By Dominique Carson

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The therapeutic potential of light therapy is often considered a "superpower" for humans, with applications in various medical subspecialties, including pain management.
  Preferred Health Magazine recently interviewed Dr. Scott Sigman, a renowned board-certified orthopedic surgeon from Massachusetts, known as the “Healer of shoulders and knees” - to discuss Photobiomodulation Therapy (PBMT)- its functioning, contraindications, benefits, and future in healthcare and wellness.
  Dr. Sigman is a strong supporter of PBMT, previously known as low-light laser therapy, a light-based treatment that stimulates cellular processes, enhances tissue repair, and reduces inflammation.
  At his orthopedic practice, Orthopedic Surgical Associates in Lowell, Massachussettes, Dr. Sigman highlights the potential in treating post-surgical pain, arthritis, and injuries without the use of opioids. 
He has been actively involved in clinical trials and educational efforts to promote the benefits of PBMT as a non-invasive alternative for pain and inflammation management. His research has significantly contributed to the growing recognition of laser therapy in orthopedic care and its relevance in pandemic-related treatments.

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PHM: We hear so much about laser therapies, but what exactly is Photobiomodulation Therapy (PBMT)?
Dr. Scott Sigman: I always start off by asking, 'Do you believe in photosynthesis?' Moreover, as a general rule, most people shake their heads together in high school chemistry or biology class, as if the light shines down, it’s visible light, creating a chemical reaction inside of plants. They then break down CO2. They then provide oxygen for plants to grow and provide sustenance for the species on the planet. And so it should not come as a surprise that in our most profound genetic code, as a human species that has been on this planet for 300,000 years, that in our most profound genetic code, we’d be sensitive to light as well. 
  The point is we are, and so is photobiomodulation therapy, photo meaning light, bio meaning sort of life or cells, and modulation means creating and exerting an influence. So, the idea is that if you can shine light in various wavelengths, frequencies, and intensities, that light will affect the cells in your body, including the living cells. The energy of light is the photon. Let’s think about it as Bitcoin for cryptocurrency base units, and those photons can get into your cells. Moreover, your cells have mitochondria, which most of us also remember. Moreover, a specific enzyme called cytochrome oxidase is in the credit cycle.

  Moreover, that enzyme, believe it or not, is sensitive to wavelengths of light, and it should come as a surprise. Again, we are a species on a planet that walks around on the surface of a planet with the sun. And so what happens is that those photons can actually stimulate cytochrome oxidase to make more ATP, which is the energy unit of the cell. This is the start of a series of chemical reactions within the cell, known as a downstream cascade of events. This cascade sends a message to the cell’s nucleus, where RNA transcription occurs, and these proteins, also called cytokines, can be produced. There are good cytokines, and there are bad cytokines, and the good cytokines are the ones that reduce inflammation, and the bad cytokines are the ones that promote it. Thus, shining the light down into the cell creates good cytokines. 

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You get a whole bunch of things that can happen in the setting, and that is, for example, increased blood flow because the cytokines are sending out messages to the blood vessels to open up in the area where the inflammation is; it will recruit fibroblasts, which are the healing cells of the body, that they call collagen, which is the building block of most of our cells, muscles, bones, and cartilage.   It can send signals to create healing in nerve cells. It can recruit muscle cell healing as well. Moreover, all these things are well documented on a petri dish in the basic science studies that have occurred with 1000s and 1000s of papers over decades, and there are also many clinical studies.

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PHM: How does it work in medical practice?
SS: As the light comes in, it creates a healing environment for a single cell, and that’s where it starts; that cell is then part of the tissue, and that tissue is part of an organ. That organ could be your brain, for example, your knee joint. It could be any of the organs in your body. What does that mean at the end of the day?   
   It means the patient gets better, and it is remarkable how photobiomodulation therapy has now expanded into more standard medical practice. They are using photobiomodulation therapy to alter the metabolism of the brain and can help patients with anxiety and depression as well as traumatic brain injury as well. It’s being used in the cancer world, where there’s a wonderful study down at Children’s Hospital in Texas, where they’re using photobiomodulation therapy to affect the throats of children that are undergoing bone marrow transplants, undergo radiation, chemotherapy, and they can’t eat for two weeks because the lining of their esophagus gets broken down secondary to the therapy. They then use photobiomodulation therapy, and these kids can eat in literally half the time, much faster recovery. 
  It’s used for head and neck cancers and breast cancer, for patients that have developed scar tissue secondary to radiation therapy. Our veterinarian uses it routinely for your dogs and cats, for those that have arthritis, and for surgical interventions. 
   We are seeing some great work, even at the level of microscopic analysis, of biologists and virologists using photobiomodulation therapy, with blue light therapy in particular, to potentially reduce The bacterial load of bacteria viruses, even for antibiotic resistance, bacteria, and viruses. So it is incredible. We are now seeing these things with photobiomodulation therapy in medical practice.

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PHM: Would you say it’s a valuable alternative, especially for those who do not want to take pills such as opioids? 
SS: Great question. That’s exactly where my interest as an orthopedic surgeon was born: using photobiomodulation therapy.  It started for me almost about 15 years ago, but I began to recognize the severity of the opioid crisis. Then, elective surgery had become an inadvertent gateway to opioid addiction because we were using these opioid pills for postoperative pain relief. I was looking at an all-hands-on-deck approach to identifying opioid alternatives. That’s when I was first introduced to lasers about seven years ago. 
   I went to Italy to get educated on photobiomodulation and therapy for potential use for orthopedic conditions, pain, and inflammation. I started using the laser in my own clinical practice and was getting terrific results, and then decided to open up the ortho laser, orthopedic laser franchise. I  was able to make centers so that we could give treatment options to patients without using opioids, both for chronic conditions that people were looking to try and avoid surgery, needles, or opioids. Then, we were using it after surgery as well to reduce inflammation and pain so patients didn’t require opioids.
  One of the major things that happened was about two years ago, the Centers for Disease Control, for the first time in quite some time, updated the guidelines on opioid prescribing, and it was for all doctors in the United States who were using prescriptions for pain medication. And they basically said a few things. The first thing was we should be reducing opioid prescriptions for our patients. There were exceptions, and there are still good reasons to use opioids for patients that have severe trauma or end of life, or for patients that have cancer, then opioids do have their role. But they recommended for opioid naive patients that had either an acute or chronic injury to try and minimize opioids because of the high rate of addiction associated with that, and then they made two major recommendations. They said, first and foremost, we should also be looking at different drugs that can help to treat patients for their pain, that are not addictive, and we use long necking anesthetics, Tylenol, and other medications that we use based on their recommendations. But they also did a deep dive into the literature and made recommendations on non-drug-related alternative treatment options for patients who are in pain. They looked at physical therapy, bracing, and all different types of injections. They also looked at photobiomodulation therapy and lasers. 
  Laser made the list as one of the recommended treatment options for patients that have acute, subacute and chronic pain, which really helped to validate our process. So that way, we feel even more comfortable talking to our patients, to say that photobiomodulation therapy is a wonderful adjunctive or alternative treatment option for patients with pain and inflammation of all the different types of musculoskeletal injuries.

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PHM: What are the contraindications? 
SS:  There are some soft contraindications, so for patients that are on blood thinners or anticoagulants, we still allow for treatment. We just monitor them very closely, because remember, with lasers, I said we could increase blood flow to an area, so we want to make sure that there’s no evidence for bleeding or issues. We’ve treated 1000s of patients at this time, over five years of treatment, and we’ve never had a complication from monitoring patients that are on anticoagulants. Obviously, pregnancy would be something just because we don’t know, not because there’s any data to suggest that there would be a problem, but most of us stay away from pregnant women. We don’t want to create any potential issues. 
  And then for patients that have blood borne cancers, for example, like leukemia, etc., where the cells are traveling through all of the bloodstream. In theory, the laser could sort of activate those cells. So we’d recommend that if you do have an active leukemia or blood borne cancer that we do not recommend laser treatment for those patients. 

PHM: What are the light sources that are used in PBMT?
SS: There are a couple of options for light sources. 
The first is an LED. So, the LED sort of doesn’t give a specific wavelength. It provides a broad spectrum of wavelengths that are all kind of close to one another. So, I think the best way to think about LEDs is to think about red light therapy. Now, you have the visual scale for the ability to see things. Now, Violets to the left, and red is to the right. Now, the thing about red light therapy, when you’re using an LED is that it only penetrates about three to four millimeters, so it doesn’t penetrate into the deep tissues. Still, at three to four millimeters, it does get into the blood supply below the skin. 
  So what I typically tell patients is that red light therapy can provide excellent photobiomodulation therapy, but it’s more systemic. It needs to be for the entire body. And in order to really get good acceptance of that red light, you need to increase the surface area. So that can be very good for patients that are low energy or having systemic issues, you know, fatigue, etc., where Red Light Therapy can provide significant relief. 
  Next is a laser. The difference between LED and laser is that there has to be electricity that creates the laser. It’s not like a light bulb where you turn it on, which is what the LEDs do. You have to send current through a diode, which then creates this photon beam, which is very narrow because lasers are very narrow. Can it be combined with any other alternatives, or must it be utilized separately? 
  There’s a lot of wellness clinics that are considering the use of photobiomodulation therapy there, for example, you know, ultrasound devices as well, that use sound waves, that are not using light waves. People have had success with that. Some people are using it with electromagnetic pulses as well. Then, there is hyperbaric oxygen, which people use. There’s IV therapies, and then there’s also ortho biologics. 

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PHM: Is it PBMT covered by insurance or just considered as an alternative treatment?
SS: Unfortunately, it is not covered by insurance at this point. As a matter of fact, most of the things that we’ve talked about are not covered by insurance. So, it is a patient-pay model. We found across our clinics that people really want to keep moving, and they’re willing to, you know, pay money to be able to reduce inflammation. We set our prices so that they’re quite reasonable. You know, all of our treatments. If you do a 12-treatment package, it’s under $1,000 for the complete treatment cycle, not just for a single treatment. So we try to do our best to keep it reasonably priced and then allow this as an alternative treatment option. 

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PHM: Do you need any additional training or certifications for PBMT?
SS: There are very specific state regulations that occur, not at the national level, but each state's board of medical registration has regulations as to who can administer the laser, which is our national franchise business. We provide all of the training associated with laser technicians, both at the basic level and for master status. So we're not just selling lasers. We want to ensure the lasers are correctly utilized in a business model. As a general rule, our centers that are open across the country adhere to each state's medical regulations as to who can press the button. The overwhelming majority of states allow for delegation of that responsibility. Most of our laser technicians are, for example, athletic trainers, physical therapists, or medical assistants who have gone through additional training to learn how to use the laser. 

 

PHM: Is it PBMT covered by insurance or just considered as an alternative treatment?
SS: Unfortunately, it is not covered by insurance at this point. As a matter of fact, most of the things that we’ve talked about are not covered by insurance. So, it is a patient-pay model. We found across our clinics that people really want to keep moving, and they’re willing to, you know, pay money to be able to reduce inflammation. We set our prices so that they’re quite reasonable. You know, all of our treatments. If you do a 12-treatment package, it’s under $1,000 for the complete treatment cycle, not just for a single treatment. So we try to do our best to keep it reasonably priced and then allow this as an alternative treatment option. 

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PHM: Do you need any additional training or certifications for PBMT?
SS: There are very specific state regulations that occur, not at the national level, but each state's board of medical registration has regulations as to who can administer the laser, which is our national franchise business. We provide all of the training associated with laser technicians, both at the basic level and for master status. So we're not just selling lasers. We want to ensure the lasers are correctly utilized in a business model. As a general rule, our centers that are open across the country adhere to each state's medical regulations as to who can press the button. The overwhelming majority of states allow for delegation of that responsibility. Most of our laser technicians are, for example, athletic trainers, physical therapists, or medical assistants who have gone through additional training to learn how to use the laser. 

 

PHM: Based on your skills & expertise, what is the future for PBMT?
SS: I think that PBMT is going to absolutely become more and more involved in mainstream healthcare across all subspecialties. And I think that, you know, again, we have been a successful species on the planet for 300,000 years. I would argue that light therapy is our superhero power. If we use blue light therapy to the left hand side, we can kill bacteria and viruses, which are the things that can cause harm to human beings. And then if you go to the right-hand side, which is the red light therapy and the near-infrared, there's incredible healing power associated. Indicated with the use of light therapy as well. So I see this basically in every possible subspecialty within medical care.

 

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Dr. Scott A. Sigman is a board certified and fellowship trained orthopaedic surgeon specializing in shoulder and knee care. With a focus on the latest techniques and technologies, Dr. Sigman offers procedures that help patients recover more quickly so that they can enjoy improved quality of life and get back to the activities they love. His practice also has a strong focus on opioid-sparing surgery, utilizing pain management methods that help patients recover comfortably without the need for highly addictive opioid medications.

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To learn more visit scottasigmanmd.com