Recommendation:
700-880 probes =
- 1.5-163 Joules (6 Joules average)
- 1-3 spots
- Frequency = 1x per day down to 1x per week
900 probes =
- 6 Joules average (4 Joules WALT)
- 1-6 spots (1 Joule per spot)
- Frequency = 1x per day down to 1x per week
In 2020 Berry et al. performed a randomized, double-blind, sham-controlled study looking at the effectiveness of LLLT for treating lower back pain. They found 72.4% of subjects treated with the low-level laser achieved a ≥ 30% decrease in low back pain VAS scores vs. 27.6% of sham-treated subjects (44.8% difference; p<0.005). The mean decrease in low back pain VAS scores was 34.2 points for subjects treated with the laser vs. 11.0 points for sham-treated subjects (23.4-point difference; p<0.001). This lead to the FDA approving a laser device for chronic low back pain treatment.
In a review of 15 studies involving 1039 participants Glazov, Yelland, and Emery (2015) said at immediate and short-term follow-up there was significant pain reduction in favor of laser treatment, occurring in trials using at least 3 Joules (J) per point, (patients had baseline pain, <30 months symptoms, and the trials were non-acupuncture LLLT).
In the same year using stricter criteria Huang, Z., Ma, J., Chen, J. et al. (2015) found that in patients with over 12 weeks of symptoms visual analog scale (VAS) pain outcome score after treatment was significantly lower in the LLLT group compared with placebo. They did state that laser showed good short term effects but not intermediate to long term effects.
The use of lasers in back pain is common place. In a study of the effectiveness of high vs low power lasers on nslbp Abdelbasset (2020) said:
‘there are no different effects of LLLT versus HILT in the treatment of chronic nsLBP. Both LLLT and HILT reduce pain and disability and improve lumbar ROM and quality of life in patients with chronic nsLBP’.
How does laser achieve this?
- Elevating of pain threshold
- Inhibiting the transmission of A-δ and C fibers
- Suppressed peripheral nociceptors
- Increased hydroxyindoleacetics
- Decreased inflammatory cytokines such as IL-1β, IL-8, and TNF-α
- Reduced prostaglandin levels (Nambi et al. 2017)
- Enhancing the secretions of peripheral endogenous opioids (Kholoosy et al. 2020)
- Reducing the level of C-reactive protein (Hagiwara et al. 2008).
So it would appear laser is effective at alleviating pain in patients with over a 12 week history of symptoms in the short term. Longer term other strategies should be employed to address the underlying issue.