthy individuals: an FMRI investigation. PLoS One. 2010 Sep 7;5(9):e12619. doi: 10.1371/journal.pone.0012619. PMID: 20838644; PMCID: PMC2935390.


Karaman MI, Koca O, Küçük EV, Öztürk M, Güneş M, Kaya C. Laser acupuncture therapy for primary monosymptomatic nocturnal enuresis. J Urol. 2011 May;185(5):1852-6. doi: 10.1016/j.juro.2010.12.071. Epub 2011 Mar 21. PMID: 21420121.

 

Alsharnoubi J, Sabbour AA, Shoukry AI, Abdelazeem AM. Nocturnal enuresis in children between laser acupuncture and medical treatment: a comparative study. Lasers Med Sci. 2017 Jan;32(1):95-99. doi: 10.1007/s10103-016-2090-9. Epub 2016 Oct 15. PMID: 27744492.


Varejão CDS, Santo FHDE. Laser Acupuncture for Relieving Nausea and Vomiting in Pediatric Patients Undergoing Chemotherapy: A Single-Blind Randomized Clinical Trial. J Pediatr Oncol Nurs. 2019 Jan/Feb;36(1):44-54. doi: 10.1177/1043454218810140. PMID: 30798684.

 

Butkovic D, Toljan S, Matolic M, Kralik S, Radesić L. Comparison of laser acupuncture and metoclopramide in PONV prevention in children. Paediatr Anaesth. 2005 Jan;15(1):37-40. doi: 10.1111/j.1460-9592.2004.01388.x. PMID: 15649161.


Moustafa Y, El Nady HG, Saber MM, Dabbous OA, Kamel TB, Abel-Wahhab KG, Sallam SF, Zaki DA. Assessment of Allergic Rhinitis among Children after Low-Level Laser Therapy. Open Access Maced J Med Sci. 2019 Jun 30;7(12):1968-1973. doi: 10.3889/oamjms.2019.477. PMID: 31406538; PMCID: PMC6684433.


Gottschling S, Meyer S, Gribova I, Distler L, Berrang J, Gortner L, Graf N, Shamdeen GM. Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial. Pain. 2008 Jul 15;137(2):405-412. doi: 10.1016/j.pain.2007.10.004. Epub 2007 Nov 19. PMID: 18022318.

 

Oates A, Benedict KA, Sun K, Brakeman PR, Lim J, Kim C. Laser acupuncture reduces pain in pediatric kidney biopsies: a randomized controlled trial. Pain. 2017 Jan;158(1):103-109. doi: 10.1097/j.pain.0000000000000734. PMID: 27749608; PMCID: PMC5234680.


Elseify MY, Mohammed NH, Alsharkawy AA, Elseoudy ME. Laser acupuncture in treatment of childhood bronchial asthma. J Complement Integr Med. 2013 Jul 9;10:/j/jcim.2013.10.issue-1/jcim-2012-0006/jcim-2012-0006.xml. doi: 10.1515/jcim-2012-0006. PMID: 23843569.

 

Dabbous OA, Soliman MM, Mohamed NH, Elseify MY, Elsheikh MS, Alsharkawy AA, Abd Al Aziz MM. Evaluation of the improvement effect of laser acupuncture biostimulation in asthmatic children by exhaled inflammatory biomarker level of nitric oxide. Lasers Med Sci. 2017 Jan;32(1):53-59. doi: 10.1007/s10103-016-2082-9. Epub 2016 Oct 5. PMID: 27709308.


Surapaty IA, Simadibrata C, Rejeki ES, Mangunatmadja I. Laser Acupuncture Effects on Speech and Social Interaction in Patients with Autism Spectrum Disorder. Med Acupunct. 2020 Oct 1;32(5):300-309. doi: 10.1089/acu.2020.1417. Epub 2020 Oct 19. PMID: 33101575; PMCID: PMC7583335.

 

Vanzini M, Gallamini M. Amblyopia: Can Laser Acupuncture be an Option? J Acupunct Meridian Stud. 2016 Oct;9(5):267-274. doi: 10.1016/j.jams.2016.01.017. Epub 2016 Feb 17. PMID: 27776766.


Elbay M, Tak Ö, Şermet Elbay Ü, Kaya C, Eryılmaz K. The use of low-level laser therapy for controlling the gag reflex in children during intraoral radiography. Lasers Med Sci. 2016 Feb;31(2):355-61. doi: 10.1007/s10103-016-1869-z. Epub 2016 Jan 11. PMID: 26754182.


Quah-Smith I, Sachdev PS, Wen W, Chen X, Williams MA. The brain effects of laser acupuncture in healthy individuals: an FMRI investigation. PLoS One. 2010 Sep 7;5(9):e12619. doi: 10.1371/journal.pone.0012619. PMID: 20838644; PMCID: PMC2935390.




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