Spotlight - Dr. Bernard Filner

Pain relief in as few as three minutes. With no side effects. No risks. No pain. No major contraindications.

“I can stop a migraine headache in six minutes—three minutes on each side with a laser.” —Dr. Filner

Is this possible? According to MicroLight, the answer is YES. MicroLight Corporation of America, established in 1990, is a pioneer in cold laser therapy and the first company with FDA clearance to market low-level laser therapy for the nonsurgical treatment of pain through adjunctive therapy.  PAINWeek talked with Dr. Bernard E. Filner, the Medical Director at MicroLight. He is also an expert in the treatment of myofascial pain syndrome, fibromyalgia, and trigger point techniques.

Skepticism Is Healthy

“I was introduced to the MicroLight laser in a roundabout way,” says Dr. Filner. “I read an article in the Washington Post1 that said the Patriots’ star wide receiver was not likely to play in Super Bowl XXXVIII because of a hamstring problem. The week preceding the big game, a physical therapist in Boston treated his hamstring injury with a MicroLight laser for about five minutes, three or four times a day. The wide receiver played, and the Patriots won!

“When I read that, I didn’t believe it. I was very skeptical. I called MicroLight and talked to Mike Barbour, president of the company. Then a sales manager came to my office to demonstrate the laser. I immediately used it on myself. I have trigger points in my neck and upper back. The pain from those trigger points went away. Then I treated half a dozen patients who were in my office. I treated about six or eight trigger points in each of them, and the pain from their trigger points disappeared. I bought the laser on the spot.”

Dr. Filner practiced medicine for 51 years, the first 19 as an anesthesiologist. In the 1980s, he met Dr. Janet Travell, who published a book on myofascial pain. She taught him how to palpate muscles for trigger points. “Because I was an anesthesiologist, and we didn’t have a lot of technical things with which to do nerve blocks, we had to do them by feel. I got pretty good at injecting trigger points, and in that first 15 years, I did about 600,000.”

Over the course of two years following his initiation with the laser, Dr. Filner switched to using only the laser to inactivate trigger points. In the past 18 years he has inactivated about 300,000 trigger points! “There were only four I couldn’t inactivate: three people with very large buttocks, which the laser beam would not penetrate, and a bodybuilder whose hurt pectoral muscle was so dense that the laser beam wasn’t strong enough to reach the pectoral trigger point. So, I injected that one.”

How Does It Work?

The unique science of the MicroLight laser couples low power (90 milliwatts) with the 830 nanometer wavelength to penetrate the skin three to four inches; it is not absorbed by the skin, melanin, or hemoglobin, and doesn’t produce heat. When the laser hits small blood vessels, the cells lining the small vessels release nitric oxide, which is a vasodilator. Blood flow increases to the tight and painful muscle and flushes out lactic acid and other compounds through the lymphatic system and kidneys. The laser also desensitizes the C fibers that carry pain impulses.

Dr. Filner helped design the latest model of MicroLight Lasers, the Smart Laser, which can be configured with a Triple Probe Paddle, or the new Single Probe, which concentrates the power into a single beam and basically functions as a noninvasive injection.

Trigger Points

Stretching to get back to normal resting length—the ultimate treatment for myofascial pain—can only be accomplished adequately when trigger points are no longer painful. There are many ways to inactivate trigger points, all of which, except the laser, can be uncomfortable or painful. Physical therapists (PTs), trained to strengthen muscles, may have difficulties with patients who have been in an accident or have had surgery, because trying to strengthen a muscle that has active trigger points may make the problem worse and cause more pain.

“Many PTs have been taught that trigger points are inflammatory when in fact they’re not. Ice is frequently used after treatment and it aggravates trigger points. If you have an injury with bleeding or swelling, ice can be used in the first 24 hours, but muscles must have heat, which facilitates the stretching.”

CAUTION

Although there is essentially no risk in using the laser:

• Do not treat directly over the thyroid—it increases blood flow and could increase the output of the thyroid gland
• Do not treat over an active pregnancy—the effect on a fetus is unknown
• Do not treat right over a cancerous tumor—it could increase blood flow and possibly lead to metastasis
• Do not aim the laser directly at the eye, even with the eyelids closed

Training

Practitioners using the MicroLight laser technology treat at least 25,000 patients a year in the United States and abroad, and Dr. Filner trains people all over the world. “We can set up a Zoom with a patient and often get them to work with their practitioner. We start off with the 3-beam paddle because it’s more forgiving,” said Dr. Filner. With the smaller, single beam laser, if you are off five degrees, you might miss the trigger point. A number of patients in his practice have purchased a laser. “I have patients bring in cell phone to document the location of their trigger points and the stretches I recommend. I make sure they’re doing it correctly and that significant others can help them as well.”

Carpal Tunnel Syndrome, FDA Approval, and the General Motors Study

People working on an assembly line are at high risk of developing symptoms of overuse syndrome in their arms and carpal tunnel. General Motors (GM) realized they were spending more on carpal tunnel—on treatment, including surgeries and rehab, and retirements and disability payments—than they were for steel.

GM doctors set up a 5 week study of 116 employee volunteers: half received PT and cold laser treatments, half PT and sham laser treatments. Findings from the double blind trial2:   

• Cold laser treatment group grip strength improvement vs sham group
  • Flexed elbow, 48% vs 14%
  • Extended elbow, 41% vs 11%
  • Pinch grip, 28% vs  15%
• Employees reported pain relief and decreased numbness
• One employee canceled scheduled hand surgery

Dr. Filner: “If workers did PT but didn’t get better and needed surgery, the return-to-work rate was about 20%. After the GM study, the laser group had an 80% return-to-work rate. That’s how the FDA approved the laser for carpel tunnel!”

Education and…

Trigger Points
Dr. Filner: “When I was in medical school, there were essentially no courses about chronic pain in the United States. That’s mostly still true. Surgeons, by and large, and neurologists, and rheumatologists, if they’ve even heard the words ‘trigger point,’ it would be surprising. They talk about muscle contraction but don’t know how to identify a trigger point by palpation, and they don’t know how to inactivate them. That’s a skill you must learn.”

Migraines

“I had gone to a lecture by a dentist who was treating migraines by using a 25-gauge needle and injecting the sphenopalatine ganglion just below the nasal passages from above the zygomatic arch. I developed a technique for using the single beam laser, aiming for the sphenopalatine ganglion. As long as you avoid the eye, which is protected by bone, you don’t have a problem. I can stop a migraine headache in six minutes—three minutes on each side with the MicroLight laser.”

With most people, migraines start with trigger points that develop in the neck and create the start of a headache which mushrooms into a migraine.3 “I know if a patient truly has a migraine it’s on one side and they have an aura. Without that, it might just be trigger points in the posterior neck muscles and side muscles of the neck that can be causing the headache. I treat those first, and if they still have a headache—any severe headache can cause nausea, vomiting, and sensitivity to light and sound—I do the protocol for stopping migraines.4

Chronic Pain

Over 32 years of treating patients, Dr. Filner has “learned that every patient with chronic pain has some component of trigger points.”5 It becomes a very easy diagnostic tool using the laser. In a few sessions, you can completely eliminate the trigger point problem.6 If there’s still a pain difficulty, you refer the patient to the proper treating physician.

Fibromyalgia

“I’d say more than half the people with a fibromyalgia diagnosis just have myofascial pain with trigger points.7 When their thalamus is hyperstimulated, they interpret everything as pain. Someone tries to hug them, they hurt. If they turn over in bed, it hurts and they can’t get into REM sleep. You can imagine how totally disruptive to normal living fibromyalgia is. These patients have huge numbers of trigger points, like 35 or 40.8 If you try to do any injections, they’re in bed for a week because they hyper respond to pain. The laser is ideal to treat them. I sometimes spend two to three hours with a patient inactivating every single trigger point I can find. They leave my office relatively pain-free to the point where they can do some activities of daily living. They can work around the house. They can socialize. And as often as necessary, those trigger points need to be inactivated.

The Future

Dr. Filner: “The thrust of MicroLight is to reach the point where people can use the laser on their own, at home, or in a retirement home. Mike Barbour and I, since I’ve retired, have said that whatever time we have left, we want to spread the word about dealing with chronic pain. And the laser is probably the safest and the easiest way. Anybody can use it. Practitioners, patients (with guidance), and we’re starting to work with dentists. It’s important to spread the word, in the United States and the rest of the world. I’ve been Zooming in Europe, and hopefully soon in South America. People may be able to make themselves more functional. Imagine the improvement in pain, and the decrease in healthcare costs.”

Visit the MicroLight booth and meet Dr. Filner at the PAINWeek 2022 Exhibit Hall.

References

1. Lindstrom L. The light stuff. Washington Post. February 17, 2004. www.washingtonpost.com/archive/lifestyle/wellness/2004/02/17/the-light-stuff/12069014-a589-4ba3-a2c8-08c3103edee4/.
2. Baird J. Laser therapy effective for carpal tunnel syndrome. South Florida Sun-Sentinel. Sep 11, 1994.
3. Do et al. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 2018;19(1):84. pubmed.ncbi.nlm.nih.gov/30203398/  
4. Dr. Filner’s observations of 50,000 patient visits over 32 years, and discussions with colleagues.
5. Fricton. [Diagnosis and treatment of myofascial pain. Ned Tijdschr Tandhellkd. 1996;103(7):249-253. pubmed.ncbi.nlm.nih.gov/11921897/ .
6. Dr. Filner’s presentation titled “Techniques of Trigger Point Injections” at the American Academy of Pain Management annual meeting in Nashville, Tennessee in September, 2008. microlightcorp.com/wp-content/uploads/2021/12/Trigger-Point-Injections-Techniques-Pitfalls-and-Alternatives.pdf.
7. Filner. (A) Fibromyalgia (B) Myofascial Pain Syndrome (C) All of the Above. https://microlightcorp.com/wp-content/uploads/2021/12/Fibromyalgia-Myofascial-Pain-Syndrome.pdf.
8. Giamberardino et al. Effects of treatment of myofascial trigger points on the pain of fibromyalgia. Curr Pain Headache Rep. 2011;15(5):393-399. pubmed.ncbi.nlm.nih.gov/21541831/.