Open access peer-reviewed chapter

Managing Pain with Laser Acupuncture

Written By

Szu-Ying Wu, Chun-En Kuo, Yu-Chiang Hung and Wen-Long Hu

Submitted: 24 February 2016 Reviewed: 04 March 2016 Published: 25 May 2016

DOI: 10.5772/62863

From the Edited Volume

Pain Management

Edited by Milica Prostran

Chapter metrics overview

2,292 Chapter Downloads

View Full Metrics

Abstract

According to the theory of traditional Chinese medicine, Qi flows through the body along specific paths known as meridians. Any disturbance in Qi evokes a Ying−Yang imbalance in the body, and consequently leads to disease. Pain results from blood stasis and Qi stagnation. Laser acupuncture (LA), first introduced clinically in the 1970s, combines the advantages of traditional acupuncture and modern laser medicine and has been applied for the treatment of various diseases. Here, we investigated studies on the use of LA for pain management according to current evidence. Articles including English keywords related to the use of LA for pain, published between January 2006 and August 2015 were sourced from PubMed, Medline, and Cochrane Library databases. On the basis of these papers, we explored the modern applications, mechanisms, and analgesic effects of LA. LA integrates the positive effects of acupuncture and low-level laser therapy, and is therefore effective in activating blood and in moving Qi. LA relieves pain through both anti-inflammatory and analgesic effects. No adverse effects or complications resulting from LA were reported in the literature. In the hands of an experienced physician, LA can be a useful and safe method for pain management.

Keywords

  • laser acupuncture
  • low-level laser therapy
  • acupuncture
  • pain
  • traditional Chinese medicine

1. Introduction

Although written accounts of acupuncture date back over 2000 years, archaeological evidence suggests more than 3000 years of practice. According to the principles of traditional Chinese medicine (TCM), energy (or Qi) flows through the body along specific paths known as meridians. Balanced Qi contributes to the maintenance of good health. On the other hand, any disturbance in Qi results in an energy imbalance in the body. This imbalance, either an excess or a deficiency, may then result in disease [1]. Both blood stasis and Qi stagnation will lead to pain [2]. In 1996, the World Health Organization (WHO) confirmed 64 indications for acupuncture treatment. Acupuncture treats the underlying diseases by stimulating specific acupuncture points along the meridians. Acupuncture is one of the most common types of alternative treatments for patients who suffer from long-term pain. Moreover, it is a relatively safe procedure with minimal adverse effects [3]. Even though acupuncture has been proven to be effective for many therapeutic applications, metal needling is not widely accepted owing to fear of possible contamination or transcutaneous lesions [4]. Consequently, following the theory of TCM, the use of low-level laser on acupuncture points has been developed as a new therapeutic approach called laser acupuncture (LA) [5, 6].

LA was first introduced clinically in the 1970s [7]. It has been widely studied over several years to turn it into an evidence-based clinical practice. The use of low-intensity and nonthermal laser irradiation stimulation of acupuncture points is an effective alternative to traditional metal needling; it is a safe technique because it is noninvasive and is acceptable to needle-phobic persons. Thus, LA can be used at acupuncture points that require complicated applications of needles [1, 8]. The laser beam is an electromagnetic wave and can stimulate acupuncture points in the human body by depositing energy without causing heating. In contrast to needling, acupuncture points irradiated by a laser beam need to receive sufficient energy to induce a physiological effect at the cellular level based on the principle of “photobiomodulation.” The beam excites the relevant channels and activities, regulates the function of organs, and promotes metabolism. Recently, several papers have reported that the decisive factor in the efficacy of LA is the applied dosage [5, 911].

Although the mechanisms underlying LA are not well understood, LA is widely applied clinically. LA is also referred to as low-level laser therapy (LLLT), with 0.1–0.5 J/cm2 deposited per acupuncture point, or 1–4 J/cm2 per Ashi point [12]. LLLT has an anti-inflammatory function because it can reduce the levels of certain biochemical factors (prostaglandin E2, messenger ribonucleic acid cyclooxygenase-2, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α), neutrophil influx, oxidative stress, edema, and hemorrhaging [13]. Analgesia induced by laser phototherapy is mediated by peripheral opioid receptors [14]. Nevertheless, LA has both local and distant analgesic effects, which may be mediated by different mechanisms. LA combines the advantages of traditional metal-needle acupuncture and LLLT. This chapter on managing pain by LA focuses on how LA may be an alternative method of relieving pain and improving functional outcomes.

Advertisement

2. Review of the clinical literature

Clinical literature in electronic databases—PubMed, Medline, and Cochrane library—was surveyed using the terms “laser acupuncture”, “low level laser therapy”, and “pain”, published from January 2006 to August 2015. All papers had to meet the following criteria: randomized controlled trials (RCTs) that considered a control group (either placebo, sham LA, nonstandard traditional acupuncture, or other therapeutic equipment) and retrospective/prospective clinical studies in which LA/LLLT was used. Studies cited in review articles were also included. Papers published in languages other than English were excluded. Conference abstracts, single-case studies, and paper for which full text was not available were also excluded.

Among the reviewed literature, most studies targeted myofascial pain, fibromyalgia, tendinopathy, radiculopathy, osteoarthritis (OA), low back pain, temporomandibular joint dysfunction (TMD), and headache. These are discussed below.

2.1. Myofascial pain

Kiralp et al. [15] reported a RCT in which 43 patients with myofascial pain were enrolled, and showed the positive effect of LA as compared to prilocaine injection. Eight other RCTs also showed the pain-relieving effect of LA; some of these focused on myofascial pain over the cervical region [16, 17], masseter [18], masticatory muscles [19, 20], trapezius [21, 22], or trigger points [23]. The consistency of these trials highlighted the efficacy of LA in the treatment of myofascial pain.

2.2. Fibromyalgia

Two RCTs showed different results for LA treatment of fibromyalgia [24, 25]. Both of these studies obtained subjective pain presentation using a visual analog scale (VAS), the Fibromyalgia Impact Questionnaire (FIQ), and other measures. Armagan et al. [24] reported positive results of LA for treating the pain of fibromyalgia. The difference between these studies was the dose and power density. Armagan et al. set the parameters of LA to 830 nm, 2 J/point, and 50 mW. These results suggested that the treatment effect of LA was inconclusive in fibromyalgia or that the power density used should be sufficiently high to manage the pain in this disease group.

2.3. Tendinopathy

Two RCTs showed positive results of LA in pain management of lateral epicondylitis (LE) [26, 27], also known as tennis elbow. Emanet et al. [27] reported that even though LA had no short-term advantage over the placebo in patients with LE, there was a significant long-term improvement, especially in functional parameters. Another RCT reported that LA had a treatment effect equal to that of ultrasound [28]. Moreover, a systemic review revealed that applying LLLT to myofascial trigger points of LE patients was an effective treatment for pain reduction and also led to increase in grip force, range of motion (ROM), and weight test [9]. As for tendomyopathy of the masticatory musculature, the pilot study showed inconclusive results because there were few participants [19].

2.4. Radiculopathy

Konstantinovic et al. [29] performed an RCT that enrolled 60 patients with acute neck pain with cervical radiculopathy. After a 3-week LA treatment, VAS, neck movement, neck disability index, and quality of life indicated the positive effect of LA. Radiculopathy of other spinal segments was not reported.

2.5. Osteoarthritis

Among the four RCTs on the use of LA in treating the pain of knee OA, two showed a positive result [30, 31], one was inconclusive [32], and the other one reported efficacy after 2 weeks of treatment but not at the 4-week assessment [33]. However, the RCT showed the inconclusive result for only one point, ST35. An inappropriate dose or insufficient irradiation at a point may be the reason for the poor treatment effect.

2.6. Low back pain

Glazov et al. [34] had reported negative result for the use of LA to relieve low back pain in their study, in which LA was applied to local points of three meridians (Bladder, Gallbladder, and Governor vessel) and Ashi points. Subsequently, Glazov [35] reported another RCT, in which 100 patients with low back pain were enrolled, and found a positive result for pain management with LA. However, the parameter settings used for the second RCT were not described. Therefore, we were not able to determine the differences that contributed to the successful treatment. Nevertheless, further two RCTs showed a positive response for low back pain treated with LA [36, 37].

2.7 Temporomandibular joint disorder

In our literature search, all four RCTs suggested a positive treatment effect for LA in treating the pain associated with TMD [4, 3840]. Occlusal splinting is the nonsurgical standard treatment for this condition in dental clinics. In two RCTs, LA was found to be as effective as occlusal splinting in relieving TMD-associated pain [39, 40]. LA could be an alternative treatment choice to occlusal splinting. Sattayut and Bradley [41] compared low- and high-grade LA and found that high-grade LA, i.e., 820 nm, 107 J/cm2, and 300 mW, showed a superior treatment effect. More recently, Hu et al. [42] clearly showed the therapeutic effects of LA in managing treatment-resistant TMD. In our literature review, another two clinical trials revealed the benefit of LA therapy for TMD patients [43, 44].

2.8. Headache

Gottschling et al. [45] reported an RCT in which LA was used to treat headache in children and showed a decrease in the VAS score and monthly hours with headache. Interestingly, the treatment in this study consisted of only four treatment episodes, at a frequency of once a week, yet the improvement of symptoms was excellent. This study also focused on the meridian-based selection of irradiation points. The basic points for patients with frontal headache were LI4 and ST36; for lateral pain, they were TE6 and GB34; for occipital pain, they were SI3 and BL60, and for holocephalic pain, it was GV20. Additional body acupuncture points and ear acupuncture points were chosen individually. The combination of TCM meridian theory with LA energy treatment seemed to provide a better effect than simply irradiating the tender points.

2.9. Others

Chow et al. [17] reported that chronic neck pain of any etiology could be treated successfully with a program of 14 LA treatments over a period of 7 weeks. Ip and Fu [46] reported a prospective cohort study that proved the treatment efficacy of LA in painful adhesive capsulitis of the shoulder.

Advertisement

3. Conclusions

We have presented evidence supporting the use of LA in the management for various types of pain (Table 1). LA is a noninvasive technique involving the stimulation of traditional acupuncture points with low-intensity laser irradiation. LA has the advantages of being painless and safe as no heat is generated during the procedure, and it is more effective in some medical conditions and requires less time than needle-based acupuncture [47]. No adverse effects or complications resulting from LA have been reported in any study to date. The effectiveness of LA in managing pain depends on the selection of appropriate points and frequencies. Insufficient energy and very few therapeutic sessions will result in ineffective therapy. In conclusion, LA combines the positive effects of traditional Chinese acupuncture and LLLT, and is therefore effective in both activating blood and moving Qi. LA relieves pain through both anti-inflammatory and analgesic effects. As experienced physicians, we should optimize laser parameters, treatment intervals, and long-term follow-up for LA therapy.

Study Study design Subjects  Diagnosis Control Intervention
time
Wavelength Dose Power Irradiation time (s) Acupoints Outcome measure Results
Kiralp et al. [15] RCT 43 Myofascial pain syndrome Prilocaine injection 4 weeks (12 sessions) 180 Trigger points in the neck,
shoulder, and back muscles
VAS, VPS, pressure pain threshold
by pressure algometer
Positive in pressure
algometer
Chow et al. [17] RCT 90 Chronic neck pain Placebo 7 weeks
(14 sessions)
830 nm 0.67 W/cm2 300 mW 30 Tender
points
VAS Positive
Armagan et al. [24] RCT 32 Fibromyalgia Placebo 2 weeks (10 sessions) 830 nm 2 J/point 50 mW 60 Tender points NTP, FIQ,
morning
stiffness,
VSGI, and total myalgia score
Positive
Yurtkuran et al. [30] RCT 52 Knee OA Placebo 2 weeks (10 sessions) 904 nm 0.48 J 10 mW 120 SP9 VAS, 50-foot walking time,
KC, MTS, WOMAC, NHP
Improvement in KC
Mazzetto et al. [38] RCT 48 TMD Placebo 4 weeks (8 sessions) 708 nm 89.7 J/cm2 70 mW 10 One point inside the
external auditive duct
VAS Positive
Matsutani et al. [25] RCT 20 Fibromyalgia Stretching
plus LLLT
versus no
laser
End of intervention 830 nm 3 J/cm2 30 mW VAS, dolorimetry at
tender points, FIQ, SF-36
Negative
Lam and Cheing [26] RCT 39 Lateral
epicondylitis
Placebo 3 weeks (9 sessions) 904 nm 2.4 J/cm2 25 mW 11 Tender points VAS, DASH
questionnaire
Positive
Dundar et al. [16] RCT 64 Cervical
Myofascial pain
Placebo 3 weeks (15 sessions) 830 nm 7 J/point 58 mW 120 Trigger points VAS, ROM,
neck disability index
Positive
Shen et al. [31] RCT 48 Knee OA Combined
laser versus red light
3 times/week for
2 weeks then 2 times/week for 4 weeks
650 nm semiconductor
laser plus 10.6 μm CO2 laser
ST35 WOMAC Positive but
in-conclusive difference
Gottschling et al. [45] RCT 43 Headache in
children
Placebo 4 weeks (4 sessions) 830 nm 0.9 J/point 30 mW 30 LI4, ST36; TE6,
GB34; SI3, BL60; GV20
VAS; monthly
hours with headache
Positive
Shirani et al. [20] RCT 16 Myofascial pain
of masticatory
system
Placebo 3 weeks (6 sessions) 660 nm; 890 nm 6.2 J/cm2; 1 J/cm2 17.3mW; 9.8 W 180; 600 Tender points VAS Positive
Shen et al. [32] RCT 40 Knee OA Placebo 4 weeks (12 sessions) 650 nm semiconductor
laser plus 10.6 μm CO2 laser
36 mW; 200 mW 1200 ST35 WOMAC In-conclusive
Glazov et al. [34] RCT 100 Chronic non-specific
low back pain
Placebo 5–10 sessions 830 nm 0.2 J/point 10 mW 20 Points on BL, GB,
GV meridians; Ashi points
VAS; ODI;
DASS-21; PWI-A
Negative
Carrasco et al. [23] RCT 60 Myofascial pain Placebo 4 weeks (8 sessions) 780 nm 25, 60 and 105 J/cm2 Trigger point Positive
Zhao et al. [33] RCT 40 Knee OA Non-acupoint sham control 4 weeks (12 sessions) 650 nm semiconductor
laser plus
10.6 μm CO2 laser
650 nm laser energy of
43.2 J ; 10.6 μm
laser energy of 120 J
36 mW; 200 mW 1200 ST35 WOMAC Positive after 2 weeks
treatment, but not at 4 weeks
Öz et al. [39] RCT 40 Myofascial
pain due to TMD
occlusal splint 5 weeks (10 sessions) 820 nm 3 J/cm2 300 mW VAS As effective
Katsoulis et al. [19] Pilot study 11 Tendomyopathy of
masticatory musculature
Placebo 3 weeks (6 sessions) 690 nm 40-60 J 40 mW 900 ST6, SI18, SI3, LI4 VAS In-conclusive
Glazov [35] RCT 100 Low back pain Placebo 5–10 sessions VAS Positive
Hotta et al. [43] Clinical trial 10 TMD No treatment 10 weeks (10 sessions) 780 nm 35 J/cm2 70 mW 20 LI4, HT3, ST6, ST7 EMG, VAS Positive
Konstantinovic
et al. [29]
RCT 60 Acute neck pain
with cervical radiculopathy
Placebo 3 weeks (15 sessions) 905 nm 2 J/cm2 12 mW/cm2 120 Lateral to spinous
process and the two next spinal segment
VAS, neck movement,
neck disability index, quality of life
Positive
Lee and Han [21] RCT 24 Myofascial trigger
point pain
Placebo End of intervention 830 nm 386, 771, 1929 J/cm2 450 mW 1, 2, 5 min Trigger points PPT Positive in 5 min
Emanet et al. [27] RCT 50 Lateral epicondylitis Placebo 3 weeks (15 sessions) 905 nm 1 J/cm2 120 Two most sensitive points
around the lateral epicondyle
VAS, tenderness, DASH questionnaire,
PRTEE test, pain-free grip strength, NHP questionnaire
Positive in long-term
evaluation (12 weeks)
Skorupska et al. [28] RCT 80 Tennis elbow Ultrasound 10 days with a weekend
break (10 sessions)
820 ± 10 nm 1; 5 J/cm2 400 mW Trigger points Algometer, VAS, DASH
questionnaire, and hand grip strength
Equally effective
Kannan [22] RCT 45 Myofascial pain
of upper trapezius
ultrasound ;
ischemic compression
5 days (5 sessions) 904 nm 74 mJ/cm2 30 Trigger points VAS, provocative pain test,
active lateral bending of the cervical spine
Positive
Sattayut and Bradley [41] RCT 30 Temporomandibular
joint disorder
Low-energy-density
laser versus high-energy versus placebo
1 week (3 sessions) 820 nm 21.4, 107 J/cm2 60 mW; 300 mW 3 points around TMJ;
3 most tender trigger points
PPT, MOSP,
SSI, EMG
Positive in
higher energy group
Lin et al. [36] RCT 60 Low back pain Placebo 5 days (5 sessions) 808 nm 15 J/cm2 40 mW 600 BL40; Ashi
acupoints
VAS, Ryodoraku Positive
Ferreira et al. [4] RCT 40 TMD Placebo 3 months
(12 sessions)
780 nm 112.5 J/cm2 50 mW 90 ST6, SI19, GB20,
GB43, LI4, LR3, NT3, EX-HN3
VAS Positive
Uemoto et al. [18] RCT 21 Myofascial pain
syndrome of masseter muscle
Anesthetic injection,
dry needling, placebo
8 days (4 sessions) 795 nm Right: 4 J/cm2; Left: 8 J/cm2 80 mW Trigger points Surface EMG,
mouth opening, VAS
Positive
Huang et al. [44] Clinical trial 20 TMD Placebo Once a week till symptom
relief or 3 weeks of no improvement
800 nm 100.5 J/cm2 0.75 W/cm2 134 ST6, ST7, LI4 and
one local Ashi point
VAS Positive
Demirkol et al. [40] RCT 30 Myofascial pain
due to TMD
occlusal splint; placebo 10 days (10 sessions) 1064 nm 8 J/cm2 250 mW 20 Trigger points VAS As effective
as occlusal splint
Hu et al. [42] Clinical trial 29 Treatment-resistant TMD 4 weeks (12 sessions) 810 nm 7.5–26.25 J/cm2 5 W/cm2 5 sec (acupoint);
40 sec (Ashi point)
ST7, ST6, LI4
and Ashi point
VAS, MMO Positive
Shin et al. [37] RCT 56 Low back pain Sham laser 1 week (3 sessions) 660 nm 50 mW 180 GV3, GV4, GV5, BL23,
BL24, BL25, BL40, GB30
VAS, PPT,
PGIC, EQ-5D
Positive
Ip and Fu [46] Prospective cohort study 50 Painful adhesive
capsulitis of
shoulder
8 week (24 sessions) 810 nm 5.4 J/point 20 mW/cm2 20–30 6 anatomic
points; SI11, SI12
Constant
Murley shoulder score
Positive

Table 1.

Summary of clinical studies into pain management with laser acupuncture.

Advertisement

Abbreviations

DASH disabilities of the arm, shoulder and hand

DASS-21 Depression Anxiety Stress Scale

EMG electromyography

EQ-5D Euro-Quality-of-Life Five Dimensions questionnaire

FIQ Fibromyalgia Impact Questionnaire

FIQ Fibromyalgia Impact Questionnaire

KC knee circumference

LA laser acupuncture

LE lateral epicondylitis

LLLT low-level laser therapy

MOSP maximum mouth opening (MMO) without pain

MTS medial tenderness score

NHP Nottingham Health Profile

NTP number of tender points

OA osteoarthritis

ODI Oswestry Disability Index

PGIC Patient Global Impression of Change

PPT pressure pain threshold

PRTEE Patient-Related Lateral Epicondylitis Evaluation

PWI-A Personal Wellbeing Index

RCT randomized controlled trial

ROM active range of motion

SF-36 36-item Short-Form Health Survey

SSI symptom severity index

TCM traditional Chinese medicine

TMD temporomandibular joint (TMJ) disorder

VAS visual analogue scale

VPS verbal pain scale

VSGI global improvement on a verbal scale

WHO World Health Organization

WOMAC Western Ontario and McMaster Universities osteoarthritis index

References

  1. 1. Whittaker P. Laser acupuncture: past, present, and future. Lasers in Medical Science. 2004;19(2):69–80.
  2. 2. Bing Z, Hongcai W. Diagnostics of traditional Chinese medicine. 1st ed. London and Philadelphia: Singing Dragon; 2010. 224 p.
  3. 3. Rickards LD. Therapeutic needling in osteopathic practice: An evidence-informed perspective. International Journal of Osteopathic Medicine. 2009;12(1):2–13.
  4. 4. Ferreira LA, de Oliveira RG, Guimarães JP, Carvalho ACP, De Paula MVQ. Laser acupuncture in patients with temporomandibular dysfunction: A randomized controlled trial. Lasers in Medical Science. 2013;28(6):1549–1558.
  5. 5. Baxter GD, Bleakley C, McDonough S. Clinical effectiveness of laser acupuncture: A systematic review. Journal of Acupuncture and Meridian Studies. 2008;1(2):65–82.
  6. 6. Round R, Litscher G, Bahr F. Auricular acupuncture with laser. Evidence-Based Complementary and Alternative Medicine. 2013;2013:984763. doi: 10.1155/2013/984763. 22 pages.
  7. 7. Hill S. Letter: Acupuncture research in the USSR. The American Journal of Chinese Medicine. 1976;4(2):204.
  8. 8. Litscher G. High-tech laser acupuncture is Chinese medicine. Medical Acupuncture. 2008;20(4):245–254.
  9. 9. Chang W-D, Wu J-H, Yang W-J, Jiang J-A. Therapeutic effects of low-level laser on lateral epicondylitis from differential interventions of Chinese-Western medicine: Systematic review. Photomedicine and Laser Surgery. 2010;28(3):327–336.
  10. 10. Peplow PV, Chung T-Y, Baxter GD. Laser photobiomodulation of proliferation of cells in culture: A review of human and animal studies. Photomedicine and Laser Surgery. 2010;28(S1):S3–S40.
  11. 11. Litscher G, Opitz G. Technical parameters for laser acupuncture to elicit peripheral and central effects: State-of-the-art and short guidelines based on results from the Medical University of Graz, the German Academy of Acupuncture, and the scientific literature. Evidence-Based Complementary and Alternative Medicine. 2012;2012:697096. doi: 10.1155/2012/697096. 5 pages.
  12. 12. Wen-Long Hu, Yu-Chiang Hung, I-Ling Hung. Explore Laser Acupuncture’s Role. In: Lucy L. Chen, Tsung O. Cheng, editors. Acupuncture in Modern Medicine. 1st ed. Rijeka: InTech; 2013. p. 205-220. ch9.
  13. 13. Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RAB. Low-level laser therapy in acute pain: A systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomedicine and Laser Therapy. 2006;24(2):158–168.
  14. 14. Serra AP, Ashmawi HA. Influence of naloxone and methysergide on the analgesic effects of low-level laser in an experimental pain model. Brazilian Journal of Anesthesiology. 2010;60(3):302–310.
  15. 15. Kiralp MZ, Ari H, Karabekir I, Dursun H. Comparison of low intensity laser therapy and trigger point injection in the management of myofascial pain syndrome. The Pain Clinic. 2006;18(1):63–66.
  16. 16. Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: A double blind, placebo-controlled study. Clinical Rheumatology. 2007;26(6):930–934.
  17. 17. Chow RT, Heller GZ, Barnsley L. The effect of 300mW, 830nm laser on chronic neck pain: A double-blind, randomized, placebo-controlled study. Pain. 2006;124(1):201–210.
  18. 18. Uemoto L, Antonio C Garcia M, Vinicius D Gouvêa C, Vilella OV, Alfaya TA. Laser therapy and needling in myofascial trigger point deactivation. Journal of Oral Science. 2013;55(2):175–181.
  19. 19. Katsoulis J, Ausfeld-Hafter B, Katsoulis K, Blagojevic N, Mericske-Stern R. Laser acupuncture for myofascial pain of the masticatory muscles. A controlled pilot study. Schweiz Monatsschr Zahnmed. 2010;120(3):213-225.
  20. 20. Shirani AM, Gutknecht N, Taghizadeh M, Mir M. Low-level laser therapy and myofacial pain dysfunction syndrome: A randomized controlled clinical trial. Lasers in Medical Science. 2009;24(5):715–720.
  21. 21. Lee JH, Han JT. The dose-dependent effect of an 830-nm, 450-mW low-level laser therapy on the myofacial trigger point of the upper trapezius muscle: A randomized, double-blinded, clinical trial. Journal of Physical Therapy Science. 2011;23(6):933–935.
  22. 22. Kannan P. Management of myofascial pain of upper trapezius: A three group comparison study. Global Journal of Health Science. 2012;4(5): 46-52.
  23. 23. Carrasco TG, Guerisoli LDC, Guerisoli DMZ, Mazzetto MO. Evaluation of low intensity laser therapy in myofascial pain syndrome. CRANIO®. 2009;27(4):243–7.
  24. 24. Armagan O, Tascioglu F, Ekim A, Oner C. Long-term efficacy of low level laser therapy in women with fibromyalgia: A placebo-controlled study. Journal of Back and Musculoskeletal Rehabilitation. 2006;19(4):135–140.
  25. 25. Matsutani L, Marques A, Ferreira E, Assumpção A, Lage L, Casarotto R, et al. Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Clinical and Experimental Rheumatology. 2007;25(3):410–415.
  26. 26. Lam LKY, Cheing GLY. Effects of 904-nm low-level laser therapy in the management of lateral epicondylitis: A randomized controlled trial. Photomedicine and Laser Surgery. 2007;25(2):65–71.
  27. 27. Emanet SK, Altan Lİ, Yurtkuran M. Investigation of the effect of GaAs laser therapy on lateral epicondylitis. Photomedicine and Laser Surgery. 2010;28(3):397–403.
  28. 28. Skorupska E, Lisinski P, Samborski W. The effectiveness of the conservative versus myofascial pain physiotherapy in tennis elbow patients: Double-blind randomized trial of 80 patients. Journal of Musculoskeletal Pain. 2011;20(1):41–50.
  29. 29. Konstantinovic LM, Cutovic MR, Milovanovic AN, Jovic SJ, Dragin AS, Letic MD, et al. Low‐level laser therapy for acute neck pain with radiculopathy: a double‐blind placebo‐controlled randomized study. Pain Medicine. 2010;11(8):1169–1178.
  30. 30. Yurtkuran M, Alp A, Konur S, Özçakir S, Bingol U. Laser acupuncture in knee osteoarthritis: A double-blind, randomized controlled study. Photomedicine and Laser Therapy. 2007;25(1):14–20.
  31. 31. Shen X-Y, Ding G-H, Wu F, Wang L-Z, Zhao L, Wang M, et al. Effects of 650 nm-10.6 μm combined laser acupuncture-moxibustion on knee osteoarthritis: A randomized, double-blinded and placebo-controlled clinical trial. Journal of Acupuncture and Tuina Science. 2008;6:315–317.
  32. 32. Shen X, Zhao L, Ding G, Tan M, Gao J, Wang L, et al. Effect of combined laser acupuncture on knee osteoarthritis: A pilot study. Lasers in Medical Science. 2009;24(2):129–136.
  33. 33. Zhao L, Shen X, Cheng K, Deng H, Ding G, Tan M, et al. Validating a nonacupoint sham control for laser treatment of knee osteoarthritis. Photomedicine and Laser Surgery. 2010;28(3):351–356.
  34. 34. Glazov G, Schattner P, Lopez D, Shandley K. Laser acupuncture for chronic non-specific low back pain: A controlled clinical trial. Acupuncture in Medicine. 2009;27(3):94–100.
  35. 35. Glazov G. The influence of baseline characteristics on response to a laser acupuncture intervention: An exploratory analysis. Acupuncture in Medicine. 2010;28(1):6–11.
  36. 36. Lin M-L, Wu H-C, Hsieh Y-H, Su C-T, Shih Y-S, Lin C-W, et al. Evaluation of the effect of laser acupuncture and cupping with ryodoraku and visual analog scale on low back pain. Evidence-Based Complementary and Alternative Medicine. 2012;2012:521612. doi: 10.1155/2012/521612. 7 pages.
  37. 37. Shin J-Y, Ku B, Kim JU, Lee YJ, Kang JH, Heo H, et al. Short-Term effect of laser acupuncture on lower back pain: A Randomized, Placebo-Controlled, Double-Blind Trial. Evidence-Based Complementary and Alternative Medicine. 2015;2015:808425. doi: 10.1155/2015/808425. 8 pages.
  38. 38. Mazzetto MO, Carrasco TG, Bidinelo EF, de Andrade Pizzo RC, Mazzetto RG. Low intensity laser application in temporomandibular disorders: A phase I double-blind study. CRANIO®. 2007;25(3):186–92.
  39. 39. Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: Low-level laser therapy versus occlusal splints. Journal of Craniofacial Surgery. 2010;21(6):1722–1728.
  40. 40. Demirkol N, Sari F, Bulbul M, Demirkol M, Simsek I, Usumez A. Effectiveness of occlusal splints and low-level laser therapy on myofascial pain. Lasers in Medical Science. 2014;30(3):1007–1012.
  41. 41. Sattayut S, Bradley P. A study of the influence of low intensity laser therapy on painful temporomandibular disorder patients. Laser Therapy. 2012;21(3):183–192.
  42. 42. Hu W-L, Chang C-H, Hung Y-C, Tseng Y-J, Hung I-L, Hsu S-F. Laser acupuncture therapy in patients with treatment-resistant temporomandibular disorders. PLoS One. 2014;9(10):e110528.
  43. 43. Hotta PT, Hotta TH, Bataglion C, Bataglion SA, de Souza Coronatto EA, Siéssere S, et al. Emg analysis after laser acupuncture in patients with temporomandibular dysfunction (TMD). Implications for practice. Complementary Therapies in Clinical Practice. 2010;16(3):158–160.
  44. 44. Huang Y-F, Lin J-C, Yang H-W, Lee Y-H, Yu C-H. Clinical effectiveness of laser acupuncture in the treatment of temporomandibular joint disorder. Journal of the Formosan Medical Association. 2014;113(8):535–539.
  45. 45. Gottschling S, Meyer S, Gribova I, Distler L, Berrang J, Gortner L, et al. Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain. 2008;137(2):405–412.
  46. 46. Ip D, Fu N-Y. Two-year follow-up of low-level laser therapy for elderly with painful adhesive capsulitis of the shoulder. Journal of Pain Research. 2015;8:247–252.
  47. 47. Hu W-L, Chang C-H, Hung Y-C. Clinical observations on laser acupuncture in simple obesity therapy. The American Journal of Chinese Medicine. 2010;38(05):861–867.

Written By

Szu-Ying Wu, Chun-En Kuo, Yu-Chiang Hung and Wen-Long Hu

Submitted: 24 February 2016 Reviewed: 04 March 2016 Published: 25 May 2016