“Low-level laser therapy (LLLT) has only been used in the United States since 2002, although it has been used widely in Europe and Asia for the past several decades. I admit to being biased—originally against it, and now energetically in favor of more widespread use of this valuable technology. Insurance companies are very short-sighted in refusing to pay for this therapy; it is less costly, safer, and allows for a more “complete” treatment of chronic pain syndromes.
It is known that infra-red laser beams will penetrate to various depths, depending on wavelength (the 830 nanometer [nm] wavelength will penetrate to a depth of nearly 5 cm). The laser beam at a low power (under 200 milliwatts [mW] or so) will not heat the soft tissue that it reaches, even with continuous use. When the beam hits the cells that line small arterioles, nitric oxide (a vasodilator) is released, thereby increasing local blood flow. Additionally, the laser will “desensitize” local nociceptors, thereby decreasing or eliminating pain at the site. There is also some evidence that the laser beam will decrease inflammation, especially chronic inflammation (although acute inflammation can be aggravated by the increased local blood flow) (1-4).
The world literature is filled with hundreds, if not thousands, of papers detailing studies on the use of low-power lasers to treat various conditions. Many of these papers are confusing, give conflicting results, and often lead to a presumption that the technology is not well understood, and is certainly not very effective or “ready for prime time.” However, careful review of the literature reveals that most of these studies are not comparable, using different types of equipment, different wavelengths, different treatment protocols, different wattages (power), and different endpoints to evaluate efficacy. Hopefully, with increased use of this technology, this will change. I hope to be able to contribute to the growing standardization of this literature (5,6).
I have found LLLT to be most useful for inactivating myofascial trigger points. I have been in practice treating chronic pain for 29 years. During the first 19 years (and for a few patients since) I administered approximately 450,000 trigger point injections. Since I began using LLLT in 2004, I have inactivated approximately 150,000 individual trigger points with this modality (only four could not be inactivated—three due to the depth of large buttocks, and one due to a dense pectoral muscle in a bodybuilder). I have found the use of LLLT to be most gratifying in the treatment of patients with fibromyalgia. These patients are extremely sensitive to any treatment that causes pain. They are often in bed for several days after receiving only a few trigger point injections, and many of these patients have too-numerous-to count numbers of trigger points, literally everywhere. Use of the LLLT has dramatically changed the outlook for treatment of these patients”. -Bernard E. Filner, MD
References
- Tuner J, Hode L. Low level laser therapy—clinical practice and scientific background. In: Turner J, Hode L, eds. –Low Level Laser Therapy—Clinical Practice and Scientific Background. Spjutvagen, Sweden: Prima Books;1999:101-104.
- Sattayut S, Hughes F, Bradley P. 820 nm gallium aluminium arsenide laser modulation of prostaglandin E2 production in interleukin-1 stimulated myoblasts. Laser Ther. 1999;11:88-95.
- Bjordal JM, Johnson MI, Iversen V, et al. Photoradiation in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized, placebo-controlled trials. Photomed Laser Surg. 2006;24:158-168.
- Chow RT, David MA, Armati PJ. 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst. 2007:12:28-39.
- World Association of Laser Therapy. Consensus agreement on the design and conduct of clinical studies with low-level laser therapy and light therapy for musculoskeletal pain and disorders. Photomed Laser Surg. 2006:24:761-762.
- Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double-blind, placebo-controlled study. Clin Rheumatol. 2007;26:930-934.
- Meditech International
