Low level laser therapy

Low level laser therapy
Intervention
MeSH D028022

Low-level laser therapy (LLLT) is a form of alternative medicine that uses low-level (low-power) lasers or light-emitting diodes (LEDs). Other names include low-power laser, soft laser, cold laser, biostimulation laser, therapeutic laser, and laser acupuncture.[1] Whereas high-power lasers used in laser medicine destroy or cut tissue, low-power lasers are claimed to stimulate it and to encourage the cells to function.

LLLT is integrated with mainstream medicine with ongoing research to determine where there is a demonstrable effect. Areas of dispute include the ideal location of treatment (specifically whether LLLT is more appropriately used over nerves versus joints[2]) The effects of LLLT appear to be limited to a specified set of wavelengths of laser,[3] and administering LLLT below the dose range does not appear to be effective.[4]

Despite a lack of consensus over its scientific validity, specific test and protocols for LLLT suggest it may be mildly effective, but in most cases no better than placebo, in relieving short-term pain for rheumatoid arthritis,[2] osteoarthritis,[5] acute and chronic neck pain,[6] tendinopathy,[3][7] and possibly chronic joint disorders.[4] The evidence for LLLT being useful in the treatment of low back pain,[8][9] dentistry[10][11] and wound healing is unclear.[12]

Medical uses

Musculoskeletal

LLLT may be useful in the treatment of both acute and chronic neck pain.[6] In neck pain the benefit was not of significant importance and the evidence had a high risk of bias.[13] A 2008 Cochrane Library review concluded that LLLT has insufficient evidence for treatment of nonspecific low back pain,[8] a finding echoed in a 2010 review of chronic low back pain.[9] A 2015 review found benefit in nonspecific chronic low-back pain.[14]

There is tentative data that LLLT is useful in the short-term treatment of pain caused by rheumatoid arthritis,[2] and possibly chronic joint disorders.[4] While it does not appear to improve pain in temporomandibular disorders in may improve function.[15] Evidence for useful in osteoarthritis is poor.[16]

There is tentative evidence of benefit in tendinopathy.[3][7] A 2015 review found benefit in shoulder tendinopathy.[17] A 2014 Cochrane review found tentative evidence that it may help in frozen shoulders.[18]

Evidence does not support a benefit in delayed-onset muscle soreness.[19]

Teeth

Similarly, the use of lasers to treat chronic periodontitis[10] and to speed healing of infections around dental implants[11] is suggested, but there is insufficient evidence to indicate a use superior to traditional practices.[20]

There is tentative evidence for dentin hypersensitivity.[21] It does not appear to be useful for orthodontic pain[22][23]

Might be useful

Similarly, the use of lasers to treat chronic periodontitis[10] and to speed healing of infections around dental implants[11] is suggested, but there is insufficient evidence to indicate a use superior to traditional practices.[20]

Hair loss

2008 and 2012 reviews found little evidence to support the use of lasers to treat hair loss.[26][27] Additionally none are FDA approved for this use.[27] They however appear to be safe.[26]

A 2014 review found tentative evidence of benefit for lasers.[28] While another 2014 review concluded that the results are mixed, have a high risk of bias, and that its effectiveness is unclear.[29] A 2015 review also found tentative evidence of benefit.[30]

Other

LLLT might be effective to reduce pain and swelling in breast-cancer related lymphedema[31]

Though it has been suggested that LLLT may be useful in speeding wound healing, the appropriate parameters (dose, type of laser, materials, wavelength, etc.) have not been identified.[12]

Stephen Barrett, writing for Quackwatch, concluded (2009) in there was evidence to support LLLT use for temporary pain relief, but "there's no reason to believe that they will influence the course of any ailment or are more effective than other forms of heat delivery."[32]

Mechanism

It is unclear how LLLT might work. 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[33][34]

Society and culture

The insurance company, Cigna, has reviewed (2010) the evidence for LLLT and concluded that it is still considered an experimental treatment. Therefore, Cigna does not provide coverage for it.[35]

At least one LLLT practitioner, Robert Lytle DDS, has been cited by the FDA for promoting non-FDA approved treatments on company websites.[36]

See also

References

  1. ↑ American Cancer Society. Cold Laser Therapy Page archived April 24, 2015
  2. 1 2 3 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. |first1= missing |last1= in Editors list (help)
  3. 1 2 3 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.
  4. 1 2 3 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.
  5. ↑ 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.
  6. 1 2 Chow, R.; Johnson, M.; Lopes-Martins, R.; Bjordal, J. (Nov 2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.". Lancet 374 (9705): 1897–1908. doi:10.1016/S0140-6736(09)61522-1. PMID 19913903.
  7. 1 2 Tumilty, S. .; Munn, J. .; McDonough, S. .; Hurley, D. A.; Basford, J. R.; Baxter, G. D. (2010). "Low Level Laser Treatment of Tendinopathy: A Systematic Review with Meta-analysis". Photomedicine and Laser Surgery 28 (1): 3–16. doi:10.1089/pho.2008.2470. PMID 19708800.
  8. 1 2 Yousefi-Nooraie, R.; Schonstein, E.; Heidari, K.; Rashidian, A.; Pennick, V.; Akbari-Kamrani, M.; Irani, S.; Shakiba, B.; Mortaz Hejri, S.; Mortaz Hejri, S. O.; Jonaidi, A. (2008). Yousefi-Nooraie, Reza, ed. "Low level laser therapy for nonspecific low-back pain". Cochrane database of systematic reviews (Online) (2): CD005107. doi:10.1002/14651858.CD005107.pub4. PMID 18425909.
  9. 1 2 Middelkoop, M.; Rubinstein, S. M.; Kuijpers, T.; Verhagen, A. P.; Ostelo, R.; Koes, B. W.; Van Tulder, M. W. (2010). "A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain". European Spine Journal 20 (1): 19–39. doi:10.1007/s00586-010-1518-3. PMC: 3036018. PMID 20640863.
  10. 1 2 3 Cobb, C. M. (2006). "Lasers in Periodontics: A Review of the Literature". Journal of Periodontology 77 (4): 545–564. doi:10.1902/jop.2006.050417. PMID 16584335.
  11. 1 2 3 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.
  12. 1 2 Da Silva, J. P.; Da Silva, M. A.; Almeida, A. P. F.; Junior, I. L.; Matos, A. P. (2010). "Laser Therapy in the Tissue Repair Process: A Literature Review". Photomedicine and Laser Surgery 28 (1): 17–21. doi:10.1089/pho.2008.2372. PMID 19764898.
  13. ↑ Kadhim-Saleh, Amjed; Maganti, Harinad; Ghert, Michelle; Singh, Sheila; Farrokhyar, Forough (2013-10-01). "Is low-level laser therapy in relieving neck pain effective? Systematic review and meta-analysis". Rheumatology International 33 (10): 2493–2501. doi:10.1007/s00296-013-2742-z. ISSN 1437-160X. PMID 23579335. his systematic review provides inconclusive evidence because of significant between-study heterogeneity and potential risk of bias.
  14. ↑ Huang, ZeYu; Ma, Jun; Chen, Jing; Shen, Bin; Pei, FuXing; Kraus, Virginia Byers (2015-01-01). "The effectiveness of low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis". Arthritis Research & Therapy 17: 360. doi:10.1186/s13075-015-0882-0. ISSN 1478-6362. PMID 26667480.
  15. ↑ Chen, J.; Huang, Z.; Ge, M.; Gao, M. (2015-04-01). "Efficacy of low-level laser therapy in the treatment of TMDs: a meta-analysis of 14 randomised controlled trials". Journal of Oral Rehabilitation 42 (4): 291–299. doi:10.1111/joor.12258. ISSN 1365-2842. PMID 25491183.
  16. ↑ 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. PMID 25914044.
  17. ↑ 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: The Journal for Researchers and Clinicians in Physical Therapy 20 (2): 108–125. doi:10.1002/pri.1606. ISSN 1471-2865. PMID 25450903.
  18. ↑ Page, MJ; Green, S; Kramer, S; Johnston, RV; McBain, B; Buchbinder, R (Oct 1, 2014). "Electrotherapy modalities for adhesive capsulitis (frozen shoulder).". The Cochrane database of systematic reviews 10: CD011324. doi:10.1002/14651858.CD011324. PMID 25271097.
  19. ↑ 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.
  20. 1 2 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.
  21. ↑ Sgolastra, F.; Petrucci, A.; Severino, M.; Gatto, R.; Monaco, A. (2013-06-01). "Lasers for the treatment of dentin hypersensitivity: a meta-analysis". Journal of Dental Research 92 (6): 492–499. doi:10.1177/0022034513487212. ISSN 1544-0591. PMID 23609160.
  22. ↑ Eslamian, L.; Borzabadi-Farahani, A.; Hassanzadeh-Azhiri, A.; Badiee, M.R.; Fekrazad, R. (2013-01-20). "The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators". Lasers in Medical Science 29 (2): 559–564. doi:10.1007/s10103-012-1258-1. PMID 23334785.
  23. ↑ Ren, Chong; McGrath, Colman; Yang, Yanqi (2015-09-01). "The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis". Lasers in Medical Science 30 (7): 1881–1893. doi:10.1007/s10103-015-1743-4. ISSN 1435-604X. PMC: 4562996. PMID 25800534.
  24. ↑ He, W. L.; Yu, F. Y.; Li, C. J.; Pan, J.; Zhuang, R.; Duan, P. J. (2015-08-01). "A systematic review and meta-analysis on the efficacy of low-level laser therapy in the management of complication after mandibular third molar surgery". Lasers in Medical Science 30 (6): 1779–1788. doi:10.1007/s10103-014-1634-0. ISSN 1435-604X. PMID 25098769.
  25. ↑ Oberoi, Sapna; Zamperlini-Netto, Gabriele; Beyene, Joseph; Treister, Nathaniel S.; Sung, Lillian (2014-01-01). "Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis". PLOS ONE 9 (9): e107418. doi:10.1371/journal.pone.0107418. ISSN 1932-6203. PMC: 4157876. PMID 25198431.
  26. 1 2 Rogers, NE; Avram, MR (October 2008). "Medical treatments for male and female pattern hair loss.". Journal of the American Academy of Dermatology 59 (4): 547–66; quiz 567–8. doi:10.1016/j.jaad.2008.07.001. PMID 18793935.
  27. 1 2 Rangwala, Sophia; Rashid, Rashid M. (Feb 2012). "Alopecia: a review of laser and light therapies". Dermatology Online Journal 18 (2): 3. ISSN 1087-2108. PMID 22398224. Since then, a number of studies have suggested the use of lasers as an effective way to treat alopecia, particularly androgenetic alopecia and alopecia areata, but there is still a paucity of independent, peer-reviewed blinded clinical trials.
  28. ↑ Avci, Pinar; Gupta, Gaurav K.; Clark, Jason; Wikonkal, Norbert; Hamblin, Michael R. (2014-2). "Low-Level Laser (Light) Therapy (LLLT) for Treatment of Hair Loss". Lasers in surgery and medicine 46 (2): 144–151. doi:10.1002/lsm.22170. ISSN 0196-8092. PMC: 3944668. PMID 23970445. Check date values in: |date= (help)
  29. ↑ Gupta, AK; Daigle, D (April 2014). "The use of low-level light therapy in the treatment of androgenetic alopecia and female pattern hair loss.". The Journal of dermatological treatment 25 (2): 162–3. doi:10.3109/09546634.2013.832134. PMID 23924031.
  30. ↑ Zarei, Mina; Wikramanayake, Tongyu C.; Falto-Aizpurua, Leyre; Schachner, Lawrence A.; Jimenez, Joaquin J. (2015-12-21). "Low level laser therapy and hair regrowth: an evidence-based review". Lasers in Medical Science. doi:10.1007/s10103-015-1818-2. ISSN 1435-604X. PMID 26690359.
  31. ↑ Smoot, Betty; Chiavola-Larson, Laura; Lee, Jeannette; Manibusan, Hidelisa; Allen, Diane D. (2015-06-01). "Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis". Journal of Cancer Survivorship: Research and Practice 9 (2): 287–304. doi:10.1007/s11764-014-0411-1. ISSN 1932-2267. PMID 25432632.
  32. ↑ Barrett, S (2009-07-17). "A Skeptical Look at Low Level Laser Therapy". Quackwatch. Retrieved 2010-07-23.
  33. ↑ Chung, Hoon; Dai, Tianhong; Sharma, Sulbha K.; Huang, Ying-Ying; Carroll, James D.; Hamblin, Michael R. (2012-02-01). "The nuts and bolts of low-level laser (light) therapy". Annals of Biomedical Engineering 40 (2): 516–533. doi:10.1007/s10439-011-0454-7. ISSN 1573-9686. PMC: 3288797. PMID 22045511.
  34. ↑ Prindeze, Nicholas J.; Moffatt, Lauren T.; Shupp, Jeffrey W. (2012-11-01). "Mechanisms of action for light therapy: a review of molecular interactions". Experimental Biology and Medicine (Maywood, N.J.) 237 (11): 1241–1248. doi:10.1258/ebm.2012.012180. ISSN 1535-3699. PMID 23239434.
  35. ↑ "Cigna Medical Coverage Policy - Subject: Low Level Laser Therapy" (pdf). Cigna. 2010-07-15. Retrieved 2010-08-06.
  36. ↑ http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm246619.htm
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