What is Photobiomodulation (PBM)?
Photobiomodulation (PBM), also known as low-level laser therapy (LLLT), is a method of using lasers or LEDs to improve tissue repair and reduce pain and inflammation at the site where the beam is applied. PBM is used to treat specific areas of pain or strain and promotes the healing of muscle and tissue in a targeted fashion.
Red, near-infrared, and class 3B lasers are used to heal muscles, improve joint range of motion, increase analgesic effects on nerves, and help lymph-node stimulation.
PBM has been used for many years on sports injuries, arthritic joints, neuropathic pain syndromes, back and neck pain. Over 700 randomized clinical trials have been published on PBM, half of which are on pain.
How it Works
PBM uses specific wavelengths of red and near-infrared light to penetrate the skin and create a biochemical effect within the cells that increases mitochondrial function. This improves the production of ATP – the source of energy for every cell in the body. As the production of ATP within the cell increases, the cell is better able to repair itself and function more optimally.
There are two mechanisms of action for pain relief:
- Anti-inflammatory. Photobiomodulation reduces oxidative stress1
- Analgesia. PBM creates a nerve block2
What is photobiomodulation used for?
Photobiomodulation, or low level laser therapy, is a safe, drug-free and non-invasive treatment that can be beneficial for:
- Neck pain
- Back pain
- Soft-tissue strains
- Joint conditions
- Tendinopathies
- Neuropathic pain
- Post-operative pain
How is photobiomodulation for back pain specifically used?
A customized protocol of photobiomodulation for back pain is developed based on a patient’s diagnosis, that uses red, near-infrared, and class 3B lasers at specific wavelengths and intensity, for a specific period of time, at specific anatomic locations, to heal strained muscles of the back, reduce muscle spasm, create analgesia (pain relief) at the nerves, promote lymph-node stimulation, reduce inflammation, and improve tissue repair. Laser is also used to deactivate trigger points, instead of needles, in the lumbar and gluteal musculature. In the case of patients suffering from sciatic pain, the laser is used along the sciatic nerve to provide pain relief, reduce inflammation and stimulate healing.
How soon will I get relief from photobiomodulation for back pain?
This can vary per person and per case. Typical low-level light therapy treatments are two times per week on average for a certain number of weeks. Some patients experience relief immediately, after 1 or two treatments, others have meaningful reduction or the resolution of pain after several treatments.
Dr. Panjwani will determine your specific protocol and treatment length at your initial consultation.
Each treatment plan is customized to a patient’s specific needs and is based on established treatment protocols and results from studies and clinical trials.
Can photobiomodulation be paired with other treatment options to help with back pain?
Yes. Photobiomodulation for back pain can be paired or combined with other treatment modalities including physical therapy.
What you can expect with photobiomodulation treatments?
Treatments take about 15 minutes and are painless. You’ll be asked to wear protective glasses and relax.
Depending on the condition, two treatments per week for a few weeks are generally recommended.
Low-Risk Treatment
Photobiomodulation is a low-risk treatment with no reported side effects, though pain may occasionally feel slightly worse for a few hours after treatment.
Note, we do not treat over tumors or tattoos, the eyes, or during pregnancy.
During the lower level laser therapy portion of treatment, you will be asked to wear special safety glasses to protect your eyes.
Can you receive more than one treatment a week? (Safe amount/restrictions)
Yes, one may receive more than one treatment a week. Depending on your case, one to two treatments are recommended per week for a number of weeks. Photobiomodulation is considered a low-risk treatment with no reported side effects. It was discovered in 1967, since then there have been over 700 clinical trials using LED and 3b laser devices, with no significant adverse effects reported.
Class 3b lasers are potentially hazardous to the eye, therefore you will be asked to wear safety eyewear.
Note we do not treat over tumors or tattoos, the eyes, or during pregnancy. We also do not treat those individuals who are photosensitive or have a seizure disorder.
Evidence of Efficacy
Over 700 PBM clinical trials (RCTs) have been published. It has proven to be more effective and safer than pharmaceutical antiinflammatories across a range of musculoskeletal conditions. PBM also improves healing and reduces muscle fatigue and muscle damage
- 2017 – American College of Physicians Guidelines include a “strong recommendation” for Low-Level Laser Therapy as a non-invasive treatment for Acute, Subacute & Chronic Low Back Pain.
- 2016 – British Medical Journal (BMJ) PBM for chronic non-specific low back pain: a systematic review and meta-analysis of randomised controlled trials found “moderate quality of evidence” and “clinically important benefits” in the short term.
- 2011 – British Medical Journal (BMJ) Clinical Guidelines for tennis elbow “Likely to be beneficial for short-term pain relief & improvement of function”.
- 2010 – The International Association for the Study of Pain (Global Task Force on musculoskeletal pain) recommend laser for myofascial pain syndrome.
- 2010 – British Journal of Sports Medicine, systematic review of surgical and conservative interventions for frozen shoulder found “strong evidence” for PBM.
- 2010 – American Physical Therapy Association guidelines recommend PBM for Achilles tendonitis.
- 2009 – The Lancet “PBM reduces pain immediately after treatment in acute neck pain and for up to 22 weeks in patients with chronic neck pain”.
- 2008 – World Health Organisation (Bone and Joint Task Force) recommended PBM for neck pain.
1 When cells are stressed, nitric oxide (NO) inhibits oxygen consumption by mitochondrial cytochrome c oxidase. This reduces production of ATP and causes oxidative stress leading to increased inflammation and reduced production of ATP. PBM displaces NO from cytochrome c oxidase thereby reducing inflammation and restoring ATP production, helping tissues heal more quickly. A cascade of downstream metabolic effects lead to a reduction in inflammatory markers including prostaglandin E2, interleukin 1β and tumor necrosis factor α.
2 Higher irradiance / energy treatments can induce an analgesic effect by disrupting fast axonal transport in small diameter fibres, in particular nociceptors. This temporary (reversible) inhibition of A-delta and C fibre transmission reduces tonic peripheral nociceptive afferent input and facilitates reorganisation of the modulation of synaptic connections. Repeated treatments lead to a reduction in central sensitization.
