Low-level laser therapy (LLLT) involves using low-powered lasers or LEDs to stimulate injured or diseased tissues. It works by increasing cell metabolism through absorption of light in mitochondria. While some studies show benefits for pain, healing, and nerve regeneration, its mechanisms and effectiveness are still debated. The FDA has approved some devices as adjunct therapies but insurers view it as investigational due to lack of high-quality evidence. Proper research is still needed but LLLT may have potential medical applications when used judiciously.

1. Phototherapy with low level energy
LASER

2. Basic science
• Laser is a source of light
• Using of light for treatment is called phototherapy
• Interaction of light with chemical substances is studied by
photochemistry
• Interaction of light with living organisms is studied by
photobiology
• For photochemical or photo biological effects to occur, ENERGY
CARRIED BY LIGHT MUST BE ABSORBED by a system
• Amount of ENERGY (J) absorbed by the system depends mainly
on INTENSITY (W/cm2) and TIME (s) of exposure to the
incoming light
• The magnitude and type of the biological effect depends also on
WAVELENGTH of the light and physiological state of the cell at
the moment of irradiation

3. Technical characteristics of LLLT
• The source of energy are Low-level energy lasers also
known as “cold or soft lasers” with output of 5 – 500
milliwatts. When applied to the skin, these lasers produce
no thermal sensation. (Lasers used in surgery typically use
300 watts).
• Wavelength spectrum is between 600 and 1000 nm red or
near-infrared beam
• In general the wavelength is non ionizing and intensity is
non thermal on physiological level
• Why LASER? Because it is well defined source of light
that is almost monochromatic, polarized, coherent, can be
precisely dosed in intensity and studied regarding its
biological effects

4. Why red or near infrared

7. Therapeutic objective
• To help the natural healing process by photo
stimulation.

8. How is it supposed to work?
• The exact mechanism is still being explored and debated but it is
agreed that the mechanism is photochemical rather than heat-
related.
• Observed biological and physiological effects include changes in
cell membrane permeability, up-regulation and down-regulation of
ATP and NO.
• Visible and near-infrared radiation is absorbed in the respiratory
chain molecules in the mitochondria (e.g., cytochrome c oxidase),
which results in increased metabolism, which leads to signal
transduction to other parts of the cell, including cell membranes,
and ultimately to the photoresponse (e.g., stimulation of growth).
• Certain wavelengths of light at certain intensities, applied in
certain clinical situations may aid tissue regeneration, resolve
inflammation, relieve pain and boost the immune system.
• Clinical applications that show some potential of effectiveness
include treating of soft tissue injury, chronic pain, wound healing,
effects on tinnitus, nerve regeneration and hair growth.

10. Does it really work?
• In 1967 Endre Mester in Semmelweis University experimented
with the effects of lasers on skin cancer. While applying lasers to
the backs of shaven mice, he noticed that the shaved hair grew
back more quickly on the treated group than the untreated group.
From this time on several hundreds of studies had been published.
• The topic of Low Level Light Therapy (LLLT) is still very
controversial. Some researchers claim to have achieved positive
clinical and pre-clinical results, while others remain skeptical.
• This type of therapy has not yet been accepted into the
mainstream of science and medicine, because many of the studies
have been conducted without a proper understanding of the
properties and biological effects of light. In addition, many studies
have not been conducted with proper scientific methodology.
• http://www.lni.wa.gov/ClaimsIns/Files/OMD/LLLTTechAssessM
ay032004.pdf

11. US Food and Drugs Administration Status
• Between 2002 and 2004, the Food and Drug
Administration granted approval to several
companies to market lasers that provide
LLLT. The LLLT lasers are classified under
“Lamp, Non-heating, for Adjunctive Use in
Pain Therapy”.
It means the procedure is
safe but not necessarily
effective.

12. US Insurers opinion
• Aetna's September 2003 policy states that cold laser
therapy is experimental and investigational. There is
inadequate evidence of the effectiveness of low-energy
lasers in wound healing, pain relief, or for other
musculoskeletal dysfunction, arthritis, and neurological
dysfunction.
• Blue Cross of California and BlueCross BlueShield of
Georgia determined in March 2004 that low-level laser for
carpal tunnel is investigational.
• The Regence Group determined in January 2004 that
LLLT for neuromuscular pain was investigational.
• General Motors offers LLLT to injured workers in its in-
plant medical clinics.

13. Speaker opinion…
As is a brush for the painter,
the chisel for the sculptor or
an instrument for the
musician – In the hands of a
sensible physician – the
laser may be a useful tool
for the art of healing…
Not forgetting the ultimate
healer

14. Surah 24. Light
35. Allah is the Light of the heavens
and the earth. The Parable of His
Light is as if there were a Niche
and within it a Lamp: the Lamp
enclosed in Glass: the glass as it
were a brilliant star: Lit from a
blessed Tree, an Olive, neither of
the east nor of the west, whose
oil is well-nigh luminous, though
fire scarce touched it: Light upon
Light! Allah doth guide whom
He will to His Light: Allah doth
set forth Parables for men: and
Allah doth know all things.