Low-level laser therapy (LLLT)–also known as photobiomodulation–applies low-power lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, studies have supported the application of LLLT in relieving pain and the stimulation and enhancement of cell function.

The efficacy and applications of photobiomodulation have received more attention from researchers of late in response to the ever-increasing opioid epidemic and it appears the FDA will be looking at approval for regulated therapies very soon. A recent article in Chiropractic Economics quotes Phil Harrington, DC, CMLSO, FASLMS, clinical manager, human medical director, and laser safety officer at Summus Medical Laser as saying “if they [the FDA] put tighter criteria on devices that are approved, it’s a win for everyone.”

While government regulation can be a burden in many cases, Harrington argues this attention and approval from the FDA will help further the research, with costs for even basic human studies starting at $150,000 NIH grants and federal support for finding non-opioid treatments for pain being a necessary boon to researchers who might otherwise struggle to put together sufficient resources. Ultimately it would also mean the broad adoption of photobiomodulation therapy as a valid component of a treatment plan, paving the way for insurance and medicaid payments, which so far have been rare.

A number of studies have already shown the promise of photobiomodulation. In 2010 a paper published in the journal Lancet looked at 16 trials including a total of 820 patients. In two trials looking for LLLT’s effect on acute neck pain researchers showed a relative risk of 1.69 (95% CI 1.22-2.33) for pain improvement versus placebo. More promising were five trials looking at chronic neck pain showing an RR of for pain improvement of 4.05 (CI 2.74-5.98). Included in that studies findings: Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo. (Lancet. 2010 Mar 13;375(9718):894.)

Another study looked for novel areas of applications for LLLT and posited since “…mitochondria are the principal photoacceptors present inside cells, and it is known that muscle cells are exceptionally rich in mitochondria, this suggests that LLLT should be highly beneficial in muscle injuries. The ability of LLLT to stimulate stem cells and progenitor cells means that muscle satellite cells may respond well to LLLT and help muscle repair. Furthermore the ability of LLLT to reduce inflammation and lessen oxidative stress is also beneficial in cases of muscle fatigue and injury.” It concluded LLLT and LEDT can improve muscle performance, reduce muscle fatigue during exercises and benefit the muscle repair saying “We believe these patients can be benefited with the power of light of LLLT and LEDT, accelerating muscle repair via satellite cells and decreasing oxidative stress of muscle tissue.” It even encouraged further investigations with the promise of encouraging results for patients suffering from muscular dystrophy. (Ferraresi, C., Hamblin, M. & Parizotto, N. (2012). Low-level laser (light) therapy (LLLT) on muscle tissue: performance, fatigue and repair benefited by the power of light. Photonics & Lasers in Medicine, 1(4), pp. 267-286. Retrieved 5 Nov. 2019, from doi:10.1515/plm-2012-0032)

So what can LLLT/photobiomodulation do for chiropractors?

In the most recent issue of Chiropractic Economics (links below), they looked at a number of treatments DC’s could potentially use in their practices, from treatment of a wide variety of musculoskeletal issues to potential use helping patients deal with aging and non-invasive fat loss. Crucially they examined the relevant factors facing chiropractors considering implementing LLLT, and found that while initial investments carry a high price tag, the ROI remains attractive. Devices for laser therapy range anywhere from $7,900 to $40,000 (with some units targeted at aesthetic treatments going even higher). However, if you consider a lease payment in the neighborhood of $200/mo and treatments that bill patients $30-50 each, the expense is recouped with just 4-6 sessions, so the potential for profits for a lot of practices is easy enough to see.

But they encourage any DC looking into purchasing a LLLT device to do their homework. With regulation still sparse, there is little guarantee for how well a given machine might function or how long it will work without trouble. According to the interview with Phil Harrington, his advice was to “Ask colleagues who are using a laser. Seek out laser providers in other parts of the country. Ask them what they are using the laser for, how successful it is, whether patients come in asking for the laser treatments, the number of referrals and repeat customers the laser generates, etc.” Additionally they recommend only considering devices that have been backed by independent review boards and placebo-controlled trials.

Among the considerations for LLLT devices, chiropractors should look at:

• Tissue penetration depth
• Areas of treatment
• Attended treatments versus non-attended
• Initial costs and maintenance required

The next big caveat to implementation is effective marketing to your patients. With this field of treatment being largely unknown to the general public, it’s important that you work to inform your clientele and make sure they understand the benefits and applications involved. The article includes several ideas for promoting the services. With the desperate need for non-invasive, non-drug therapies for things like chronic pain and healing, as well as the ever-present longing for anti-aging and fat-loss methods, it seems marketing LLLT should be fairly straightforward but as with any type of promotional work, it will take a good deal of effort and time before you start to realize its full potential.