Low Level Laser Part Three


Low Level Laser Medicine of the Future, Part Three Jeffrey Dach MD

Clinical Applications, Animal and Human Studies

In Part One and Part Two, of this series, we discussed the mechanism of action of low level laser light therapy.  In a nutshell, this treatment delivers light energy to the mitochondria which easily absorb the light and convert it into cellular energy thanks to a primitive pathway shared by photosynthetic bacteria.

Image at left shows mitochondria with inner membrane bristling with electrical activity.

Mitochondria are like little batteries, and have the ability to absorb light energy in the infrared spectrum, very similar to bacterial life forms that have photosynthetic ability.  The respiratory enzyme system in mitochondria make an electrical gradient across this inner membrane (lighted surface in diagram).  An enzyme imbedded in the inner membrane called Cytochrome C Oxidase absorbs and converts infrared light into electrical energy and thence to ATP, the cell’s currency of energy.

Once one realizes that most medical conditions are associated with mitochondrial dysfunction, one quickly realizes that light therapy can be of great clinical benefit for practically “anything that ails you”.

Perhaps the most obvious use of the low level laser is for professional athletes who are prone to tendon and muscle injuries from competitive sports.  The low level laser provides the professional athlete with “the competitive edge” allowing rapid healing and quick return to peak performance.  This technology has been embraced by most professional athletes in order to stay competitive on the playing field.

Massage therapists, Plastic Surgeons and Chiropractors are three groups who have started using low level laser in large numbers.  LLLT has also found a niche with cosmetic uses, hair growth, skin conditioning and body contouring by plastic surgeons.

Huge Body of Medical Studies

A huge body of medical research on low level laser has been created at major university medical centers over the last 20 years. Here is a brief summary of literally thousands of research studies published in the mainstream medical literature from major university centers over 30 years.

Wound Healing – Animal Studies

In a series of animal model studies at major university research centers, LLLT,   Light therapy with laser stimulation was found to accelerate healing of wounds.   The inflammatory phase is shortened.  The proliferative and maturation phase of wound healing speeds up, and the epidermis and striated muscle heal faster as well, demonstrated with many elegant histology studies. (1-4)

Post Head and Neck Radiation  Oral Mucositis – Human studies

One of the dreaded consequences of treatment for Head and Neck Cancer with radiation and chemotherapy is sloughing and ulceration of the oral mucosa resulting in severe pain and poor quality of life.  For example, treatment for cancer of the tongue, or squamous cell cancer of the mouth  with radiation therapy causes severe pain and mucous membrane ulceration.  Low level Laser Therapy (LLT) delivered to the oral cavity is highly beneficial and makes a huge difference to these patients.  A number of randomized controlled studies in humans have found that Low-level laser therapy during radiotherapy is effective in controlling the intensity of mucositis and pain. (5-8)

Sjogrens Syndrome- Dry Mouth

In a case report, a patient with Sjogrens Syndrome and dry mouth was treated with low level laser (LLLT). The parotid, submandibular, and sublingual glands, were treated three times per week for a period of 8 months.  By the end of the treatment period, the dry mouth symptoms improved and the parotid salivary gland pain and swelling were no longer present. The treatment with light therapy was effective at improving the quality of life of this Sjogren’s patient in a case report from Brazil.(9)

Recurrent Herpes Simplex Infections

Herpes is a dreaded sexually transmitted virus with recurrent, painful vesicular eruptions.   Desperate patients may suffer for years with oral or genital Herpes outbreaks every few weeks, and turn to  anti-viral treatments such as Acyclovir in spite of its adverse side effects.  A number of studies have shown Low Level Laser Therapy more effective than Acyclovir as an anti-viral treatment, eliminating the pain and swelling and reducing the frequency of the Herpes outbreaks. (10-12)

Herpes Zoster – Shingles

A painful nerve pain called “Shingles” or herpes zoster responds nicely to treatment with low level laser. (13)

Trigeminal Neuralgia and others

Various disorders of the maxillofacial area were treated in a laser clinic including temporomandibular joint (TMJ) pain, trigeminal neuralgia, muscular pain,  and tooth hypersensitivity. One hundred fifty four out of 241 patients were asymptomatic at the end of the treatment, 50 improved considerably, and 37 were symptomatic. (14-15)

Dermatology and Acne

Light therapy appears useful for various skin conditions such as acne, psoriasis, scleroderma, wrinkles, aging etc. (16-17)

Traumatic Brain Injury and Nerve Regeneration

A number of elegant animal studies show LLLT (low level laser therapy) very beneficial in animal model of traumatic brain injury.  The treated animals had full recovery without neurologic deficit and less infarction on MRI brain imaging.(18-19)
An animal model of sciatic nerve resection showed faster and more complete healing with laser treatment. (20)

Anti-inflammatory Effect

In a rabbit study of eye infection, researchers found that (low level laser) LLLT has an anti-inflammatory effect similar to that of dexamethasone, a commonly used drug.

Histology and Ultrastructure Studies – Rat Masseter Muscle and Gerbil Muscle Trauma

Published in Micron 2011, a study of rat masseter muscle with electron microscopy showed that treated muscles had more healthy mitochondria with organelles containing large amounts of energy.  Immunostaining showed dose dependent increased  VEGF (Vascular Endothelial Growth Factor), a growth factor that stimulates new blood vessels as part of the healing process.(22)

Another electron microscope study of muscle trauma in Gerbils showed improved healing and other benefits of LLLT.  Electron Q10001microscopy after seven days of laser treatment  showed increased mitochondrial activity in muscular fibers, activated fibroblasts and macrophages and stimulated angiogenesis. (23)

Left Image: hand held low level laser, Q1000ng by DrLarry Lytle.

Below Image: is an electric toothbrush. The home laser device will soon be as common as the electric toothbrush in everyone’s home along with the band-aids and neosporin/bacitracin First Aid kit.

ElectricaltoothbrushjeffreydachmdAchilles tendinitis, Tennis Elbow, Rotator Cuff tendinitis

LLLT low level laser therapy is extremely beneficial for any type of tendinitis.  It accelerates migration of fibroblasts and rapidly heals the inflamed tendon.  High dose vitamin C, amino acids, proline and lysine, and digestive enzymes also suggested for collagen healing(24-27)

LLLT significantly reduces inflammation with less COX-2-derived gene expression and PGE(2) production, resulting in less edema formation  As LLLT reduces inflammation through a selective inhibition of the COX-2 pathway, LLLT is safer and more effective  than the COX-inhibitor anti-inflammatory drugs.(25)

Osteo- Arthritis

Osteoarthritis of the Hands and Knees is quite common.  LLLT is an effective treatment for reducing pain, improving mobility and stimulating healing.   I would add nutritional support with Glucosamine, chondroitin, MSM and hydrolyzed collagen. (28-29)

Carpal Tunnel Syndrome

Carpal tunnel patients typically have pain and tingling in the hand from compression of the median nerve in the carpal tunnel of the wrist.  LLLT is an effective treatment.  I would add supportive nutritional supplements with B12 and B6. (30-31)

Neck Pain

Studies show LLLT is useful treatment for neck pain originating in cervical spine , osteoarthritis or degenerative disk disease of the cervical spine.(32-35)  Similarly LLLT is useful for low back pain.

Antimicrobial Actions of LLLT

Another useful feature of LLLT is that it has been shown to be antimicrobial, and is very useful for viral, bacterial and fungal infections in-vivo.A Summary of Clinical Conditions Which Benefit From Low Level Laser Treatment:

Repetitive Stress Injury
Carpal Tunnel Syndrome
Rotator Cuff Tear
Epicondylitis (Tennis Elbow)
Reflex Sympathetic Dystrophy
Temporo-mandibular Joint Dysfunction
Headaches & Migraines
Alopecia – Hair regrowth
Ligament And Tendon Tears
Fractures With Associated Soft Tissue Injuries
Facet Joint Syndrome
Bulging And Herniated Discs
Inflammatory Conditions
Plantar Fasciitis
Rheumatoid Arthritis

Degenerative Conditions

Chondromalacia Patella
Discogenic And Vertebrogenic Radiculopathy
Spinal Stenosis
Calcifications (E.g. Bone Spurs)

Other Applications

Wound Healing
Dermal Ulcers: Venous Stasis, Atherosclerotic, Contact, Diabetic, Traumatic
Burns: Thermal, Chemical, Lymphedema (Acute & Chronic)
Dermatology: Herpes Zoster (Shingles), Ezcemas, Psoriasis
Gout / Arthritis
Neuropathies (Diabetic, Etc)

Serves as antibacterial, antifungal, antiviral therapy

Removes adipose tissue- liquifies fat cells
Useful Treatment for Nail Fungus of toenails or fingernails

Future Research Uses:

Neurological Disorders Stroke, Parkinson’s, ALS,  Alzheimers dementria.

Type Two Diabetes -Lowers blood glucose, Hgb A1C and improved insulin sensitivity

Blood Pressure Control

Renal Failure on Dialysis

Cardiac Muscle Failure: cardiomyopthy

Hepatic Failure: Cirrhosis

Post-OP: As an adjunct to any surgical procedure with fiber-optic lines left in place in the chest or abdominal cavity  for a week or two after surgery to deliver light therapy to speed healing and prevent infection of the wound.

Gasteroenterology: fiberoptic cables placed into the colon or small bowel to deliver Low Level Laser to the inner mucosa for inflammatory bowel disease patients.

This article is Part Three of a three part series.

For Part Two, Click Here:

For Part one, Click Here:

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314

Links and References

review of literature low level lasers

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(1) www.ncbi.nlm.nih.gov/pubmed/16942428
Photomed Laser Surg. 2006 Aug;24(4):480-8.

Histological assessment of the effect of laser irradiation on skin wound healing in rats. Gál P, Vidinský B, Toporcer T, Mokrý M, Mozes S, Longauer F, Sabo J. Source Department of Medical Biophysics, Faculty of Medicine, Pavol Jozef safárik University in Ko[scaron]ice, Kosice, Slovak Republic. galovci@yahoo.com

Abstract OBJECTIVE: The purpose of this study was to evaluate, from the histological point of view, the effect of diode laser irradiation on skin wound healing in Sprague-Dawley rats.

BACKGROUND DATA: Various biological effects have been described in different studies after low-level laser therapy (LLLT).

METHODS: Two parallel full-thickness skin incisions were performed on the back of each rat (n = 49) and immediately sutured. After surgery, one wound of each rat was exposed to laser irradiation (continuous mode, 670 nm, daily dose 30 J/cm2), whereas the parallel wound was not irradiated and served as control. Both wounds were removed 24, 48, 72, 96, 120, 144, and 168 h after surgery and routinely fixed and embedded in paraffin sections, stained with hematoxylin and eosin, van Gieson, periodic acid Schiff + periodic acid Schiff diastase, Mallory’s phosphotungstic hematoxylin, and azur and eosin, and histopathologically evaluated.

RESULTS: As compared to nonirradiated control wounds, laser stimulation shortened the inflammatory phase as well as accelerated the proliferative and maturation phase, and positively stimulated the regeneration of injured epidermis and the reparation of injured striated muscle.

CONCLUSION: LLLT at 670 nm positively influences all phases of rat skin wound healing.

(2) www.ncbi.nlm.nih.gov/pubmed/16218351
Rozhl Chir. 2005 Aug;84(8):417-21.
[Effect of laser irradiation of diode laser on healing of surgical wounds in rats]. [Article in Czech] Vidinský B, Gál P, Toporcer T, Balogácova M, Hutnanova Z, Kilík R, Bober J, Sabo J, Longauer F. Source Ustav lekárskej biofyziky, Lekárska fakulta Univerzity Pavla Jozefa Safarika v Kosiciach, Slovenská republika.

Abstract The aim of this work was to continue in previous study, which concerns biostimulation of skin wound healing evaluated after 24, 48, 120, 168 hours and so complete the chronological continuance of the process during the first seven days. Male, Sprague-Dawley rats (n=21) were used for the experiment. The rats were divided into 3 groups of 7 animals. In general anaesthesia (combination of xylazine, ketamine and tramadol) under aseptic condition two 3,5 cm long parallel skin incisions were performed on the left and right side of the rats spine and immediately sutured. The left wounds were daily stimulated with the diode laser (670 nm). The right wounds were not stimulated and served as control. The specimens of skin wounds were removed for histological evaluation 72, 96 and 144 hours after surgery. The biological specimens were stained with hematoxylin and eosin and histopathologically evaluated.

In summary, in our histomorphological study of the influence of laser irradiation on primary wound healing evaluated after 72, 96 and 144 hours was concluded, that the healing of stimulated wounds was accelerated in comparison with controls. The histological evaluation showed earlier regress of inflammatory phase, faster finishing of reepithelization and acceleration in maturation phase. Presented experimental study completes the previous study and achieves the positive effect of biostimulation on all phases of skin wound healing in vivo.

(3) www.ncbi.nlm.nih.gov/pubmed/16942427
Photomed Laser Surg. 2006 Aug;24(4):474-9.

Comparison between wound healing in induced diabetic and nondiabetic rats after low-level laser therapy. Rabelo SB, Villaverde AB, Nicolau R, Salgado MC, Melo Mda S, Pacheco MT. Source Instituto de Pesquisa e Desenvolvimento (IP&D), Universidade do Vale do Paraiba (UNIVAP), São José dos Campos, São Paulo, Brazil. Abstract OBJECTIVE: The aim of this work was to compare the effect of low-level laser therapy (LLLT) on the wound healing process in nondiabetic and diabetic rats.

BACKGROUND DATA: Among the clinical symptoms caused by diabetes mellitus, a delay in wound healing is a potential risk for patients. It is suggested that LLLT can improve wound healing.

METHODS: The tissue used for this study was extracted from animals suffering from diabetes, which was induced by Streptozotocin, and from nondiabetic rats. Animals were assembled into two groups of 25 rats each (treated and control) and further subdivided into two groups: diabetic (n = 15) and nondiabetic (n = 10). A full-thickness skin wound was made on the dorsum area, with a round 8-mm holepunch. The treated group was irradiated by a HeNe laser at 632.8 nm, with the following parameters: 15 mW, exposition time of 17 sec, 0.025 cm2 irradiated area, and energy density of 10 J/cm2. Square full-thickness skin samples (18 mm each side, including both injured and noninjured tissues) were obtained at 4, 7, and 15 days after surgery and analyzed by qualitative and quantitative histological methods.

RESULTS: Quantitative histopathological analysis confirmed the results of the qualitative analysis through histological microscope slides. When comparing tissue components (inflammatory cells, vessels and fibroblast/area), we found that treated animals had a less intense inflammatory process than controls.

CONCLUSION: Results obtained by both qualitative and quantitative analyses suggested that irradiation of rats with HeNe (632.8 nm), at the tested dose, promoted efficient wound healing in both nondiabetic and diabetic rats as, compared to the control group.

(4) www.ncbi.nlm.nih.gov/pubmed/18716824

Lasers Med Sci. 2009 Jul;24(4):539-47. Epub 2008 Aug 21.

Effect of equal daily doses achieved by different power densities of low-level laser therapy at 635 nm on open skin wound healing in normal and corticosteroid-treated rats. Gál P, Mokrý M, Vidinský B, Kilík R, Depta F, Harakalová M, Longauer F, Mozes S, Sabo J. Source Department of Medical Biophysics, Pavol Jozef Safárik University, Kosice, Slovak Republic. galovci@yahoo.com A

bstract Optimal parameters of low-level laser therapy (LLLT) for wound healing are still discussed. Hence, our study was aimed to compare effects of different power densities of LLLT at 635 nm in rats. Four, round, full-thickness, skin wounds were made on the backs of 48 rats that were divided into two groups (non-steroid laser-treated and steroid laser-treated). Three wounds were stimulated daily with a diode laser (daily dose 5 J/cm(2)) each with different power density (1 mW/cm(2), 5 mW/cm(2), and 15 mW/cm(2)), whereas the fourth wound served as a control. Two days, 6 days, and 14 days after surgery, eight animals from each group were killed and samples were removed for histological evaluation. In the non-steroid laser-treated rats, significant acceleration of epithelization and collagen synthesis 2 days and 6 days after surgery was observed in stimulated wounds.

In steroid laser-treated rats, 2 days and 14 days after surgery, a decreased leucocyte/macrophage ratio and a reduction in the area of granulation tissue were recorded, respectively. In conclusion, LLLT, by the method we used, improved wound healing in the non-steroid laser-treated rats, but it was useless after corticosteroid treatment.

 —- wound healing in rats —–

Acta Cir Bras. 2011 Apr;26(2):129-34.
Effect of low level laser on sutured wound healing in rats.

Melo VA, Anjos DC, Albuquerque Júnior R, Melo DB, Carvalho FU. Source Department of Experimental Surgical, Federal University of Sergipe, Aracaju, SE, Brazil. vamelo@infonet.com.br

PURPOSE: To evaluate the effect of low-level laser therapy (LLLT) ë904 nm on healing of surgical wounds in rats.

METHODS: Forty male Wistar rats were used, divided into four groups, underwent incision along the lines Alba covering skin, subcutaneous and muscle abdominal, sutured continuously for nylon 5-0. Eight and fifteen days after the surgery process, the repairing area was removed and histological sections were stained with hematoxylin-eosin to assess cellularity inflammatory, Masson’s Trichrome and Picrossirus to quantify the collagen fibers and immunohistochemical technique for counting newly formed vessels. The data were compared statistically using analysis of variance ANOVA, with a “post-hoc Tukey test, p <0.05.

RESULTS: Low-level laser therapy reduced the intensity of the inflammatory reaction and influenced the dynamic of the immunoinflammatory response by inducing switching of the leukocyte infiltration pattern (neutrophilic to lymphoplasmacytic infiltration). Also stimulate the deposition and enhance the organization of collagen fibers, featuring a delicate collagen type III. Furthermore, it appeared to a significant increase in the average number of newly formed vessels (p = 0.00 and p = 0.02, respectively).

CONCLUSION: Low-level laser therapy resulted in modulate of the inflammatory response, enhanced deposition of collagen fibers and increase in the average number of newly formed vessels.

S/P radiation therapy to the neck with post radiation ulcerations ———————————

5) www.ncbi.nlm.nih.gov/pubmed/21911312
Oral Oncol. 2011 Sep 10. [Epub ahead of print]

Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: A double-blind randomized study in head and neck cancer patients. Carvalho PA, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA. Source Stomatology Department – Hospital A.C. Camargo, São Paulo, Brazil.

Abstract The purpose of this prospective study was to determine the effect of the low-level laser in the prevention and treatment of mucositis in head and neck cancer patients. A total of 70 patients with malignant neoplasms in the oral cavity or oropharynx were evaluated.

The patients were randomized into two low-level laser therapy groups: Group 1 (660nm/15mW/3.8J/cm(2)/spot size 4mm(2)) or Group 2 (660nm/5mW/1.3J/cm(2)/spot size 4mm(2)) starting on the first day of radiotherapy. Oral mucositis was assessed daily and weekly using the NCI and WHO scales. Oral pain was scored daily with a visual analogue scale before laser application. The patients in Group 1 had a mean time of 13.5days (range 6-26days) to present mucositis grade II, while the patients in Group 2 had a mean time of 9.8days (range 4-14days) (both WHO and NCI p=0.005). In addition, Group 2 also presented a higher mucositis grade than Group 1 with significant differences found in weeks 2 (p=0.019), 3 (p=0.005) and 4 (p=0.003) for WHO scale and weeks 2 (p=0.009) and 4 (p=0.013) for NCI scale. The patients in Group 1 reported lower pain levels (p=0.004).

Low-level laser therapy during radiotherapy was found to be effective in controlling the intensity of mucositis and pain.

6) www.ncbi.nlm.nih.gov/pubmed/18800946
Photomed Laser Surg. 2009 Apr;27(2):371-4.
Improvement in quality of life of an oncological patient by laser phototherapy. Campos L, Simões A, Sá PH, Eduardo Cde P. Source Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil. Abstract OBJECTIVE AND

BACKGROUND DATA: Common side effects of radiotherapy (RT) to the head and neck include oral mucositis, xerostomia, and severe pain. The aim of this study is to report improvement in the quality of life of an oncological patient by laser phototherapy (LPT).

CLINICAL CASE AND LASER PHOTOTHERAPY PROTOCOL: The patient, a 15-year-old girl diagnosed with mucoepidermoid carcinoma, underwent surgical excision of a tumor of the left palatomaxilla. After that, she was subjected to 35 sessions of RT (2 Gy/d). Clinical examination revealed the spread of severe ulcerations to the jugal mucosa, gums, lips, hard palate, and tongue (WHO mucositis score 3). She had difficulty in moving her tongue and she was unable to eat any solid food. Oral hygiene orientation and LPT were performed throughout all RT sessions. A continuous diode laser, 660 nm, 40 mW, 6 J/cm(2), 0.24 J per point in contact mode, with spot size of 0.04 cm(2) was used in the entire oral cavity. A high-power diode laser at 1 W, 10 sec per cm of mucositis, approximately 10 J/cm(2), was used in defocused mode only on ulcerative lesions. After the first laser irradiation session, decreases in pain and xerostomia were reported; however, a more significant improvement was seen after five sessions. At that point although the mucositis score was still 2, the patient reported that she was free of pain, and consequently a palatine plate could be made to rehabilitate the entire surgical area. Seventeen laser irradiation sessions were necessary to eliminate all oral mucositis lesions. CONCLUSION: Normal oral function and consequent improvements in the quality of life of this oncologic patient were observed with LPT.

7) www.ncbi.nlm.nih.gov/pubmed/21537592

Braz Dent J. 2011;22(2):162-5.
Laser phototherapy as a treatment for radiotherapy-induced oral mucositis. Lino MD, Carvalho FB, Oliveira LR, Magalhães EB, Pinheiro AL, Ramalho LM. Source Center of Biophotonics, Dental School, Federal University of Bahia, Salvador, BA, Brazil.

Abstract Oral mucositis is a harmful side effect of radiotherapy (RT) on the head and neck region. There are encouraging reports on the beneficial aspects of the use of laser light on the treatment of oral mucositis. This paper reports the efficacy of laser phototherapy (LPT) on the treatment of oral mucositis in a patient undergoing RT after surgical removal of a squamous cell carcinoma with osseous invasion of the maxilla. Palatal and commissural lesions were treated with λ660 nm, 40 mW, ∅=4 mm(2), in contact mode, 5 x 2.4 J/cm(2) per point, 14.4 J/cm(2) per session. For treating the lesion on the patient’s nasal mucosa, LPT (∅=4 mm(2), λ780 nm, 70 mW, 3 x 2.1 J/cm(2) per point, 6.3 J/cm(2) per session, contact mode) was used on the external area of the nose. A single dose (2.4 J/cm(2)) with the λ660 nm laser, as described before, was applied on the entrance of each nostril. LPT was used 3 times/week during 4 weeks.

Treatment results indicate that the use of LPT on oral mucositis was effective and allowed the patient to carry on the RT without interruption. However, long-term and controlled clinical trials are necessary to establish both preventive and curative protocols using LPT.

8) www.ncbi.nlm.nih.gov/pubmed/19764899
Photomed Laser Surg. 2010 Apr;28(2):233-7.

Use of 660-nm diode laser in the prevention and treatment of human oral mucositis induced by radiotherapy and chemotherapy.

Zanin T, Zanin F, Carvalhosa AA, Castro PH, Pacheco MT, Zanin IC, Brugnera A Jr. Source Photobiology and Lasertherapy Center, Vale do Paraíba University, São Jose dos Campos, SP, Brazil.

OBJECTIVE: The aim of this multidisciplinary study was to evaluate quantitatively and qualitatively the effect of a 660-nm diode laser in the prevention and treatment of human oral mucositis (OM) in patients suffering from head and neck cancer who had undergone radiotherapy and chemotherapy.

BACKGROUND DATA: OM is a severe oral lesion resulting from the toxic effects of treatment for cancer in the head and neck region. Low-level laser therapy is indicated to prevent and treat this oral complication and may be used alone or in association with conventional drug treatment, producing pain relief and wound repair.

METHODS: This study included 72 patients with head and neck cancer treated at the Cancer Hospital of Mato-Grosso, Brazil, and divided into a control group (C; n = 36) and a laser group (L; n = 36). Laser therapy was performed in combination with radiotherapy and chemotherapy twice a week using a diode laser (lambda = 660 nm, power = 30 mW, spot size = 2 mm, energy = 2 J per point). RESULTS: Statistically significant differences were observed between the two groups. Patients in group L usually did not present with OM or pain, but all patients in group C presented with OM ranging from Level I to III associated with pain. This difference was significant from week 1 on, increased until week 4 and remained stable up to week 7.

CONCLUSION: Laser therapy was effective in preventing and treating oral effects induced by radiotherapy and chemotherapy, thus improving the patient’s quality of life.

case report- effective for sjogren’s syndrom dry mouth ——————————————–
9) http://www.ncbi.nlm.nih.gov/pubmed/19938253
Spec Care Dentist. 2009 May-June;29(3):134-7.

Laser as a therapy for dry mouth symptoms in a patient with Sjögren’s syndrome: a case report. Simões A, Platero MD, Campos L, Aranha AC, Eduardo Cde P, Nicolau J. Source Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.

Abstract This clinical case study reports on dry mouth symptoms in a patient with Sjögren’s syndrome (SS) who was treated with laser phototherapy (LPT). A 60-year-old woman diagnosed with SS was referred to the laboratory for lasers in dentistry to treat her severe xerostomia. A diode laser (780 nm, 3.8 J/cm2, 15 mW) was used to irradiate the parotid, submandibular, and sublingual glands, three times per week, for a period of 8 months. The salivary flow rate and xerostomia symptoms were measured before, during, and after LPT. Dry mouth symptoms improved during LPT. After LPT, the parotid salivary gland pain and swelling were no longer present. Treatment with LPT was an effective method to improve the quality of life of this patient with SS.

effective for labial herpes simplex 1
10) www.ncbi.nlm.nih.gov/pubmed/22047597
Photomed Laser Surg. 2011 Nov 2. [Epub ahead of print]

The Effect of 670-nm Low Laser Therapy on Herpes Simplex Type 1. Muñoz Sanchez PJ, Capote Femenías JL, Díaz Tejeda A, Tunér J. Source 1 Leonardo Fernández Sánchez Dental Clinic , Cienfuegos, Cuba .

The purpose of this work was to study the effect of low-level laser therapy (LLLT) on the healing and relapse intervals in patients with recurrent labial herpes simplex infections.

Background data: Several pharmaceuticals are available to reduce symptoms and improbé healing of labial herpes, but only LLLT has been reported to significantly influence the length of the recurrence period.

Material and methods: In an initial study, 232 patients with herpes simplex type 1 virus symptoms were consecutively selected for either LLLT or conventional therapy, including acyclovir cream or tablets. One of the dentists was responsible for the diagnosis, a second dentist for the treatment, and and a third for the evaluation, to allow for a semi-blinded procedure. Patients in the laser group received 670-nm laser irradiation, 40 mW, 1.6 J, 2.04 J/cm(2), 51 mW/cm(2) per blister in the prodromal stage and 4.8 J in the crust and secondarily infected stages, plus 1.2 J at the C2-C3 vertebrae. Patients were monitored daily during the first week to control healing, and monthly for 1 year to check on recurrence. In a consecutive study, 322 patients receiving LLLT were followed during 5 years to observe the period of ocurrences.

Results: An obvious effect of LLLT was found for both initial healing and for the length of the recurrence periods.

Conclusions: LLLTof herpes simples virus 1 (HSV-1) appears to be an effective treatment modality without any observed side effects.

11)  www.ncbi.nlm.nih.gov/pubmed/19669856
Lasers Med Sci. 2010 May;25(3):397-402. Epub 2009 Aug 11.

Effect of laser phototherapy on recurring herpes labialis prevention: an in vivo study. de Carvalho RR, de Paula Eduardo F, Ramalho KM, Antunes JL, Bezinelli LM, de Magalhães MH, Pegoretti T, de Freitas PM, de Paula Eduardo C. Source Special Laboratory of Lasers in Dentistry, Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil.

Abstract Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus.

Seventy-one patients, divided into experimental (n = 41) and control (n = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm(2) or 4.5 J/cm(2) on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions (P = 0.013) and inflammatory edema (P = 0.031). The reduction in pain level (P = 0.051) and monthly recurrences (P = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.

12) www.ncbi.nlm.nih.gov/pubmed/10469307
J Invest Dermatol. 1999 Aug;113(2):221-3.

Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection.

Results from a randomized double-blind placebo-controlled study.
Schindl A, Neumann R. Source Department of Dermatology, University of Vienna Medical School, Austria. Andreas.

Abstract Recurrent infection with herpes simplex virus is a common disease. Recently, alternative therapies have been introduced. Among those, low-intensity laser therapy mainly used for the acceleration of wound healing and in pain therapy has previously been shown to be of benefit in herpes zoster infections. In this study we evaluated the influence of low-intensity laser therapy (wavelength 690 nm, intensity: 80 mW per cm2, dose: 48 J per cm2) in 50 patients with recurrent perioral herpes simplex infection (at least once per month for more than 6 mo) in a randomized, double-blind placebo-controlled trial design.

Patients in the laser group received daily irradiations for 2 wk, whereas patients in the placebo group were sham-irradiated. After completion of the laser/sham treatment, patients were asked to return to the Department of Dermatology, University of Vienna Medical School at the time of recurrence. All except two patients completed the study and were monitored for 52 wk. The median recurrence-free interval in the laser-treated group was 37.5 wk (range: 2-52 wk) and in the placebo group 3 wk (range: 1-20 wk). This difference was found to be statistically significant (p < 0.0001; Wilcoxon’s Rank Sum Test).

In conclusion, we demonstrated that a total of 10 irradiations with low-intensity laser therapy significantly lowers the incidence of local recurrence of herpes simplex infection. Since this athermic phototherapeutic modality represents a safe, noninvasive treatment, it might be considered as an alternative to established therapeutic regimens in this indication.

free full text – herpes simplex with photos of before and after

12A) Ferreira, Dennis Carvalho, et al. “Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment.” Revista da Sociedade Brasileira de Medicina Tropical 44.3 (2011): 397-399.Recurrent herpes simplex infections laser therapy successful treatment Ferreira Dennis Carvalho 2011

Ferreira DC, Reis HL, Cavalcante FS, Santos KR, Passos MR. Source Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. Abstract Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Shingles Herpes Zoster- Post Herpetic Neuralgia

13) Falaki, Farnaz, Amir Hossein Nejat, and Zohreh Dalirsani. “The effect of low-level laser therapy on trigeminal neuralgia: a review of literature.” Journal of dental research, dental clinics, dental prospects 8.1 (2014): 1.The effect of low-level laser therapy on trigeminal neuralgia Falak 2014

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males, 38 females with an average age of 69 years) managed at our pain clinic over the past four years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminium arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a noninvasive, painless and safe method of therapy, it is well acceptable by patients.

14) www.ncbi.nlm.nih.gov/pubmed/1334163
1992 Nov;41(11):1809-13.
[Low reactive-level laser therapy near the stellate ganglion for postherpetic facial neuralgia]. [Article in Japanese] Ohtsuka H, Kemmotsu O, Dozaki S, Imai M.
Source Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.

Low reactive-level laser therapy near the stellate ganglion was given for a 68-year-old female with postherpetic neuralgia, suffering from burning pain in the right forehead for 11 years. Stellate ganglion block and supraorbital nerve block with oral medication were not effective to relieve this pain. The laser irradiation induced warm sensation in her face followed by an excellent pain relief. Thermograms illustrated a remarkable increase from 30.6 degrees C to 31.5 degrees C in temperature of her right face. The irradiation near the right carotid artery also had the similar effect. The results imply that the irradiation with low reactive-level laser of the stellate ganglion and/or the carotid artery increases a facial blood flow and relieves facial neuralgia.

15) http://www.ncbi.nlm.nih.gov/pubmed/9796491
J Clin Laser Med Surg. 1998 Aug;16(4):223-6.
Low-level laser therapy is an important tool to treat disorders of the maxillofacial region. Pinheiro AL, Cavalcanti ET, Pinheiro TI, Alves MJ, Miranda ER, De Quevedo AS, Manzi CT, Vieira AL, Rolim AB. Laser Center, School of Dentistry, Universidade Federal de Pernambuco, Brazil. Abstract OBJECTIVES:

The authors report on the effects of low-level laser therapy (LLLT) in the treatment of maxillofacial disorders.


Further to our previous studies, this paper reports the results of the use of LLLT on the treatment of several disorders of the oral and maxillofacial region. This paper presents LLLT as an effective method of treating such disorders.

Two hundred and five female and 36 male patients ages between 7 and 81 years old (average 38.9 years old), suffering from disorders of the maxillofacial region, were treated with 632.8, 670, and 830 nm diode lasers at the Laser Center of the Universidade Federal de Pernambuco, Recife, Brazil (UFPE).

The disorders included temporomandibular joint (TMJ) pain, trigeminal neuralgia, muscular pain, aphatae, inflammation, and tooth hypersensitivity postoperatively and in small hemangiomas. Most treatment consisted of a series of 12 applications (twice a week) and in 15 cases a second series was applied. Patients were treated with an average dose of 1.8 J/cm2.

One hundred fifty four out of 241 patients were asymptomatic at the end of the treatment, 50 improved considerably, and 37 were symptomatic.


These results confirm that LLLT is an effective tool and is beneficial for the treatment of many disorders of the maxillofacial region.


16) http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-0243

Acta Derm Venereol 2009; 89: 372–378

Single Low-dose Red Light is as Efficacious as Methylaminolevulinate–
Photodynamic Therapy for Treatment of Acne:

Clinical Assessment and Fluorescence Monitoring
Camilla Hörfelt 1, Bo Stenquist1, Christina B. Halldin1, Marica B. Ericson1,2 and Ann-Marie Wennberg1 1Department of Dermatology, Sahlgrenska University Hospital and 2Department of Physics, Göteborg University, Göteborg, Sweden

This controlled study investigated single low-dose red light photodynamic therapy and methyl-aminolevulinate (MAL) for treatment of moderate to severe facial acne in 19 patients. The right cheek was treated with MAL (160 mg/g) for 3 h prior to illumination. The left cheek received red light only. Both cheeks were illuminated with narrow-band red light (635 nm) at a light dose of 15 J/cm2. The global severity of acne was assessed at baseline and at follow-up, 10 and 20 weeks after treatment. Fluorescence images, clinical photographs and skin surface biopsies were obtained. Both MAL-photodynamic therapy and control areas showed a significant decrease in acne score at follow-up; no significant difference was found compared with control. MAL-photodynamic therapy was associated with adverse effects such as ery­thema and stinging. Fluorescence images revealed poor selectivity of MAL-induced fluorescence to the acne lesions, suggesting a general photoablating mechanism rather than selective destruction of sebaceous glands. No significant reduction in Propionibacterium acnes or sebum excretion was found.

17) http://www.ncbi.nlm.nih.gov/pubmed/20944910

An Bras Dermatol. 2010 Aug;85(4):501-11.
Photodynamic therapy: a review of the literature and image documentation.
[Article in English, Portuguese] Issa MC, Manela-Azulay M. Source
Universidade Federal Fluminense, Niterói, RJ, Brasil.

however, various publications in the literature indicate that PDT is a safe option for the treatment of acne vulgaris, psoriasis, viral warts and localized scleroderma. 54 More recently, it has also been recommended for the treatment of photo-damaged skin. 49,50 We believe that the new indications for PDT in the treatment of the various other non-neoplastic dermatoses should be reserved for specific cases in which PDT could be considered as an alternative therapy rather than a first line option.

Low level laser for traumatic brain injury- rat model israel larger numbers of survival with complete neuologoc recovery and Smaller infarct size on MRI scan ——————————————————————-

18) http://www.ncbi.nlm.nih.gov/pubmed/22040267
J Neurotrauma. 2011 Oct 31. [Epub ahead of print]
Near infrared Transcranial Laser Therapy applied at Various Modes to Mice Following Traumatic Brain Injury Significantly Reduces Long-Term Neurological Deficits.
Oron U. Source Ramat Aviv, Tel-Aviv, Israel, 69978;

Abstract Near-infrared transcranial laser therapy (TLT) has been found to modulate various biological processes including traumatic brain injury (TBI). Following TBI in mice, in this study we assessed the possibility of various near-infrared TLT modes (pulsed vs. continuous) producing a beneficial effect on the long-term neurobehavioral outcome and brain lesions of these mice.

TBI was induced by a weight-drop device, and neurobehavioral function was assessed from one hour and up to 56 days post-trauma using a neurological severity score (NSS). The extent of recovery is expressed as dNSS, the difference between the initial score, and that at any other, later, time point. An 808nm Ga-Al-As diode laser was employed transcranially 4, 6 or 8 hrs post-trauma to illuminate the entire cortex of the brain. Mice were divided into several groups of 6-8 mice: one control group that received a sham treatment and experimental groups that received either TLT continuous wave (CW) or pulsed wave (PW) mode transcranially. MRI was taken prior to sacrifice 56 days post-CHI. From 5 to 28 days post-TBI, the NSS of the laser-treated mice were significantly lower (p<0.05) than the non-laser-treated, control mice. The percentage of surviving mice that demonstrated full recovery 56 days post-CHI, namely NSS=0 (as in intact mice) was the highest (63%) in the group that had received TLT in the PW mode at 100 Hz. In addition, MRI analysis demonstrated significantly smaller infarct lesion volumes in laser treated mice as compared to control.

Our data suggest that non-invasive TLT of mice post-TBI provides a significant long-term functional neurological benefit, and that the pulsed laser mode at 100 Hz is the preferred mode for such treatment. Key words: low-level laser therapy; mice; traumatic brain injury; pulsed laser; motor function, MRI.

19) www.ncbi.nlm.nih.gov/pmc/articles/PMC3196530/?tool=pubmed full text

Comparison of Therapeutic Effects between Pulsed and Continuous Wave 810-nm Wavelength Laser Irradiation for Traumatic Brain Injury in Mice Takahiro Ando,1,2 Weijun Xuan,1,3,4 Tao Xu,1,3,5 Tianhong Dai,1,3 Sulbha K. Sharma,1 Gitika B. Kharkwal,1,3 Ying-Ying Huang,1,3,6 Qiuhe Wu,1,3,7 Michael J. Whalen,8 Shunichi Sato,9 Minoru Obara,2 and Michael R. Hamblin1,3,10*

Nerve Regeneneration- animal study
20) www.ncbi.nlm.nih.gov/pubmed/22009383
Lasers Med Sci. 2011 Oct 19. [Epub ahead of print]

Low-level laser therapy improves repair following complete resection of the sciatic nerve in rats.

Medalha CC, Di Gangi GC, Barbosa CB, Fernandes M, Aguiar O, Faloppa F, Leite VM, Renno AC. Source Department of Bioscience, Federal University of São Paulo (UNIFESP), Avenida Ana Costa 95, CEP 04021-001, Santos, SP, Brazil, cmedalha@unifesp.br. Abstract The aim of this study is to analyze the effects of low-level laser therapy (LLLT) on the regeneration of the sciatic nerve in rats following a complete nerve resection. Male Wistar rats were divided into a control injury group, injury groups irradiated with a 660-nm laser at 10 or 50 J/cm(2), and injury groups irradiated with an 808-nm laser at 10 or 50 J/cm(2). Treatment began 24 h following nerve resection and continued for 15 days. Using the sciatic functional index (SFI), we show that the injured animals treated with 660 nm at 10 and 50 J/cm(2) had better SFI values compared with the control injury and the 808-nm groups. Animals irradiated with the 808-nm laser at 50 J/cm(2) show higher values for fiber density than do control animals. In addition, axon and fiber diameters were larger in animals irradiated with 660 nm at 50 J/cm(2) compared to the control group.

These findings indicate that 660-nm LLLT is able to provide functional gait recovery and leads to increases in fiber diameter following sciatic nerve resection.

anti-inflammatory effect similar to Dexamethazone
Lasers Med Sci. 2011 Sep 27. [Epub ahead of print]

Antiinflammatory effect of low-level laser therapy on Staphylococcus epidermidis endophthalmitis in rabbits.  Ma WJ, Li XR, Li YX, Xue ZX, Yin HJ, Ma H. Source Tianjin Medical University Eye Centre, Tianjin, 300070, China. Abstract A rabbit model of endophthalmitis was established to evaluate the antiinflammatory effect of low-level laser therapy (LLLT) as an adjunct to treatment for Staphylococcus epidermidis endophthalmitis. Rabbits were randomly divided into three groups to receive intravitreal injections into their left eye: group A received 0.5 mg vancomycin (100 μl), group B received 0.5 mg vancomycin + 0.2 mg dexamethasone (100 μl), and group C received 0.5 mg vancomycin (100 μl) and continuous wave semiconductor laser irradiation (10 mW, λ = 632 nm) focused on the pupil. Slit lamp examination and B-mode ultrasonography were conducted to evaluate the symptoms of endophthalmitis. Polymorphonuclear cells and tumour necrosis factor alpha (TNF-α) in aqueous fluid were measured at 0 h, and 1, 2, 3, 7 and 15 days. A histology test was conducted at 15 days. B-mode ultrasonography and histology revealed that groups B and C had less inflammation than group A at 15 days. Groups B and C had fewer polymorphonuclear cells and lower levels of TNF-α in aqueous fluid than group A at 2, 3 and 7 days (P < 0.05). There was no significant difference between groups B and C (P > 0.05). There was no significant difference between groups A, B and C at 15 days (P > 0.05). As an adjunct to vancomycin therapy to treat S. epidermidis endophthalmitis, LLLT has an antiinflammatory effect similar to that of dexamethasone.

HISTOLOGY of RAT Muscle after low level laser
22) www.ncbi.nlm.nih.gov/pubmed/21924919

Micron. 2011 Aug 30. [Epub ahead of print]

Effects of low-level laser irradiation in ultrastructural morphology, and immunoexpression of VEGF and VEGFR-2 of rat masseter muscle. Dias FJ, Issa JP, Barbosa AP, de Vasconcelos PB, Watanabe IS, Mizusakiiyomasa M. Source Department of Morphology, Stomatology and Physiology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n, Monte Alegre, 14040-904 Ribeirão Preto, SP, Brazil.

Abstract The present study evaluates by ultrastructural and immunohistochemical methods, the possible changes on muscular tissue affected by LLLI during a treatment, for example, in cases of temporomandibular joint disorders.

Sixty male Wistar rats divided into 6 groups (n=10) received ten laser irradiations, with different energy densities (groups I-0; II-0.5; III-1.0; IV-2.5; V-5.0; and VI-20J/cm(2)). Muscles were removed and processed for transmission electron microscopic and immunohistochemical (VEGF and VEGFR-2) analyses. Captured photomicrographs of immunohistochemistry and transmission electron microscopy were evaluated.


It was observed in the irradiated muscles, mitochondria of different shapes and sizes, with increased plasticity evidenced by organelles in fusion, division and the presence of elongated structures with characteristics of mitochondria, proximity with the dilated sarcoplasmatic reticulum, suggesting organelles with large amounts of energy, and the presence of cytoplasmic protrusions in the capillaries with high dosages.
All studied groups showed immunostainings for both markers (VEGF and VEGFR-2), but in general those who received higher doses also showed the markings more pronounced, suggesting dose-dependent biomodulation.

It was concluded that the LLLI was able to modify the ultrastructural characteristics and immunohistochemical pattern of VEGF and VEGFR-2 in the masseter muscle of rats.

more histology – Muscle Trauma in the Gerbil

23) www.ncbi.nlm.nih.gov/pubmed/19269186

Micron. 2009 Jun;40(4):413-8. Epub 2009 Feb 13.

Ultrastructural analysis of the low level laser therapy effects on the lesioned anterior tibial muscle in the gerbil. Iyomasa DM, Garavelo I, Iyomasa MM, Watanabe IS, Issa JP. Source Department of Physiotherapy, São Paulo State University, Presidente Prudente, SP, Brazil.

Abstract Low level laser therapy (LLLT) is known for its positive results but studies on the biological and biomodulator characteristics of the effects produced in the skeletal muscle are still lacking. In this study the effects of two laser dosages, 5 or 10 J/cm(2), on the lesioned tibial muscle were compared. Gerbils previously lesioned by 100 g load impact were divided into three groups: GI (n=5) controls, lesion non-irradiated; GII (n=5), lesion irradiated with 5 J/cm(2) and GIII (n=5), lesion irradiated with 10 J/cm(2), and treated for 7 consecutive days with a laser He-Ne (lambda=633 nm).

After intracardiac perfusion, the muscles were dissected and reduced to small fragments, post-fixed in 1% osmium tetroxide, dehydrated in increasing alcohol concentrations, treated with propylene oxide and embedded in Spurr resin at 60 degrees C.

Ultrafine cuts examined on a transmission electron microscope (Jeol 1010) revealed in the control GI group a large number of altered muscle fibers with degenerating mitochondria, intercellular substance containing degenerating cell fragments and budding blood capillaries with underdeveloped endothelial cells. However, groups GII and GIII showed muscle fibers with few altered myofibrils, regularly contoured mitochondria, ample intermembrane spaces and dilated mitochondrial crests. The clean intercellular substance showed numerous collagen fibers and capillaries with multiple abluminal processes, intraluminal protrusions and several pinocytic vesicles in endothelial cells.


It was concluded that laser dosages of 5 or 10 J/cm(2) delivered by laser He-Ne (lambda=633 nm) during 7 consecutive days increase mitochondrial activity in muscular fibers, activate fibroblasts and macrophages and stimulate angiogenesis, thus suggesting effectivity of laser therapy under these experimental conditions.


achilles tendinitis

24) http://blog.thorlaser.com/apta-recommends-lllt-for-achilles-tendinopathies/

Achilles Pain, Stiffness, and Muscle Power Deficits / Achilles Tendinitis:
Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association

American Physical Therapy Association (APTA) Clinical Guidelines recommend Low Level Laser Therapy (LLLT) for Achilles tendinopathies. The report says “Clinicians should consider the use of low level laser therapy to decrease pain and stiffness in patients with Achilles tendinopathy.”

Achilles Tendonitis – animal model- Better than NSAID Drugs

25) http://www.ncbi.nlm.nih.gov/pubmed/21910734
Photochem Photobiol. 2011 Nov-Dec;87(6):1447-52. doi: 10.1111/j.1751-1097.2011.00999.x. Epub 2011 Oct 7.
Infrared (810 nm) low-level laser therapy in rat achilles tendinitis: a consistent alternative to drugs. Marcos RL, Leal EC Jr, Messias Fde M, de Carvalho MH, Pallotta RC, Frigo L, dos Santos RA, Ramos L, Teixeira S, Bjordal JM, Lopes-Martins RÁ.
Source   Laboratory of Pharmacology and Experimental Therapeutics, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP-Brazil.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used and can reduce musculoskeletal pain in spite of the cost of adverse reactions like gastrointestinal ulcers or cardiovascular events. The current study investigates if a safer treatment such as low-level laser therapy (LLLT) could reduce tendinitis inflammation, and whether a possible pathway could be through inhibition of either of the two-cyclooxygenase (COX) isoforms in inflammation.

Wistar rats (six animals per group) were injected with saline (control) or collagenase in their Achilles tendons. Then, we treated them with three different doses of IR LLLT (810 nm; 100 mW; 10 s, 30 s and 60 s; 3.57 W cm(-2); 1 J, 3 J, 6 J) at the sites of the injections, or intramuscular diclofenac, a nonselective COX inhibitor/NSAID.

We found that LLLT dose of 3 J significantly reduced inflammation through less COX-2-derived gene expression and PGE(2) production, and less edema formation compared to nonirradiated controls. Diclofenac controls exhibited significantly lower PGE(2) cytokine levels at 6 h than collagenase control, but COX isoform 1-derived gene expression and cytokine PGE(2) levels were not affected by treatments. As LLLT seems to act on inflammation through a selective inhibition of the COX-2 isoform in collagenase-induced tendinitis, LLLT may have potential to become a new and safer nondrug alternative to coxibs.

12 positive studies for treatment of tendinopathy (achilles and epicondyle)

26) http://www.ncbi.nlm.nih.gov/pubmed/19708800
Photomed Laser Surg. 2010 Feb;28(1):3-16.
Low level laser treatment of tendinopathy: a systematic review with meta-analysis.
Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD.
Source Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand

To assess the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of tendinopathy. Secondary objectives were to determine the relevance of irradiation parameters to outcomes, and the validity of current dosage recommendations for the treatment of tendinopathy.


Twenty-five controlled clinical trials met the inclusion criteria. There were conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies would support the existence of an effective dosage window that closely resembled current recommended guidelines. In two instances where pooling of data was possible, LLLT showed a positive effect size; in studies of lateral epicondylitis that scored > or =6 on the PEDro scale, participants’ grip strength was 9.59 kg higher than that of the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale.


LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.


27) www.ncbi.nlm.nih.gov/pubmed/17508839

Photomed Laser Surg. 2007 Apr;25(2):65-71.

Effects of 904-nm low-level laser therapy in the management of lateral epicondylitis: a randomized controlled trial.  Lam LK, Cheing GL. Source Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong.

Abstract OBJECTIVE: The aim of this study was to evaluate the effectiveness of 904-nm low-level laser therapy (LLLT) in the management of lateral epicondylitis.

BACKGROUND DATA: Lateral epicondylitis is characterized by pain and tenderness over the lateral elbow, which may also result in reduction in grip strength and impairment in physical function. LLLT has been shown effective in its therapeutic effects in tissue healing and pain control. METHODS: Thirty-nine patients with lateral epicondylitis were randomly assigned to receive either active laser with an energy dose of 0.275 J per tender point (laser group) or sham irradiation (placebo group) for a total of nine sessions. The outcome measures were mechanical pain threshold, maximum grip strength, level of pain at maximum grip strength as measured by the Visual Analogue Scale (VAS) and the subjective rating of physical function with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Significantly greater improvements were shown in all outcome measures with the laser group than with the placebo group (p < 0.0125), except in the two subsections of DASH.

CONCLUSION: This study revealed that LLLT in addition to exercise is effective in relieving pain, and in improving the grip strength and subjective rating of physical function of patients with lateral epicondylitis.

 —————————-  arthritis ———————


28) www.ncbi.nlm.nih.gov/pubmed/22053992
Photochem Photobiol. 2011 Nov 7. doi: 10.1111/j.1751-1097.2011.01032.x. [Epub ahead of print]

Effects of Low-Level Laser Therapy at Wavelengths of 660 nm and 808 nm in Experimental Model of Osteoarthritis.

da Rosa AS, Dos Santos AF, da Silva MM, Perreira DM, Alves AC, Leal Junior EC, de Carvalho PD. Source Post Graduation Program for Health and Development of the Central-West Region, Federal University of Mato Grosso do Sul- Campo Grande, Mato Grosso do Sul / Brazil. Department of Physiotherapy, Anhanguera – University for the Development of the State and the Pantanal Region (UNIDERP)/ Campo Grande, Mato Grosso do Sul/Brazil Post Graduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.

Abstract The aim of the present study was to analyze the influence of low-level laser radiation at wavelengths of 660nm and 808nm in an experimental model of osteoarthritis. The sample was composed of 36 male adult Wistar rats divided into three groups (G1, G2 and G3). For the induction of cartilage injury, three injections of 4% papain and 10μl of a cysteine solution were performed at right knee of the hind leg. Two weeks after the last injection, group G1 was treated with InGaAlP (660nm, 100 mW, 3.57 W/cm(2) , 40 sec) and G2 was treated with AsGaAl (808nm, 100 mW, 3.57 W/cm(2) , 40 sec) both with energy of 4J. There were significant differences in the type of squamous epithelium between days 7 and 14 in G2 (p<0.05) and on Day 14 between G1 and G2 (p<0.05). Moreover, statistically significant differences were found in formation of new blood vessels between G1 and G3 on Days 7 and 21 as well as between G2 and G3 on day 21.

The formation of fibrotic tissue was greater in G3 (p<0.05).

In conclusion, laser therapy, especially at a wavelength of 808nm, stimulated angiogenesis and reduced the formation of fibrosis in an experimental model of osteoarthritis.

Arthritis – LLLT reduces inflammation animal model better than LED

29) http://www.ncbi.nlm.nih.gov/pubmed/19780633
Photomed Laser Surg. 2010 Apr;28(2):227-32.
Anti-inflammatory effect of low-level laser and light-emitting diode in zymosan-induced arthritis. de Morais NC, Barbosa AM, Vale ML, Villaverde AB, de Lima CJ, Cogo JC, Zamuner SR.Laboratory of Inflammation, Institute of Research and Development, University of Vale do Paraíba, Sáo José dos Campos, Brazil.

The aim of this work was to investigate the effect of low-level laser therapy (LLLT) and light-emitting diode (LED) on formation of edema, increase in vascular permeability, and articular joint hyperalgesia in zymosan-induced arthritis.
BACKGROUND DATA: It has been suggested that low-level laser and LED irradiation can modulate inflammatory processes.

MATERIAL AND METHODS: Arthritis was induced in male Wistar rats (250-280 g) by intra-articular injection of zymosan (1 mg in 50 microL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1 h, and 2 h after zymosan administration with a semiconductor laser (685 nm and 830 nm) and an LED at 628 nm, with the same dose (2.5 J/cm(2)) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1 h prior to the zymosan administration. Edema was measured by the wet/dry weight difference of the articular tissue, the increase in vascular permeability was assessed by the extravasation of Evans blue dye, and joint hyperalgesia was measured using the rat knee-joint articular incapacitation test.

Irradiation with 685 nm and 830 nm laser wavelengths significantly inhibited edema formation, vascular permeability, and hyperalgesia. Laser irradiation, averaged over the two wavelengths, reduced the vascular permeability by 24%, edema formation by 23%, and articular incapacitation by 59%.

Treatment with LED (628 nm), with the same fluence as the laser, had no effect in zymosan-induced arthritis.


LLLT reduces inflammatory signs more effectively than LED irradiation
with similar irradiation times (100 sec), average outputs (20 mW), and energy doses (2 J) in an animal model of zymosan-induced arthritis. The anti-inflammatory effects of LLLT appear to be a class effect, which is not wavelength specific in the red and infrared parts of the optical spectrum.


—— carpal tunnel ——————–

30) www.ncbi.nlm.nih.gov/pubmed/22037175

Adv Med Sci. 2011 Oct 29:1-5. [Epub ahead of print]

Comparison of the long – term effectiveness of physiotherapy programs with low – level laser therapy and pulsed magnetic field in patients with carpal tunnel syndrome.

Dakowicz A, Kuryliszyn-Moskal A, Kosztyła-Hojna B, Moskal D, Latosiewicz R. Source Department of Rehabilitation, Medical University of Bialystok, Bialystok, Poland.

Abstract Purpose: The aim of the study was to compare the long term effects of low – level laser therapy (LLLT) and pulsed magnetic field (PMF) in the rehabilitation of patients with carpal tunnel syndrome (CTS).

Methods: The study included 38 patients with idiopathic CTS, confirmed by electroneurographic (ENG) examination. All patients were randomly assigned to 2 groups: group L (18 patients) treated with LLLT and group M (20 patients) with PMF therapy. Clinical assessment, including day and night pain, the presence of paresthesia, functional tests (Phalen, Tinel, armband tests) and pain severity according to the Visual Analogue Scale (VAS) was conducted before treatment, after the first series of 10 sessions, after a two-week break, after the second series of 10 sessions and six months after the last series.

Results: After LLLT a significant reduction of day and night pain was observed at each stage of treatment and 6 months after the last series (p<0.05). However, in group M, a significant reduction of both day and night pain was demonstrated only after the second series (p<0.05). A reduction of the incidence of Phalen’s symptoms were noticed in both groups, however, only in group L the improvement was significant (p<0.05). In groups L and M a significant reduction of pain intensity was observed at every stage of treatment (p<0.05).

Conclusions: Although after LLL as well as PMF therapy clinical improvement was observed, the most significant differences were registered after the second series and persisted for up to 6 months in both groups.

31) www.ncbi.nlm.nih.gov/pubmed/19025407
Photomed Laser Surg. 2008 Dec;26(6):551-7.

Carpal tunnel
syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament. Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT. Source Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, Taiwan.

Abstract OBJECTIVE: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome (CTS).

BACKGROUND DATA: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT. MATERIALS AND

METHODS: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm(2), at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up.

RESULTS: Before treatment, there were no significant differences between the two groups for all assessments (p > 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p < 0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p > 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p < 0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2-wk follow-up.

CONCLUSIONS: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.

Neck and Low Back PAin

32) http://www.ncbi.nlm.nih.gov/pubmed/18394495
J Manipulative Physiol Ther. 2008 Mar;31(3):191-8.
Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging.
Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S.

Department of Physical Medicine and Rehabilitation, Medical Faculty, Celal Bayar University, Manisa, Turkey. zelihaunlu@yahoo.com

This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH).

A total of 60 patients were enrolled in this study and randomly assigned into 1 of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at 1 and 3 months after treatment.

There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups.

This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.

33) http://www.ncbi.nlm.nih.gov/pubmed/12605431
Lasers Surg Med. 2003;32(3):233-8.
Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M.

Physical Medicine and Rehabilitation, School of Medicine, Dicle University, Diyarbakir, Turkey.

The aim of this study was to determine whether low power laser therapy (Gallium-Arsenide) is useful or not for the therapy of chronic low back pain (LBP).

This study included 75 patients (laser + exercise-25, laser alone-25, and exercise alone-25) with LBP. Visual analogue scale (VAS), Schober test, flexion and lateral flexion measures, Roland Disability Questionnaire (RDQ) and Modified Oswestry Disability Questionnaire (MODQ) were used in the clinical and functional evaluations pre and post therapeutically. A physician, who was not aware of the therapy undertaken, evaluated the patients.

Significant improvements were noted in all groups with respect to all outcome parameters, except lateral flexion (P < 0.05).

Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP.

neck pain- whiplash

34) http://lasertherapeutics-us.lasertherapeutics.net/papers/Roberta_T_Chow_LLLT[1].pdf


The Lancet, Volume 374, Issue 9705, Pages 1897 – 1908, 5 December 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
Dr Roberta T Chow MBBS a Corresponding AuthorEmail Address, Prof Mark I Johnson PhD b, Prof Rodrigo AB Lopes-Martins PhD c, Prof Jan M Bjordal PT d e

Background Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.
Methods We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.

We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1·69 (95% CI 1·22–2·33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4·05 (2·74–5·98) of LLLT.

Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19·86 mm (10·04–29·68). Seven trials provided follow-up data for 1–22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22·07 mm (17·42–26·72). Side-effects from LLLT were mild and not different from those of placebo.

We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.

35) http://www.ncbi.nlm.nih.gov/pubmed/16806710
Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27.
The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study. Chow RT, Heller GZ, Barnsley L.
Source  Castle Hill Medical Centre, 269-271 Old Northern Road, Castle Hill, NSW 2154, Australia. rtchow@bigpond.net.au Abstract

A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain was conducted with the aim of determining the efficacy of 300 mW, 830 nm laser in the management of chronic neck pain. Subjects were randomized to receive a course of 14 treatments over 7 weeks with either active or sham laser to tender areas in the neck. The primary outcome measure was change in a 10 cm Visual Analogue Scale (VAS) for pain. Secondary outcome measures included Short-Form 36 Quality-of-Life questionnaire (SF-36), Northwick Park Neck Pain Questionnaire (NPNQ), Neck Pain and Disability Scale (NPAD), the McGill Pain Questionnaire (MPQ) and Self-Assessed Improvement (SAI) in pain measured by VAS. Measurements were taken at baseline, at the end of 7 weeks’ treatment and 12 weeks from baseline.

The mean VAS pain scores improved by 2.7 in the treated group and worsened by 0.3 in the control group (difference 3.0, 95% CI 3.8-2.1). Significant improvements were seen in the active group compared to placebo for SF-36-Physical Score (SF36 PCS), NPNQ, NPAD, MPQVAS and SAI. The results of the SF-36 – Mental Score (SF36 MCS) and other MPQ component scores (afferent and sensory) did not differ significantly between the two groups.

Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.
LLLT for Burns animal model

36) http://www.ncbi.nlm.nih.gov/pubmed/19533211
Lasers Med Sci. 2010 Mar;25(2):221-8. Epub 2009 Jun 17.
Effect of photodynamic therapy on the healing of cutaneous third-degree-burn: histological study in rats. Garcia VG, de Lima MA, Okamoto T, Milanezi LA, Júnior EC, Fernandes LA, de Almeida JM, Theodoro LH.

Study and Research Group in Lasers in Dentistry, Araçatuba School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, 16015-500 Araçatuba, São Paulo, Brazil. vgouveia@foa.unesp.br

The aim of this study was to conduct a histological assessment of the effect of photodynamic therapy (PDT) on the repairing of third-degree-burn wounds made on the backs of rats with a heated scalpel. Ninety-six rats were divided into groups:
G1, control (n = 24), cold scalpel;
G2, burned, heated scalpel (n = 24);
G3, low-level laser therapy (LLLT) (n = 24), on burns; and
G4, photodynamic therapy (PDT) (n = 24), toluidine-O blue (100 microg/ml) and LLLT treatment on burns.

The laser (685 nm) was applied in continuous mode, 50 mW, 4.5 J/cm(2), contact mode at nine points (9 s/point). Eight animals in each group were killed at 3 days, 7 days or 14 days after surgery, and tissue specimens containing the whole wounded area were removed and processed for histological analysis; the results were statistically analyzed with Kruskal-Wallis and Dunn’s tests (P < 0.05). The results demonstrated significant differences between G2 and G3, and between G2 and G4, at both 3 days and 7 days, with regard to acute inflammation scores; G1 and G2 showed significant differences when compared with G4 at 3 days, with regard to neo-angiogenesis scores; G1 and G2 were statistically different from G3 and G4 at both 3 days and 7 days, with regard to re-epithelization scores; G2 showed statistically significant differences when compared with G3 and G4 with regard to collagen fiber scores at 7 days. LLLT and PDT acted as a biostimulating coadjuvant agent, balancing the undesirable effect of the burn on the wound healing process, acting mainly in the early healing stages, hastening inflammation and increasing collagen deposition.


full text Free Mechanism of Benefits of Low Level Lasers-
Activates Mitochondrial respiration-

———- low level laser for sciatic – successful animal model – full text ————-

Arq Neuropsiquiatr. 2011;69(2:356-9. 
low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica.

Bertolini GR, Artifon EL, Silva TS, Cunha DM, Vigo PR. Source Injury and Physiotherapeutic Resource Study Laboratory, Western Paraná State University, Cascavel, PR, Brazil. gladson_ricardo@yahoo.com.br Abstract Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.

———- Tinnitus – full text ———


J Res Med Sci. 2011 Jan;16(1):33-8.
Low-level laser for treatment of tinnitus: a self-controlled clinical trial.
Okhovat A, Berjis N, Okhovat H, Malekpour A, Abtahi H. Source Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

Abstract BACKGROUND: Despite the high prevalence and morbidity, tinnitus still remains an obscure symptom. We assessed the efficacy of low-level laser for treatment of tinnitus.

METHODS: It was a self controlled clinical trial study on 61 outpatients with subjective tinnitus. The patients were irradiated with a 650-nm, 5-mW soft laser for twenty days and twenty minutes per day. The sensation of tinnitus was measured on a Visual Analog Scale (VAS) before and two weeks after treatment and they were compared by means of Wilcoxon signed ranktest. RESULTS: Thirty-eight (62.3%) patients were men and twenty-three (37.7%) were women. Fourteen patients (31.8%) worked in noisy environment. The VAS mean difference before and after the treatment was statistically significant (p < 0.0001). The best treatment effect was in the youngest group and there were significant differences between this group and the middle age and older groups (p = 0.018 and 0.001, respectively). The mean VAS score reduction was not statistically significant between male and female patients (p = 0.23). Also, the treatment outcome according to the noise level in patient’s workplaces was not significantly different in women (p = 0.693), but it was significant in men (p = 0.029).

CONCLUSIONS: Transmeatal low-level laser irradiation is effective for the treatment of tinnitus and some variables like age and job can affect the treatment outcome. The present study for treatment of tinnitus resulted in subjectively mentioned tinnitus reduction in 30 (49.1%) patients, tinnitus disappearance in eleven (18%), and without change in twenty (32.7%) patients two weeks after completion of therapy. The mean reduction of tinnitus intensity was 35.9%. Generally these results are in concordance with therapeutic outcomes of the previous studies that have shown the range of tinnitus relief between 37% and 58%

———— pain relief animal model full ————-

Rev Bras Anestesiol. 2010 May-Jun;60(3):302-10. Influence of naloxone and methysergide on the analgesic effects of low-level laser in an experimental pain model. Peres e Serra A, Ashmawi HA. Source Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP. serra88@uol.com.br Abstract

BACKGROUND AND OBJECTIVES: Although the mechanism of action of laser phototherapy (LPT) is not known, it is a promising analgesic method. The aim of this study was to evaluate whether the action of LPT depends on the activation of peripheral opioid or serotonergic receptors. METHOD: Inflammatory pain was induced through the injection of carrageenin in the left posterior paw of male Wistar rats. The InGaAIP visible laser diode (660 nm) with fluency of 2.5 J*cm(-2) was used. Von Frey filaments were used to analyze mechanical hyperalgesia. Animals were separated into five groups: Carrageenin; Laser (LPT); Non-coherent light; LPT + Naloxone; and LPT + Methysergide.

RESULTS: Low-Level Laser phototherapy proved to be an effective analgesic method, while non-coherent light did not show a similar effect. The use of naloxone blocked the analgesic effect of LPT, while methysergide did not affect LPT-induced analgesia.

CONCLUSIONS: According to the parameter used in this study, LPT produced analgesia. Analgesia induced by laser phototherapy is mediated by peripheral opioid receptors. Laser phototherapy does not seem to interact with peripheral serotonergic receptors


PLoS One. 2011;6(7):e22453. Epub 2011 Jul 21.

Low-level laser therapy activates NF-kB via generation of reactive oxygen species in mouse embryonic fibroblasts.

Chen AC, Arany PR, Huang YY, Tomkinson EM, Sharma SK, Kharkwal GB, Saleem T, Mooney D, Yull FE, Blackwell TS, Hamblin MR. Source Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America. BACKGROUND: Despite over forty years of investigation on low-level light therapy (LLLT), the fundamental mechanisms underlying photobiomodulation at a cellular level remain unclear.

METHODOLOGY/PRINCIPAL FINDINGS: In this study, we isolated murine embryonic fibroblasts (MEF) from transgenic NF-kB luciferase reporter mice and studied their response to 810 nm laser radiation. Significant activation of NF-kB was observed at fluences higher than 0.003 J/cm(2) and was confirmed by Western blot analysis. NF-kB was activated earlier (1 hour) by LLLT compared to conventional lipopolysaccharide treatment. We also observed that LLLT induced intracellular reactive oxygen species (ROS) production similar to mitochondrial inhibitors, such as antimycin A, rotenone and paraquat. Furthermore, we observed similar NF-kB activation with these mitochondrial inhibitors. These results, together with inhibition of laser induced NF-kB activation by antioxidants, suggests that ROS play an important role in the laser induced NF-kB signaling pathways. However, LLLT, unlike mitochondrial inhibitors, induced increased cellular ATP levels, which indicates that LLLT also upregulates mitochondrial respiration.

CONCLUSION: We conclude that LLLT not only enhances mitochondrial respiration, but also activates the redox-sensitive NFkB signaling via generation of ROS. Expression of anti-apoptosis and pro-survival genes responsive to NFkB could explain many clinical effects of LLLT.

FUll text- nice intro and review by Harvard prof Dr Hamblin


Lasers Surg Med. 2010 August; 42(6): 447–449.
Introduction to Experimental and Clinical Studies Using Low-Level Laser (Light) Therapy (LLLT) Michael R. Hamblin, PhD, Associate Professor Michael R. Hamblin, Harvard Medical School; *Correspondence to: Michael R Hamblin, PhD, Assistant Professor, Harvard Medical School

Photoceutical for stem cell growth and regeneration

Combining LLLT with Stem Cell Therapy
From a Stem Cell COmpany:


J Transl Med. 2010; 8: 16.
Lasers, stem cells, and COPD
Feng Lin,#1 Steven F Josephs,#1 Doru T Alexandrescu,#2 Famela Ramos,1 Vladimir Bogin,3 Vincent Gammill,4 Constantin A Dasanu,5 Rosalia De Necochea-Campion,6 Amit N Patel,7 Ewa Carrier,6 and David R Kooscorresponding author1

The medical use of low level laser (LLL) irradiation has been occurring for decades, primarily in the area of tissue healing and inflammatory conditions. Despite little mechanistic knowledge, the concept of a non-invasive, non-thermal intervention that has the potential to modulate regenerative processes is worthy of attention when searching for novel methods of augmenting stem cell-based therapies. Here we discuss the use of LLL irradiation as a “photoceutical” for enhancing production of stem cell growth/chemoattractant factors, stimulation of angiogenesis, and directly augmenting proliferation of stem cells. The combination of LLL together with allogeneic and autologous stem cells, as well as post-mobilization directing of stem cells will be discussed. “A pubmed search for “low level laser therapy” yields more than 1700 results, yet before stumbling across this concept, none of us, or our advisors, have ever heard of this area of medicine.”

————————— Nuclear Factor Kappa Beta ————————– www.researchersworld.com/vol2/issue3/Paper_6.pdf

THE BIOLOGY OF NUCLEAR FACTOR KAPPA BETA (NFk IN HEALTH AND PATHOLOGY by Carlos Kusano Bucalen Ferrari, Biomedical Research Group, Institute of Biological and Health Sciences (ICBS), “Campus Universitário do Araguaia”, “Universidade Federal de Mato Grosso” (UFMT), Barra do Garças, MT, Brazil.

J Mol Med (Berl). 2004 Jul;82(7):434-48. Epub 2004 Jun 3.
Nuclear factor-kappaB: its role in health and disease.
Kumar A, Takada Y, Boriek AM, Aggarwal BB. Source Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA. axkumar@bcm.tmc.edu Abstract

Nuclear factor-kappaB (NF-kappa is a major transcription factor that plays an essential role in several aspects of human health including the development of innate and adaptive immunity.)

The dysregulation of NF-kappaB is associated with many disease states such as AIDS, atherosclerosis, asthma, arthritis, cancer, diabetes, inflammatory bowel disease, muscular dystrophy, stroke, and viral infections.

Recent evidence also suggests that the dysfunction of NF-kappaB is a major mediator of some human genetic disorders. Appropriate regulation and control of NF-kappaB activity, which can be achieved by gene modification or pharmacological strategies, would provide a potential approach for the management of NF-kappaB related human diseases. This review summarizes the current knowledge of the physiological and pathophysiological functions of NF-kappaB and its possible role as a target of therapeutic intervention

———————- Literature reveiw ————————-


Our latest LLLT literature review with abstracts including muscle fatigue, TMJ, myofacial pain, acne and a possible application for morphine withdrawal. selected pubmed references from this pdf file:

Improvement in Cardiac Muscle


Biofizika. 2008 Sep-Oct;53(5):879-85. [Photon radiation-induced structural and functional changes in the myocardium of hypertensive SHR rats]. [Article in Russian] Santalova IM, Zakharova NM, Khramov RN, Kraev IV, Murashev AN, Averin AS, Fakhranurova LI.

Abstract Male rats were irradiated by a Korobkov photon light-emitting diode matrix with a maximum irradiation at 612 nm every day 1 h per day for 13 days. After a course of irradiation, the rhythmoinotropic characteristics of the cardiac muscle significantly improved. Exposure to photon radiation initiated an active rearrangement in myocytes as shown by a morphological analysis. Considerable changes were found in the structure of sarcoplasmic reticulum (SR); the area of SR profiles increased more than twofold compared to control. This suggests a proportional increase in the ability of SR to absorb calcium, due to both an increase in its buffer capacity and possibly, an improved functioning of Ca2+ ATPase of the reticulum. Probably, the photon therapy leads to the normalization of calcium homeostasis in myocytes and improvement of the characteristics of the cardiac muscle contraction-relaxation cycle. Furthermore, changes in the proportions of the myocardium capillaries (increased by 75% compared to control; p < 0.001) and the area of mitochondrial profiles of myocytes (increased by 13%; p < 0.05) were observed, which lead to more active metabolic processes and a rise in energy potential in myocardial cells after photon radiation treatment.

increases ATP in lyphocytes


Photomed Laser Surg. 2008 Oct;26(5):451-3.

Intracellular ATP level increases in lymphocytes irradiated with infrared laser light of wavelength 904 nm. Benedicenti S, Pepe IM, Angiero F, Benedicenti A. Source Department of Medical Science, Dentistry, and Biophysics, University of Genoa, Milan, Italy. stefano.benediceneti@tiscali.it Abstract

OBJECTIVE: Red and near-infrared laser irradiation is reported to have a range of biological effects on cultured cells and different tissues, leading to the hypothesis that laser light can affect energy metabolism. Increased adenosine triphosphate (ATP) synthesis has been reported in cultured cells and rat brain tissue after irradiation at 632.8 nm and 830 nm, respectively. This study investigated whether diode pulsed laser irradiation enhances ATP production in lymphocytes.

MATERIALS AND METHODS: Aliquots (500 microL) of an extract of cultured lymphocytes of the Molt-4 cell line were irradiated with diode laser light (lambda = 904 nm, pulsed mode, 6 kHz frequency) with an average emission power of 10 mW for 60 min. A Spectra Physics M404 power meter was used to measure light intensity. Controls were treated similarly but not irradiated. The amount of ATP was measured by the luciferin-luciferase bioluminescent assay. RESULTS: The amount of ATP in irradiated cell cultures was 10.79 +/- 0.15 microg/L (SD; n = 10), and in non-irradiated cell cultures it was 8.81 +/- 0.13 microg/L (SD; n = 10). The average percentage increase of irradiated versus control cell cultures was about 22.4% +/- 0.56% SD (p < 0.001).

CONCLUSION: This significant increase is probably due to laser irradiation; it cannot be attributed to any thermal effect, as the temperature during irradiation was maintained at 37.0 degrees +/- 0.5 degrees C. Thus the therapeutic effects of the biostimulating power of this type of laser are identified and its indications may be expanded. Increases nitric oxide

Role of Nitric Oxide


Photomed Laser Surg. 2008 Oct;26(5):443-9. Role of nitric oxide in the visible light-induced rapid increase of human skin microcirculation at the local and systemic levels: II. healthy volunteers. Samoilova KA, Zhevago NA, Petrishchev NN, Zimin AA. Source Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia. samoilova3@yandex.ru Abstract

OBJECTIVE: The aim of this study is to evaluate the skin microcirculation increase seen in healthy volunteers after a single exposure to polychromatic visible (pVIS) light, and to prove the role of nitric oxide (NO) in the development of this effect.

BACKGROUND DATA: Improvement of microcirculation is one of the most important effects of laser and pVIS light therapy; however, its mechanism of action remains unknown. A main role in the regulation of vascular tone is known to be played by NO. It is produced by NO-synthase (NOS) located in membranes of many cells, including endothelial and blood cells. NOS, a biopteroflavohemoprotein, absorbs pVIS light, resulting in its activation.

MATERIALS AND METHODS: The central area of the dorsal side of the right hand (24 cm2) of 42 volunteers was irradiated for 5 min with pVIS light from a Q-light (385-750 nm, 95% polarization, 40 mW/cm2, 12 J/cm2). Then for 90 min, the blood flow rate (Qas) was measured eight times, both in the area of the irradiation (local effect) and in the non-irradiated left hand (systemic effect) by using a high-frequency ultrasound Doppler device, recording Qas in human skin to a depth up to 5 mm. In the central area of the right hand of 14 volunteers an NOS inhibitor, N-monomethyl-L-arginine (L-NMMA, 0.1% solution), was iontophoretically administered prior to exposure, whereas in 10 other subjects it was administered to the left hand with subsequent exposure of the right hand.

RESULTS: As soon as 2 min after exposure, Qas in the irradiated area rose on average by 32%, and in 20 min by 45%; it then decreased and in 90 min returned to the initial level. A statistically significant Qas increase in the non-irradiated hand was recorded in 5 min (+9%), and in 20 min it reached a maximum level (+39%), and 90 min later it decreased to the initial values. The presence of L-NMMA in the light-exposed area completely blocked the photoinduced rise of microcirculation, both in the irradiated and in non-irradiated hand; however, its administration to the non-irradiated hand did not prevent these effects. CONCLUSION: The increase in skin microcirculation produced by pVIS light at the local and systemic levels is due to activation of NO synthesis in the irradiated area.


———- Q LAser dr Lytle _—————-

“Use Mode 1 to re-energize muscle, ligament and tendon cells for healing wounds and injuries or for reducing pain and inflammation; Mode 1 also benefits tendonitis, arthritis, burns, sprains, cuts, bruises, muscle pulls, sore throat, and any pain or inflammation.”

“Use Mode 2 to re-energize brain and heart cells and to normalize brain neuropeptides and heart cell energy.”

“Use Mode 3 as a multi-organ cell re-energizer that cycles through 29 different frequencies proven effective and beneficial for healing, and to benefit inflammation or disorders of all internal, and for the treatment of any unknown condition.”

[Note: The proprioceptive points are
(1) just in front of the ear over the TMJ,
(2) under the angle of the jaw, (3) two inches below the collar bone, and
(4) one inch up from the rounded angle of the shoulder blade (scapula).]


A Transcript of Dr. Lytle’s webinar April 2010

Dr. Irina: Why did you choose osteoarthritis as the basis of your first FDA clinical trials? What were the results of the trials? And we get the exciting news\

Healing Light by Dr. Larry Lytle


Electrotherapeutic DevicesPrinciples, Design, and Applications ——————–

MAcular Degeneration – Microcurrent ——————-

Macular Degeneration Treatment with Nutrients and Micro Current Electricity Merrill J. AIlen, O.D., Ph.D.;1 John B. Jarding, O.D.;2 Ralph Zehner, O.D.;3

The Treatment of Retinal Diseases With Micro Current Stimulation And Nutritional Supplementation Edward L Paul Jr  TThe Treatment of Retinal Diseases With Micro Current Stimulation And Nutritional Supplementation Edward L. Paul, Jr., O.D., Ph.D.* *Visiting Professor of Ophthalmology Chairman, Department of Continuing Medical Education St. Luke?s University School of Medicine Abstract From May 2001 to November 2002, 94 eyes diagnosed with typically untreatable retinal diseases including age-related macular degeneration, retinitis pigmentosa and Stargardt?s were treated with an integrated treatment protocol employing micro current electrical stimulation and nutritional supplementation. Overall, 68% showed a marked increase in vision function and visual acuity following therapy. The success rate in age-related macular degeneration was 72% (26 out of 36 eyes), in retinitis pigmentosa 53% (18 out of 34 eyes), and in Stargardt?s 83% (20 out of 24 eyes). The average level of improvement was 2-3 lines as measured using the Snellen eye chart.


Treatment of Retinal Diseases With Micro Current Stimulation Edward I. Paul, O.D., Ph.D. Visiting Professor of Ophthalmology Chairman, Department of Continuing Medical Education St. Luke’s University School of Medicine

Conf Proc IEEE Eng Med Biol Soc. 2009;2009:2133-6.
Electrotherapeutic device/protocol design considerations for visual disease applications.
O’Clock GD, Jarding JB. Source Department of Pediatrics, Pulmonary Disease & Critical Care, Minneapolis, MN 55455 USA. george.oclock@mnsu.edu

Abstract One of the more interesting applications of electrotherapy involves its use in the treatment of visual disease; including retinitis pigmentosa, diabetic retinopathy and macular degeneration. The therapeutic efficacy of electrotherapy is highly dependent upon the incorporation of appropriate design choices for both the electrotherapeutic device and treatment protocol. Electrotherapeutic design drivers include electrode probe-tissue interface, device reliability, operational constraints, treatment protocol procedures, and safety. In FDA guided and FDA supervised clinical studies (FDA pre-IDE numbers 1980275 and 1000038 and FDA IDE number G020106) involving electrotherapeutic intervention for dry macular degeneration, 61% of a 400 patient cohort treated with electrotherapy achieved visual acuity improvements of two lines or more on the Snellen chart. Average electric current intensities in the range of 60 to 125 muA were utilized to achieve this level of therapeutic efficacy. With further improvements in the design of electrotherapeutic device waveforms, frequency selection, treatment protocols and electrode probe configurations; long-term visual acuity improvements of two lines or better on the Snellen chart can be anticipated for more than 60% of the patients who are in the early stages of retinitis pigmentosa, diabetic retinopathy and dry macular degeneration.

Dr. Kondrot’s two best selling books,
Healing the Eye the Natural Way and
Microcurrent Stimulation: Miracle Eye Cure,

Changes in Microcurrent Stimulation for the treatment of eye disease.

www.healingtheeye.com/PDF/mcs.pdf Published in the Townsend Letter- Pages 65- 67, October 2002 Initial results of Microcurrent Stimulation in the treatment of Age related MacularDegenerationEdward C. Kondrot, MD(H), CCH

Dr. Damon P. Miller M.D. Restoring Vision for Macular Degeneration, RP, and Stargardt. There is HOPE for your sight!

Macular Regeneration: Hope for Sight Home Treatment Programs and Seminars Offered by Damon P. Miller, M.D.

Dr. Miller has treated hundreds of people with serious eye diseases. Using the newest tested therapies – therapies designed to support the health of your eyes and your vision. Research has shown that the tissues in the eye are capable of healing and regeneration, but the conditions must be near perfect if regeneration is to occur. We provide you with the therapies that do everything that is medically possible to allow healing and regeneration to occur.

full pdf

Journal of Photochemistry and Photobiology B: Biology 95 (2009) 89–92

Evaluation of mitochondrial respiratory chain activity in muscle healing by low-level laser therapy

Paulo C.L. Silveira a,*, Luciano Acordi da Silva a, Daiane B. Fraga b, Tiago P. Freitas b, Emilio L. Streck b, Ricardo Pinho a Background: Recent studies demonstrate that low-level laser therapy (LLLT) modulates many biochemical processes, especially the decrease of muscle injures, the increase in mitochondrial respiration and ATP synthesis for accelerating the healing process. Objective: In this work, we evaluated mitochondrial respiratory chain complexes I, II, III and IV and succinate dehydrogenase activities after traumatic muscular injury. Methods: Male Wistar rats were randomly divided into three groups (n = 6): sham (uninjured muscle), muscle injury without treatment, muscle injury with LLLT (AsGa) 5 J/cm2. Gastrocnemius injury was induced by a single blunt-impact trauma. LLLT was used 2, 12, 24, 48, 72, 96, and 120 hours after muscle- trauma.

Results: Our results showed that the activities of complex II and succinate dehydrogenase after 5 days of muscular lesion were significantly increased when compared to the control group. Moreover, our results showed that LLLT significantly increased the activities of complexes I, II, III, IV and succinate dehydrogenase, when compared to the group of injured muscle without treatment.

Conclusion: These results suggest that the treatment with low-level laser may induce an increase in ATP synthesis, and that this may accelerate the muscle healing process.


Formerly Nonlinearity in Biology, Toxicology, and Medicine Copyright © 2009 University of Massachusetts

BIPHASIC DOSE RESPONSE IN LOW LEVEL LIGHT THERAPY Ying-Ying Huang Michael R. Hamblin, BAR 414, Wellman Center for Photomedicine, Massachusetts General Hospital, 40 Blossom Street, Boston,

Michael R. Hamblin Department of Dermatology, Harvard Medical School, BAR 414 Wellman Center for Photomedicine, Massachusetts General Hospital 40 Blossom Street, Boston MA 02114

Biomedical Optics & Medical Imaging Low-level laser therapy: an emerging clinical paradigm
Ying-Ying Huang, Michael Hamblin, and Aaron C.-H. Chen 9 July 2009, SPIE Newsroom. DOI: 10.1117/2.1200906.1669
Improved understanding of the fundamental cellular and molecular mechanisms is broadening the technique’s mainstream use for many ailments. 9 July 2009, SPIE Newsroom. DOI: 10.1117/2.1200906.1669


 Photomedicine and Laser Surgery Volume 27, Number 3, 2009 ª Mary Ann Liebert, Inc. Pp. 379–380 Guest Editorial*
The Potential of Light Therapy for Central Nervous System Injury and Disease

Juanita J. Anders, Ph.D. Department of Anatomy, Physiology and Genetics Uniformed Services University of the Health Sciences 4301 Jones Bridge Rd. Bethesda, MD 20814 Juanita J. Anders

Reduced axonal transport in Parkinson’s disease cybrid neurites is restored by light therapy Patricia A Trimmer1*, Kathleen M Schwartz1, M Kathleen Borland1, Luis De Taboada2, Jackson Streeter2 and Uri Oron3

The NeuroThera® Laser System is under development for the treatment of ischemic stroke and is not approved for sale or distribution in the United States or internationally. The NeuroThera® Laser System is an investigational device that seeks to improve neurological outcomes via noninvasive delivery of near-infrared (NIR) laser energy called Transcranial Laser Therapy (TLT) into the brain. The system consists of a moveable console, a fiber optic cable, and a handpiece. A trained clinician uses the handpiece to direct the TLT to twenty predetermined treatment sites on the patient’s scalp. The total procedure time is approximately 2-3 hours. The Company believes that the NeuroThera® Laser System may offer a compelling option for the
treatment of acute ischemic stroke up to twenty-four hours following onset of stroke symptoms.

Mechanism of Photostimulation



J Invest Dermatol. 2007 Aug;127(8):2048-57.
Helium-neon laser irradiation stimulates cell proliferation through photostimulatory effects in mitochondria. Hu WP, Wang JJ, Yu CL, Lan CC, Chen GS, Yu HS. Source Faculty of Biotechnology and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract Previous reports have shown that cellular functions could be influenced by visual light (400-700 nm). Recent evidence indicates that cellular proliferation could be triggered by the interaction of a helium-neon laser (He-Ne laser, 632.8 nm) with the mitochondrial photoacceptor-cytochrome c oxidase.

Our previous studies demonstrated that He-Ne irradiation induced an increase in cell proliferation, but not migration, in the melanoma cell line A2058 cell. The aim of this study was to investigate the underlying mechanisms involved in photostimulatory effects induced by an He-Ne laser. Using the A2058 cell as a model for cell proliferation, the photobiologic effects induced by an He-Ne laser were studied. He-Ne irradiation immediately induced an increase in mitochondrial membrane potential (delta psi(mt)), ATP, and cAMP via enhanced cytochrome c oxidase activity and promoted phosphorylation of Jun N-terminal kinase (JNK)/activator protein-1 (AP-1) expressions. He-Ne irradiation-induced A2058 cell proliferation was significantly abrogated by the addition of delta psi(mt) and JNK inhibitors. Moreover, treatment with an He-Ne laser resulted in delayed effects on IL-8 and transforming growth factor-beta1 release from A2058 cells. These results suggest that He-Ne irradiation elicits photostimulatory effects in mitochondria processes, which involve JNK/AP-1 activation and enhanced growth factor release, and ultimately lead to A2058 cell proliferation.

FDA Warning Letter to Dr Larry Lytle

March 3, 2011 WARNING LETTER
CERTIFIED MAIL RETURN RECEIPT REQUESTED Refer to MIN 11-14 Robert L. Lytle, DDS, PhD President, 2035, Inc. Managing Limited Partner, QLaser Healing Light LP 520 Kansas City Street, Suite 100 Rapid City, South Dakota 57701

Dear Dr. Lytle: During an inspection of your firm located in Rapid City, South Dakota, on May 25 – 27, 2010, an investigator from the United States Food and Drug Administration (FDA) learned that your firms 2035, Inc. and QLaser Healing Light LP are marketing the Q10 Laser and 808 Enhancer Probe in the United States without marketing clearance or approval, in violation of the Federal Food, Drug, and Cosmetic Act (the Act). Q1000 Laser and 660 Enhancer Probe A review of our records indicates that we cleared a premarket notification (510(k)) for the Q1000 Laser and 660 Enhancer Probe (QLaser System), K080513, with an intended use “for providing temporary relief of pain associated with osteoarthritis of the hand, which has been diagnosed by a physician or other licensed medical professional.”

Re: K080513 Trade/Device Name: QLaser System Regulation Number: 21 CFR 890.5500 Regulation Name: Infrared lamp Regulatory Class: II Product Code: NHN Dated: January 9, 2009 Received: January 12, 2009


– ————————–


RianCorp has completed the only randomised double blind clinical trial testing the effects of LLLT on lymphoedema/lymphedema in the world.7 Fleet St, Richmond, South Australia 5033 The LTU-904 models are infra-red lasers operating at a wavelength of 904 nanometers. This invisible wavelength penetrates deeply into tissue (much deeper than the often used red laser operating in the visible red region).

LLLT position paper massage therapists – clincial indications

Examples of Conditions that Benefit from LLLT
LLLT Position Paper p. 14 J. Dais, July 2009

Among the many benefits associated with LLLT are a reduction in pain and an increase in range of motion (osteoarthritis, TMJ, myofascial pain syndrome of the neck), an increased rate of healing for a number of tendinopathies including Achilles tendinosis/itis and lateral epicondylitis, reduce lymphedema post mastectomy, decreased symptoms of carpal tunnel syndrome (paresthesia and numbness) with increased grip strength and finally reduced creatine kinase levels with pre-treatment before vigorous exercise.

Carpal Tunnel Syndrome
In a review of 7 laser therapy clinical trials using photoradiation to treat carpal tunnel syndrome (CTS) Naeser (2006) reported that the 5 studies that demonstrated low level laser therapy was effective at reducing pain used a higher power than the 2 that did not show a benefit over the control group. A more recent, better designed study involving 80 subjects and a sham laser control group concluded that LLLT reduced the carpal tunnel syndrome symptoms of paresthesia and numbness as well as improved hand grip and electrophysiological parameters (Shooshtari, 2008). Evick (2007) found that LLLT over the carpal tunnel area improved hand and pinch grip strength and Chang (2008) concluded that the same thing plus that LLLT alleviated carpal tunnel syndrome pain and symptoms.

Fibromyalgia A single-blind, RCT with 40 female subjects was conducted to see if LLLT could reduce the symptoms of fibromalgia (Gur et al. 2005). Those in the control group received placebo laser while the treatment group received a Ga-As laser treatment daily for two weeks (excluding weekends). The author’s concluded that laser therapy was a safe and effective way to relieving pain, muscle spasm, morning stiffness, and total tender point number associated with fibromyalgia.

Frozen Shoulder A preliminary RCT with 63 subjects examined the effects of LLLT on frozen shoulder. The control group received placebo laser and the active laser group was treated with a 810-nm Ga-Al-As laser with a continuous output. The author determined that there was a significant decrease in pain and disability in the treatment group versus the placebo control group (Stergioulas 2008).

Lymphedema – Postmastectomy Kozanoglu et al. (2009) reported positive effects with low level laser therapy for the reduction of limb size and pain with of patients with postmastectomy lymphedema. Also the benefits of LLLT lasted longer than pneumatic compression, the usual treatment and the control in this study. Myofascial Pain Syndrome Low level laser therapy has also been used to treat myofascial pain syndrome of the neck (Gur et al. 2004). In this double-blind RCT with 60 subjects, treatment with a Ga-Ar laser (904 nm) resulted in reduced pain, improved function and improved quality of life as compared with the placebo laser control group.

In response to Brosseau et al.’s (2007) Cochrane Review (discussed earlier) that criticized the methodology of past low level laser therapy studies on the effects of osteoarthritis, Hegedűs et al. (2009) performed a double-blind, RCT which was just published this June. They concluded that LLLT for osteoarthritis of the knee reduces pain and increases microcirculation in the treated area. Also a systematic review of the literature by Jamtvedt (2008) examined various physiotherapy interventions for osteoarthritis of the knee and noted that there was high quality evidence that exercise and losing weight can reduce pain, but that there was also moderate-quality evidence that low-level laser therapy can do so as well (along with TENS and acupuncture).

Pain In a review of 22 RCT involving the biological and clinical effects of photoradiation (LLLT) in acute pain to due soft tissue injury Bjordal et al. (2006) reported that in 19 of 22 studies that photoradiation reduced inflammatory pain in the subjects. They looked at a variety of biochemical markers, neutrophil numbers, formation of edema and hemorrhage. They commented that adequate dosage was important to see an effect. In a small study by Junior et al. (2009) eight subjects received pretreatment of the rectus femoris muscle by an LED multi-diode or cluster laser before undergoing high-intensity exercise. They found that the subjects had significantly lower levels of post-exercise creatine kinase (CK) compared to the placebo cluster group and the active single-diode laser group. However, other outcome measures were not affected (Wingate tests and post-exercise blood lactate). In a systematic review of non-invasive therapies for neck pain, Hurwitz et al. (2008) stated that for neck pain other than whiplash, the evidence suggests that low-level laser therapy was more effective than no treatment or sham treatment. In a study of general knee pain, Montes-Molina et al. (2009) reported that interferential laser therapy (using two identical laser probes located opposite each other on the knee joint) was no better than the conventional method of just one laser probe over the affected area.

Rheumatoid Arthritis Brosseau
et al.’s (2005) Cochrane Review of the effects of LLLT for rheumatoid arthritis, reported that it reduced pain and morning stiffness with a minimum four-week treatment program, but other clinical findings were inconsistent. Yamaura et al. (2009) investigated the mechanism behind how LLLT reduced joint pain in rheumatoid arthritis. They concluded that it may involve “reducing the level of pro-inflammatory cytokines/chemokines produced by synoviocytes. This mechanism may be more general and underlie the beneficial effects of LLLT on other inflammatory conditions”.

Temporal Mandibular Joint Syndrome (TMJ) Thirty-five subjects were assigned to either the treatment group receiving LLLT along with a daily exercise program or the placebo group which just followed the exercise program. Significant improvement in TMJ symptoms were obtained in the treatment group that received LLLT both in “subjective parameters such as pain and number of tender points, as well as in objective functional parameters such as mouth opening

Tendinosis – Achilles Tendon In an RCT of 52 recreational athletes with chronic Achilles tendinopathy, low-level laser therapy combined with an eccentric exercise regimen was shown to accelerate clinical recovery (reduce pain intensity during exercise post-treatment) compared to eccentric exercise (EE) alone. The results at 4 weeks were similar to the EE group lacking LLLT at 12 weeks (Stergiolas 2008).

Tendinosis – Lateral Epicondylitis The authors of more recent publications have taken the advice of systematic reviewers into consideration and have used more rigorous methodology in their studies. A case in point is the recent evidence regarding the treatment of lateral epicondylitis (tennis elbow or lateral elbow tendinopathy) with LLLT. Past studies were weak leading to systematic reviews drawing the conclusion that laser therapy wasn’t effective. However, recent findings by authors such as Shooshtari (2008) who’s study involved 80 subjects and a sham laser control group concluded that LLLT reduced the carpal tunnel syndrome symptoms of paresthesia and numbness as well as improved hand grip and electrophysiological parameters. This had lead to the most recent systematic review by Bjordal et al (2008) concluding that LLLT “administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in lateral elbow tendinopathy, both alone and in conjunction with an exercise regimen”. The authors also state that “this finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses”. In a RCT comparing LLLT to bracing and ultrasound in the treatment of lateral epicondylitis, 68 subjects were divided into the 3 groups (with subjects in each group also performing exercises throughout the study). The authors concluded that laser therapy was more effective at reducing pain than the brace, had a longer lasting effect than the brace and was more effective at improving grip strength than the brace or ultrasound treatment.

Animal Study – Myofascial Trigger Points In an animal study by Chen et al (2008) eight rabbits with one myofascial trigger point in each biceps femoris muscle were treated on one side with a gallium-aluminum-arsenate (GaAlAs) laser (six treatments with a wavelength of 660-nm, continuous-wave, at 9 J/cm2). The contralateral side received a sham laser “treatment”. The end-plate noise recorded by the electromyograph was significantly reduced on the laser treated side post-treatment. The author’s concluded that “laser irradiation may inhibit the irritability of an myofascial trigger point in rabbit skeletal muscle. This effect may be a possible mechanism for myofascial pain relief with laser therapy.” CONCLUSIONS

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BioFlex Laser Therapy System’s patented technology offers clinicians the highest clinical success rates with predictable, reliable and reproducible results. BioFlex is the most advanced laser therapy system available and is designed as a non-invasive, non-toxic therapy for a wide variety of medical conditions, including soft tissue injuries, arthritis, wound healing, repetitive motion and sports injuries. 1-888-557-4004 For additional information or to purchase, email sales@bioflexlaser.com or call 1-888-557-4004. very complete web site with references to medical literature Meditech International Inc. is a world leader in the field of Laser Medicine


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good summary of information on LLT by inventor


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Cytochrome C Oxidase is the Light Absorber

Absorption measurements of a cell monolayer relevant to phototherapy: Reduction of cytochrome c oxidase under near IR radiation Tiina I. Karu a,*, Lydmila V. Pyatibrat a, Sergei F. Kolyakov b, Natalya I. Afanasyeva c

Journal of Photochemistry and Photobiology B: Biology 81 (2005) 98–106 a Institute of Laser and Information Technologies of Russian Academy of Sciences, Troitsk, Pionerskaya Street 2, Moscow Region 142190, Russian Federation b Institute of Spectroscopy of Russian Academy of Sciences, Troitsk, Moscow Region 142190,

Phototherapy uses monochromatic light in the optical region of 600–1000 nm to treat in a non-destructive and non-thermal fashion various soft-tissue and neurological conditions. This kind of treatment is based on the ability of light red-to-near IR to alter cellular metabolism as a result of its being absorbed by cytochrome c oxidase. To further investigate the involvement of cytochrome c oxidase as a photoacceptor in the alteration of the cellular metabolism,


Anti-bacterial action of LAser Light




630 nm Laser Irradiation Kills Bacteria– in vitro study


J Clin Laser Med Surg. 2002 Dec;20(6):325-33.
Effects of 630-, 660-, 810-, and 905-nm laser irradiation delivering radiant exposure of 1-50 J/cm2 on three species of bacteria in vitro. Nussbaum EL, Lilge L, Mazzulli T. Rehabilitation Services, Mount Sinai Hospital and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada. 


OBJECTIVE: To examine the effects of low-intensity laser therapy (LILT) on bacterial growth in vitro.


BACKGROUND DATA: LILT is undergoing investigation as a treatment for accelerating healing of open wounds. The potential of coincident effects on wound bacteria has received little attention. Increased bacterial proliferation could further delay recovery; conversely inhibition could be beneficial.


MATERIALS AND METHODS: Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus were plated on agar and then irradiated with wavelengths of 630, 660, 810, and 905 nm (0.015 W/cm(2)) and radiant exposures of 1-50 J/cm(2). In addition, E. coli was irradiated with 810 nm at an irradiance of 0.03 W/cm(2) (1-50 J/cm(2)). Cells were counted after 20 h of incubation post LILT. Repeated measures ANOVA and Tukey adjusted post hoc tests were used for analysis.


RESULTS: There were interactions between wavelength and species (p = 0.0001) and between wavelength and radiant exposure (p = 0.007) in the overall effects on bacterial growth; therefore, individual wavelengths were analyzed. Over all types of bacteria, there were overall growth effects using 810- and 630-nm lasers, with species differences at 630 nm. Effects occurred at low radiant exposures (1-20 J/cm(2)). Overall effects were marginal using 660 nm and negative at 905 nm.


Inhibition of P. aeruginosa followed irradiation using 810 nm at 5 J/cm(2) (-23%; p = 0.02). Irradiation using 630 nm at 1 J/cm(2) inhibited P. aeruginosa and E. coli (-27%). Irradiation using 810 nm (0.015 W/cm(2)) increased E. coli growth, but with increased irradiance (0.03 W/cm(2)) the growth was significant (p = 0.04), reaching 30% at 20 J/cm(2) (p = 0.01). S. aureus growth increased 27% following 905-nm irradiation at 50 J/cm(2).


CONCLUSION: LILT applied to wounds, delivering commonly used wavelengths and radiant exposures in the range of 1-20 J/cm(2), could produce changes in bacterial growth of considerable importance for wound healing. A wavelength of 630 nm appeared to be most commonly associated with bacterial inhibition. The findings of this study might be useful as a basis for selecting LILT for infected wounds.


Photomed Laser Surg. 2006 Dec;24(6):680-3. 


Effects of combined 405-nm and 880-nm light on Staphylococcus aureus and Pseudomonas aeruginosa in vitro. Guffey JS, Wilborn J. 


OBJECTIVE: The aim of this study was to determine the effect of a combination of 405-nm blue light and 880-nm infrared light on Staphylococcus aureus and Pseudomonas aeruginosa in vitro.


CONCLUSION: Appropriate doses of combined 405-nm and 880-nm phototherapy can kill Staphylococcus aureus and Pseudomonas aeruginosa in vitro, suggesting that a similar effect may be produced in clinical cases of bacterial infection.

Laser effective treatment for MRSA Chronic osteomyelitis Rat Model

Photomed Laser Surg. 2011 Jun;29(6):405-12. Epub 2011 Jan 10.
The use of 808-nm light therapy to treat experimental chronic osteomyelitis induced in rats by methicillin-resistant Staphylococcus aureus.
Kaya GŞ, Kaya M, Gürsan N, Kireççi E, Güngörmüş M, Balta H.
SourceDepartment of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatürk University, Erzurum, Turkey. 


BACKGROUND DATA: In vivo and in vitro studies have reported that laser energy in differing wavelengths and irradiation regimes has a potential bactericidal effect on Staphylococcus aureus.

OBJECTIVE: The purpose of this study was to investigate whether a light wavelength of 808  nm in varying doses has an effect on chronic osteomyelitis induced experimentally in the rat tibia.

METHODS: Intramedullary cavities were surgically created in the left tibias of 39 adult Wistar albino rats. Five randomly selected subjects were injected with a sterile saline solution, and methicillin-resistant S. aureus (MRSA) was used to induce osteomyelitis in the remaining rats. After 3 weeks, rats with evidence of osteomyelitis were treated with debridement alone (n = 7), with debridement plus laser irradiation to induce photoeradication (n = 21), or were not treated at all [negative control, (n = 6)]. Active irradiation was performed using an 808  nm, 100  mW continuous-wave diode laser with a beam spot size of 0.7854 cm(2) (irradiance = 127.3  mW/cm(2)). Laser treatment commenced immediately after debridement surgery and was applied daily for 5 consecutive days. Irradiation lasted 60  secs (6  J at 7.64  J/cm(2): n = 7), 120  secs (12  J at 15.29  J/cm(2): n = 7), or 180  secs (18  J at 22.93  J/cm(2): n = 7). Rats in the sham and negative control groups were killed 21 days post-induction surgery, and those in the treatment groups were killed after 42 days. Following killing, tibias were removed and analyzed histopathologically, radiographically, and microbiologically.


RESULTS: Histopathological analysis showed that infection levels had decreased by 37%, 67%, 81%, and 93% in the groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93  J/cm(2) light therapy, respectively, compared to the negative control group.

osteomyelitis-induced rats had the highest bacteria count (5 × 10(5)). Bacterial counts fell to 1.6 × 10(4), 4.3 × 10(2), 5.5 × 10(1), and 3.3 × 10(0) in groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93  J/cm(2) light therapy, respectively, compared to the negative control group.


CONCLUSIONS: Within the limitations of this study, laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of osteomyelitis. The 808  nm 100  mW (127.3  mW/cm(2)) laser device used in this study achieved a maximum effect with an irradiation time of 180  secs, delivering 18  J at an energy density of 22.93 J/cm(2).

Photochem Photobiol Sci. 2006 Jan;5(1):31-8. Epub 2005 Nov 8.
Pre-clinical in vitro and in vivo studies to examine the potential use of photodynamic therapy in the treatment of osteomyelitis.Bisland SK, Chien C, Wilson BC, Burch S.

Osteomyelitis can lead to severe morbidity and even death resulting from an acute or chronic inflammation of the bone and contiguous structures due to fungal or bacterial infection. Incidence approximates 1 in 1000 neonates and 1 in 5000 children in the United States annually and increases up to 0.36% and 16% in adults with diabetes or sickle cell anaemia, respectively. Current regimens of treatment include antibiotics and/or surgery. However, the increasing number of antibiotic resistant pathogens suggests that alternate strategies are required. We are investigating photodynamic therapy (PDT) as one such alternate treatment for osteomyelitis using a bioluminescent strain of biofilm-producing staphylococcus aureus (S. aureus) grown onto kirschner wires (K-wire). S. aureus-coated K-wires were exposed to methylene blue (M or 5-aminolevulinic acid (ALA)-mediated PDT either in vitro or following implant into the tibial medullary cavity of Sprague-Dawley rats. The progression of S. aureus biofilm was monitored non-invasively using bioluminescence and expressed as a percentage of the signal for each sample immediately prior to treatment. S. aureus infections were subject to PDT 10 days post inoculation. Treatment comprised administration of ALA (300 mg kg(-1)) intraperitoneally followed 4 h later by light (635 +/- 10 nm; 75 J cm(-2)) delivered transcutaneously via an optical fiber placed onto the tibia and resulted in significant delay in bacterial growth. In vitro, MB and ALA displayed similar cell kill with > or =4 log(10) cell kill. In vivo, ALA-mediated PDT inhibited biofilm implants in bone. These results confirm that MB or ALA-mediated PDT have potential to treat S. aureus cultures grown in vitro or in vivo using an animal model of osteomyelitis.

Gene Expression After LAser Treatment of Fibroblasts
cDNA MicroarrayAnalysis of Gene Expression Pro¢les in Human
Fibroblast Cells Irradiated with Red Light.  Yaou Zhang, Shipeng Song,n Chi-Chun Fong, Chi-Hung Tsang, ZhongYang,1 and MengsuYang Applied Research Center for Genomic Technology, City University of Hong Kong, Kowloon, Hong Kong, China, and nHealthtech Co. Ltd, Floor 8, 1Ningbo Road, Shanghai, China<

In this paper, the cDNA microarray technique was used to investigate the gene expression pro¢les of human fibroblasts irradiated by low-intensity red light. Proliferation assays showed that the fibroblast HS27 cells responded with a curve e¡ect to di¡erent doses of lowintensity red light irradiation at a wavelength of 628
nm. An optimal dose of 0.88 J per cm2 was chosen for subsequent cDNA microarray experiments. The gene expression pro¢les revealed that 111 genes were regulated
by the red light irradiation and can be grouped into 10 functional categories
. Most of these genes directly or indirectly play roles in the enhancement of cell proliferation and the suppression of apoptosis. Two signaling pathways, the p38 mitogen-activated protein kinase signaling pathway and the platelet-derived growth factor signaling pathway, were found to be involved in cell growth induced by irradiation of low-intensity red light. Several genes related to antioxidation and mitochondria energy metabolism were also found to express differentially upon irradiation. This study provides insight into the molecular mechanisms associated with the beneficial e¡ects of red light irradiation in accelerating wound healing.

Infarct Size Smaller in Animal Model Heart Attack

Increased VEGF and Nitric Oxide, Increased Angiogenesis

Lasers Surg Med. 2006 Aug;38(7):682-8.

Modulations of VEGF and iNOS in the rat heart by low level laser therapy are associated with cardioprotection and enhanced angiogenesis. Tuby H, Maltz L, Oron U. Department of Zoology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, 69978, Israel.

It has been shown previously that low-level laser therapy (LLLT) significantly reduces infarct size following induction of myocardial infarction in rats and dogs. The aim of the present study was to investigate the effect of LLLT on the expression of vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS).

STUDY DESIGN AND MATERIAL AND METHODS: Myocardial infarction was induced by occlusion of the left descending artery in 87 rats. LLLT was applied to intact and post-infarction. VEGF, iNOS, and angiogenesis were determined.

RESULTS:Both the laser-irradiated rat hearts post-infarction and intact hearts demonstrated a significant increase in VEGF and iNOS expression compared to non-laser-irradiated hearts. LLLT also caused a significant elevation in angiogenesis.

CONCLUSIONS:It is concluded that VEGF and iNOS expression in the infarcted rat heart is markedly upregulated by LLLT and is associated with enhanced angiogenesis and cardioprotection.

Heart- Reduces Infarct Size

Impact of low level laser irradiation on infarct size in the rat following
myocardial infarction. N. Ad, U. Oron Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel Department of Zoology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel

Allergic Purpura


Low Level Laser Therapy in Children’s Allergic Purpura
C. Ailioaie, Laura Ailioaie, Iassy, Romania.

Patients with allergic purpura have characteristic purpuric skin rash and some of the following clinical manifestations may be present: migratory polyarthralgias or polyarthritis, colicky abdominal pain, nephritis. Because until now there is no satisfactory treatment, we applied low level laser therapy (LLLT) in order to compare it with the classical therapy. Thirty-one children (2-16 years of age) have been included in the study and treated at debut of the disease. They were randomly divided: group A – (15 children) received LLLT; group B (16 children) was administrated classical therapy. Two GaAlAs diode lasers in red and infrared region (670 nm and 830 nm) were used. The density of energy (4 – 10 J/cm2), irradiating frequency (2.4 Hz) – was applied one session daily, using scanning technique under a special treatment protocol on cutaneous purpuric areas (21 sessions). Very good results were obtained in laser group. In the control group, after an apparent improvement, subsequent exacerbations and remissions were present, and three children developed chronic renal disease. The results prove that LLLT is acting as a triggering factor, which induces systemic effects through the circulation, followed by a response of the children’s entire immune system. That is why LLLT is a very promising modality of treatment for the allergic diseases in children.

We conclude that early use of LLLT can cure allergic purpura in children and it is a better modality of treatment comparatively with the classical therapy.

Jeffrey Dach MD
7450 Griffin Road, SUite 190
Davie, Fl 33314


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About Jeffrey Dach MD

Medical Director of TrueMedMD, a Clinic in Davie Florida specializing in Bioidentical Hormones and Natural thyroid. Office address 7450 Griffin Road Suite 190, Davie, Florida 33314 telephone 954-792-4663

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