As options for photobiomodulation continue to evolve, the amount of power and wavelengths offered have multiplied. Green and violet laser diodes are now available as well as super pulsed laser with peak power over 600 watts.
Many claims are being made about additional conditions to treat with laser beyond the traditional ones found in chiropractic offices. That is exciting news.
Practitioners should start out their laser quest by understanding the classes of lasers and how photobiomodulation (PBM) impacts the body.
Laser safety classifications
The FDA established laser classes based upon the potential to harm unshielded eyes. Therefore, the classes are based upon safety, not clinical performance.
| Laser class | Safety level |
|---|---|
| Class 1 | Safe under reasonable operation |
| Class 1M | Generally safe; some precaution required |
| Class 2 | < 1mW average power, visible light low power, blink response limits risk |
| Class 2M | UV or IR light at low average power, generally safe LED systems |
| Class 3R(A) | Safe for viewing with the unaided eye |
| Class 3a | 1-5mW of average power |
| Class 3b* | 5-500mW of average power, viewing beam is hazardous, diffuse reflections are safe |
| Class 4* | > 500mW average power all the way to Industrial megawatts; hazardous under all conditions to eyes |
| *Requires safety goggles | |
| Table 1. Laser safety classifications |
Traditional laser uses
Chiropractors recognize lasers affect pain, ease inflammation, help tissue repair and more. In our discussions with hundreds of chiropractors, we find they have been treating the conditions in the table below for years. There are many studies on PubMed and elsewhere supporting laser treatment for these conditions.
| Arthritis | Neuropathies | Carpal tunnel syndrome |
| Pain | Disc issues | Radiculopathy |
| Epicondylitis | Restricted range of motion | Fasciitis |
| Sciatica | Fibromyalgia | Shin splints |
| Frozen shoulder | Sports injuries | Inflammation |
| Sprains/strains | Muscle spasms | Tendonitis/tendinosis |
| Table 2. Traditional laser uses |
New laser uses and research behind photobiomodulation
Professionals are continually exploring innovative applications for the modalities in which they have invested significant resources. Recently, there has been an increase in research and publications discussing emerging areas of interest.
It is essential to ensure treatment of any clinical condition remains within the scope of practice defined by your state. Please consult your licensing board for clarification.
Chemotherapy-induced peripheral neuropathy
Chemotherapy-induced peripheral neuropathy (CIPN) affects up to 70% of patients treated with neurotoxic chemotherapy agents and is one of the most common long-term complications of cancer treatment.1
Cellular mechanisms of red and infrared light therapy in nerve repair
This therapy mainly revolves around the absorption of photons by mitochondrial cytochrome c oxidase, an enzyme that plays a crucial role in the electron transport chain. When it becomes activated, it causes a surge in adenosine triphosphate (ATP) synthesis, changes calcium signaling within the cell and controls reactive oxygen species (ROS) generation. These molecular events decrease apoptotic and inflammatory responses, particularly against neuropathic CIPN pathology.2
Clinical evidence supporting photobiomodulation for CIPN
A randomized Phase II clinical trial evaluated cancer survivors with established CIPN who received twelve PBM sessions over six weeks. PBM may offer clinically meaningful symptom benefit in cancer survivors with established CIPN with improvement potentially continuing beyond completion of the intervention.3
Another article concluded that PBM proved to be a promising low-cost resource for the management of sensory symptoms of CIPN, with positive clinical repercussions on balance and gait speed.4
Irritable Bowel Syndrome (IBS)/Irritable Bowel Disease (IBD)
People with IBS experience symptoms that include abdominal pain and cramps. With IBS, you may also have frequent diarrhea, constipation or both.5
Research suggests PBM acts in three ways to relieve the symptoms of IBS:
#1. Calming low-grade inflammation
PBM has been shown to reduce the levels of proinflammatory cytokines such as TNF-α, IL-6 and IL-1β while increasing the production of anti-inflammatory cytokines such as IL-10. These effects reduce inflammation in the gut mucosa, promote tissue repair and restore normal immune function. Furthermore, PBM can modulate macrophage polarization, encouraging the transition of macrophages from a proinflammatory (M1) phenotype to an anti-inflammatory (M2) phenotype, further contributing to the resolution of inflammation in IBS.6
#2. Supporting the gut microbiome (photobiomics)
In light of the evidence that PBM can influence the microbiome and the known effect of PBM on cytokines, transcription factors and the metabolome, we introduce the term “photobiomics” to represent the combined effects of PBM on metabolomic factors, the microbiome and the interaction between the two.7 PBM has shown efficacy in treating gut-related conditions, such as IBD, by reducing inflammation and supporting gut microbial balance.8
#3. Regulating the gut–brain axis
Other findings highlight PBM modulates the gut microbiota, suggesting it could serve as a therapy for neurological conditions affecting the gut-brain axis.9 Multiple improvements were found in rats’ microbiome after duodenal lumen irradiation with PBM.10
Insurance or self-pay still requires proper documentation
Documentation standards for E&M and daily subjective, objective, assessment and plan (SOAP) notes are the same, no matter the financial category. Some practitioners wrongly believe thorough documentation isn’t necessary when insurance isn’t being billed. Although the volume of detail may vary, all notes must include the same elements. State boards and malpractice concerns demand all documentation meet the standard criteria.
Documentation examples
Multiple documentation formats are available, such as bullet points, narrative descriptions or a combination of both.
Although E&Ms report more extensive history, examination, diagnosis and plan of care (POC) compared to the sections found in daily SOAP notes, all the same elements are still required. The primary distinction lies in the POC found within an E&M note. The POC outlines anticipated actions throughout the prescribed course of care, while daily SOAP notes record actions and procedures completed on that particular day.
Example: Patient enters the office with moderate mid-back pain on the right non-radiating 8/10. An E&M was performed, Dx rendered, POC developed and care initiated.
Initial E&M POC:
- Expectation of MMI approximately 90 days.
- Progress evaluation completed every 30 days or less.
- Visit frequency up to 3 times a week until progress evaluation.
Treatment includes:
Chiropractic adjustments to address subluxations of the spine
S8948-Class 4 laser: Direct skin contact-medium penetration-safety goggles will be used. Total treatment time is five minutes at 980 nm, 30W continuous wave, a combination of gallium (Ga), aluminum (Al) and arsenic (As) atoms (GaAIA) lasers applied uniformly to the right mid-trapezius and rhomboid muscles to reduce joint edema, muscle hypertonicity, inflammation, pain and promote tissue healing. Expected dose 2-3 cm deep is 5-10 Joules/cm2 with 20 Joules/cm2cm2at the surface. Estimating 180cm2cm2treatment area, 9,000 total Joules applied. Changes may be made based on presentation for date of service.
Note: This is an example of the detail that should be presented in the POC regardless of the device used. This allows reference to the POC in daily notes without the need to repeat. Certainly, all changed data should be reflected in the daily note if it differs from the protocol stated in the POC.
A home exercise program will be prescribed when clinically appropriate.
Short-term goals: By next progress evaluation, improve pain level to approximately 5/10 from 8/10 and 20% improvement as indicated in the recent OATs.
Long-term goals: Improve pain level to approximately 1/10 and function levels to pre-episode/injury levels.
No referral is indicated at this time.
Sample active treatment time daily SOAP note
Subjective:
Since last visit, the patient stated there is an overall improvement in right mid-thoracic sharp-pain-non-radiating-now 7/10.
Objective: Add any practice/technique-specific information.
Moderate spinal joint restrictions/motion asymmetry of the mid-thoracic region
Moderate palpatory facet joint pain right T4 and T8
Moderate spinal joint effusion right T4 and T8
Moderate hypertonicity right mid-thoracic musculature
Moderate inflammation by palpation on the right mid-thoracic musculature
Leg length indicate ½ inch short right leg
X-ray analysis indicated misalignments of the thoracic and lumbar areas
Assessment:
Patient is meeting expectation
Subluxations: PRT4, PRT8
Primary Dx: Subluxation/segmental disfunctions, M99.02
Secondary Dx: 54.6, M60.88, M79.19
Plan:
The following treatments were rendered to improve complaints and findings reported in the subjective and objective sections.
98940-diversified chiropractic adjustments: Rendered to the levels indicated in the assessment to reduce subluxations/segmental dysfunction of the spine.
S8948-Class IV laser administered to reduce joint edema, muscle hypertonicity, inflammation, pain and promote tissue healing. Application described in recent POC.
Three details of the stated protocol in the POC may vary from day to day including time, intensity and whether pulsed or continuous. If they differ from the stated protocol in the POC, report the changes in the daily note.
Short-term goals and long-term goal remain unchanged as stated in most recent E&M POC.
No referral is presently indicated.
Continue frequency of up to two times a week until progress evaluation.
Patient released without incident.
Final thoughts on documenting photobiomodulation
It is evident that much of the documentation repeats, with only changes in select metrics, findings, settings, symptoms and recommendations. These changes can easily be addressed in today’s EMR systems.
Hx/S and Ex/O should include metrics to quantify symptoms and findings, enabling effective tracking of response to the treatment plan.
The Dx/A should list all relevant diagnosis codes and typically include a statement regarding patient progress and provider expectations.
The POC/plan should outline the services that may be provided along with supporting rationales, identified goals, recommendations, referrals and other pertinent information. It is important not to use more than one treatment per rationale. If one were to detail the protocol in the POC there is no need to duplicate in the daily note, assuming no changes.
Ongoing learning remains essential. Professionals continue to integrate new laser technology. Thorough and accurate knowledge and documentation are critical for maximum benefit and regulatory compliance.
Mark Davini, DC, DABCN, CPCO, is a 1981 graduate of Palmer College of Chiropractic and has more than 24 years in active practice. Davini served as chairman of the MA Board of Registration of Chiropractors, vice president of Public Information and Education and chairman of the Ethics Committee for the MCS. Since 1995, Davini has served as a compliance auditor/clinical monitor as well as a pattern practice analyst. He can be contacted at 508-612-9087 or mark@toolsofpractice.com.
Rob Berman, MBA, is a partner at Berman Partners LLC, a medical device sales and marketing company. Berman Partners specializes in new and pre-owned therapeutic lasers. He also is partner at Energia Medical LLC, which specializes in light therapy and vibration products. He helps doctors improve patient outcomes while increasing their income. He can be contacted at 860-707-4220, rob@bermanpartners.com or bermanpartners.com.
References
- Seretny M, et al. Incidence, prevalence and predictors of chemotherapy induced peripheral neuropathy: A systematic review and meta-analysis. Pain. 2014;155(12):2461–2470. https://pubmed.ncbi.nlm.nih.gov/25261162/. Accessed May 22, 2026.
- Noorelahi M. Photobiomodulation therapy for chemotherapy-induced peripheral neuropathy: Targeted mechanisms and optimized strategies for sensory symptom relief. JMRO. 2025;V(1):18-27. https://www.doi.org/10.53011/JMRO.2025.01.03. Accessed May 22, 2026.
- Teng C, et al. Evaluating laser photobiomodulation for chemotherapy-induced peripheral neuropathy:A randomized Phase II trial. Support Care Cancer. 2022;31(1):52. https://doi.org/10.1007/s00520-022-07463-y. Accessed May 22, 2026.
- Santamarina L, et al. Influence of photobiomodulation on sensory symptoms, balance and gait speed in chemotherapy-induced peripheral neuropathy. Support Care Cancer. 2025;33(4):355. https://pubmed.ncbi.nlm.nih.gov/40186772/. Accessed May 22, 2026.
- Irritable Bowel Syndrome (IBS). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs. Accessed May 22, 2026.
- Woo K, Padalhin A. Photobiomodulation and its potential in treating irritable bowel syndrome. Medical Lasers 2025;14:101-109. https://doi.org/10.25289/ML.25.011. Accessed May 22, 2026.
- Liebert A, et al. Photobiomics: Can light alter the microbiome? Photobiomodulation Photomed Laser Surg. 2019;37(11):681–693. https://journals.sagepub.com/doi/10.1089/photob.2019.4628. Accessed May 22, 2026.
- Hakimiha N, et al. Photobiomodulation and the oral-gut microbiome axis: Therapeutic potential and challenges. Front. Med. 2025;12:1555704. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1555704/full. Accessed May 22, 2026.
- da Silva LE, et al. Photobiomodulation of gut microbiota with low-level laser therapy: A light for treating neuroinflammation. Lasers Med Sci. 2025;40(1):64. https://pubmed.ncbi.nlm.nih.gov/39903307/. Accessed May 22, 2026.
- Min SH, et al. Duodenal dual-wavelength photobiomodulation improves hyperglycemia and hepatic parameters with alteration of gut microbiome in type 2 diabetes animal model. Cells. 2022;11(21):3490. https://pubmed.ncbi.nlm.nih.gov/36359885/. Accessed May 22, 2026.
