Laser acupuncture: keep it scientific.

Laser acupuncture is a rapidly developing discipline with a growing research basis. This wedding between laser and acupuncture, as in most marriages, is ‘‘for better or worse;’’usually with some of both. Like laser therapy, acupuncture can be approached scientifically; that is, one can describe its mechanisms of action with contemporary biomedical terminology. Abundant evidence exists regarding its value for a large number of conditions. However, unlike laser therapy, acupuncture has followers who still believe that needling works by shuttling a ‘‘life force’’ called ‘‘qi’’ through unseen pathways on the body, although there is no evidence that qi exists. An acupuncturist who practices from this Chinese medical perspective may select points to treat metaphorical illnesses such as ‘‘liver fire’’ and a ‘‘damp spleen.’’ These nebulous descriptors of pathophysiologic states lack a rational basis. Claiming to move qi as a means of treating disease states, therefore, precludes rigorous research, because one can neither identify nor quantify metaphorical qi, fire, or dampness. In contrast, a medical acupuncturist bases treatment on a scientific clinical assessment of the patient and that patient’s neurophysiological, myofascial, and/or palpatory dysfunction. A strictly scientific approach to acupuncture partners well with laser therapy, because of the substantial overlap in physiologic changes that each imparts. Although the style of acupuncture that one adopts is up to the particular practitioner’s discretion, introducing a beliefbased approach to the field of photomedicine could have a negative impact if introducing irrational and unscientific notions. This concern extends to the manufacturing arm of photomedicine; that is, by responding to the growing market for laser acupuncture devices, manufacturers are producing probes specifically for acupuncture point stimulation. Some machines carry frequency settings designed according to acupuncture lore, not science. In the case of electroacupuncture, in which an electrical stimulator delivers a pulse or pulses of electrical discharge through acupuncture needles, one sees explanations ranging from the scientific to the implausible. Some acupuncturists follow the approach of made popular by Paul Nogier. Nogier was said to have claimed that the body responded to frequencies now referred to as ‘‘Nogier frequencies.’’ Each frequency supposedly activates or influences portions of the nervous system, internal organs, or other more nebulous aspects of life. Nogier frequencies have no scientific or evidential support. Nonetheless, a certain number of laser device manufacturers are incorporating Nogier frequencies into their preset protocols. This has the potential to lead many users to believe that at least someone has tested and verified their validity; whereas no one has. Many laser therapy practitioners recognize that photomedicine as a whole needs much more research in order to determine which frequencies offer robust clinical benefits. Only a handful of studies have systematically and rigorously investigated this treatment parameter per se. This means that despite the fact that many photomedicine machines come with preset clinical protocols and suggested frequency settings, manufacturers cannot back these protocols with published, peer-reviewed studies either.