Chronic and neuropathic pain

management

©
Nelson Marquina, MSc, PhD, DC
Laser Biotech International
Richmond, Virginia
www.LaserBiotech.com

Copyrighted by Laser Biotech International

 Nelson Marquina, MSc, PhD DC
• Chief Technology Officer - Laser Biotech International
• Former Senior Scientist - NASA/Houston JSC
• Former Director of Research - Logan University
• Former Professor
- University of Houston - systems engineering
- University of Minnesota - electrical engineering
- University of Rhode Island - electrical engineering
- Virginia State University - biophysics
• MSc - Biomathematics - Worcester Polytechnic Institute
• PhD - Systems Engineering - University of Houston

• Doctor of Chiropractic - Logan University

• Engineer - GE, Honeywell, Lockheed Electronics

Seminar objectives
• Better understand chronic and neuropathic pain
• Identify treatment targets unique and significant
to chronic and neuropathic pain
• Have knowledge and confidence to integrate
laser with e-stim and US to treat pain conditions
• Obtain introductory information on treating
neuropathic pain and dystonia caused by
Parkinson’s Disease (PD)

How to achieve the objectives

somatic PAIN neuropathic

acute chronic peripheral central

advanced
DRG
neuro
dorsal horn seminar
medulla

pons
Alzheimer’s
thalamus
Parkinson’s
Frank Jarrell, DC
Nelson Marquina, DC, PhD
sensory
cortex
Injury to inflammation to tissue repair
therapy settings
differ

acute state chronic state

©2018

The inflammation soup

Role of mitochondria in inflammation

Not just pain…also tissue repair

Al Massucci, DC
laser: Lumix 4 - 14W

Why so much chronic pain?

Anti-inflammatories
acute phase chronic phase
Conventional approach: inhibit or ablate

Visceral pain: same process

Chronic and neuropathic pain

• Conventional approach is to chemically or

mechanically:
- Inhibit
- Ablate
• Laser therapy approach (PBM) is to:
- Repair and restore function
Patients stuck in unresolved inflammation!

causes acute pain & induce flareup

“injury”
inflammation

PBM
resolution of yes physiological no unresolved
inflammation debridement inflammation
yes

laser therapy/PBM
PBM
tissue incomplete
chronic neuropathic
repair pain pain
yes

tissue incomplete centralized

pain
remodeling

acute ©2018

Injury - inflammation - pain cycle

acute pain
tissue repair
lved
so
re

“injury” inflammation
un
re
solv
ed
chronic pain
tissue repair

Meniscal inflammation

Andrzej Zielke, MD
Lumix 2 - 250W
©2018
Classifying pathophysiological pain

central sensitization

mixed pain
nociceptive pain: neuropathic pain:
• acute • central
• chronic • peripheral

Pain differentiation

Nociceptive Pain Neuropathic Pain

• An appropriate • An inappropriate
physiologic response response caused by
to a painful stimulus primary lesion or
• Can be acute or dysfunction in the
chronic CNS or PNF
• Mostly chronic

Neuropathic = nerve “injury”

 Pain patterns

nociceptive mixed neuropathic

pain pain pain

Nociceptive or neuropathic pain?

Nociceptive or neuropathic pain?

Neuropathic pain presentations

Clearly somatic pain

Clearly neuropathic pain

 Clearly neuropathic pain?

Pain due to PD? Really?

CRPS type I and type II

CRPS

Type 1 Type 2
absence of a presence of a
major nerve lesion major nerve lesion

Reflex Sympathetic Dystrophy Causalgia

signs and symptoms are difficult to distinguish

How do we describe RSD

• Pain in excess of what is expected (allodynia)
• Swelling or edema
• Coldness or heat in limb(s)
• Joint tenderness/stiffness
• Skin color changes
• Loss of hair
• Nail growth
• Pain can be bilateral
 Some RSD presentations

Neuropathic pain prevalence

73%

Complex Regional Pain Syndrome 1: “RSD”

Complex Regional Pain Syndrome 2: “Causalgia”

LBP alone accounts for 54%!

Neuropathic pain: treatment failure

• Diagnosis failure rates are alarmingly

high, e.g, 64%
• Conventional approach is to chemically
or mechanically:
- Inhibit
- Ablate
• Laser therapy approach (PBM) is to:
- Biomodulate
 Summary so far
• Unresolved inflammation eventually leads to
chronic pain
• Unresolved nerve injury typically leads to
neuropathic pain
• Patients experiencing chronic or neuropathic
pain are stuck in unresolved inflammation

To understand what we need to do clinically,

we need to dig into the pain mechanisms

Pain: Key terms

• Hyperalgesia: an increased response to a

stimulus that is normally painful
• Neuralgia: pain in the distribution of a nerve
or nerves
• Neuropathy: a disturbance of function or
pathological change in a nerve

Key terms (cont’d)

• Neuropathic pain: pain initiated or caused by

a primary lesion or dysfunction in the CNS or
PNS (NSAIDs don’t work)
• Nociceptive pain: an appropriate physiologic
response to a painful stimulus
 Pain pathways are bidirectional

Injury Brain

Descending
Pathway

Dorsal
Peripheral Root
Nerve Ganglion

Ascending
Pathways
C-Fiber

A-beta Fiber Dorsal

Horn
A-delta Fiber
Spinal Cord

Brain actively quenches pain

medulla DRG
oblongata

Different laminae for A-delta and C fibers

 Chronic pain due to lost inhibition?

too many pain signals ascending or not enough

modulating signals descending?

Dorsal horn remodeled: sensitization

C-fiber nerve
injury
C-fiber
I I

II II

III/IV/V III/IV/V

Aβ-fiber nerve
Aβ-fiber injury

Dorsal Horn Dorsal Horn

• Normal termination pattern • Sensitization / wind-up
• C-fiber terminal atrophy
• A-fiber sprouting

Dorsal horn spill over

 Neuropathic pain centralization

nerve
“injury”

Why long-term potentiation?

Recall: nerve injury leads to inflammation,

which leads to microglia proliferation

Neuronal lesion causes high firing

nerve
“injury”
 Neuronal lesion causes
spontaneous ectopic firing
nerve
“injury”

Chronic pain pathophysiology

peripheral mechanisms
Peripheral neuron
hyperexcitability1

central mechanisms
Loss of Abnormal chronic
inhibitory controls1,2 discharges pain

central mechanisms
Central neuron
hyperexcitability
(central sensitization)1

Viscero-somatic reflex
 Neuropathic and centralized pain

Physiological processes:
• Sensitization
• Centralization
• Sprouting
• Normal and dysfunctional reflexes

Effects in local tissue, PNS and CNS

• ↑ threshold activation after injury

• ↑ response to noxious stimuli
• ↑ spontaneous activity

Chronic back pain effects on brain

 Chronic pain = shrinking brain!

thalamus

pre frontal
cortex

Revisit the pain therapy landscape

causes acute pain & induce flareup
“injury”
inflammation

PBM
resolution of yes physiological no unresolved
inflammation debridement inflammation
yes
laser therapy/PBM

PBM
tissue incomplete
chronic neuropathic
repair pain pain
yes

tissue incomplete centralized

pain
remodeling

©2018

When things go wrong!

pain
Mitochondria drives Citric Acid Cycle

Mitochondria function = more ATP

Mitochondria health is key

Mitochondria dysfunction = cell death

Cellular negative charge = healthy cell!

Positive voltage = inflammation, sickness, death!

Na-K pump causes electronegativity

Ion pumps create negative charge

Ion pumps need ATP to function

Positive membrane voltage = death!

-50 mV pH = 7.88 make new cells

-35 mV pH = 7.61 normal for kids

-25 mV pH = 7.44 normal for adults

-15 mV pH = 7.25 tired

-10 mV pH = 7.18 sick

0 mV pH = 7.0 change polarity

+30 mV pH = 6.48 cancer occurs

pH to voltage conversion

pH = 0 +414 mV

pH = 4 +177 mV

pH = 7 0 mV

pH = 10 -177 mV

pH = 14 -414 mV

Can’t measure patient’s pH?

no problema!
• SalivarypH values are about 0.8 units lower than
intracellular pH
- Salivary pH is an indicator of cellular voltage
• UrinepH values are about 0.8 units lower than
extracellular pH
- Urine pH is an indicator of voltage in
extracellular fluids
 Electron thieves vs. donors
Electron thief Electron donor
causes damage can do work

pH = 0 to 6.9 pH = 7.1 to 14

acidic alkaline

free radicals antioxidant

positive pole negative pole

destructive constructive

Why recharge the mitochondria?

©2018

Mitochondria: another way of looking

 Mitochondria functions!
• ATP Synthesis (aerobic)
• ATP Consumption (anaerobic or
aerobic with uncoupling)
• Redox Poise Homeostasis
• Platelet Aggregation and Activation
• Neutrophil Chemotaxis
• Late Neutrophil Oxidative Burst
• Macrophage Activation
• T-Cell Activation
• Sperm cell motility/fertilization
• Cortisol Synthesis
• Mineralocorticoid Synthesis
• Sex Steroid Synthesis
• Vitamin D Metabolism
• Cytoskeleton Architecture/
Mechanotransduction
• Calcium Storage and Release
• Iron Storage and Metabolism
• DNA and RNA--De Novo Pyrimidine
Synthesis (DHO-QO)

• Angiogenesis
• Lipids--Fatty Acid Oxidation

• Lymphedema
• Proteins--Amino Acid Metabolism

• Nitric Oxide Synthesis

• Sugars--Carbohydrate Metabolism
(Krebs Cycle)
• Apoptosis/Caspase Activation
• Urea Cycle and NH3 Metabolism
• Prostaglandin Inactivation
• Peripheral Benzodiazapine Receptor
• Cholesterol Synthesis
©2018

Target tissues and structures

So far, we have identified target

structures during the seminar

Let’s find them and treat them!

Chronic and neuropathic pain:

“treatment players”
• Local tissue, precipitating lesion
• DRGs
• Dorsal horn
• Medulla, pons and thalamus
• Sensory cortex
• Sympathetic chain (lowest priority)

Let’s find the treatment players so we know

what tissues to treat
First let’s review therapeutic photons

photon

photons are electromagnetic waves

Main purpose of laser therapy?

recharge the mitochondria!

laser must reach target tissues

in the correct amount!

photonic energy

pos. & neg. factors cell

patient factors
laser factors
laser
©2018

Not all photons reach the mitochondria!

n
io
at ic
ul m
t im y na y
os toD rap
bi o e
Ph Th
ery
rg
su
Not all photons reach the mitochondria!

h ing !
t s
no pen
p
ha
io n
t rat
e
en n
op or ptio
n
io
at ic
ul m
n im na y

or
t y
os toD rap
bi

b s
o
Ph Th
e

oa
ery
su
rg
n

Laser therapy effects ATP synthesis

Muscle
Cell

ATP produced

Mitochondrion

absorbs laser

Key target: cytochrome c

3H+
H+ H+ H+
H+ H+ H+ H+ H+ H+ H+ H+ H
+

H+ H+ H+ H+ H+
H+ H+ H+ H+ H+ H+
H+ H+
H+ H +
H+ H+
H+ H+ H+ H+

H+ H+ H+

cytochrome c
Mitochondria migration: key to health

d rium ptic
hon yna
itoc t-s
m pos

Knott AB, et al. Mitochondrial fragmentation in neurodegeneration.

Nature Reviews Neuroscience. 2008; 9:505-518 ©2013 The Institute for Functional Medicine

How else to support the mitochondria

How to support the mitochondria

What are the dark lines on my hand?

infrared laser beam

infrared
photograph

Photon absorption depends on wavelength

650 810 910 980 1064
hemo

Therapeutic Window
relative absorption

water
globi
Absorption Coefficient (cm-1)

water

wavelength (nm)
Wavelength (nm)
©2018

More thermal effect = less tissue penetration

650 nm 810 nm 910 nm 980 nm 1064 nm

tissue penetration

How do we enhance tissue penetration?

 Two types of therapeutic lasers
cw
cw
cw pulsed

diode laser

superpulsed

Continuous wave (CW) laser pulsed

12W
average power

6W

continuous wave (CW) 1 sec

Continuous wave (CW) laser pulsed

12W
average power

pulse train (4Hz) 1 sec

NOTE: each pulse is 12 W power
peak power = 12 W; average power = 6 W
 Pulsed CW laser and superpulse

CW pulse SP pulse
power power
e.g., 600 W
12 W

e.g., 5 W
6W
SP average
power

CW average
power

CW pulse train (4 Hz) 1 sec

Super brief review of laser terms

• Average power and energy

• Power density (“intensity”)
• Energy density (dose)
• Dosage principles
• Average dose per tissue type

Power and power density illustration

higher

X gallons/second gallons/second

same X gallons/sec &

higher water pressure

 Watts = “photons per second”

higher

X gallons/second gallons/second

same X gallons/sec &

higher water pressure

What do we mean by laser power and energy

• Average Power; unit in watts (W):

photons per second (“rate of emission”)
• Energy; unit in joules (J):
total laser emission
1 joule = 1 watt x 1 sec

target 1J = 0.5 W x 2s
energy
1J = 0.1 W x 10s
240 J = 12 W x (t)s?
• Energy = average power X treatment time

Dose: most important parameter

• Power = photons per second
• Power density = “intensity of photons”
• Power density = average power (W)
÷ size of beam or “spot size” (cm2)
• Power density = W/cm2
• Energy density = power density X time (sec)
= J / cm2 (dose)
Main factors for effective laser therapy
• Average power (amount of laser energy per second)
• Pulse or peak power (max. power level in a pulse)
• Power density (“intensity” of laser beam)
• Energy density (“energy concentration” = dose)

Laser must reach target tissues

in the correct amount
easier said than done!

30 June 2020

Director, American Society for Laser Medicine and Surgery

Average dose per tissue type

• Muscles: 7 J/cm2
• Nerve, skin, bursa: 5 J/cm2
• Tendon, ligament, fascia, bone: 10 J/cm2

must compensate for tissue depth!

use 50% rule

50% rule to account for tissue depth
laser
40J energy

1 cm
20J

2 cm 10J

5J
3 cm

Reach your target

If you can’t reach it,

you can’t treat it! .

• Correct amount is driven by average power

• Tissue penetration is driven by pulse power

and wavelength

Adjustable power density (Lumix)

 Laser treatment “spot”

playing card: 6.5 cm x 9 cm = 60 cm2

©2018

Chronic and neuropathic pain:

“treatment players”
• Local tissue, precipitating lesion
• DRGs
• Dorsal horn
• Medulla, pons and thalamus
• Sensory cortex
• Sympathetic chain (lowest priority)

Now we can treat the treatment players

DRG/VRG live near the IVF

3 cm

cervical spine IVF

 Cervical DRG

DRG

depth:
approx.
2-8 cm

How about treating the cervical DRGs?

DR
G

depth:
approx. 3 cm
2-8 cm

Example: treating cervical spine DRGs

Lumix 4 - 250W; CW power = 2 W; pulse rate = 40 kHz

 Thoracic access to DRG

sympathetic
ganglion

dorsal &
depth:
ventral
approx.
roots
4-6 cm
2 cm

Facet joint and DRG are close

dorsal root lumbar facet joint

Lumbar access to nerve roots

sympathetic
ganglion

depth: dorsal &

approx. ventral
4-8 cm roots
3 cm
 Lumbar access to DRG

DRG

DRG
depth:
approx.
4-8 cm facet

iliac
crest

Treating Lumbar spine DRGs

Lumix 4 - 250W; CW power = 4 W; pulse rate = 30 kHz

Neuropathic pain:
more “treatment players”

• Medulla and thalamus

• Sensory cortex
Important accessible structures

us
lam
tha

G
medulla DR ssible
c ce
accessible a orn
r sal h ble
do essi
acc

©2018

Medulla oblongata and thalamus

thala
mus

medu
lla
©2018

Targeting the medulla

protub
erance

depth: ccess point acces depth:

s poin
approx.
a t approx.
4-6 cm Atl
6-8 cm
medulla as
 Medulla and access point

acce
ss p
o int
lla
medu

©2018

Sensory cortex is also treatable

Sensory cortex: reachable with laser

sensory
cortex
approx. 2 cm
depth
 Sensory cortex: where to treat
coronal suture

bregma

5 cm

sensory
cortex

Easily locate the sensory cortex

+5 cm
coronal
suture sensory

auditory
meatus

Sympathetic chain located T1 to L2

 Sympathetic chain: T10 example

peripheral
distribution of
sympathetics
via cutaneous
branches of
spinal nerves
T1 to L2

Why is the sympathetic chain important

Maintains the
RSD

Sympathetically maintained pain

Case study - female patient w/CRPS

before treatment 3 min into laser treatment 4 min into laser treatment

6 min into laser treatment 8 min into laser treatment

Andrzej Zielke, MD
Lumix 2 - 250W

Craniofacial pain is rather unique

The mighty trigeminal nerve (CN V)

subnucleus
• CN V carries pain signals from the face
caudalis
tri trac
ge t

• Trigeminal nucleus travels caudally to

mi
na

upper cervical (the subnucleus caudalis)

l
tri ang
ge li
g

m on
in
al
 The craniocervical map

C2 nerve root
trigeminal
C2-C3 nerve roots
nerves
C3 nerve root

C4 nerve root
C2 - C3 roots
C5 nerve root
C3 - C4 roots

Line of sight to trigeminal ganglion

Trigeminal ganglion

laser dose:
5 J/cm2 at
the ganglion

Treating the trigeminal ganglion

J. Tregaskes, DMD, MS
 Craniofacial pain general protocol
trigeminal lesser
ganglion occipital

supra orbital greater

occipital
infra orbital
great
auricular
CN5 subnucleus
caudalis

What’s the big deal with caudalis?

• Big problem: besides cranial nerve V,

cranial nerves VII, IX and X plus cervical
nerves 1 to 3 also converge in the
subnucleus caudalis
• Fortunately,
the subnucleus caudalis can
be accessed in the upper cervical spine!

V3 and C2 “crosstalk” in the nucleus

sen
sor
yc
ort
ex
Houston, we have a bigger problem!
Trigeminal ganglion produces CGRP

calcitonin
gene-related
peptide

CGRP are vasodilators migraines

CGRP are vasodilators

 CGRP are vasodilators

Medical: block CGRP and its receptors

recent drug: monoclonal antibodies - Aimovig

But, CGRP has important functions!

• Inhibitor of platelet aggregation
• Powerful vasodilator - esp. in meningeal and
cerebral arteries (hence migraines)
• Helps prevent hypertension
• Protector of ischemia and inflammation
• Promotes angiogenesis
• Promotes bone metabolism
• Promotes GI motility and protects gastric mucosa
• Stimulates production of ACTH (pituitary)
And you thought all that was bad!

peripheral and central sensitization

Stellate ganglion stimulation helps

Hippocampus

Stellate ganglion access

C7-T1
 Stellate ganglion lies deep
about 4 to 8
cm depth

Lumix treatment of stellate ganglion

Dr. Katsuhiro Nakazawa: Lumix 4 - 45W

Stellate ganglion: more than pain!

Recall: laser beam must reach the targets

h ing !
t s
no pen
p
ha
io n
trat
e
p en n
no or ptio
sor
b
noa

More thermal effect = less tissue penetration

650 nm 810 nm 910 nm 980 nm 1064 nm

tissue penetration

How do we enhance tissue penetration?

Use ultrasound and/or e-stim

Let’s look at laser + US or e-stim

 Laser + ultrasound

Ultrasound pulse wave

Continuous & pulsed ultrasound

 Ultrasound tissue attenuation

Attenuation drives absorption;

therefore, US best for tendon, cartilage, bone

Experiment: laser + ultrasound

Result: much deeper laser penetration

Lasers + ultrasound devices

Laser
LaserPW 45W
CW 100mW CPS
+ 100mW
US + 45W

1cm

laser beam
penetrates
deeper
 Attenuation 635 nm laser + US

3 MHz

1 MHz

Marginally deeper penetration

with 635 nm laser + 1 MHz US

Attenuation 1064 nm laser + US

3 MHz

1 MHz
Significantly deeper penetration
with 1064 nm laser + 1 MHz US

Ultrasound non-thermal effects

Cavitation:
• affects cell membrane permeability to ions
Acoustic wave streaming:
• affects cell membrane permeability to ions
• induces second-messenger activity
• increased protein synthesis
• increased growth factors by macrophages
 Combining US and laser

Combining ultrasound and laser

Combining US and laser

US gel
 Laser + e-stim

Type of conventional TENS features

Churchill Livingstone - Elsevier 2008

Electrical wave shapes in TENS

TENS pulse
shape
irrelevant
current

for our
purposes

time
Churchill Livingstone - Elsevier 2008
 Experiment: laser + e-stim

-
Result: much deeper laser penetration

Attenuation 808 nm laser + e-stim

Deeper penetration
808 nm laser + 1200 Hz e-stim

1000 Hz

1200 Hz

Attenuation 1064 nm laser + e-stim

1500 Hz

2000 Hz

2500 Hz

Significantly deeper penetration

1064 nm laser + 2500 Hz e-stim
Combining TENS and laser

Combining TENS and laser

Combining TENS and laser

 50% rule revisited
Recall: 50% of laser energy is lost
for every centimeter of tissue depth

Electrophysical therapies potentiate

laser therapy
Only 25% of laser energy is lost for every
centimeter of tissue depth when used with
TENS, US or pEMF therapy

50% rule revisited

laser + electrophysical laser
energy 12J 40J energy

1 cm
9.0J 20J

6.7J 2 cm 10J

5J 5J
3 cm

PEMF also enhances laser effects

high
amplitude
PEMF
 Combining PEMF and laser

Laser before
high power
PEMF

Combining resonance PEMF and laser

Resonance PEMF and laser

could be concurrent
treatments

Dr. Robert Becker’s discovery

Robert Becker, MD
“current of injury”
in Body Electric
-
-+-
- +++
-
Tissue repair phases: another view

produces

ces
du
re

stimulates
Churchill Livingstone - Elsevier 2008

Loop device: generates pEMF

Negative ions driven into tissues

Treatment guidelines and strategies
• ApplyUS or e-stim treatments before (<20
minutes) or concurrently with laser

- Apply e-stim or US energy perpendicular to

the laser beam (as feasible)
• Applyhigh amplitude pEMF before laser to
avoid damaging the laser electronics
• Applyresonance pEMF (e.g., Maxi) before or
concurrently with laser

Treatment guidelines and strategies

• Acute pain relief with pulse rates (PR) of 20 kHz
• Reduction of inflammation and tissue healing:
PR > 30 kHz and AP > 0.5 W
• Induce acute flare up in treated tissue: use high
pulse rates (> 40 kHz), Graston, GuaSha, etc.
• Treat the dorsal root ganglia and dorsal horns
corresponding to the target tissues
• Treat the medulla in the upper cervical spine
• Treat the trigeminal ganglion and subnucleus
caudalis in neuropathic facial pain

Clinical pearls

• Clinical results: choose devices for thermal

vs. biostimulation effects

• Therapy goal: generate ATP at target

• Dose effects vary per laser wavelengths and

electrophysical frequencies used

• Protocols are only reference points

 Clinical pearls
TM
• If you can’t reach it, you can’t treat it!

• Treatment time is determined by target depth,

laser average power and electrophysical
frequencies used

• Better laser penetration is obtained with less

treatment time using high laser pulse power
with electrophysical therapy

Clinical pearls
Keep it simple:
• For target dose: only 3 tissue types - target
dose per tissue type
• 50% rule for estimating treatment times with
laser for the target depth
• 25% rule for estimating treatment times with
laser + electrophysical therapy for the target
depth

Taking it back to the clinic

The basics of laser therapy:

TM
• If you can’t reach it, you can’t treat it!
• Laser protocols are not recipes
• 50% rule for estimating dose
• Nerve tissue target dose is 5 J/cm2
 Taking it back to the clinic

• Acute treatment most profound response

• Chronic treatment - make it acute again!
• Specialized therapeutic effects:
- 20 kHz or less - normalizes
- 30 kHz or more - supports, stimulates regeneration
- 40 to 60 kHz - re-initiates acute inflammatory cycle

©2018

Taking it back to the clinic

• Neuro pain: it’s a team play, you must know the

players, play the players

• DRG and dorsal horn are always significant

high yield targets

• Address the medulla

How Lumix lasers address chronic

and neuropathic pain relief

Lumix 2, 3 & 4

• 2 to 4 wavelengths from 650, 810, 910, 980

or 1064 nm (tissue affinities)
• Pulse rate up to 100 kHz (gene expression)
• Average powers 0.5 to 35 W (effective dose) Lumix 2, 3 & 4
• Pulse powers 110 W to 660 W (depth)
 Recommended resources
• Laser Biotech webinars and online seminars
‣ website: www.LaserBiotech.com
• North American Association for Laser Therapy
‣ website: www.NAALT.org
• World Association for Laser Therapy
‣ website: www.WALTA.no

Best for electrophysical protocols

Good overview and

treatment guidelines

Recommended resources

Clinical science and

plenty of protocols

Nelson with Lars Hode, PhD

 Certified Laser Therapist

CERTIFIE Contact Laser Biotech

D LASER
THERAP
IST
www.LaserBiotech.com
ON-LIN
E PRO
Info@LaserBiotech.com
GRAM
S
Certification Program
(804) 377-2234
The 5-hour on-line program Certified Laser Therapist is certified by the University of Bridgeport
Postgraduate Education Division and provided by Dr. Nelson Marquina, Chief Technology Officer of
Laser Biotech International. The program delivers the scientific basis and safety standards to ensure
high proficiency of the participant in the use of therapeutic lasers in the clinical setting.

Know the safest and most effective way of using treatment protocols for pain relief, resolving
inflammation, and increasing the speed, quality and strength of tissue repair. Lasers are powerful tools
for healing when in the hands of a trained therapist to properly apply treatment techniques.

Dr. Marquina is the author of ‘Energy Medicine: Focus on Lasers’ in The Scientific Basis of
Integrative Health, third edition. This chapter provides a scientific basis for the clinical application of
lasers, illuminating the capabilities of therapeutic laser light to be safely absorbed by human tissues
and organs for repair and cellular regeneration. Dr. Marquina also authored a chapter in Pain Relief
and Healing with Lasers: Dental Protocols of Laser Treatments.

.com
Instructor: Nelson Marquina, MSc, PhD, DC
Dr. Marquina is known for his enjoyable and
effective teaching style and down-to-earth, Register at www.LaserBiotech.com
hands-on approach to lasers. Dr. Nelson (click on Events)
Marquina is a developer of biophotonic email: Info@LaserBiotech.com
and bioelectromagnetic systems and
Phone: 804-377-2234
treatment protocols.

Laser photobiostimulation
“discovered” as therapy by Endre Mester, MD (Hungary)

©2018

Chronic and neuropathic pain

management

Nelson Marquina, MSc, PhD, DC

©
Copyrighted by Laser Biotech International

Laser Biotech International

Richmond, Virginia
www.LaserBiotech.com