Celebrating 20 years of photobiomodulation benefits by highlighting the latest supporting research
This year laser therapy, now referred to as photobiomodulation therapy (PBMT), enters its 20th year of FDA-recognized clearance in the USA medical market. Since its beginnings, there have been a steady growth of photobiomodulation benefits and breakthroughs, new laser companies, models and technologies.
On Jan. 17, 2002, the FDA issued the first 510K clearance for a non-surgical laser — a Class IIIa laser for therapy indications for use.1 A few weeks later on Feb. 6, 2002, the second laser company was the next to receive an FDA 510k clearance for their Class IIIb laser.2 A major addition to the laser therapy market then occurred on Dec. 11, 2002, with a medical laser company receiving the first FDA 510k clearance for a Class IV therapy laser.3
The past 20 years have also seen an increase in published research, with thousands of studies on pubmed.gov covering a number of clinical applications with many of them focused on acute and chronic musculoskeletal pain.4 Despite ongoing differences in laser devices and their specifications for power levels, wavelengths, operating modes and treatment protocols, recent breakthroughs are occurring that are providing new opportunities for professional and patient awareness and acceptance of PBMT.
A number of these breakthroughs include the following:
Centers for Disease Control (CDC) — On Feb. 10, 2022, the CDC issued new guidance on prescribing opioids. The 229-page document advises doctors to limit new opioid prescriptions and discuss alternative therapies with patients. More than 100,000 Americans died of drug overdoses in the 12 months after the COVID-19 lockdowns (2020-21), the most overdose deaths ever recorded in a one-year span according to the CDC. It is estimated that drug overdoses are now costing the U.S. around $1 trillion every year.5 This is a tremendous opportunity for PBMT to take a new position as an effective, non-invasive and drug-free, alternative therapy treatment for pain relief, inflammation reduction and accelerated healing.
Medical associations — A growing number of medical associations are now recommending laser therapy. The result of this is increased awareness and new credibility and acceptance for PBMT by larger groups of doctors (MD, DO) and other medical associations.
The American Academy of Orthopaedic Surgeons (AAOS) — The AAOS has included laser therapy in its latest 2021 recommendations for the treatment of osteoarthritis of the knee joint.6
The American College of Physicians (ACP) — The ACP has issued Guideline For Treating Nonradicular Low Back Pain (2017) that includes low-level laser therapy.7
The American Physical Therapy Association (APTA) Orthopaedic Section — The APTA has issued a number of official recommendations for laser therapy that include heel pain plantar fasciitis,8 neck pain9 and Achilles tendinitis.10
The World Health Organization (WHO) — The WHO recommends laser therapy and its photobiomodulation benefits for neck pain.11
Clinical application breakthroughs
Published research of PBMT for a number of clinical applications are becoming more comprehensive and relevant by providing the evidence that is needed to validate treatments.
This is in sharp contrast to other therapy products that often lack published clinical research, and address symptoms and not the cause. In today’s competitive health care market, physicians need to have an evidence-based practice that evaluates and improves outcomes for all their patients, in particular those who are in the age range for reporting good and bad outcomes in their social media posts.
Photobiomodulation is a cutting-edge tool that can enhance outcomes with almost every patient and clinical application, with a potential result of positive social media reviews of the practice. Patients who have positive experience can become loyal patients and often refer family and friends. A number of recently published studies for a growing number of applications include the following:
Low Back Pain — A published study in 2022 reviewed and analyzed randomized controlled trials of PBMT treatments for chronic low back pain, indicating positive outcomes for the most common request for chiropractic care.12
Discogenic Lumbar Radiculopathy — A 2022 double-blind study concluded that PBMT is proved as an efficient adjunct therapy to conventional physical therapy for discogenic lumbar radiculopathy.13
Neurodegenerative Diseases — A systematic review published in 2022 shows photobiomodulation benefits in altering the progression of neurodegenerative diseases.14
Spinal Cord Injuries — A review published in 2022 indicates PBMT can enable recovery in the treatment of spinal cord injuries.15
Lateral Epicondylitis (LE) — PBMT used to treat patients with LE shows improvement in a review and meta-analysis published in 2022.16
Temporomandibular Joint Disorder — A double-blind study published in 2022 shows highly effective results for PBMT in treating myogenic temporomandibular joint disorder.17
Tendinopathy — A review of preclinical studies published in 2022 indicated enhanced tendon structure and function with PBMT.18
Osteoporosis — A 2022 randomized controlled trial showed positive effects for PBMT on bone density and pain of osteoporosis.19
Musculoskeletal Pain — A systematic review published in 2021 showed short- and long-term effectiveness for reducing pain and improving functionality in MSDs.20
Knee Osteoarthritis — A systematic review and meta-analysis of randomized controlled trials in 2020 proved effectiveness of PBMT on pain, stiffness and function in patients with knee osteoarthritis.21
Subacromial Impingement Syndrome — A double-blinded study in 2022 using PBMT showed statistically significant improvement compared with the placebo group on pain, range of motion, functional capacity, quality of life and muscle strength.22
Traumatic Brain Injury (TBI) — A number of studies have been published that show PBMT to be an effective treatment for TBI,23 PTSD,24 depression25 and other brain conditions, with lasers incorporating specific power levels, wavelengths and treatment protocols.
Modality breakthroughs with photobiomodulation benefits
The combinations of PBM therapy with many therapeutic modalities are providing new synergistic treatment protocols with exciting results. Many modalities can benefit from using PBMT before or during application of the specific modality.
The underlying mechanism of PBMT provides energy to cells that triggers a cascade of benefits, including reduction in pain and inflammation and improvement in blood circulation, range of motion and overall recovery. Any practice currently providing therapeutic modalities can now add PBMT to their existing protocols.
A number of treatments and modalities enhanced with laser therapy include:
Laser + Chiropractic Treatment of Spinal Manipulation — A study at the University of Colorado-Denver added laser therapy to conventional chiropractic treatment of spinal manipulation. A statistical comparison of the study groups indicated that manipulation with laser offers greater pain reduction when compared to manipulation only.26
Laser + Soft Tissue Mobilization — A study performed at Logan University provided data demonstrating a reduction in pain with Graston and laser therapy combined to be an effective treatment in the management of myofascial trigger points and pain.27
Laser + Decompression Therapy — A study that utilized laser therapy before a non-surgical spinal decompression treatment showed statistically signiﬁcant improvement in low back pain.28
Laser + Shockwave Therapy — A number of studies combining laser and shockwave therapy indicate they are beneficial and effective in treating pain, including myofascial pain syndrome29 and plantar fasciitis.30
Laser + PhotoKinetic Topicals — A new field is emerging called PhotoKinetics, which is technology combining bioactive topicals with light actuation (lasers). This produces optical skin clearing efficacy31 that significantly provides a non-invasive way to enhance infusion of bio-active formulations while optimizing photobiomodulation and increasing blood flow. A research scientist has developed and patented a number of bioactive topicals.32
Laser + Stem Cell Therapy — The application of PBM can be a promising combination to improve mesenchymal stem cell therapy by enhancing proliferation or differentiation of stem cells.33,34
Laser + Acupuncture — The combination of PBM with acupuncture could maximize both the reparative potential and the wider acceptance of acupuncture treatment methods.35
Laser + Photobiomics — A growing number of studies demonstrate that PBM delivered to the abdomen can alter the gut microbiome in a potentially beneficial way.36
Laser + Cryotherapy — A study demonstrated that cryotherapy in combination with laser therapy can produce an anti-inflammatory “add-on” effect with the order of therapy administration important — application of cryotherapy first, followed by laser therapy.37
Laser + Vagus Nerve Therapy — New protocols are being researched and developed using laser therapy for vagus nerve stimulation,38 indicating that laser therapy should be considered for future protocols to recover parasympathetic/sympathetic nervous system balance in different conditions.39 Wearable auricular nerve field stimulation technology is being released in 2022 that can be combined with laser therapy.40
Laser + Lymphatic Therapy — A study using laser therapy with lymphatic therapy utilizing soft cupping showed it to be effective for lower back pain.41 New electronic cupping technology providing vacuum massage utilizing negative pressure42 works synergistically with laser therapy that provides positive pressure.
Laser tech breakthroughs and financial strategies
A number of new technology developments are occurring with many laser manufacturers. Whether a practice is currently using laser therapy or is still new to add it, it is worth the time and effort to learn about new laser product developments in 2022.
These may involve wavelengths, power levels, operating modes, continuous wave and pulse settings and other exciting technology advancements. The result of these are better lasers that have many new features and photobiomodulation benefits, providing improved and more consistent clinical outcomes.
In addition, there are financial strategies and opportunities from purchasing a new laser in 2022 with a number of tax benefits, including IRS Section 179, ADA Section 44, and the IRS research and development tax credit. All of this will have a positive impact for a practice, and often result in a higher ROI from using the new laser with existing patients and prospective patients. The time to research and learn about the new advances in laser technology is worthwhile.
A key component to generating the best clinical outcomes with a laser are the protocols and training provided by the laser manufacturer. This can vary significantly between the various laser companies.
Research has indicated that patients will often respond differently to a laser therapy treatment, including a lower response rate. Training with specific protocols can help the laser practitioner know how to overcome any outcome challenges and optimize the treatment results.
Physicians who take the time to be educated and trained, becoming a PBMT expert (certified) and incorporating the newest PBMT technology into their practice, will be in the best position to deliver optimal care and differentiate their practice as an advanced and evidence-based health care leader in their community.
In addition to the breakthrough actions and trends happening in photobiomodulation therapy is the overall decline of the health condition of the average adult in America.
A national survey review published in 202243 indicates that over the past 18+ months, 90% of all adults have significantly decreased their physical activity, with a resulting major decline in overall health, fitness and mental well-being. Because of this, the medical and wellness industries are in a unique position to take the lead and help every patient improve their health, resulting in a better quality of life.
Photobiomodulation benefits to patients can be the single breakthrough opportunity for every practice to elevate their clinical and financial outcomes as they become educated about new laser protocols and incorporate the new laser technology now available.
CHARLES E. VORWALLER is a 35-year veteran of the medical device industry with a focus and passion for photomedicine and innovative medical technologies. He has traveled the world meeting with doctors, scientists and researchers in pursuit of new technology advances and medical outcomes. Charles is devoted to his family, celebrating 40 years of marriage and spoiling his six grandchildren, and is committed to his religious faith. He is the president and CEO of Aspen Laser, an FDA-registered manufacturer of photobiomodulation lasers and TheraLight, a manufacturer of LED products. He can be reached at email@example.com or by visiting aspenlasers.com and theralight.com.