SoLá Pelvic Therapy Mechanism of Action
Photobiomodulation
Most of us are familiar with the numerous effects of light energy on living tissue. These effects surround us every day. Plants grow by photosynthesis, converting light energy into cellular energy, and you are reading this narrative because light is causing an intracellular process within your retinas. The primary mechanism of action of SoLá Pelvic Therapy is a light stimulated intracellular process known as Photobiomodulation (PBM). PBM has been described in thousands of published manuscripts and validated by hundreds of controlled trials.
PBM is a form of near-infrared (NIR) light therapy shown in systematic reviews to improve pain in musculoskeletal and arthritic conditions such as low back pain, fibromyalgia, knee and shoulder pain.1-3 PBM uses non-ablative NIR to affect the mitochondrial chromophore cytochrome c oxidase (COX).4 Nitric oxide (NO) is a mitochondrial waste product that is capable of binding to COX, displacing oxygen, and impairing cellular respiration.5
It is believed that PBM photo-dissociates NO from COX resulting in the release of NO and increased production of ATP. NO is a powerful relaxer of both smooth and skeletal muscle, and it is also capable of reducing muscle pain and improving circulation to oxygen-deprived tissues.6-9.
PBM’s pain reducing effect is likely also linked to a decrease in painful prostaglandin production.
Chronic neuropathic pain has been associated with elevated PGE2 levels. Indeed, the entire NSAID industry is based on the science of PG related pain.10,11 The link between prostaglandin production and pain is well described in the dysmenorrhea literature.12-14. Multiple studies have reported on the ability near-infrared light to impair cyclooxygenase activity and reduce prostaglandin levels.15-19.
Additional benefits are believed to be secondary to activation of various transcription factors that result from mitochondrial stimulation as well as the modulation of reactive oxygen species.20
We did not invent photobiomodulation. We invented how to effectively apply it to the tissues and organs of the pelvis.
Although PBM is routinely used to treat musculoskeletal and arthritic pain, until recently there was no gynecologic applications for this technology. This was, at least in part, secondary to the difficulty of delivering therapeutic doses of PBM energy to the deep tissues and organs of the pelvis. To achieve a therapeutic effect, sufficient energy must be delivered to the mitochondrial chromophore of the target tissue. Chromophores are molecules in a given material or tissue that absorb particular wavelengths of light. The mitochondrial chromophore for PBM is cytochrome c oxidase (COX). In order for sufficient laser energy to reach COX, it must get past the chromophores of intervening tissues. To overcome this problem one must deliver sufficient energy at the surface (increasing the power) without overdosing (injuring) the intervening tissue.
Although a therapeutic range of PBM energy (power density and total energy delivered) is contemplated in the peer reviewed published literature, until 2019 it was not known how much energy must be emitted at the vaginal mucosa to deliver a therapeutic power density (irradiance) and total dose (fluence) to the tissues and organs of the pelvis.21-23 Additionally, no device had yet been shown capable of such delivery. In 2019 and 2021 we performed the requisite studies to demonstrate that the proprietary SoLá Pelvic Therapy laser system was capable of delivering therapeutic irradiance and fluence to the pelvic musculature and organs.24,25
The proprietary SoLá Pelvic Therapy system not only delivers therapeutic PBM dosing to the deep tissues of the pelvis, but its unique “orb” array of energy emission is capable of treating the large surface area and volume of the pelvis in minutes.
SoLá Pelvic Therapy is Non-Ablative
Lasers that emit wavelengths that are strongly absorbed by water (Er:Yag, CO2) are classified as ablative. The rapid absorption of electromagnetic energy by water results in heating and destruction of tissue. The therapeutic effect of ablative lasers is thought to be achieved by destruction of tissue followed by tissue healing (e.g Mona Lisa Touch®, Femilift, DiVa®). Lasers that emit wavelengths that are poorly absorbed by water (Near-Infrared) are classified as non-ablative (SoLá Pelvic Therapy). The electromagnetic energy is minimally absorbed by water allowing a non-thermal effect, photobiomodulation.
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2. Glazov G, Yelland M, Emery J. Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials. Acupunct Med. 2016;34(5):328-341.
3. Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH, Kuan YC. Low-Level Laser Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis. Pain Physician. 2019;22(3):241-254.
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10. Jang Y, Kim M, Hwang SW. Molecular mechanisms underlying the actions of arachidonic acid-derived prostaglandins on peripheral nociception. J Neuroinflammation. 2020;17(1):30.
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13. Creatsas G, Deligeoroglou E, Zachari A, et al. Prostaglandins: PGF2 alpha, PGE2, 6-keto-PGF1 alpha and TXB2 serum levels in dysmenorrheic adolescents before, during and after treatment with oral contraceptives. Eur J Obstet Gynecol Reprod Biol. 1990;36(3):292-298.
14. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762-778.
15. Tomazoni SS, Leal-Junior EC, Pallotta RC, Teixeira S, de Almeida P, Lopes-Martins RA. Effects of photobiomodulation therapy, pharmacological therapy, and physical exercise as single and/or combined treatment on the inflammatory response induced by experimental osteoarthritis. Lasers Med Sci. 2017;32(1):101-108.
16. Castano AP, Dai T, Yaroslavsky I, et al. Low-level laser therapy for zymosan-induced arthritis in rats: Importance of illumination time. Lasers Surg Med. 2007;39(6):543-550.
17. Lim W, Choi H, Kim J, et al. Anti-inflammatory effect of 635 nm irradiations on in vitro direct/indirect irradiation model. J Oral Pathol Med. 2015;44(2):94-102.
18. Tomazoni SS, Frigo L, Dos Reis Ferreira TC, et al. Effects of photobiomodulation therapy and topical non-steroidal anti-inflammatory drug on skeletal muscle injury induced by contusion in rats-part 1: morphological and functional aspects. Lasers Med Sci. 2017;32(9):2111-2120.
19. Tomazoni SS, Costa LOP, Joensen J, et al. Photobiomodulation Therapy is Able to Modulate PGE2 Levels in Patients With Chronic Non-Specific Low Back Pain: A Randomized Placebo-Controlled Trial. Lasers Surg Med. 2021;53(2):236-244.
20. Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012;40(2):516-533.
21. Young S, Bolton P, Dyson M, Harvey W, Diamantopoulos C. Macrophage responsiveness to light therapy. Lasers Surg Med. 1989;9(5):497-505.
22. Anders JR, T,; Moges, H; Ilev, I; Waynan,t R; Longo, L. . Light Interaction With Human Central Nervous System Progenitor Cells. . NAALT conference proceedings; 2007.
23. Anders JJ, Moges H, Wu X, et al. In vitro and in vivo optimization of infrared laser treatment for injured peripheral nerves. Lasers Surg Med. 2014;46(1):34-45.
24. Zipper R, Pryor B. Evaluation of a novel deep tissue transvaginal near-infrared laser and applicator in an ovine model. Lasers Med Sci. 2021.
25. Kohli N, Jarnagin B, Stoehr AR, Lamvu G. An observational cohort study of pelvic floor photobiomodulation for treatment of chronic pelvic pain. J Comp Eff Res. 2021.