Laser Therapy

Low-level laser therapy (LLLT) is a form of alternative medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of or in orifices of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, it is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function.

The effects of LLLT appear to be limited to a specified set of wavelengths of laser,[1] and administering LLLT below the dose range does not appear to be effective.[2]

Despite a lack of consensus over its validity, some studies suggest that LLLT may be modestly effective, in relieving short-term pain for rheumatoid arthritis,[3] osteoarthritis,[4] acute and chronic neck pain,[5] tendinopathy,[1][6] and possibly, chronic joint disorders.[2] The evidence for LLLT being useful in the treatment of low back pain,[7][8] dentistry,[9][10] and wound healing[11] is unclear.

Variations of LLLT have gone by a variety of alternate names including low-power laser therapy (LPLT), soft laser therapy, low-intensity laser therapy, low-energy laser therapy, cold laser therapy, bio-stimulation laser therapy, photobiomodulation,[12] photo-biotherapy, therapeutic laser, and monochromatic infrared light energy (MIRE) therapy.[13] When LLLT is administered to so-called “acupuncture points”, the procedure may be called laser acupuncture. When applied to the head, LLLT may be known as transcranial photobiomodulation, transcranial near-infrared laser therapy (NILT) ,[14] or transcranial low level light therapy.

Medical uses

Various LLLT devices have been promoted for use in treatment of several musculoskeletal conditions including carpal tunnel syndrome (CTS), fibromyalgia, osteoarthritis, and rheumatoid arthritis. They have also been promoted for temporomandibular joint (TMJ) disorders, wound healing, smoking cessation, and tuberculosis. While these treatments may briefly help some people with pain management, evidence does not support claims that they change long term outcomes, or that they work better than other, low tech ways of applying heat.[15]

LLLT appears to be effective for preventing oral mucositis in recipients of a stem cell transplant with chemotherapy.[16][17]


Research is ongoing about the mechanism of LLLT. The effects of LLLT appear to be limited to a specified set of wavelengths of laser,[1] and administering LLLT below the dose range does not appear to be effective.[2] Photochemical reactions are well known in biological research; it may be that the light applied in low level laser therapy might react with the respiratory enzyme cytochrome c oxidase which is involved in the electron transport chain in mitochondria.[12][18]


Hungarian physician and surgeon Endre Mester (1903-1984) is credited with the discovery of the biological effects of low power lasers,[19] which occurred a few years after the 1960 invention of the ruby laser and the 1961 invention of the helium–neon (HeNe) laser.[12] Mester accidentally discovered that low-level ruby laser light could regrow hair during an attempt to replicate an experiment that showed that such lasers could reduce tumors in mice. The laser he was using was faulty and wasn’t so powerful as he thought. It failed to affect the tumors, but he noticed that in the places where he had shaved the mice in order to do the experiments, the hair grew back more quickly on the treated mice than on those among the control group.[20] He published those results in 1967.[12] He went on to show that low level HeNe light could accelerate wound healing in mice.[12] By the 1970s he was applying low level laser light to treat people with skin ulcers.[12] In 1974 he founded the Laser Research Center at the Semmelweis Medical University in Budapest, and continued working there for the remainder of his life.[21] His sons carried on his work and brought it to the United States.[19]

By 1987 companies selling lasers were claiming that they could treat pain, accelerate healing of sports injuries, and treat arthritis, but there was little evidence for this at that time.[19] By 2016 they had been marketed for wound healing, smoking cessation, tuberculosis, and musculoskeletal conditions such as temporomandibular joint disorders, carpal tunnel syndrome, fibromyalgia, osteoarthritis, and rheumatoid arthritis, and there was still little evidence for these uses, other than a possible use in temporarily treating muscle or joint pain.[15] Mester originally called this approach “laser biostimulation'”, but it soon became known as “low level laser therapy” and with the adaptation of light emitting diodes by those studying this approach, it became known as “low level light therapy”, and to resolve confusion around the exact meaning of “low level”, the term “photobiomodulation” arose.[20]

Society, culture & Health-care systems

In the US as of 2006 the Centers for Medicare and Medicaid Services did not provide coverage for LLLT,[22] as of 2014 Aetna did not provide coverage,[23] and as of 2016 Cigna did not provide coverage.[24] Blue Cross and Blue Shield Association as of 2017 provide coverage if for the prevention of oral mucositis.[25]



A 2008 Cochrane Library review concluded that LLLT has insufficient evidence for treatment of nonspecific low back pain,[7] a finding echoed in a 2010 review of chronic low back pain.[8] A 2015 review found benefit in nonspecific chronic low-back pain.[26]

LLLT may be useful in the treatment of both acute and chronic neck pain.[5] In 2013, however, a systematic review and meta-analysis of LLLT for neck pain indicated that the benefit was not of significant importance and that the evidence had a high risk of bias.[27]

There are tentative data that LLLT is useful in the short-term treatment of pain caused by rheumatoid arthritis,[3] and possibly chronic joint disorders.[2] While it does not appear to improve pain in temporomandibular disorders, it may improve function.[28] Evidence for usefulness in osteoarthritis is poor.[4][29]

There is tentative evidence of benefit in tendinopathy.[1][6] A 2014 review found benefit in shoulder tendinopathy.[30] A 2014 Cochrane review found tentative evidence that it may help in frozen shoulders.[31]

Evidence does not support a benefit in delayed-onset muscle soreness.[32] It may be useful for muscle pain and injuries.[33]


Similarly, the use of lasers to treat chronic periodontitis[9] and to speed healing of infections around dental implants[10] is suggested, but there is insufficient evidence to indicate a use superior to traditional practices.[34] There is tentative evidence for dentin hypersensitivity.[35] It does not appear to be useful for orthodontic pain[36][37] LLLT might be useful for wisdom tooth extraction (complications)[38] and oral mucositis.[39]

Hair loss

LLLT has been studied as a treatment for hair loss; a review in 2012 found little evidence to support the use of lasers to treat hair loss.[40] A 2014 review found tentative evidence for benefit for lasers,[41] while another 2014 review concluded that the results were mixed, had a high risk of bias, and that its effectiveness was unclear.[42] A 2015 review found tentative evidence of benefit.[43]

Brain injuries

LLLT has been studied for traumatic brain injury (TBI) and stroke among other conditions.[12] When applied to the head it is known as transcranial photobiomodulation or transcranial low level light therapy.


LLLT has been studied as a way to reduce pain and swelling in breast-cancer related lymphedema.[44][11]  There evidence to support LLLT use for temporary pain relief.[45]

Stem cells

An ongoing area of research is the application of LLLT for increasing cell proliferation, including stem cells.[46]

Veterinary use

Veterinary clinics use cold laser devices to treat a wide variety of ailments, from arthritis to wounds, on dogs and cats.[47][48] Very little research has been done on the effects of this treatment on animals. Currently, laser therapy equipment is aggressively marketed to veterinarians as a supposedly powerful therapeutic tool and revenue generator. Brennen McKenzie, president of the Evidence-Based Veterinary Medicine Association, has stated that “research into cold laser in dogs and cats is sparse and generally low quality. Most studies are small and have minimal or uncertain controls for bias and error”.[49][50] While allowing that some studies show promising results, he reports that others do not. While believing that there is enough evidence to warrant further study, he concludes that there is not enough evidence to support routine clinical use of cold laser in animals.

If vets want to try this therapy, they have an obligation to be clear with client that the risks and benefits have not been established and that the treatment is essentially experimental. There is nothing wrong with using such a treatment given appropriate informed consent, but the aggressive marketing of laser equipment to vets as a profitable treatment is ethically questionable given the lack of good evidence that it is a truly safe and effective treatment for any condition.[51]

Text under construction


  1. Bjordal, J. M.; Lopes-Martins, R. A.; Joensen, J. .; Couppe, C. .; Ljunggren, A. E.; Stergioulas, A. .; Johnson, M. I. (2008). “A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)”. BMC Musculoskeletal Disorders. 9: 75. doi:10.1186/1471-2474-9-75. PMC 2442599. PMID 18510742.
  2. ^ Jump up to:
    a b c d Bjordal, JM; Couppé, C; Chow, RT; Tunér, J; Ljunggren, EA (2003). “A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders”. The Australian journal of physiotherapy. 49 (2): 107–16. doi:10.1016/s0004-9514(14)60127-6. PMID 12775206.
  3. ^ Jump up to:
    a b Brosseau, L.; Welch, V.; Wells, G. A.; de Bie, R.; Gam, A.; Harman, K.; Morin, M.; Shea, B.; Tugwell, P. (2005). “Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis”. Cochrane Database of Systematic Reviews (4): CD002049. doi:10.1002/14651858.CD002049.pub2. PMID 16235295.
  4. ^ Jump up to:
    a b Jamtvedt, G.; Dahm, K. T.; Christie, A.; Moe, R. H.; Haavardsholm, E.; Holm, I.; Hagen, K. B. (2007). “Physical Therapy Interventions for Patients with Osteoarthritis of the Knee: an Overview of Systematic Reviews”. Physical Therapy. 88 (1): 123–136. doi:10.2522/ptj.20070043. PMID 17986496.
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    a b Sculean, A.; Schwarz, F.; Becker, J. (2005). “Anti-infective therapy with an Er:YAG laser: influence on peri-implant healing”. Expert Review of Medical Devices. 2 (3): 267–76. doi:10.1586/17434440.2.3.267. PMID 16288590.
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  13. ^ American Cancer Society. Cold Laser Therapy Page archived April 24, 2015
  14. ^ Lapchak, PA (December 2010). “Taking a light approach to treating acute ischemic stroke patients: transcranial near-infrared laser therapy translational science”. Annals of medicine. 42 (8): 576–86. doi:10.3109/07853890.2010.532811. PMC 3059546. PMID 21039081.
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    a b Hamblin, MR (1 October 2016). “Shining light on the head: Photobiomodulation for brain disorders”. BBA Clinical. 6: 113–124. doi:10.1016/j.bbacli.2016.09.002. PMC 5066074. PMID 27752476.
  21. ^ “Celebrating the 100th birthday of Professor Endre Mester”. Laser World. Swedish Laser-Medical Society. April 18, 2004. Archived from the original on March 3, 2016.
  22. ^ “Decision memo for infrared therapy devices” (CAG00291N). Center for Medicare & Medicaid Services, Oct 24, 2006.
  23. ^ “Infrared therapy”. Aetna clinical policy bulletin 0604, reviewed Oct 23, 2014. Aetna has additional information in its “Clinical Policy Bulletin on Cold Laser and High-Power Laser Therapies”.
  24. ^ “CIGNA medical coverage policy: Low-level laser therapy”. Revised, July 15, 2016.
  25. ^ (PDF) Retrieved 24 February 2018. Missing or empty |title= (help)
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  29. ^ Huang, Z.; Chen, J.; Ma, J.; Shen, B.; Pei, F.; Kraus, V. B. (2015-09-01). “Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis”. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 23 (9): 1437–1444. doi:10.1016/j.joca.2015.04.005. ISSN 1522-9653. PMC 4814167. PMID 25914044.
  30. ^ Haslerud, Sturla; Magnussen, Liv Heide; Joensen, Jon; Lopes-Martins, Rodrigo Alvaro Brandao; Bjordal, Jan Magnus (2015-06-01). “The efficacy of low-level laser therapy for shoulder tendinopathy: a systematic review and meta-analysis of randomized controlled trials”. Physiotherapy Research International. 20 (2): 108–125. doi:10.1002/pri.1606. ISSN 1471-2865. PMID 25450903.
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  32. ^ Nampo, Fernando Kenji; Cavalheri, Vinícius; Ramos, Solange de Paula; Camargo, Enilton Aparecido (2016-01-01). “Effect of low-level phototherapy on delayed onset muscle soreness: a systematic review and meta-analysis”. Lasers in Medical Science. 31 (1): 165–177. doi:10.1007/s10103-015-1832-4. ISSN 1435-604X. PMID 26563953.
  33. ^ Ferraresi, C; Hamblin, MR; Parizotto, NA (1 November 2012). “Low-level laser (light) therapy (LLLT) on muscle tissue: performance, fatigue and repair benefited by the power of light”. Photonics & lasers in medicine. 1 (4): 267–286. doi:10.1515/plm-2012-0032. PMC 3635110. PMID 23626925.
  34. ^ Karlsson, M. R.; Diogo Löfgren, C. I.; Jansson, H. M. (2008). “The Effect of Laser Therapy as an Adjunct to Non-Surgical Periodontal Treatment in Subjects with Chronic Periodontitis: A Systematic Review”. Journal of Periodontology. 79 (11): 2021–2028. doi:10.1902/jop.2008.080197. PMID 18980508.
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Lasers Med Sci. 2002;17(1):57-61.

Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial.

Gür A1, Karakoç M, Nas K, Cevik R, Saraç J, Demir E.

Author information


Low energy lasers are widely used to treat a variety of musculoskeletal conditions including fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomised, single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser therapy in 40 female patients with fibromyalgia. Patients with fibromyalgia were randomly allocated to active (Ga-As) laser or placebo laser treatment daily for two weeks except weekends. Both the laser and placebo laser groups were evaluated for the improvement in pain, number of tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm. In both groups, significant improvements were achieved in all parameters (p<0.05) except sleep disturbance, fatigue and skinfold tenderness in the placebo laser group (p>0.05). It was found that there was no significant difference between the two groups with respect to all parameters before therapy whereas a significant difference was observed in parameters as pain, muscle spasm, morning stiffness and tender point numbers in favour of laser group after therapy (p<0.05). None of the participants reported any side effects. Our study suggests that laser therapy is effective on pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and suggests that this therapy method is a safe and effective way of treatment in the cases with fibromyalgia.

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