預約治療

高強度激光治療與痛症的關係 – ENG

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The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review

  • 19 studies included, approximately 94% of the included articles (n=18) revealed positive effects of the HILT on pain.
  • The Function of the Laser Beam (Most Effect to Less Effect) on the Diseases
GroupsAuthor (Year)Disease
HILT or HILT + ExecciseAlayat et al (2017)43Osteopenia or osteoporosis (Lower back and hip regions)
Ordahan et al (2018)13Plantar fascia
Kheshie et al (2014)12Osteoarthritic knee of grade 2–3
Alayat et al (2016)35Unilateral or bilateral chronic neck pain
Casale et al (2013)33Carpal tunnel syndrome
Dundar et al (2014)34Myofascial trigger point (upper trapezius)
Fiore et al (2011)32Lumbar pain
Santamato et al (2009)31Shoulder pain
Kim et al (2015) 41Shoulder pain and limitation of passive movement
Taradaj et al (2018)14Lumbar disc degenerative dysfunction
Salli et al (2016)36Lateral epicondylitis
HILT+ other interventionsChoi et al (2017)16Chronic back pain
El-Shamy et al (2018)42Children with Juvenile rheumatoid arthritis
El-Shamy et al (2016)39Bilateral knee haemarthrosis with mild to moderate haemophilia
Ebid et al (2017)40The post-burn healing
Ebid et al (2015)38Breast cancer including axillary node dissection for stage II or III
Chen et al (2017)18Disc protrusion in lumbar
Haładaj et al (2017)17Pain and limited mobility of the cervical spine
Kolu et al (2018)20Low back with unilateral leg pain
  • The studies that demonstrated positive effects of HILT on pain have some common features as follows:
    • Patients were monitored over a long period of time (up to 3 months);
    • Higher amounts of energy were used with the average power of 3 and 25 W;
    • The patients most commonly did not use other interventions with laser therapy;
    • The laser therapy pulsed for at least ten sessions
  • It was not possible to make a judgment on whether the energy parameters may have contributed to a sub-optimal outcome
    • As most studies did not include the amount
  • Long-term, randomized controlled trials with an appropriate methodological design are needed to determine the effect of HILT on pain

Ezzati, K., Laakso, E. L., Salari, A., Hasannejad, A., Fekrazad, R., & Aris, A. (2020). The beneficial effects of high-intensity laser therapy and co-interventions on musculoskeletal pain management: a systematic review. Journal of lasers in medical sciences, 11(1), 81.

Mechanism of high power laser

  • The mechanism of action for HILT is primarily photobiomodulation (PBM).
  • PBM stimulates cells, including pain receptors in peripheral tissues, the immune system, and can cause vasodilation and analgesic (pain-relieving) effects.
    • This is due to the way HILT interacts with chromophores (light-absorbing molecules) within cells.
  • The specific parameters of the laser, such as wavelength, irradiation mode (continuous or pulsed), pulse duration, energy fluence, power output, and irradiance, all influence the cellular and tissue-level responses.
  • At the cellular level, HILT has been shown to increase mitochondrial activity, leading to increased ATP production.
    • This can enhance cellular metabolism and repair processes.
  • HILT also influences signaling pathways, gene expression, and the release of regulatory molecules like cytokines and growth factors.
    • These changes can reduce inflammation, promote tissue regeneration, and inhibit pain transmission.
  • In terms of specific effects on musculoskeletal tissues, HILT can
    • stimulate nerve regeneration,
    • increase peripheral circulation,
    • provide analgesic effect by modulating the transmission of pain signals through the stimulation of specific nerve endings and the release of endogenous opioids
    • produce relaxation to muscles, reducing muscle spasms and tension
    • and enhance metabolic activity in muscles, tendons, and ligaments.
  • By targeting these mechanisms, HILT aims to reduce pain, improve function, and facilitate the body’s natural healing processes for various musculoskeletal conditions.

Ezzati, K., Laakso, E. L., Salari, A., Hasannejad, A., Fekrazad, R., & Aris, A. (2020). The beneficial effects of high-intensity laser therapy and co-interventions on musculoskeletal pain management: a systematic review. Journal of lasers in medical sciences, 11(1), 81.

Song, H. J., Seo, H. J., Lee, Y., & Kim, S. K. (2018). Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: A systematic review and meta-analysis of randomized controlled trials. Medicine, 97(51), e13126.

Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders

A systematic review and meta-analysis of randomized controlled trials

  • 12 studies (RCT) were selected for this systematic review. In 11 studies, comprising 736 patients, pain was significantly improved by HILT compared with a control group
  • From the analysis of 688 patients from 10 studies, the pooled standardized mean difference (SMD) of HILT showed a significant improvement in disability scores compared with those in the control group
  • In subgroup analysis by treatment regions, the mean difference (MD) in neck pain was the highest at −1.02 (95% CI: −1.45, −0.58) than in controls, followed by back pain (MD, −0.91; 95% CI: −1.24, −0.59)
  • The disability following HILT significantly improved compared to the placebo group (SMD: −0.96; 95% CI: −1.28, −0.64), however, there was no significant improvement between the HILT and the active control groups
  • The risk of bias in the included studies was moderate, and there was significant heterogeneity, suggesting the need for additional well-designed studies with larger samples and longer follow-up.

Song, H. J., Seo, H. J., Lee, Y., & Kim, S. K. (2018). Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: A systematic review and meta-analysis of randomized controlled trials. Medicine, 97(51), e13126.

Effectiveness of high-intensity laser therapy in the… : Medicine

High power laser and different musculoskeletal disorder

Low back

Alayat MS, Atya AM, Ali MM, et al. Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial. Lasers Med Sci 2014;29:1065–73.

Subject Background: 72 male pateints with chronic low back pain

Treatment Groups:

  • Group 1 was treated with HILT and exercise (HILT + EX group), group 2 received placebo laser and exercise (PL + EX group), and group 3 was treated by HILT alone (HILT group).

Parameter of Laser:

  • Patients received pulsed Nd:YAG laser treatment, produced by a HIRO 3 device (ASA Laser, Arcugnano, Italy). The apparatus provided pulsed emission (1,064 nm), very high peak power (3 kW), a high level of fluency/energy density (510–1,780 mJ/cm), a brief duration (120–150 μs), a low
  • A total energy dose of 3,000 J was administered through three phases of treatment. The initial phase was performed with fast manual scanning for a total of 1,400 J. In the initial phase, the laser fluency was set to three successive subphases of 610, 710, and 810 mJ/cm2, for a total of 1,400 J. An intermediate phase applied the handpiece to the eight paravertebral points from L1 to S3 [14], with 25 J, a fluency of 610 mJ/cm2 , and a time of 14 s at each point, for a total of 200 J. The final phase was the same as the initial phase, except that slow manual scanning was used. The application time for all three phases was approximately 15 min

Result:

  • A significant ROM improvement in the HILT + EX group, greater than that seen in the PL + EX group; the least effect was seen in the HILT group, at both 4 and 12 weeks (Table 2). There was a non-significant difference between the PL + EX and the HILT groups in RDQ and MODQ scores (Figs. 3 and 4). The HILT + EX group had a larger significant decrease in the VAS score than the PL + EX group, with the least effect experienced by the HILT group, at both 4 and 12 weeks Screenshot 2024-05-10 110629.png

Chen L, Liu D, Zou L, et al. Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: a randomized controlled trial. J Back Musculoskelet Rehabil 2018;31:191–6.

Subject Background: The study included 63 patients suffering from protrusion of lumbar intervertebral disc. These patients were experiencing symptoms including pain, reduced mobility, and discomfort.

Treatment Group:

  • The participants were divided into two groups:
    • Group 1 (n=32): Received HILT combined with a spinal decompression system (SDS).
    • Group 2 (n=31): Received only the SDS treatment.

Parameters of Laser Used: not specified

Results of the Study:

  • After two weeks of treatment, both groups showed significant improvements in the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) scores for lumbosacral portion pain, and lower limb radiation pain.
  • Additionally, there were improvements in lumbar flexion range and angle of straight leg raising.
  • However, Group 1, which received HILT, showed a smaller difference in VAS scores, indicating a greater reduction in pain compared to Group 2.
  • The study concluded that HILT can accelerate improvement in lumbar segment motion, angle of straight leg raising, and overall function, allowing patients an earlier return to normal activities. The treatment effects were long-lasting and deemed suitable for clinical application

Fiore P, Panza F, Cassatella G, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial. Eur J Phys Rehabil Med 2011;47:367–73.

Subject Background:

  • The study was a randomized clinical trial that involved 30 patients with LBP.
  • The study focused on patients with low back pain (LBP)
  • This study aimed to compare the effectiveness of high-intensity laser therapy (HILT) with ultrasound (US) therapy.

Treatment Group:  These patients were randomly assigned to two groups:

  • HILT group: Received high-intensity laser therapy.
  • US therapy group: Received ultrasound therapy.

Parameters of Laser Used:

  • The study participants received fifteen treatment sessions of HILT or US therapy over a period of three consecutive weeks (five days/week).
  • The specific parameters of the laser used, such as wavelength, power, and duration of each session, are not detailed in the search results.

Results of the Study:

  • At the end of the 3-week intervention, the HILT group showed a significantly greater decrease in pain (measured by the Visual Analog Scale – VAS) and an improvement of related disability (measured by the Oswestry Low Back Pain Disability Questionnaire – OLBPDQ) compared with the group treated with US therapy
  • The findings suggest that HILT may be more effective than US therapy in the short-term treatment of LBP, proposing HILT as a promising new therapeutic option for the rehabilitation of this condition.

Neck

Alayat MS, Mohamed AA, Helal OF, et al. Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebo-control trial. Lasers Med Sci 2016;31:687–94.

Subject Background: The research focused on patients with chronic neck pain, which is a common condition that can significantly affect quality of life and functional ability.

Treatment Group:

  • Patients were randomly assigned to receive either:
    • HILT + Exercise (HILT+EX): A combination of high-intensity laser therapy and exercise.
    • Placebo Laser + Exercise (PL+EX): A placebo laser treatment combined with exercise.

Parameters of Laser Used: not specified

Results of the Study:

  • The combination of HILT and exercise (HILT+EX) was found to be an effective physical therapy modality for patients with CNP compared to placebo laser and exercise therapy (PL+EX).
  • The treatment effectively increased cervical range of motion (ROM), functional activity, and reduced pain after 6 weeks of treatment

Dundar U, Turkmen U, Toktas H, et al. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study. Lasers Med Sci 2015;30:325–32.

Subject Background:

  • Myofascial pain syndrome (MPS) of the trapezius muscle is a common cause of neck pain.
  • MPS is characterized by deep, intense pain in skeletal muscles and the presence of myofascial trigger points (MTPs).
  • Randomized, double-blind trial.
  • Female patients with chronic MPS of the trapezius muscle were included.

Treatment Groups:

  • HILT Group: Received high-intensity laser therapy (HILT) along with exercise.
  • Sham Therapy Group: Received placebo HILT (sham) along with exercise.

Parameters of Laser Used:

  • HILT was administered using pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.
  • HILT is a noninvasive and painless treatment.

Results of the study:

  • Both groups showed significant improvement in pain, cervical active range of motion, disability, and quality of life at weeks 4 and 12.
  • The HILT group demonstrated greater improvement in pain scores, neck disability index, and several subparts of the short-form 36 health survey (SF-36) compared to the sham therapy group.
  • Conclusion: HILT is an effective therapeutic method for treating chronic MPS of the trapezius muscle.

Haładaj R, Pingot M, Topol M. The effectiveness of cervical spondylosis therapy with Saunders traction device and high-intensity laser therapy: a randomized controlled trial. Med Sci Monit 2017;23:335–42.

Subject Background:

  • Cervical spondylosis is a common condition affecting the cervical spine.
  • The cervical segment is sensitive to injuries, pain, and requires special care due to its mobility and delicate construction.
  • The study included 174 patients (114 women and 60 men) aged 24-67 years

Treatment Groups:

  • Patients were randomly divided into two groups:
    • Group I: Received traction therapy with the Saunders device.
    • Group II: Received high-intensity laser therapy (HILT).
  • Saunders Traction Device: Applied in Group I.
  • High-Intensity Laser Therapy (HILT): Applied in Group II using pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.

Results of the study:

  • Outcome Measures:
    • Range of cervical spine movement.
    • Subjective visual scale for pain (Visual Analog Scale [VAS]).
    • Neck Disability Index-Polish Version (NDI) questionnaire.
  • Both methods improved efficiency and demonstrated analgesic efficacy immediately and in the medium term after therapy.
  • In long-term follow-up, HILT was more effective than the Saunders method in maintaining positive therapeutic effects

Shoulder

Kim SH, Kim YH, Lee HR, et al. Short-term effects of high-intensity laser therapy on frozen shoulder: a prospective randomized control study. Man Ther 2015;20:751–7.

Subject Background:

  • Frozen shoulder, characterized by shoulder pain and limited range of motion (ROM), is a common disorder.
  • High-intensity laser therapy (HILT) has been introduced as a musculoskeletal treatment.
  • Participants: 66 Patients with frozen shoulder.

Treatment Groups:

  • HILT Group (n = 33): Received HILT.
  • Placebo Group (n = 33): Received sham treatment.

Parameters of Laser Used:

  • HILT was administered using pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.
  • 3 times per week on alternate days for 3 weeks.

Results of the study:

  • Pain Visual Analog Scale (VAS):
    • HILT group had lower pain scores at 3 weeks (3.2 ± 1.7 vs. 4.3 ± 2.2, p = 0.033) and 8 weeks (2.2 ± 2.0 vs. 3.4 ± 2.7, p = 0.042).
    • No significant difference in pain VAS between groups at the final follow-up (12 weeks).
  • Range of Motion (ROM) and Satisfaction VAS:
    • No statistical difference between the two groups at serial follow-ups.
  • HILT provided significant pain relief at 3 and 8 weeks but not at the final follow-up.
  • HILT is a noninvasive adjuvant treatment for reducing pain in frozen shoulders.

Pekyavas NO, Baltaci G. Short-term effects of high-intensity laser therapy, manual therapy, and Kinesio taping in patients with subacromial impingement syndrome. Lasers Med Sci 2016;31:1133–41.

Subject Background:

  • Subacromial impingement syndrome (SAIS) is a major contributor to shoulder pain.
  • Various treatment approaches have been developed to alleviate SAIS-related pain, including Kinesio® taping (KT), exercise (EX), manual therapy (MT), and high-intensity laser therapy (HILT).
  • The study included 70 patients with SAIS

Treatment Groups:

  • Patients with SAIS, randomly divided into four groups:
    1. EX Group (n = 15): Received exercise therapy.
    2. KT + EX Group (n = 20): Received Kinesio taping along with exercise.
    3. MT + KT + EX Group (n = 16): Received manual therapy, Kinesio taping, and exercise.
    4. MT + KT + HILT + EX Group (n = 19): Received manual therapy, Kinesio taping, high-intensity laser therapy, and exercise.

Parameters of Laser Used:

  • HILT: Administered using pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.

Results of the study:

  • Statistically significant differences were observed in the treatment outcomes of all parameters in the MT + KT + EX and HILT + MT + KT + EX groups.
  • Shoulder pain and disability index (SPADI) scores improved significantly in both the HILT and MT groups.
  • Further studies with longer follow-up periods are needed to conclusively determine the advantages of these treatments.

Santamato A, Solfrizzi V, Panza F, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther 2009;89:643–52.

Subject Background:

  • SAIS is a common shoulder disorder causing pain and limited range of motion.
  • 70 Participants had SAIS included.

Treatment Groups:

  • HILT Group (n = 35): Received HILT.
  • US Therapy Group (n = 35): Received ultrasound therapy.

Parameters of Laser Used:

  • HILT utilized pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.

Results of the study:

  • After a 3-week intervention, the HILT group showed:
    • Greater pain reduction (measured by Visual Analog Scale [VAS]).
    • Improved disability (measured by the Oxford Shoulder Pain and Disability Questionnaire [OLBPDQ]) compared to the US therapy group 2.

Elbow

Dundar U, Turkmen U, Toktas H, et al. Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci 2015;30:1097–107.

Subject Background:

  • LE causes pain on the outside of the elbow and weakness during gripping.
  • Participants had LE.

Treatment Groups:

  • Patients were randomly assigned to three groups:
    • HILT Group: Received high-intensity laser therapy (HILT).
    • Sham Therapy Group: Received placebo HILT.
    • Brace Group: Used a lateral counterforce brace for LE.

Parameters of Laser Used:

  • HILT utilized pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.

Results of the study:

  • Both HILT and brace groups showed significant improvements in pain scores, grip strength, disability, and quality of life after treatment (at 4 and 12 weeks).
  • However, these improvements were not reflected in ultrasonographic findings.
  • No significant difference was observed between HILT and brace groups in terms of percentage changes in parameters after treatment.

Salli A, Akkurt E, İzkі AA, et al. Comparison of high intensity laser and epicondylitis bandage in the treatment of lateral epicondylitis. Arch Rheumatol 2016;31:234–8.

Subject Background:

  • Participants: 65 patients with unilateral LE (18 males, 47 females; mean age 46.5±8.1 years).
  • Unilateral complaints related to LE.

Treatment Groups:

  • HILT Group (n=31): Received HILT for 10 sessions.
  • Bandage Group (n=34): Used only an LE bandage for treatment.

Parameters of Laser Used:

  • HILT utilized pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy.

Results of the study:

  • Both groups showed significant improvement in all evaluated parameters (pain scores, hand grip strength, disability, and quality of life) at the sixth week after treatment.
  • HILT group demonstrated better resting visual analog scale and SF-36 physical component subscale scores compared to the LE bandage group.

Wrist

Casale R, Damiani C, Maestri R, et al. Pain and electrophysiological parameters are improved by combined 830-1064 high-intensity LASER in symptomatic carpal tunnel syndrome versus Transcutaneous Electrical Nerve Stimulation. A randomized controlled study. Eur J Phys Rehabil Med 2013;49:205–11.

Subject Background:

  • The study focused on patients with mild to moderate carpal tunnel syndrome (CTS), a condition characterized by compression of the median nerve at the wrist.
  • The aim was to compare the effectiveness of two treatments: high-intensity LASER therapy and transcutaneous electrical nerve stimulation (TENS).
  • Twenty symptomatic CTS patients participated in the study.

Treatment Groups:

  • They received either:
    1. TENS: Transcutaneous electrical nerve stimulation (100 Hz, 30 minutes) with rectangular waves (80 ms width) and intensity below muscle contraction.
    2. LASER: Combined 830-1064 nm LASER therapy delivered to the skin overlying the course of the median nerve at the wrist

Parameters of LASER Used:

  • The LASER combined wavelengths of 830 nm and 1064 nm (radiating dose: 250 J cm-2) for 100 seconds at 25 W (18 W [1064 nm] + 7 W [830 nm]) via a fiber-optic probe with a spot size of approximately 1 cm².
  • These wavelengths were chosen because they produce better transparency with less scattering and high energy transfer.

Results of the study:

  • Both LASER and TENS led to clinical improvement.
  • However, LASER was more effective in:
    • Reducing pain and paraesthesia (abnormal sensations).
    • Modifying neurophysiological parameters related to the median nerve.
  • TENS, on the other hand, showed limited improvement and was statistically insignificant.

Knee

Kheshie AR, Alayat MSM, Ali MM. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci. 2014;29(4):1371–6. doi: 10.1007/s10103-014-1529-0.

Subject Background:

  • The study included 53 male patients with a mean age of 54.6 years who had knee osteoarthritis.
  • KOA is a common musculoskeletal joint disease characterized by degeneration of articular cartilage, bony overgrowth, and joint-related symptoms.

Treatment Groups:

  1. High-Intensity Laser Therapy (HILT) + Exercise (HILT+EX):
    • Patients received high-intensity laser therapy (HILT) combined with exercise.
    • The HILT was delivered using a pulsed Nd:YAG laser (produced by the HIRO 3 device).
  2. Low-Level Laser Therapy (LLLT) + Exercise (LLLT+EX):
    • Patients received low-level laser therapy (LLLT) combined with exercise.
  3. Placebo Laser + Exercise (PL+EX):
    • This group received placebo laser treatment (no therapeutic effect) combined with exercise.

Parameters of Laser Used:

  • HILT: Pulsed Nd:YAG laser (produced by the HIRO 3 device).
  • LLLT: Low-level laser therapy.

Results of the study:

  • Both HILT and LLLT combined with exercise were effective in decreasing pain levels (measured by visual analog scale, VAS) and improving knee function (measured by Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) after 6 weeks of treatment.
  • HILT combined with exercises was more effective than LLLT combined with exercises.
  • Both laser therapy modalities were better than exercises alone in treating patients with KOA.

Ankle

Ordahan B, Karahan AY, Kaydok E. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci. 2018;33(6):1363–9. doi: 10.1007/s10103-018-2497-6.

Subject Background:

  • The study included 70 patients (35 in each group) with a mean age of approximately 48.7 years.
  • Plantar fasciitis (PF) is the most common cause of heel pain in adults.
  • Risk factors for PF include middle age, obesity, excessive foot pronation, pes cavus, excessive running, pes planus, and prolonged standing.

Treatment Groups:

  1. High-Intensity Laser Therapy (HILT) Group:
    • Patients received high-intensity laser therapy (HILT) using a 1064 nm laser.
    • HILT was performed three times per week over a period of 3 weeks.
    • Each treatment was combined with a silicone insole and stretching exercises.
  2. Low-Level Laser Therapy (LLLT) Group:
    • Patients received low-level laser therapy (LLLT) using a 904 nm laser.
    • LLLT was also performed three times per week over 3 weeks, combined with the same interventions as the HILT group.

Parameters of Laser Used:

  • HILT: 1064 nm laser.
  • LLLT: 904 nm laser.

Results of the study:

Osteoporosis

Alayat MSM, Abdel-Kafy EM, Elsoudany AM, Helal OF, Alshehri MA. Efficacy of high intensity laser therapy in the treatment of male with osteopenia or osteoporosis: a randomized placebo-controlled trial. J Phys Ther Sci. 2017;29(9):1675–9. doi: 10.1589/jpts.29.1675

Subject Background:

  • The study focused on male patients with osteopenia or osteoporosis.
  • Osteopenia and osteoporosis are conditions characterized by reduced bone density, making bones more susceptible to fractures.

Treatment Groups:

  • The study included a randomized placebo-controlled trial.
  • Two treatment groups were compared:
    1. High-Intensity Laser Therapy (HILT) Group:
      • Patients received high-intensity laser therapy (HILT).
      • The laser used was a pulsed Nd:YAG laser.
      • HILT was combined with exercise.
    2. Placebo Group:
      • This group received placebo treatment (no therapeutic effect).
      • Placebo treatment was also combined with exercise.

Parameters of Laser Used:

  • HILT: Pulsed Nd:YAG laser.

Results of the study:

  • The study found that the combination of laser therapy (HILT) with exercises had a significant effect in reducing pain and improving quality of life in male patients with osteopenia or osteoporosis.
  • HILT was more effective than placebo treatment combined with exercises.

Wound healing

Ebid AA, Ibrahim AR, Omar MT, El Baky AM. Long-term effects of pulsed high-intensity laser therapy in the treatment of post-burn pruritus: a double-blind, placebo-controlled, randomized study. Lasers Med Sci. 2017;32(3):693–701. doi: 10.1007/s10103-017-2172-3.

Subject Background:

  • The study focused on patients experiencing post-burn pruritus (itching) after burn injuries.
  • Post-burn pruritus can significantly affect a patient’s quality of life and daily functioning.

Treatment Groups:

  • The study included a randomized, double-blind, placebo-controlled trial.
  • Two treatment groups were compared:
    1. HILT Group:
      • Patients received pulsed Nd:YAG laser treatment produced by a HIRO 3 device (ASA Laser, Arcugnano, Italy).
      • HILT was combined with a routine physical therapy program (RPTP).
    2. Placebo Group:
      • This group received placebo laser treatment (no therapeutic effect) along with the same RPTP.

Results of the study:

Summary of parameter used

GroupsAuthorsWavelength (nm)Energy Density (J/cm 2 )Power Average (W)Continouos/PulseFrequency (Hz)Time Per Point (s)Location of IrradiationNumber of Treatments
HILT or HILT + ExecciseSantamato et al (2009)3110640.510, 0.610, 0.7106Pulse–0.150Upper trapezius, deltoid and pectoralis minor10
Fiore et al (2011)3210640.766Pulse–30On lumbar, dorsal musclesOn trigger point until the pain was 70-80% reduction
Casale et al (2013)33830, 10340.25025––100The skin over median nerve to wrist21
Kheshie et al (2014)121064Point 1=0.710- 0.810,Point 2=0.610–Pulse–14All aspects of the knee joint. The joint line between the tibial and femoral epicondyles12
Dundar et al (2014)3410640.360–1.7803Pulse10–40Point 1: 30
Point 2:6
Point 3:60On trigger point15
Kim et al (2015)411064––Pulse30 Hz
20-2530
5Anterior and posterior joint line of the shoulder9
Alayat et al (2016)3510640.510–0.17803000Pulse10–4014Trapezius and sternocleidomastoid muscles, and posterior and lateral shoulder areas–
Salli et al (2016)36–Phase 1: 6Phase 2: 100-15046––Painful areas in circular motion from the center to the outside10
Alayat et al (2017)431,0640.510–1.78010.5Pulse10–30–Lower back, proximal thigh36
Ordahan et al (2018)131064Phase 1: 6Phase 2: 0.120 -0.15086––7530Plantar fascia area9
Taradaj et al (2018)141,0646010––480Area 3 cm lateral to L5-S1 on the lower back.15
HILT+ other interventionsEbid et al (2015)381064 nm0.510–1.7803000Pulse10–4014Total 16 points (6 points in the breast, 5 points in the axilla, and 5 points in the arm)12
El-Shamy et al (2016)39–0.610_0.810–Pulse–14The knee joint line between the tibial and femoral epicondyles, in the anterior, medial, and lateral, 10 points36
Choi et al (2017)161.378––––L1–L5 and S112
Ebid et al (2017)4010640.510–1.7803000Pulse10–401416 points of the forearm and hand18
Haładaj et al (2017)1798050.6Pulse25–C4 to T410
Chen et al (2017)1810640.15012Continuous–10Pain points between rib inferior margin and posterior superior iliac spine10
El-Shamy et al (2018)4210640.510–1.78010.5Pulse10–3014All aspects of the knee joint, the joint line between the tibial and femoral epicondyles12
Kolu et al (2018)19–1210Pulse25 Hz6Lumbar region10

Conclusion

  • High power laser is effective in treating wide range of musculoskeletal conditions, however, no study with high level of evidence proved its positive effect on hip pain.
  • The mechanism of high power laser is confirmed and mentioned in previous paragraph
  • However, the parameter used varies greatly across different studies, no golden standard or protocol of parameter used is determined.
    • The generalized parameters are as follow:
      • Patients were monitored over a long period of time (up to 3 months);
      • Higher amounts of energy were used with the average power of 3 and 25 W;
      • The patients most commonly did not use other interventions with laser therapy;
      • Most research use pulsed mode (averagely 10-30Hz) and 1064nm laser as treatment parameter;
      • The laser therapy pulsed for at least ten sessions
  • High power laser is a more effective treatment when combined with exercise therapy.
  • High power laser is significantly more effective than traditional physiotherapy equipment, including TENS, ultrasound, low level grade laser, etc.
  • Same as low level grade laser, high power laser is also beneficial to wound healing.