The Use of Low-Level Laser Therapy (LLLT) For Musculoskeletal Pain

The Use of Low-Level Laser Therapy (LLLT) For Musculoskeletal Pain

Howard B Cotler 1,2,*, Roberta T Chow 3, Michael R Hamblin 4,5,6, and James Carroll 7 


1 Gulf Coast Spine Care LTD, USA
2 Laser Health Spa LLC, USA
3 Brain and Spine Research Institute, University of Sydney, Australia
4 Wellman Center for Photo medicine, Massachusetts General Hospital, USA
5 Department of Dermatology, Harvard Medical School, USA
6 Division of Health Sciences and Technology, USA
7 Thor Photomedicine Ltd, UK
*Corresponding author: Howard B Cotler, Owner and Medical Director, Laser Health Spa LLC, 1200 Binz Street, Suite 970 Houston, Texas, USA 77004, Tel: 713-523-8884; Shamanhbc@yahoo.com

PCMID: PMC4743666
PMID: 26858986
DOI: 10.15406/mojor.2015.02.00068


Pain is the most common reason for physician consultation in the United States. One out of three Americans is affected by chronic pain annually. The number one reason for missed work or school days is musculoskeletal pain. Currently, accepted therapies consist of non-steroidal anti-inflammatory drugs, steroid injections, opiate pain medications, and surgery, each of which carries their own specific risk profiles. What is needed are effective treatments for pain that have an acceptably low risk-profile. For over forty years, low-level laser (light) therapy (LLLT) and LED (light-emitting diode) therapy (also known as photobiomodulation) has been shown to reduce inflammation and edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies. The purpose of this paper is to review the use of LLLT for pain, the biochemical mechanisms of action, the dose-response curves, and how LLLT may be employed by orthopedic surgeons to improve outcomes and reduce adverse events.

With the predicted epidemic of chronic pain in developed countries, it is imperative to validate cost-effective and safe techniques for managing painful conditions which would allow people to live active and productive lives. Moreover, the acceptance of LLLT (which is currently being used by many specialties around the world) into the armamentarium of the American health care provider would allow for additional treatment options for patients. A new cost-effective therapy for pain could elevate the quality of life while reducing financial strains.

Keywords: Musculoskeletal, Pain, Low-level laser therapy, Photobiomodulation, Injury repair


Musculoskeletal pain affects 116 million Americans annually at a cost of $635 billion a year in medical bills, lost productivity, and missed work or school [1,2]. All therapeutic treatments have their benefits, but also possess different side effects, risks, and or complications. The current treatment for musculoskeletal pain includes modalities, immobilization, medications, chiropractic care, physical therapy, behavioral management, injections, and/or surgery. These standard therapies have their particular associated risks/side effect profiles including peptic ulcers/gastric bleeding [3], systemic effects (cardiovascular) [4], infections (including epidural abscess) [5], narcotic dependency/addiction [6], deformities, neurologic deficits, and surgical complications [7]. The natural history of chronic pain is one of increasing dysfunction, impairment, and possible disability.

The definition of pain by the “International Association for the Study of Pain” states: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage [8]”. Withdrawal of the painful stimulus usually resolves pain promptly. Sometimes, however, pain persists in spite of the removal of the stimulus and even after healing of the body. Pain can also arise in the absence of any stimulus, disease or injury. Acute pain is considered to last less than thirty days, while chronic pain is of more than six months duration or as “pain that extends beyond the expected period of healing”. There are three different types of pain; nociceptive, neuropathic, and central. The current medical treatment of pain or analgesics is directed at various steps of the pain pathways (Figure 1). Clinically, low-level laser therapy (LLLT) can treat nociceptive [9] and neuropathic pain [10], while central pain has not yet been proven to be responsive to LLLT.

Low-Level Laser Therapy (LLLT) sometimes known as Low-Level Light Therapy or Photobiomodulation (PBM) is a low-intensity light therapy. The effect is photochemical, not thermal. The light triggers biochemical changes within cells and can be compared to the process of photosynthesis in plants, where the photons are absorbed by cellular photoreceptors and triggers chemical changes.


One has to be realistic about the therapeutic use of LLLT. The previous discussion has shown that LLLT is beneficial for pain relief and can accelerate the body’s ability to heal itself. LLLT has a long history and strong basic science evidence, which supports its use in pain management. It has few side effects and is well tolerated by the elderly. A laser or LED does not correct situations involving structural deficits or instabilities whether in bone or in soft tissue. Also, LLLT should only be used as adjuvant therapy for pain relief in patients with neuropathic pain and neurologic deficits. Successful outcomes, like all medical management, depend on good clinical skills linked with an understanding of the nature of the injury, inflammation, repair, pain, and the mechanism of laser and LED effects.


Michael R Hamblin was supported by US NIH grant R01AI050875.


LED – Light Emitting Diodes

LLLT – Low-Level Laser Therapy

PBM – Photobiomodulation

NO – Nitric Oxide

ATP – Adenosine Triphosphate

ROS – Reactive Oxygen Species

MMP – Membrane Potential