Diabetes

MaMMA light therapy in relation to diabetes wound healing

This article by:
Sheila Khanna, MD
Angela Mullett-Silva, DC
Kathleen Linaker, DC
Quoc Giang, DC

There has been over 40 years of independent research showing that Light Therapy ("phototherapy") has demonstrated powerful therapeutic benefits. These studies show that both visible red and infrared effect at least 24 different positive changes at a cellular level. Although initial scientific research was primarily focused on laser technologies, it has become evident that the effects of light therapy are a direct effect of light itself, generated at specific wavelengths, and not a function of coherency and polarization associated with lasers.¹

Light Emitting Diodes (LED?s) are the recent development of the laser industry. LED?s are similar to lasers inasmuch as they have the same healing effect, but the energy is dispersed over a greater surface area, with less danger of soft tissue injury. This arrangement allows for better absorption of the light by the body tissues and thus a stronger biological effect with the result being better and more consistent clinical outcomes.

Light therapy has been established as a useful tool to release nitric oxide, the initiator of the healing process, from hemoglobin. In 1999, research through the University of Health Science Center, discovered that there is an increase in nitric oxide levels after application of 890nm phototherapy. It is the endogenous, localized release of nitric oxide that is the possible mechanism of action of the Anodyne Therapy System. These effects include:

• Vasodilation
• Anti-Inflammatory
• Decreased platelet adhesion
• Anti-viral, Anti-bacterial
• Fibroblastic proliferation
• Osteoblastic proliferation/activity (healing of non-union fractures)
• Pain Relief

What is Light Therapy being used for and why is it effective?

Reversal of peripheral neuropathy

Anodyne Therapy, LLC received a US patent No 6,607,550 entitled "Method of Treating Neuropathy Using a Photoenergy device". A condition that has never been treated is now being effective reversed by Anodyne technology in thousands of patients.² The increased circulation and anti-inflammatory effects combined with the pain relief and restoration of normal nerve conduction lead to reversal of the damage that cause the peripheral neuropathy.

Wound healing

Therapy has shown to speed up healing process from 40-55%. Increases in RNA and DNA synthesis helps damaged cells to be replaced more promptly. The light therapy stimulates cell proliferation and motility as well as tissue granulation and connective tissue projections. The technology has successfully treated pressure ulcers, venous stasis ulcers, diabetic ulcers, arterial ulcers, post-op wounds, and even gangrene.³ Nitric oxide is also the mediator for all growth factors responsible for healing.⁴

Reduces pain and restores normal nerve conductio

Stimulation of the cGMP cycle by nitric oxide yields peripheral morphine analgesia.⁵ Directly nitric oxide ? cGMP- phosphorylation of potassium gated ion channels will normalize membrane potential offering pain control.⁶ Indirectly nitric oxide will establish better blood flow providing oxygen and nutrients for ATP to also normalize membrane potential.

Increases vascularity (circulation) via angiogenesis⁷

New capillaries speed up the healing process by carrying more oxygen and nutrients needed for healing, as well as moving waste products away.⁸ NO-cGMP (kinase) yields phosphate groups on smooth muscle offering vasodilation lasting 4-6 hours post treatment. Nitric oxide is a powerful endogenous vasodilator.

Reduces edema in increase lymphatic system activity

Research has shown that lymph vessel diameter and the flow of lymph system can be doubled with the use of light therapy. Venous and arterial diameters are also increased. This lends to edema being evacuated at a much faster rate to relieve swelling and inhibit prostoglandin effects on tissue. Light therapy also assists in intercellular pH balance.

Stimulates collagen production

Collagen is the essential protein used to repair and replace damaged tissue. Nitric oxide increases collagen production which results in a dramatic decrease in scar tissue.⁹ There is an increased tensile strength and elasticity in scar tissue allowing the scar to withstand a greater challenge without breaking down over time.

Bone healing

Phototherapy has effectively been used in non union fracture repair. Nitric oxide stimulates osteoblastic activity and increases bone mineralization activity. Nitric oxide also inhibits osteoclastic activity to prevent bone resorption.

Overall, the phototherapy technologies of today have gained widespread cceptance by healthcare providers at thousands of clinical sites nationwide because of the consistent improvement they see with their patients in actual clinical practice. There are many companies now developing products with this technology.

So how do you know which company?s technology will be best for your patients? There are two things that you must evaluate to answer this question. First ? which wavelengths(s) of light does the equipment generate. The first law of photochemistry is that only light that is absorbed can have an effect. The effective biological wavelength that is absorbed by hemoglobin causing nitric oxide to be released is in the range of 870-910nm. Secondly it is important to remember to inquire about the actual energy density (Power X Time) the technology applies. The most effective technology will have a high power output and will recommend a long treatment time. This allows a larger total amount of energy to be absorbed by tissues and a larger release of nitric oxide as the blood flows under the treatment pads.

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1. Low-Energy Laser Therapy; Controversies & Research Findings, Jeffrey R. Basford MD; Mayo Clinic; Lasers in Surgery and Medicine 9,pp.1-5 (1989)
2. Restoration of Sensation, Reduced Pain, and Improved Balance in Subjects With Diabetic Peripheral Neuropathy, Leonard DR, Farooqi MH, Myers S, Joslin Center for Diabetes FL, The Journal of Clinical and Applied Research and Education Diabetes Care, 2004, 27:1, pp 168-172.
3. Augmentation of Wound Healing Using Monochromatic Infrared Energy, Horowitz LR, Burke TJ, Carnegie DH. Dept. of Surgery, Denver Veterans Affairs Medical Center, CO; Advances in Wound Care. 1999, 12:35-40.
4. Diabetes Impaired Wound Healing predicted by urinary nitrate assay; A preliminary retrospective study, JV Boykin; Wounds; 11(3): 62-69, 1999
5. The molecular mechanism of action of peripheral morphine analgesia: stimulation of the cGMP system via nitric oxide release, Ferreira SH, Duarte ID, Lorenzetti BB; Eur J Pharmacol 1991 Aug 16;201:121-2.
6. Monochromatic infrared irradiation (890 nm): effect of a multisource array upon conduction in the human median nerve, Nobel JG, Lowe AS, Baxter GD; Rehabilitation Sciences Research Group, University of Ulster at Jordanstown, Newtownabbey, Northern Ireland; J Clin Laser Med Surg. 2001, 19:291-5.
7. Impaired Wound Healing and angiogenesis in eNOS-deficient Mice, PC Lee; American Journal of Physiology , 1999 October,277 (4 Pt 2):H1600-8
8. Nitric Oxide in human skin; Current status and future prospects, D Bruch-Gerharz; J Invest Dermatol 1998;110:1-7
9. Diabetes Impaired Healing and reduced wound nitric oxide synthase: A possible pathophysiologic correlation, MR Shaffer; Surgery; May 1997, V121 No5; 513-19