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Medicine » Orthopedics, Physical Medicine and Rehabilitation » "Pain Management", book edited by Milica Prostran, ISBN 978-953-51-2414-6, Print ISBN 978-953-51-2413-9, Published: May 25, 2016 under CC BY 3.0 license. © The Author(s).

Chapter 3

Managing Pain with Laser Acupuncture

By Szu-Ying Wu, Chun-En Kuo, Yu-Chiang Hung and Wen-Long Hu
DOI: 10.5772/62863

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Managing Pain with Laser Acupuncture

Szu-Ying Wu1, Chun-En Kuo1, Yu-Chiang Hung1, 2 and Wen-Long Hu1, 3, 4
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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.

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.

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.

StudyStudy designSubjects DiagnosisControlIntervention
WavelengthDosePowerIrradiation time (s)AcupointsOutcome measureResults
Kiralp et al. [15]RCT43Myofascial pain syndromePrilocaine injection4 weeks (12 sessions)180Trigger points in the neck,
shoulder, and back muscles
VAS, VPS, pressure pain threshold
by pressure algometer
Positive in pressure
Chow et al. [17]RCT90Chronic neck painPlacebo7 weeks
(14 sessions)
830 nm0.67 W/cm2300 mW30Tender
Armagan et al. [24]RCT32FibromyalgiaPlacebo2 weeks (10 sessions)830 nm2 J/point50 mW60Tender pointsNTP, FIQ,
VSGI, and total myalgia score
Yurtkuran et al. [30]RCT52Knee OAPlacebo2 weeks (10 sessions)904 nm0.48 J10 mW120SP9VAS, 50-foot walking time,
Improvement in KC
Mazzetto et al. [38]RCT48TMDPlacebo4 weeks (8 sessions)708 nm89.7 J/cm270 mW10One point inside the
external auditive duct
Matsutani et al. [25]RCT20FibromyalgiaStretching
plus LLLT
versus no
End of intervention830 nm3 J/cm230 mWVAS, dolorimetry at
tender points, FIQ, SF-36
Lam and Cheing [26]RCT39Lateral
Placebo3 weeks (9 sessions)904 nm2.4 J/cm225 mW11Tender pointsVAS, DASH
Dundar et al. [16]RCT64Cervical
Myofascial pain
Placebo3 weeks (15 sessions)830 nm7 J/point58 mW120Trigger pointsVAS, ROM,
neck disability index
Shen et al. [31]RCT48Knee OACombined
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
ST35WOMACPositive but
in-conclusive difference
Gottschling et al. [45]RCT43Headache in
Placebo4 weeks (4 sessions)830 nm0.9 J/point30 mW30LI4, ST36; TE6,
GB34; SI3, BL60; GV20
VAS; monthly
hours with headache
Shirani et al. [20]RCT16Myofascial pain
of masticatory
Placebo3 weeks (6 sessions)660 nm; 890 nm6.2 J/cm2; 1 J/cm217.3mW; 9.8 W180; 600Tender pointsVASPositive
Shen et al. [32]RCT40Knee OAPlacebo4 weeks (12 sessions)650 nm semiconductor
laser plus 10.6 μm CO2 laser
36 mW; 200 mW1200ST35WOMACIn-conclusive
Glazov et al. [34]RCT100Chronic non-specific
low back pain
Placebo5–10 sessions830 nm0.2 J/point10 mW20Points on BL, GB,
GV meridians; Ashi points
Carrasco et al. [23]RCT60Myofascial painPlacebo4 weeks (8 sessions)780 nm25, 60 and 105 J/cm2Trigger pointPositive
Zhao et al. [33]RCT40Knee OANon-acupoint sham control4 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 mW1200ST35WOMACPositive after 2 weeks
treatment, but not at 4 weeks
Öz et al. [39]RCT40Myofascial
pain due to TMD
occlusal splint5 weeks (10 sessions)820 nm3 J/cm2300 mWVASAs effective
Katsoulis et al. [19]Pilot study11Tendomyopathy of
masticatory musculature
Placebo3 weeks (6 sessions)690 nm40-60 J40 mW900ST6, SI18, SI3, LI4VASIn-conclusive
Glazov [35]RCT100Low back painPlacebo5–10 sessionsVASPositive
Hotta et al. [43]Clinical trial10TMDNo treatment10 weeks (10 sessions)780 nm35 J/cm270 mW20LI4, HT3, ST6, ST7EMG, VASPositive
et al. [29]
RCT60Acute neck pain
with cervical radiculopathy
Placebo3 weeks (15 sessions)905 nm2 J/cm212 mW/cm2120Lateral to spinous
process and the two next spinal segment
VAS, neck movement,
neck disability index, quality of life
Lee and Han [21]RCT24Myofascial trigger
point pain
PlaceboEnd of intervention830 nm386, 771, 1929 J/cm2450 mW1, 2, 5 minTrigger pointsPPTPositive in 5 min
Emanet et al. [27]RCT50Lateral epicondylitisPlacebo3 weeks (15 sessions)905 nm1 J/cm2120Two 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]RCT80Tennis elbowUltrasound10 days with a weekend
break (10 sessions)
820 ± 10 nm1; 5 J/cm2400 mWTrigger pointsAlgometer, VAS, DASH
questionnaire, and hand grip strength
Equally effective
Kannan [22]RCT45Myofascial pain
of upper trapezius
ultrasound ;
ischemic compression
5 days (5 sessions)904 nm74 mJ/cm230Trigger pointsVAS, provocative pain test,
active lateral bending of the cervical spine
Sattayut and Bradley [41]RCT30Temporomandibular
joint disorder
laser versus high-energy versus placebo
1 week (3 sessions)820 nm21.4, 107 J/cm260 mW; 300 mW3 points around TMJ;
3 most tender trigger points
Positive in
higher energy group
Lin et al. [36]RCT60Low back painPlacebo5 days (5 sessions)808 nm15 J/cm240 mW600BL40; Ashi
VAS, RyodorakuPositive
Ferreira et al. [4]RCT40TMDPlacebo3 months
(12 sessions)
780 nm112.5 J/cm250 mW90ST6, SI19, GB20,
GB43, LI4, LR3, NT3, EX-HN3
Uemoto et al. [18]RCT21Myofascial pain
syndrome of masseter muscle
Anesthetic injection,
dry needling, placebo
8 days (4 sessions)795 nmRight: 4 J/cm2; Left: 8 J/cm280 mWTrigger pointsSurface EMG,
mouth opening, VAS
Huang et al. [44]Clinical trial20TMDPlaceboOnce a week till symptom
relief or 3 weeks of no improvement
800 nm100.5 J/cm20.75 W/cm2134ST6, ST7, LI4 and
one local Ashi point
Demirkol et al. [40]RCT30Myofascial pain
due to TMD
occlusal splint; placebo10 days (10 sessions)1064 nm8 J/cm2250 mW20Trigger pointsVASAs effective
as occlusal splint
Hu et al. [42]Clinical trial29Treatment-resistant TMD4 weeks (12 sessions)810 nm7.5–26.25 J/cm25 W/cm25 sec (acupoint);
40 sec (Ashi point)
ST7, ST6, LI4
and Ashi point
VAS, MMOPositive
Shin et al. [37]RCT56Low back painSham laser1 week (3 sessions)660 nm50 mW180GV3, GV4, GV5, BL23,
BL24, BL25, BL40, GB30
Ip and Fu [46]Prospective cohort study50Painful adhesive
capsulitis of
8 week (24 sessions)810 nm5.4 J/point20 mW/cm220–306 anatomic
points; SI11, SI12
Murley shoulder score

Table 1.

Summary of clinical studies into pain management with laser acupuncture.

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; KC: knee circumference; MOSP: maximum mouth opening (MMO) without pain; MTS: medial tenderness score; NHP: Nottingham Health Profile; NTP: number of tender points; 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; SF-36: 36-item Short-Form Health Survey; VPS: verbal pain scale; VSGI: global improvement on a verbal scale; WOMAC: Western Ontario and McMaster Universities osteoarthritis index.


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


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