Revolutionary Laser Therapy Offers Hope for Snakebite Victims: JAMA

In a groundbreaking clinical trial conducted at the Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Brazil, researchers have explored the potential of low-level laser therapy (LLLT) in alleviating the local effects of Bothrops venom, known for causing rapid tissue damage in snakebite victims. They found that LLLT was safe and feasible for reducing muscle damage and the local inflammatory process caused by B atrox envenomations.

The study results were published in the journal JAMA Internal Medicine. 

Snakebite envenomations (SBEs) are considered a disease of poverty. Bothrops venom envenomated by Bothrops atrox is the most prevalent venomous snake in the Brazilian Amazon. This acts almost immediately at the bite site and causes tissue damage. Besides antivenom therapy, photobiomodulation therapy has shown promising results for treating venom effects caused by snake venom. Hence, researchers from Manaus, Brazil conducted a study to investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. 

The study, a double-blind randomized clinical trial, enrolled 60 adult participants between November 2020 and March 2022, with half receiving LLLT in conjunction with regular antivenom treatment and the other half undergoing antivenom treatment alone. The primary objective was to investigate the feasibility, safety, and efficacy of LLLT in reducing the immediate impact of Bothrops envenomations.

Bothrops venom acts swiftly at the bite site, causing significant tissue damage. The common complaints associated with such snakebites include tinnitus, reduced sound-level tolerance, and difficulty hearing in noisy environments. The severity of these symptoms prompted researchers to explore innovative approaches to mitigate the complications associated with Bothrops envenomations.

In the intervention group, patients received LLLT using a gallium arsenide laser with infrared and red laser emitters. The application involved delivering 4 J/cm2 for 40 seconds at each point. The trial assessed various outcomes, including myolysis estimated by creatine kinase levels, pain intensity, circumference measurement ratio, extent of edema, temperature differences at the bite site, need for analgesics, frequency of secondary infections, necrosis, and disability assessment after discharge.

Findings:

• Results from the study, analyzed between August and December 2022, demonstrated the feasibility and safety of LLLT in a hospital setting.
• Patient retention and acceptability were notably high.
• Significantly, creatine kinase levels were lower in the LLLT group 48 hours after admission compared to the comparator group.
• Pain intensity, circumference measurement ratio, and edema extent were also significantly lower in the LLLT group, highlighting the potential of laser therapy in reducing muscle damage and local inflammatory processes caused by Bothrops envenomations.
• Importantly, the study found no significant difference between the groups regarding secondary infections, necrosis, disability outcomes, or the frequency of needing analgesics.
• No adverse events were observed during the trial.

These groundbreaking findings suggest that LLLT could represent a pivotal intervention in snakebite management, offering hope for quicker recovery and reduced complications associated with Bothrop's envenomations. As researchers delve deeper into the potential of laser therapy, it opens up new avenues for future therapeutics, ultimately contributing to more effective treatments for snakebite victims.

Further reading: Carvalho ÉDS, Souza ARDN, Melo DFC, et al. Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial. JAMA Intern Med. Published online December 04, 2023. doi:10.1001/jamainternmed.2023.6538