Category Archives: Low Level Laser Therapy (LLLT)

External Laser Therapy and Laserneedle Acupuncture for Chronic Pain

Featured Image:   Comb Jelly (Mnemiopsis sp.)

Dear Pain Matters blog readers,

External laser therapy is used to exert various biological/cellular effects in the body including:

  • Stimulation of various acupuncture points (via noninvasive, painless Laserneedle acupuncture); and
  • Treatment of local damaged areas within the tissue.  Local laser therapy may be done for pain management, rehabilitation and regeneration of damaged tissue.

External laser therapy uses various laser wavelengths (i.e. colours) to penetrate different depths and tissues beneath the skin including:

  • Infrared laser (800 – 900 nanometers, ‘nm’; 810 nm, may be used) – 5 to 7 cm depth below the skin;
  • Red laser (630 – 680 nm; 658 nm may be used) – 2 to 3 cm depth below the skin.  Red laser can increase cellular activity and blood circulation as well as stimulate immune cells, fibroblasts and mitochondria, leading to regeneration and improved healing including wound healing;
  • Green laser  (532 nm) – 0.5 to 1 cm depth beneath the skin.  Green light is largely absorbed by haemoglobin in the red blood cells; and
  • Blue laser (405 nm) – 1 to 2 mm depth only.  Blue laser light has anti-inflammatory effects.

External laser therapy can be applied via:

  • Single point lasers.  Only one point and 1 wavelength can be used in single point lasers; or
  • Laserneedles.  Up to 12 multi-channel lasers/points including different wavelengths/colours/power outputs may be used at the same time (e.g. Weberneedle system, Lasershower).

External laser therapy may treat various painful medical conditions including:

  • Spine syndromes/back pain;
  • Osteoarthritis;
  • Rheumatoid diseases;
  • Tendon inflammation;
  • Migraine/headache; and
  • Trigeminal neuralgia

(Michael Weber MD).




A study involving laser acupuncture treatment for fibromyalgia patients reported an average Pain Scale of 4.4, post-laser acupuncture (compared to an average Pain Scale of 8.5, pre-laser acupuncture).

Further improvements occurred when laser acupuncture plus intravenous laser was offered to fibromyalgia patients (i.e. average Pain Scale of 2.9, post-laser acupuncture plus intravenous laser, compared to 8.9, pre-treatment).


  • Laser acupuncture; and
  • Laser acupuncture plus intravenous laser

were more effective for pain management than medication alone (6.8, post-medication, versus 8.7, pre-medication) and metal needle acupuncture (6.0, post-treatment, versus 8.5, pre-treatment) in fibromyalgia patients (Wieden).

(For more on intravenous laser, please refer to:

Possible Mechanisms:

I urge all interested readers to read Chapter 4 called ‘Rewiring a Brain with Light’, in Norman Doidge’s 2nd book, ‘The Brain’s Way of Healing’.  This book provides an excellent introduction into phototherapy (i.e. low level laser therapy; LLLT) (Doidge, 2016).  

Scientists have recently shown that humans (including the human eye and brain) may detect and perceive a single photon (Tinsley et al, 2016).  This is very interesting as it shows the sensitivity of the human body to the biological (hence potential healing) effects of natural light including its visible wavelengths from 400 to 700 nm (blue to red) and invisible wavelengths from 800 to 900 nm (near infrared).


Whilst relatively new (and undergoing further research), external laser therapy and Laserneedle acupuncture may be useful for reducing pain in many chronic pain conditions including fibromyalgia.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.


(1A) Michael Weber MD

Laser in Pain Therapy and Rehabilitation

(1B) Michael Weber MD, Robert Weber, Martin Junggebauer

Medical Low Level Laser Therapy – Foundations and Clinical Applications (2nd Edition, June 2015)

(1C) Michael Weber MD, President of International Society for Medical Laser Applications (ISLA)

International Society for Medical Laser Applications (ISLA)

(1D) Michael Weber MD, Thomas Fussgänger-May MD, Tillman Wolf MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

(1E) Michael Weber MD, Zulia Frost MD

Multi-Laser Needle Acupuncture and Laser Blood Irradiation Therapy – Clinical Application of Biological Laser Therapy (Pages 1-50)

Other Papers, Articles and a Blog by Fred Kahn, MD FRCS(C):

(2) Wieden, Torsten E. (MD Anaesthesiologist, Special pain therapy)


Fibromyalgia in Pain Therapy – Mechanisms and Treatment Options in Laser Therapy

(3) Pryor, Brian A

Class IV Laser Therapy – Interventional and Case Reports Confirm Positive Therapeutic Outcomes in Multiple Clinical Indications (2009)

(4) Class IV Laser Therapy – Case Study Reports (Pages 1-39)

(5) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture Using Laser Needles Modulates Brain Function: First Evidence From Functional Transcranial Doppler Sonography and Functional Magnetic Resonance Imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

(6) Norman Doidge MD

The Brain’s Way of Healing – Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (Chapter 4 – Rewiring a Brain with Light)

Publisher: Penguin Publishing Group (26 January 2016)

ISBN: 9780143128373

(7) Blog by Fred Kahn, MD FRCS(C), LLLT Specialist

(8) Tinsley JN et al

Direct detection of a single photon by humans.

Nat. Commun. 7:12172

doi: 10.1038/ncomms12172 (2016).



Migraines and Low Level Laser Therapy (LLLT) – More Case Studies

Dear Pain Matters blog readers,

Despite being common, migraines are often difficult to manage as their underlying reasons are frequently unknown.

Low level laser therapy (LLLT; also known as cold laser therapy) may alleviate some migraines in certain cases.

Case Studies by Lee et al:

(1) A study involving 32 chronic migraine patients (10 males, 22 females; mean age 44.1, aged 21 to 67) was performed.  Most patients had unpleasant pressure and/or pulsating pain as well as tender areas and/or swelling around the head and in the frontal and temporal areas.

Clinical histories that (likely) caused migraines included motor vehicle accidents, sports and other injuries (e.g. falls) and trauma (e.g. birth trauma).  Injuries included muscle-tendon tears and ligament insertion injuries (i.e. possible tearing of Sharpey’s fibres at the periosteal-osseous junctions) in the head and neck areas.

Painless low level laser therapy (LLLT; near infrared 830 nm wavelength) was directly applied to injury/trauma-affected anatomical sites in the head/neck regions (30 to 100 mW, 1 – 2 minutes per damaged region).

All patients benefited from LLLT treatment including significantly reduced pain in some patients and complete elimination of pain and tenderness in other patients.  Decreased edema and relaxed muscles resulted at the tender sites within 1-5 minutes following LLLT treatment.

Low level laser therapy (LLLT) treatment resulted in nil adverse effects including no toxicity (Lee et al).

(2) An earlier study with 9 female migraineurs (mean age 49.4, aged 41 to 60) reported similarly impressive results.  Specifically, overall mean pain scores reduced from 7.2 to 4.3 following LLLT treatment for 10 minutes maximum to the frontal, temporal and/or occipital areas.  Three (3) of 9 patients enjoyed nil migraine pain, post-LLLT.

No side effects were reported (Lee et al).

NB It is not known how long the pain relief lasted, post-LLLT treatment, as this was not reported in these 2 studies.


Targeted low level laser therapy (LLLT; 830 nm wavelength) may offer effective and safe pain relief from migraines.

Sabina Walker

“Sedare dolorem divinum opus est”

“It is divine to alleviate pain”

Galen, 130-200 C.E.


(1A) Lee, Garrett; Wong, Edmund; Choy, Norman; Mason, Dean T

Safety and Efficacy of Treatment of Common Migrainous Headaches Applying the Low Power Laser by the Principles and Methods of Wong

San Francisco, CA

(1B) Seymore, Brian L; Cappelletti, Ryan J

A Brief Synopsis of the Research on Cold Laser Therapy (Low Level Laser Therapy) (Pages 6-7)

(2) Lee, Garrett; Zucherman, James; Mason, Dean T

Application of the Low Power Laser in a Single-Blind Randomised Trial in Migrainous Headache Patients

St. Mary’s Spine Center, San Francisco, CA


Low Level Laser Therapy (LLLT) for Migraines Caused By Traumatic Brain Injury?

Dear Pain Matters blog readers,

Low level laser therapy (LLLT) may alleviate migraines in some cases.

Case Study:

A 25-year old man suffered a traumatic brain injury (TBI) when he was savagely attacked and repeatedly hit over the head with a lead pipe in May 2010.  He required many surgical stitches and sutures to close the head injury, and was left with a permanent scar on his brain.

Since that fateful day, the TBI victim experienced ongoing excruciating and incapacitating migraines for 2 long years.  His daily migraine pain ranged from 7 to 10 (on a scale from 0 to 10, using the visual analog scale ‘VAS’).  He stated that his migraines were ‘throbbing’ and ‘squeezing’, and were mainly in his occipital part of his brain.  He was unable to sleep properly nor play with his 4 children (aged up to 9) due to his constant migraines.

After ‘literally trying everything’ for 2 long years, and almost giving up hope, he agreed to try LLLT.  He was given 5 LLLT treatments over 2 weeks.

Specifically, LLLT treatment was delivered at 905 nm (near infrared) superpulsed wavelength set to 50 mW average power.  His LLLT targeted 4 areas on his scalp, 2.5 minutes each area (i.e. the occipital region, the area above the Circle of Willis as well as above the mastoid processes, both right and left side), totalling 10 minutes per treatment.


Following the first 10-minute-treatment, the patient immediately reported a 43% reduction in migraine pain (i.e. from VAS = 7 to VAS = 4).  He added that the ‘throbbing’ and ‘squeezing’ part of his migraine had disappeared immediately following his first LLLT treatment, and he was left with a residual ‘dull achy pain’.

He continued with 4 additional LLLT treatments, and his migraine pain further diminished after each treatment.

After completing 5 LLLT treatments (10 minutes per LLLT treatment), the patient’s overall migraine pain had decreased by more than 90%, while a ‘minor ache’ remained (that was hardly noticeable to him).

The patient had no side effects other than a slight ‘warm’ feeling above the region where the laser was placed.

The patient no longer has constant excruciating migraine pain, and his family says he looks much happier.  After 2 years of severely excruciating ‘throbbing’ and ‘squeezing’ migraines, he was finally able to sleep properly.

Possible Mechanisms:

Low level laser therapy (LLLT) may reduce inflammation and promote temporary vasodilation in capillaries by activating the nitric oxide pathway, leading to increased blood flow.  This may enhance oxygen delivery to TBI-affected brain regions that may ultimately lead to decreased migraine pain.

The 905 nm ‘pulsed’ (as opposed to ‘continuous’) wavelength may increase the expression of the inducible nitric oxide synthase (iNOS) gene by 700% (Stephan et al, 2012; Moriyama et al, 2009).


Mr Banas has achieved significant success with most of his LLLT-treated migraine patients (more than 65 migraine patients including TBI and non TBI) (Stephan et al, 2012).

Targeted low level laser therapy (LLLT)  may offer significant, life-changing relief from pain due to migraines.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.


(1) Stephan W, Banas L , Bennett M and Tunceroglu H.

Efficacy of super-pulsed 905 nm Low Level Laser Therapy (LLLT) in the management of Traumatic Brain Injury (TBI): A case study.

World Journal of Neuroscience (2012), 2, 231-233.

doi: 10.4236/wjns.2012.24035

(2) Moriyama Y, Nguyen J, Akens M, Moriyama E H, Lilge L,

In vivo effects of low level laser therapy on inducible nitric oxide synthase.

Lasers Surg. Med. (2009), 41: 227–231.


Interstitial and Intra-Articular Laser Therapy for Chronic Pain Including Back Pain and Painful Osteoarthritis

Featured Image – Intra-articular laser treatment


Dear Pain Matters blog readers,

Recent developments have enabled the delivery of low level laser therapy (LLLT) beneath the skin including via:

  • Interstitial laser therapy;
  • Intra-articular laser therapy; and
  • Intravenous laser therapy.


Dr. Med. Dipl. Chem. Michael Weber



This Blog Post will focus on:

  • Interstitial laser therapy; and
  • Intra-articular laser therapy

for pain management.

Different laser lights are used in interstitial and intra-articular laser therapy including:

  • Red laser light – Red laser may increase cell activity and blood circulation as well as enhance regeneration of damaged body tissues in chronic pain conditions;
  • Green laser light – Green laser may have anti-inflammatory effects in acute painful conditions including acute swellings; and
  • Blue laser light – Blue laser may have strong anti-inflammatory effects, hence reduce acute pain as well as promote wound healing.

Interstitial Laser Therapy:

(Percutaneous) interstitial laser therapy may offer some pain relief for chronic back pain (spinal pain) including:

  • Chronic spinal illnesses;
  • Slipped discs;
  • Scar pain after slipped disc surgery;
  • Spinal stenoses;
  • Neural lesions; and
  • Deep tendinitis and strains.

Interstitial laser therapy uses a sterile catheter to enable laser light (e.g. green and blue laser light) to access deep within the tissue (up to 12 cm penetration depth).  Thus, for example, blue laser light can exert its anti-inflammatory effects deep within the body tissue.

Without a sterile catheter, green and blue laser light cannot access deep body tissue regions.  Instead, most of the higher energy waves (i.e. green and blue) are absorbed in the skin during external laser therapy only.


Interstitial laser therapy


A Study Involving Interstitial Laser Therapy for Back Pain: 

Eleven (11) patients with chronic spinal disorders (disc herniation and spinal stenosis) received interstitial laser spine laser treatments (average = 7.64 treatments per patient).



Red = Pain (before interstitial laser spine treatments)

Green = Pain (after interstitial laser spine treatments)

(‘Kreuzschmerzen’, in German = Back pain; VAS = visual analogue scale; Pain from 0 to 10)

Chronic back pain before interstitial laser spine treatment averaged 5.45 (VAS) (Refer to red).

Chronic back pain after 7 interstitial laser spine treatments decreased to an average of 2.55 (VAS) (Refer to green) (Weber).


Intra-Articular Laser Therapy: 

Intra-articular laser therapy may offer some pain relief for painful arthroses including:

  • Knee osteoarthritis;
  • Hip osteoarthritis;
  • Painful shoulder syndromes; and
  • Ankle joint osteoarthritis.

Specifically, intra-articular laser therapy allows direct access into painful and injured/diseased intra-articular joints including knee and shoulder joints.


Intra-articular laser therapy


A Study Involving Intra-Articular Laser Therapy for Shoulder Pain:

Ten (10) patients with chronic shoulder pain received intra-articular laser treatments (average = 9.2 treatments per patient).



Red = Pain (before intra-articular laser treatments)

Green = Pain (after intra-articular laser treatments)

(‘Schulterschmerzen’, in German = Shoulder pain; VAS = visual analogue scale; Pain from 0 to 10)

Chronic shoulder pain before intra-articular laser treatments averaged 6.2 (VAS) (Refer to red).

Chronic shoulder pain after 7 intra-articular laser treatments decreased to an average of 2.8 (VAS) (Refer to green) (Weber).


Other Information About Low Level Laser Therapy (LLLT):

Classical low level laser therapy (LLLT) can be topically and non-invasively applied to the skin surface and may include:

  • External laser therapy;
  • Laser needle acupuncture; and
  • Laser needle treatment of the skull (transcranial) and the ear.

Low level laser therapy (LLLT) can also form part of photodynamic therapy including external/topical, systemic and interstitial.  Photodynamic therapy includes:

  • Photodynamic tumor therapy (for cancer); and
  • Anti-microbial photodynamic therapy (e.g. for Lyme disease) (Weber & Junggebauer).

Treatment and research involving stem cells and laser therapy is ongoing.


Whilst relatively new (and undergoing further research), interstitial laser therapy may be useful for reducing chronic back pain (spinal pain), while intra-articular laser therapy may provide certain relief from painful arthroses including knee osteoarthritis, hip osteoarthritis, painful shoulder syndromes and ankle joint osteoarthritis.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

“Medical knowledge is not enough; we must apply it with a passion”

Dr Henri Basam, Spine Care Center, Cairo, Egypt


(1A) Michael Weber, MD, President of International Society for Medical Laser Applications (ISLA)

(1B) Medical Low-Level-Lasertherapy – Foundations and Clinical Applications (2nd Edition, June 2015)

Michael Weber, MD, Robert Weber, Martin Junggebauer

(1C) Michael Weber, MD

Interstitial and intraarticular laser therapy – attractive new therapeutic option for the treatment of spinal diseases and advanced joint osteoarthritis

(1D) Dr Henri Basam, Sherry N Fanous

Knee Pain Management Using Ultrasound-Guided Weberneedle Endo-Laser in Comparison to Fluoroscopy-Guided Thermal Radio-Frequency (2015) (9AP5-10)

Spine Care Center, Cairo, Egypt

(1E) Michael Weber, MD, Thomas Fussgänger-May, MD, Tillman Wolf, MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

(1F) Weber & Junggebauer. Anti-Microbial Photodynamic Therapy (aPDT) – A New Treatment Option for Infectious Diseases. ISLA Research Group.


(1G) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture using laser needles modulates brain function: first evidence from functional transcranial Doppler sonography and functional magnetic resonance imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

(1H) International Society for Medical Laser Applications (ISLA)

(2) Norman Doidge MD

The Brain’s Way of Healing – Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (Chapter 4 – Rewiring a Brain with Light)

Publisher: Penguin Publishing Group (26 January 2016)

ISBN: 9780143128373

(3) Blog by Fred Kahn, MD FRCS(C), LLLT Specialist


YouTubes (in English and German):


(2A) New fiber optic cannula. Interstitial therapy at the root of the Ischia hernia


(2C) Where ‘Coxarthrosis’ = Osteoarthritis of the hip joint


Low Level Laser Therapy (LLLT) for Chronic Pain Including Fibromyalgia

Dear Pain Matters blog readers,

I will introduce the topic of low level laser therapy (LLLT) for chronic pain (e.g. fibromyalgia) here, and in future blog posts.

Low level laser therapy (LLLT) is relatively safe, and has no known adverse effects.

People with fibromyalgia often have extreme fatigue, pain and insomnia.  For some sufferers, even getting dressed in the morning can be a daunting task.

Ms Kay Greenlee (aged 70, of Indiana, USA) had suffered from fibromyalgia for years.  This painful condition made it difficult for her to perform domestic chores including washing windows without incurring pain in her legs, shoulders and elsewhere.  Due to allergic reactions, she was unable to take pain medication for pain.

A study by the Indiana State University allocated fibromyalgia patients into 4 groups that performed:

  1. Resistance training only;
  2. Low level laser therapy (LLLT) only;
  3. Placebo (instead of LLLT) only; and
  4. Both LLLT and resistance training.

The patients who were in the 4th group enjoyed the most improvements, compared to the other 3 groups.

Ms Greenlee was randomly allocated to the 4th group.  Following months of LLLT and resistance exercise training including chest presses, leg extensions, seated rowing and leg curls, Ms Greenlee had reduced fibromyalgia pain.  

In other words, months later, Ms Greenlee is almost pain free.  As a result, she was able to exercise (see photo).  Quoting Ms Greenlee:

“I have gone from having a lot of pain to very minimal amount of pain in the shoulder. I have little or no pain at all in the legs.”

“It is exciting to be able to go for several hours and be energetic and do the work that needs to be done at home and to enjoy things.”

Targeted LLLT and resistance training may facilitate increased blood flow into the painful areas as well as the release of endorphins, hence contributing to reduced pain.

Quoting Ifeanyi Osude (LLLT researcher, see photo):

“I’ve seen great results. Women came in with immense pain they have had for weeks or even months and after they have done the laser treatment, along with the resistance training, they came to me and said, ‘Ifeanyi, I feel a lot better.'”

Thus, LLLT can help reduce fibromyalgia pain, while physical activity can help keep the painful symptoms at bay.




Low level laser therapy (LLLT) plus exercise may be useful for reducing pain in fibromyalgia by increasing blood flow into the painful areas (Taylor, 2013). 

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.



(1) Research uses lasers, resistance training to zap fibromyalgia pain

Taylor, Dave

Indiana State University Newsroom (10 June 2013)

(2) LLLT a treatment option for fibromyalgia patients

Stewart, Dava

Chiropractic Economics (21 August 2014)

Peer-Reviewed Papers:

(3) Kingsley JD, Demchak T, Mathis R

Low-level laser therapy as a treatment for chronic pain. Front. Physiol. (2014), 5:306.

doi: 10.3389/fphys.2014.00306

Refer also to References section of paper by Kingsley et al (2014) for additional information.

(4) Ruaro, JA, Fréz, AR, Ruaro, MB, et al.

Low-level laser therapy to treat fibromyalgia. Lasers Med Sci (Nov. 2014), 29(6):1815-1819.