Guest Editorial
Photomedicine and Laser Surgery Volume 31, Number 12, 2013 ª Mary Ann Liebert, Inc. Pp. 563–564 DOI: 10.1089/pho.2013.9870
Photomedicine: The Early Years Kevin C. Moore, MB, ChB, FRCA
I
t was something of a surprise, but nevertheless a great honor, to be invited to write a guest editorial for Photomedicine and Laser Surgery (PMLS). Having been retired from clinical laser medicine for more than 10 years, I have nothing new to add to current discussion. What I do have is a wealth of historical knowledge of the trials and tribulations that beset photomedicine in its early years; these memories might be of some interest to our newer members. The 1970s and early 1980s were dominated by high-power laser surgery. The early clinical trials of this new surgical modality posed a challenge to the anaesthetist.1 It wasn’t until the mid-1980s that low-powered lasers began to make an impact in the Western world. This was mainly because of the influence of Toshio Ohshiro from the Japan Medical Laser Laboratory ( JMLL) in Tokyo, Japan. Ohshiro was the catalyst who helped develop low-level laser therapy (LLLT), as it was to become known. He described these early years in his own guest editorial for PMLS, with the establishment of the International Laser Therapy Association (ILTA) and the publication of its journal Laser Therapy, and in 1994 the formation of the World Association for Laser Therapy (WALT).2 For this emerging treatment modality to have its own association and journal was a great step forward, but with it came a number of problems. Confusing terminology was rife, with different authors referring to their equipment as being ‘‘low power,’’ ‘‘low dose,’’ or ‘‘low energy.’’ Terms such as ‘‘soft laser,’’ ‘‘mid laser,’’ and even ‘‘cool laser’’ further confused the issue. It was Ohshiro who focused attention on LLLT, but even then, others still used the terms ‘‘low energy light irradiation (LELI),’’ ‘‘low intensity light irradiation (LILI),’’ ‘‘biostimulation,’’ ‘‘photobio-activation,’’ and ‘‘photobio-modulation,’’ before the now currently accepted terms ‘‘laser therapy,’’ ‘‘light therapy,’’ and the all-embracing ‘‘photomedicine’’ became the norm. ‘‘Photobio-activation’’ was the preferred term in these early years, until it was pointed out that excessive therapy could lead to inhibition, after which ‘‘photobio-modulation’’ became popular. However, critics were still unconvinced. Again it was Ohshiro who tried to counter the ongoing disbelief by proposing his ‘‘laser apple’’ theory.3 He postulated that when incident light from high-power lasers irradiated tissue, it spread in a similar fashion to that of the ripples when a stone is thrown into a pond, thus producing concentric circles of tissue effect with inner bands of carbonization, vaporization, coagulation, and protein denaturation, with a final outer perimeter band of
photobio-activation. Hence, he theorized, the reason why laser surgery was associated with a reduced level of postoperative pain. Eventually it was recognized that light did not have to come from a laser source to exert a therapeutic effect, and the terms ‘‘light therapy’’ and ‘‘photomedicine’’ were adopted as a truer definition. But there were other problems. Many congress reports in these early days were anecdotal with poor research. Even published articles on clinical trials omitted the full details of dosimetry, thus rendering the trials unable to be reproduced. But even more damaging were claims for therapeutic benefit that was unsubstantiated by experimental and clinical research, which led to health insurers refusing funding and in the United States, the Food and Drug Administration (FDA) remained skeptical. This led to a critical response from some scientific establishments.4 The Editorial Board of Laser Therapy tried to fill this educational void with a series of editorials exhorting researchers to use accepted protocols for their research projects and to fully report their experimental parameters and dosimetry,5,6 but progress was slow, despite encouraging laboratory reports of the effect of irradiation at cellular level, from internationally respected institutions such as the Tissue Repair Research Unit at Guy’s Hospital, London and the Russian Academy of Science in Moscow.7–9 Clinical researchers from around the world were beginning to report beneficial responses to irradiation for a variety of acute and chronic pain conditions.10–13 Throughout the 1990s, clinical trials in a variety of different disciplines began to establish LLLT as a valid therapeutic modality.14–17 But trouble lay round the corner. First, Laser Therapy faced an uncertain future. Initially published in 1989 by John Wiley & Sons, a reputable United Kingdom publishing house, with four issues per year, the publishers had set a 5 year circulation target of 500 copies per issue. When this failed to materialize, John Wiley ceased production following Volume 5. For the next 9 years, Laser Therapy was published under the auspices of the WALT Executive Council, initially in Japan by Hokkaido University Press, and later by Kansas University Medical Center Press in the United States. However, the burden proved too great, publication deadlines were met erratically, and, as a consequence, the journal failed to make an impression in the professional marketplace. WALT itself faced its own crisis in 2000 with falling membership and no journal published for more than a year. The situation was
Former Consultant Anaesthetist and Director Pain & Laser Therapy Clinic, The Royal Oldham Haspital, Oldham, UK; Medical Director and Chief Executive, Dr Kershaw’s Hospice, Oldham, UK; and Honorary Treasurer and Member of Executive Council, World Association for Laser Therapy.
563
564 rescued by the generosity of a number of members who, at the WALT Congress in Athens in late 2000, donated sufficient funds to enable the journal to be relaunched and WALT to survive. The Executive Committee, in appreciation of their financial support, granted these donors life membership in the Association. It would be remiss not to mention the laser equipment manufacturers who, during these difficult years, continued to support the Association. Companies such as Thorlaser (UK) and Lasotronic (Switzerland) remained steadfast. In 2003, the Editorial Board made the decision to seek a professional publisher, and in due course publishers Mary Ann Liebert, Inc amalgamated the Journal of Clinical Laser Medicine and Surgery with Laser Therapy and the resulting Photomedicine and Laser Surgery became the official journal of WALT and its sister organization the North American Association for Laser Therapy (NAALT). Eventually, Laser Therapy was resurrected by JMLL and now carries an extensive list of affiliations. Meanwhile, PMLS has proved an inspired choice for our two associations. It was particularly gratifying to see in the Journal Citation Reports 2012 that its impact factor had risen by 30%, and now registers an impressive 1.634. I hope this brief history will be of interest to our readers. I finish by passing on my personal greetings and warmest wishes to all those whom I have worked with, laughed with, and learned with over the years; they made us what we are today. References 1. Moore, K.C. (1986). The operative care of patients for NdYAG contact laser surgery, in: Nd-YAG Laser in Medicine and Surgery: Fundamental and Clinical Aspects. Tokyo: PPS, pp. 124–127. 2. Ohshiro, T. (2009). Guest editorial. Photomed. Laser Surg. 27, 1–2. 3. Ohshiro, T. (1996). The laser Apple: a new graphic representation of medical laser applications. Laser Ther. 8, 185– 190. 4. Basford, J.K. (1986). Low energy laser treatment of pain and wounds: hype, hope or hokum. Mayo Clin. Proc. 61, 671–675. 5. Calderhead, R.G. (1991). Watts a joule: on the importance of accurate and correct reporting of laser parameters in low reactive-level laser therapy and photobio-activation research. Laser Ther. 3, 177–182.
GUEST EDITORIAL 6. Ohshiro, T., and Calderhead, R.G. (1988). Photobioactivation, in: Low Level Laser Therapy: A Practical Introduction. Chichester, UK: John Wiley & Sons, pp. 32–38. 7. Bolton, P., Dyson, M., and Young, S. (1992). The effect of polarised light on the release of growth factors from the U-973 macrophage-like cell line. Laser Ther. 4, 33–38. 8. Karu, T. (1992). Depression of the genome after irradiation of human lymphocytes with He-Ne laser. Laser Ther. 4, 5–24. 9. Bolton, P., Young, S., and Dyson M. (1995). The direct effect of 860 nm light on cell proliferation and on succinic dehydrogenase activity of human fibroblasts in vitro. Laser Ther. 7, 53–58. 10. Moore, K.C., Hira, N., Kumar, P.S., Jayakumar, C.S., and Ohshiro, T. (1988). A double blind crossover trial of low level laser therapy in the treatment of postherpetic neuralgia. Laser Ther. Pilot Issue, 7–10. 11. Asada, K., Yutani, Y., Sakawa, A., and Shimazu, A. (1991). Clinical application of Ga Al As 830nm diode laser in treatment of rheumatoid arthritis. Laser Ther. 3, 77–82. 12. Moore, K.C., Hira, N., Broome, I.F., and Cruikshank, J.A. (1992), The effect of infra-red diode laser irradiation on the duration and severity of postoperative pain: a double blind trial. Laser Ther. 4, 145–150. 13. Kemmotsu, O. (1996). The role of laser therapy in the pain clinic. Laser Ther. 8, 123–126. 14. Rochkind, S. (1992). Central nervous system transplantation benefited by low power laser Irradiation. Lasers Med, Sci. 7, 143–151. 15. Glinkowski, W., and Rowinski J. (1995). Effect of low incident levels of infra-red laser energy on the healing of experimental bone fractures. Laser Ther. 7, 65–68. 16. Kutvolgyi, I. (1998). Low level laser therapy as a diagnostic tool in dentistry. Laser Ther. 10, 79–82. 17. Soriano, F., and Rios, R. (1998), Gallium arsenide laser treatment of chronic low back pain: a prospective, randomized and double blind study. Laser Ther. 10, 173–180.
Address correspondence to: Kevin C. Moore Sherwood House Field Lane Wroot Doncaster DN9 2BN UK Email: [email protected]
Photomedicine and Laser Surgery Volume 31, Number 12, 2013 ª Mary Ann Liebert, Inc. Pp. 563–564 DOI: 10.1089/pho.2013.9870
Photomedicine: The Early Years Kevin C. Moore, MB, ChB, FRCA
I
t was something of a surprise, but nevertheless a great honor, to be invited to write a guest editorial for Photomedicine and Laser Surgery (PMLS). Having been retired from clinical laser medicine for more than 10 years, I have nothing new to add to current discussion. What I do have is a wealth of historical knowledge of the trials and tribulations that beset photomedicine in its early years; these memories might be of some interest to our newer members. The 1970s and early 1980s were dominated by high-power laser surgery. The early clinical trials of this new surgical modality posed a challenge to the anaesthetist.1 It wasn’t until the mid-1980s that low-powered lasers began to make an impact in the Western world. This was mainly because of the influence of Toshio Ohshiro from the Japan Medical Laser Laboratory ( JMLL) in Tokyo, Japan. Ohshiro was the catalyst who helped develop low-level laser therapy (LLLT), as it was to become known. He described these early years in his own guest editorial for PMLS, with the establishment of the International Laser Therapy Association (ILTA) and the publication of its journal Laser Therapy, and in 1994 the formation of the World Association for Laser Therapy (WALT).2 For this emerging treatment modality to have its own association and journal was a great step forward, but with it came a number of problems. Confusing terminology was rife, with different authors referring to their equipment as being ‘‘low power,’’ ‘‘low dose,’’ or ‘‘low energy.’’ Terms such as ‘‘soft laser,’’ ‘‘mid laser,’’ and even ‘‘cool laser’’ further confused the issue. It was Ohshiro who focused attention on LLLT, but even then, others still used the terms ‘‘low energy light irradiation (LELI),’’ ‘‘low intensity light irradiation (LILI),’’ ‘‘biostimulation,’’ ‘‘photobio-activation,’’ and ‘‘photobio-modulation,’’ before the now currently accepted terms ‘‘laser therapy,’’ ‘‘light therapy,’’ and the all-embracing ‘‘photomedicine’’ became the norm. ‘‘Photobio-activation’’ was the preferred term in these early years, until it was pointed out that excessive therapy could lead to inhibition, after which ‘‘photobio-modulation’’ became popular. However, critics were still unconvinced. Again it was Ohshiro who tried to counter the ongoing disbelief by proposing his ‘‘laser apple’’ theory.3 He postulated that when incident light from high-power lasers irradiated tissue, it spread in a similar fashion to that of the ripples when a stone is thrown into a pond, thus producing concentric circles of tissue effect with inner bands of carbonization, vaporization, coagulation, and protein denaturation, with a final outer perimeter band of
photobio-activation. Hence, he theorized, the reason why laser surgery was associated with a reduced level of postoperative pain. Eventually it was recognized that light did not have to come from a laser source to exert a therapeutic effect, and the terms ‘‘light therapy’’ and ‘‘photomedicine’’ were adopted as a truer definition. But there were other problems. Many congress reports in these early days were anecdotal with poor research. Even published articles on clinical trials omitted the full details of dosimetry, thus rendering the trials unable to be reproduced. But even more damaging were claims for therapeutic benefit that was unsubstantiated by experimental and clinical research, which led to health insurers refusing funding and in the United States, the Food and Drug Administration (FDA) remained skeptical. This led to a critical response from some scientific establishments.4 The Editorial Board of Laser Therapy tried to fill this educational void with a series of editorials exhorting researchers to use accepted protocols for their research projects and to fully report their experimental parameters and dosimetry,5,6 but progress was slow, despite encouraging laboratory reports of the effect of irradiation at cellular level, from internationally respected institutions such as the Tissue Repair Research Unit at Guy’s Hospital, London and the Russian Academy of Science in Moscow.7–9 Clinical researchers from around the world were beginning to report beneficial responses to irradiation for a variety of acute and chronic pain conditions.10–13 Throughout the 1990s, clinical trials in a variety of different disciplines began to establish LLLT as a valid therapeutic modality.14–17 But trouble lay round the corner. First, Laser Therapy faced an uncertain future. Initially published in 1989 by John Wiley & Sons, a reputable United Kingdom publishing house, with four issues per year, the publishers had set a 5 year circulation target of 500 copies per issue. When this failed to materialize, John Wiley ceased production following Volume 5. For the next 9 years, Laser Therapy was published under the auspices of the WALT Executive Council, initially in Japan by Hokkaido University Press, and later by Kansas University Medical Center Press in the United States. However, the burden proved too great, publication deadlines were met erratically, and, as a consequence, the journal failed to make an impression in the professional marketplace. WALT itself faced its own crisis in 2000 with falling membership and no journal published for more than a year. The situation was
Former Consultant Anaesthetist and Director Pain & Laser Therapy Clinic, The Royal Oldham Haspital, Oldham, UK; Medical Director and Chief Executive, Dr Kershaw’s Hospice, Oldham, UK; and Honorary Treasurer and Member of Executive Council, World Association for Laser Therapy.
563
564 rescued by the generosity of a number of members who, at the WALT Congress in Athens in late 2000, donated sufficient funds to enable the journal to be relaunched and WALT to survive. The Executive Committee, in appreciation of their financial support, granted these donors life membership in the Association. It would be remiss not to mention the laser equipment manufacturers who, during these difficult years, continued to support the Association. Companies such as Thorlaser (UK) and Lasotronic (Switzerland) remained steadfast. In 2003, the Editorial Board made the decision to seek a professional publisher, and in due course publishers Mary Ann Liebert, Inc amalgamated the Journal of Clinical Laser Medicine and Surgery with Laser Therapy and the resulting Photomedicine and Laser Surgery became the official journal of WALT and its sister organization the North American Association for Laser Therapy (NAALT). Eventually, Laser Therapy was resurrected by JMLL and now carries an extensive list of affiliations. Meanwhile, PMLS has proved an inspired choice for our two associations. It was particularly gratifying to see in the Journal Citation Reports 2012 that its impact factor had risen by 30%, and now registers an impressive 1.634. I hope this brief history will be of interest to our readers. I finish by passing on my personal greetings and warmest wishes to all those whom I have worked with, laughed with, and learned with over the years; they made us what we are today. References 1. Moore, K.C. (1986). The operative care of patients for NdYAG contact laser surgery, in: Nd-YAG Laser in Medicine and Surgery: Fundamental and Clinical Aspects. Tokyo: PPS, pp. 124–127. 2. Ohshiro, T. (2009). Guest editorial. Photomed. Laser Surg. 27, 1–2. 3. Ohshiro, T. (1996). The laser Apple: a new graphic representation of medical laser applications. Laser Ther. 8, 185– 190. 4. Basford, J.K. (1986). Low energy laser treatment of pain and wounds: hype, hope or hokum. Mayo Clin. Proc. 61, 671–675. 5. Calderhead, R.G. (1991). Watts a joule: on the importance of accurate and correct reporting of laser parameters in low reactive-level laser therapy and photobio-activation research. Laser Ther. 3, 177–182.
GUEST EDITORIAL 6. Ohshiro, T., and Calderhead, R.G. (1988). Photobioactivation, in: Low Level Laser Therapy: A Practical Introduction. Chichester, UK: John Wiley & Sons, pp. 32–38. 7. Bolton, P., Dyson, M., and Young, S. (1992). The effect of polarised light on the release of growth factors from the U-973 macrophage-like cell line. Laser Ther. 4, 33–38. 8. Karu, T. (1992). Depression of the genome after irradiation of human lymphocytes with He-Ne laser. Laser Ther. 4, 5–24. 9. Bolton, P., Young, S., and Dyson M. (1995). The direct effect of 860 nm light on cell proliferation and on succinic dehydrogenase activity of human fibroblasts in vitro. Laser Ther. 7, 53–58. 10. Moore, K.C., Hira, N., Kumar, P.S., Jayakumar, C.S., and Ohshiro, T. (1988). A double blind crossover trial of low level laser therapy in the treatment of postherpetic neuralgia. Laser Ther. Pilot Issue, 7–10. 11. Asada, K., Yutani, Y., Sakawa, A., and Shimazu, A. (1991). Clinical application of Ga Al As 830nm diode laser in treatment of rheumatoid arthritis. Laser Ther. 3, 77–82. 12. Moore, K.C., Hira, N., Broome, I.F., and Cruikshank, J.A. (1992), The effect of infra-red diode laser irradiation on the duration and severity of postoperative pain: a double blind trial. Laser Ther. 4, 145–150. 13. Kemmotsu, O. (1996). The role of laser therapy in the pain clinic. Laser Ther. 8, 123–126. 14. Rochkind, S. (1992). Central nervous system transplantation benefited by low power laser Irradiation. Lasers Med, Sci. 7, 143–151. 15. Glinkowski, W., and Rowinski J. (1995). Effect of low incident levels of infra-red laser energy on the healing of experimental bone fractures. Laser Ther. 7, 65–68. 16. Kutvolgyi, I. (1998). Low level laser therapy as a diagnostic tool in dentistry. Laser Ther. 10, 79–82. 17. Soriano, F., and Rios, R. (1998), Gallium arsenide laser treatment of chronic low back pain: a prospective, randomized and double blind study. Laser Ther. 10, 173–180.
Address correspondence to: Kevin C. Moore Sherwood House Field Lane Wroot Doncaster DN9 2BN UK Email: [email protected]
