Low Level Laser Therapy

Laser devices are used widely in Medicine for different purposes.

Some lasers are used for cutting tissues or to stop bleeding vessels in surgical procedures. Other lasers are used in diagnostic procedures and treatments such as visual correction, the removal of skin lesions, or the treatment of some cancers.
Low Level Laser Therapy Machines
At Quantum Clinic, we use a type of laser therapy known as ‘low level laser therapy’ (LLLT) or ‘photobiomodulation.’

Unlike surgical lasers, LLLT is non-invasive and non-destructive; it does not cut or heat tissues; hence it is also known as ‘cold laser therapy.’

LLLT has been very well studied (see Scientific Basis below). It is mainly known for its beneficial effects on localised problems such as joint disease, skin conditions or sports injuries, however treatment with LLLT also results in body-wide (systemic) effects, with potential benefits in many medical conditions that are driven by an underlying chronic inflammatory process.

LLLT is also incorporated in Quantum Clinic’s Cancer Programme.

What Happens During A Laser Treatment?

Treatment With Low Level Laser Therapy

You will be lying comfortably on a couch (the treatment position can be adjusted according to your comfort and/or disability if necessary) and will be provided with protective glasses which need to be worn throughout the treatment.

Dr Tavakkoli will already have developed your treatment plan according to your personal condition and treatment goals.

A probe emitting either laser light or visible red light will be placed on the appropriate areas of your body, depending on your treatment plan, and will be moved to different sites during treatment. You should not feel anything during treatment, and the session will last around 10 minutes.

How Does It work?

Physiological Effects and Benefits of Low Level Laser Therapy

LLLT facilitates the healing process at molecular, cellular and tissue levels. The following are some of the known benefits of LLLT (from Laser-Accelerated Inflammation/Pain Reduction and Healing. Richard Martin. Practical Pain Management, Nov/Dec 2003):

Anti-inflammatory Effects

  • Increased ATP production through mitochondrial stimulation, resulting in cellular repair and improved cellular functional ability;
  • Increased nitric oxide and serotonin release resulting in vasodilation and improved tissue perfusion. Vasodilation improves nutrient and oxygen delivery to damaged cells and facilitates removal of cellular toxins;
  • Enhanced white blood cell activity, resulting in faster regeneration and repair;
  • Increased synthesis of prostaglandins (eg prostacyclin) with anti-inflammatory action;
  • Reduction in pro-inflammatory cytokines (eg IL-1) that are known to contribute to inflammatory conditions;
  • Increased number of lymphocytes, increased action of T-cells in the inflammatory response, resulting in overall enhanced lymphocyte activity;
  • Increased angiogenesis (blood vessel formation). The regeneration of capillary systems results in improved microcirculation and cellular perfusion, enhancing cellular repair and regeneration, and nutrient delivery;
  • Increased superoxide dismutase (SOD) levels. This cytokine enhances the anti-inflammatory process;
  • Decreased C-reactive protein serum level (CRP). CRP is an inflammatory marker. Laser therapy has been shown to reduce CRP level, confirming the anti-inflammatory effects of laser therapy.

The following is a summary flowchart of the cellular cascade in reducing tissue inflammation

Low Level Laser Therapy - Inflammation

Pain Reduction

  • Increase in endorphin release both locally and systemically, resulting in reduced pain levels;
  • Blocking of pain nerve fibres;
  • Increased production of nitric oxide which affects pain sensation directly and indirectly;
  • Improved nerve cell function through increased nerve cell action potential, increased release of acetylcholine and enhanced nerve cell regeneration;
  • Decreased bradykinin levels, an inflammatory mediator that can contribute to increased pain level;
  • Normalisation of calcium, sodium and potassium ion concentrations.

The following flowchart represents the effects of LLLT on pain improvement at the cellular level

Low Level Laser Therapy - Pain Reduction

Tissue Healing

  • Enhanced white blood cell activity (neutrophils, monocytes, macrophages, lymphocytes) which play an essential role during both the acute and chronic inflammatory process;
  • Improved angiogenesis, enhancing microcirculation and tissue oxygenation, promoting cellular regeneration and repair;
  • Increased proliferation of fibroblasts, keratinocytes and epithelial cells, all involved in cellular and tissue regeneration;
  • Increase in growth factor, promoting cellular regeneration;
  • Enhanced proliferation of cells through increased nitric oxide, ATP and other compounds.

The following flowchart illustrates the effects of LLLT in promoting accelerated cellular healing

Low Level Laser Therapy - Tissue Healing

Side Effects/Precautions 

There are a few precautions when using LLLT:

If you are taking medications (such as some antibiotics) that cause sensitivity to light, treatment with LLLT can result in skin discolouration or soreness. This is why it is important to let us know about all your medications and any changes to your medications.
Although damage to the eyes is extremely unlikely, for your safety you will be provided with special protective glasses to wear throughout your laser treatment.
Patients with epilepsy may be sensitive to pulsating red light (LED). Protective glasses will be supplied and it is important to keep the eyes closed during treatment. Some patients with epilepsy are sensitive not only to visual pulsating light, but also to the frequency of light used, even invisible laser light. Caution must be exercised when treating patients with epilepsy.
Whilst laser treatment in pregnancy is not known to produce any adverse outcome, it is generally not recommended.
Pacemakers are not a contraindication to receiving laser treatment.

As with many forms of treatment, there may be a temporary increase in symptoms initially. This should last less than 48 hours.

Scientific Basis

There are thousands of scientific publications on the benefits of LLLT, and hundreds of double-blind, placebo-controlled clinical studies.

Due to the documented effects of LLLT modulating the immune system and its known anti-inflammatory effects, LLLT may have a role in the treatment of any chronic disease with an underlying inflammatory component.

Below are a few published studies on the benefits of LLLT in some medical conditions (this is not an exhaustive list).

  • Heart Bypass

In this controlled study of patients who underwent heart bypass surgery, low-level laser therapy was shown to reduce damage to the heart cells and to accelerate the repair of heart tissue:

Application of Low-Level Laser Therapy Following Coronary Artery Bypass Grafting (CABG) Surgery

J Lasers Med Sci. 2014 Spring; 5(2): 86–91.

Khoo et al.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291821/

  • Rheumatoid arthritis

In this placebo-controlled study, LLLT was shown to be superior to standard anti-inflammatory medication in improving function, relieving pain and limiting the complications of rheumatoid arthritis:

Beneficial Effects of Laser Therapy in the Early Stages of Rheumatoid Arthritis Onset.

Laser Therapy. Vol 11-2 pp 79-87

Contantin Ailioaie and Laura Marinela Lupusoru-Ailioaie

https://www.researchgate.net/publication/271347187_Beneficial_effects_of_laser_therapy_in_the_early_stages_of_rheumatoid_arthritis_onset

  • Raynaud’s disease

In this placebo controlled, double blind intervention study, LLLT shown to reduce the frequency and severity of Raynaud attacks.

Low level laser therapy in primary Raynaud’s phenomenon–results of a placebo controlled, double blind intervention study.

Hirschl et al

J Rheumatol. 2004 Dec;31(12):2408-12.

https://www.ncbi.nlm.nih.gov/pubmed/15570642

  • Tissue repair and pain relief

A meta-analysis of 34 peer-reviewed papers confirming that LLLT is a highly effective therapeutic tool for tissue repair and pain relief.

The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study.

Enwemeka et al

Photomed Laser Surg. 2004 Aug;22(4):323-9.

https://www.ncbi.nlm.nih.gov/pubmed/15345176

  • Neurodegenerative diseases

The benefits of LLLT as a potential treatment in conditions such as Parkinson’s disease and Alzheimer’s is becoming better recognised and there is growing scientific interest in the potential use of LLLT in neurodegenerative disease.

In this study, LLLT was shown to suppress inflammatory pathways in the brain. LLLT is presented as a feasible therapeutic approach to control the progression of neurodegenerative diseases.

Low-level laser therapy regulates microglial function through Src-mediated signaling pathways: implications for neurodegenerative diseases

Song et al

Journal of Neuroinflammation 2012, 9:219

http://jneuroinflammation.biomedcentral.com/articles/10.1186/1742-2094-9-219

  • Asthma

A double blind placebo-controlled clinical study showing that treatment with LLLT resulted in improved lung function and reduced asthma severity, number of medical visits, daily symptoms, and nocturnal symptoms in patients with moderate to severe persistent asthma.

Low-level laser therapy as a supplementary treatment in patients with moderate to severe persistent asthma

Kiani et al

European Respiratory Journal 2013 42: P5096

http://erj.ersjournals.com/content/42/Suppl_57/P5096

  • Heart disease

LLLT was shown to reduce angina symptoms and improve functional capacity.

Laser biostimulation in end-stage multivessel coronary artery disease–a preliminary observational study.

Zycinski et al

Kardiol Pol. 2007 Jan;65(1):13-21; discussion 22-3.

https://www.ncbi.nlm.nih.gov/pubmed/17295156

  • Prevention of mouth ulcers in cancer therapy

A meta-analysis of randomised placebo-controlled trials confirms the benefit of LLLT in preventing the development of cancer treatment-induced mouth ulcers.

A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis.

Bjordal et al

Support Care Cancer. 2011 Aug;19(8):1069-77

https://www.ncbi.nlm.nih.gov/pubmed/21660670

  • Ischaemic stroke

The international NEST-1 trial indicates that low level laser therapy is safe and effective for treatment of ischaemic stroke when initiated within 24 hours of stroke onset, resulting in improved outcomes.

Infrared laser therapy for ischemic stroke: a new treatment strategy: results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1).

Lampl et al

Stroke. 2007 Jun;38(6):1843-9

https://www.ncbi.nlm.nih.gov/pubmed/17463313

  • Parkinson’s Disease

An in-vitro (laboratory) study showing the activity of mitochondria from patients with Parkinson’s Disease, following laser exposure. The mitochondrial activity following laser matched that in disease-free individuals, indicating that laser therapy has the potential to improve neuronal function in patients with Parkinson’s and other neurodegenerative diseases.

Reduced axonal transport in Parkinson’s disease cybrid neurites is restored by light therapyTrimmer et al

Mol Neurodegener. 2009 Jun 17;4:26

https://www.ncbi.nlm.nih.gov/pubmed/19534794

  • Trigeminal Neuralgia

LLLT is an effective treatment for trigeminal neuralgia.

Can low reactive-level laser therapy be used in the treatment of neurogenic facial pain? A double-blind, placebo controlled investigation of patients with trigeminal neuralgia.

Eckerdal et al

Laser Therapy 1996:8: 247-252

The Effect of Low-level Laser Therapy on Trigeminal Neuralgia: A Review of Literature

Falaki et al

J Dent Res Dent Clin Dent Prospects. 2014 Winter; 8(1): 1–5.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091693/

  • Depression

A small study showing improvement in depression. Larger human clinical studies are indicated to study the potential of LLLT in treating depression and other psychiatric disorders.

Psychological benefits 2 and 4 weeks after a single treatment with near infrared light to the forehead: a pilot study of 10 patients with major depression and anxiety

Schiffer et al

Behav Brain Funct. 2009; 5: 46.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796659/