THE “WHAT”: SUPPORTING PUBLICATIONS
What is LLLT?
LLLT (or Photobiomodulation Therapy which is the best technical term) is a laser or LED light therapy that improves tissue repair (skin wounds, muscle, tendon, bone, nerves), reduces inflammation and reduces pain wherever the beam is applied. Usually applied by a doctor, therapist or technician, treatments typically take 1 - 10 minutes and should be applied two or more times a week. Pubmed refs
How it works?
LLLT works predominately on a protein in mitochondria (cytochrome c oxidase) to increase ATP and reduce oxidative stress. A cascade of mitochondrial and intracellular downstream effects lead to improved tissue repair and reduced inflammation. Pubmed refs
How much is enough, how much is too much?
There is a dose response: not enough power density and there is no effect, too much and there can be inhibitory effects which can slow down healing and lose the anti-inflammatory effects. Pubmed refs
The analgesic mechanism
This depends on an LLLT overdose; Higher power density LLLT >300mW/cm² reduces ATP production in C fibres and A delta fibres resulting in an immediate neural blockade lasting up to approx 24 hr. Pubmed refs
So there are actually TWO kinds of LLLT ?
Yes, high power density is necessary for analgesia and deep tissue targets, low power density (< 100mW/cm²) is necessary to promote healing and reduce inflammation in superficial wounds, tendons and joints (the target is the synovia not the joint). THOR do both high and low power density for best healing, deep penetration and analgesia. Read more about class IV lasers, 3B lasers, LEDs and dose here
The progress of LLLT / Photobiomodulation Therapy towards mainstream acceptance
2018 - National Institute of Health and Care Excellence (NICE) guidance for the UK NHS recommends laser therapy for oral mucositis. Click here
2017 - UK NIHR funded RCT on the Clinical and Cost Effectiveness of Low Level Laser in the Management of Oral Mucositis in Head and Neck Cancer Irradiation, 10 NHS hospitals, 380 patients in progress. Click here
2017 - Low Level Laser improves survival of head and neck cancer patients. Click here
2017 - American College of Physicians Guidelines include a "strong recommendation" for Low-Level Laser Therapy as a non-invasive Treatments for Acute, Subacute & Chronic Low Back Pain. Click here
2016 - BMJ LLLT for chronic non-specific low back pain: a systematic review and meta-analysis of randomised controlled trials found "moderate quality of evidence" and "clinically important benefits" in the short term. Click here
2014 - 30% reduction of the costs of hospitalisation in PBM Oral Mucositis patients. Click here
2014 - MASCC guideline revisions recommend use of LLLT/PBM to reduce the incidence and severity of Oral Mucositis. Click Here.
2013 - Journal Applied Oral Science. TMJ Systematic review "it seems clear that the use of laser brings benefits when properly applied and administered". Click Here.
2012 - Multinational Association for Supportive Cancer Care (MASSC) systematic review recommends LLLT/PBM for oral mucositis. Click here
2011 - European Society for Medical Oncology (ESMO) systematic review suggest LLLT/PBM for reducing duration and severity of oral mucositis. Click here
2011 - British Medical Journal (BMJ) Clinical Guidelines for tennis elbow "Likely to be beneficial for short-term pain relief & improvement of function". Click here
2010 - The International Association for the Study of Pain (Global Task Force on musculoskeletal pain) recommend laser for myofascial pain syndrome. Click here
2010 - British Journal of Sports Medicine, systematic review of surgical and conservative interventions for frozen shoulder found "strong evidence" for LLLT/PBM. Click here
2010 - American Physical Therapy Association guidelines recommend LLLT/PBM for Achilles tendonitis. Click here
2009 - The Lancet "LLLT/PBM reduces pain immediately after treatment in acute neck pain and for up to 22 weeks in patients with chronic neck pain". Click here
2008 - World Health Organisation (Bone and Joint Task Force) recommended LLLT/PBM for neck pain. Click Here