Practitioners should exercise caution when applying Cool Laser Therapy in the presence of dark tattoos. Tattoos are heavy metal inks injected into the dermis to provide decorative designs for the recipient. The black and dark blue inks, quite often used, will tend to block red and near infrared light from penetrating into the tissue. This build-up of laser light in the dermis (where a lot of the nerve receptors are) will (depending on the power level) cause the patient to react and respond that the laser treatment feels warm or even hot.   

Tips:

1. One of the solutions is to try to stay away from the tattooed area by ½” thus avoiding “heating up” or building energy into the dermis.
2. Another solution is to treat the tattooed area as African American skin (dark skin) and to lower the average power by 50%, to lower the incident energy entering the dermis, to allow dissipation of the heat prior to “heating up” the area. Both suggestions will work, if the patient responds that the treatment feels excessively warm or hot. 
3. If treatment is still painful, remove the probe from direct contact and treat ~15 mm from the surface of the skin.

Yes. Laser therapy is contraindicated in patients with benign or malignant tumours due to its biostimulating effects. LLLT is known to increase energy production, in the form of adenosine triphosphate (“ATP”), which induces accelerated replication of mitochondrial DNA. Moreover, increased local oxygen and glucose consumption also suggests accelerated metabolism. These effects raise concerns over the further enhancement and spread of the lesion.

Tips:

1. The patient should be > 5-years cancer-free prior to treating with LLLT.
2. LLLT has a systemic effect. The biostimulatory effects can also be induced at a site not directly exposed to laser due to humoral factors (i.e., factors transported in the blood).
3. Do not treat over a site of any known malignant lesions unless the patient is undergoing chemotherapy, when LLLT can be used to reduce side effects such as oral mucositis or radiation dermatitis, but only with their physician/oncologist’s permission.
4. LLLT can be considered in terminally-ill cancer patients for palliative pain relief, but only with their physician/oncologist’s permission.

Yes. The application of low-level laser light transcranially is safe. To date, there have been no reports of major safety issues or side effects after transcranial laser treatment. Researchers are generating positive results in the treatment of traumatic brain injuries and neurodegenerative diseases such as Alzheimer’s disease and stroke.

It is recommended that you clean the laser probe surface in between patients using isopropyl alcohol.

Yes.Cool Laser Therapy can be applied safely in patients with ICDs. ICDs are prescribed for people who have a faster than normal heart rate, or tachycardia, as well as for patients suffering from ventricular fibrillation. These devices cannot be influenced by photons. The only exception is any light therapy device that also uses electrical stimulation.

The following are reasonable reasons why a patient may feel pain or soreness after therapy:

1. If an area is severely injured (i.e.: major trauma, post-surgical or severe nerve damage) then the treatment may be “reawakening” the nerves in the area, and therefore, increasing sensation. In other words, the laser treatments may be stimulating more activity within an injured area (e.g.: increased nerve activity, improved blood flow, etc.).
2. If the area is not severely injured, then overtreatment is most likely the root cause, especially if they complain of dull pain, soreness or lack of mobility after treatment. In this case, as a general rule of thumb, we recommend that the power levels are reduced by 10 to 15 mW increments.
3. A third reason is that because the laser diodes emit over very small areas, they may be “sitting” right on top of a nerve and cause the patient pain during treatment. This is quickly resolved by moving the laser head a quarter of an inch in any direction to remove the laser diode from emitting directly over a nerve.
4. Lastly, too much power over too dark of skin causing localized heating.

Avoid treating over the abdominal, pelvic and lower back regions of women who are pregnant. There is concern over interference with the normal development and growth of the fetus. There is, however, no evidence to support the idea of there being any risk in treating distant regions of the body (i.e., upper and/or lower extremities) relative to the uterus.

Yes. Cool Laser Therapy can be applied safely over metal and plastic implants (i.e., plates, rods, pins, nails, wires, etc.). The Theralase laser system is not a heating device, and therefore does not pose a risk of heating the metal.

Some authors advise practitioners to avoid Cool Laser Therapy in patients with epilepsy due to the risk of inducing an epileptic seizure. Pulsing visible red light in the 5-10 Hz range may trigger epileptic seizures. This is, however, highly uncommon.