Lasers for back pain come in several classifications and are used as symptomatic treatment for a wide range of agonizing conditions. Cold laser therapy and deep laser therapy are especially prevalent in the pain management arena, with many doctors, physical therapists and chiropractors offering sessions geared towards reducing the severity of symptoms and resolving the underlying causation of certain types of pain. Despite their popularity and FDA approval, laser therapies are highly controversial and the reasons for this will become crystal clear during the course of this essay.
This in-depth report details the effectiveness of superficial and deep laser therapies for back pain. We will provide an objective and non-financially motivated view of the treatment so that all patients can truly understand whether or not lasers are indicated to treat their specific form of pain.
There are three classifications of lasers that are used to treat back pain: class 4, class 3B and class 3A devices. Class 4 lasers are the most powerful and are rated as having the ability to damage tissues, given normal usage. Class 3B lasers are rated as deep penetrating, but without the ability to damage tissues, given normal usage. Class 3A lasers are rated as non-damaging and only penetrating superficially into the skin.
The initial lasers used to treat back pain were mostly class 3A and 3B devices, but now many class 4 lasers are also in service. Cold lasers are usually class 3B, but some devices, especially early models, are class 3A. Meanwhile, more recently popularized deep tissue lasers are mostly class 4 or 3B medical devices.
There is tremendous controversy about which classification of device works best to relieve back pain, as well as which classification is the safest to use. Of course, most of this controversy is fueled by the competition between device manufacturers and the often highly partial research they sponsor to justify their medical claims. As always, medicine is a huge business and this particular sector of back and neck pain care generates untold billions of dollars every year.
Laser treatments are all basically the same from the patient’s perspective. The care provider will use a device to send non-heat generating photons into tissue to affect the cytochrome complex. This protein is contained in each cell within the mitochondria and influences how certain cell process work. The process by which lasers influence cells is called photobiomodulation.
Most treatment sessions last between 5 and 15 minutes and may be integrated with other services, such as chiropractic adjustments, massage, spinal decompression, acupuncture, TENS and many other types of care. Patients will usually receive multiple sessions each week for a defined or open-ended time frame. During therapy, the patient will usually experience a gentle warmth in the treated area, but should not experience any pain. Many patients say the feeling is soothing, while others are neutral to the experience.
Different devices are used for different applications, with some lasers penetrating as little as 1 cm (0.4 inch) into the skin, while others can penetrate even more than 9 inches into bodily tissue (23 cm).
Like many symptom-based care practices, lasers are used to treat specific diagnoses, as well as pain and physical dysfunction of unspecified origin. Some of the many possible conditions treated in relation to a back pain complaint include: nonspecific sciatica, lower back pain, upper back pain or neck pain, unspecified joint pain or limb pain, various osteoarthritic processes and rheumatoid arthritic processes, various tendon, ligament and connective tissue injuries or pain syndromes, focal areas of fibromyalgia pain, areas of focal stiffness, muscular spasms and wound healing, including surgical wounds from operative interventions. Some of these indications are directly approved by the FDA, while some are “off label” use that is determined by care provider decision alone.
Insurance rarely pays for laser treatment, regardless of the indication of its use. However, some plans may cover partial expense, while many care providers have found “creative billing” methods that allow reimbursement of these uncovered services when packaged with other covered services. Some chiropractors, in particular, are experts at this type of creative billing, while combined care facilities are virtually always guilty of these illegal practices. In some cases, patients are told that the doctor will find a way for them to receive care without paying up front, but if the claim is denied, the patient may receive a balance billing surprise that can leave them in financial ruin.
There have been many, many studies conducted on the effectiveness of laser therapies of all varieties for their use in pain management applications. Unfortunately, most of these studies have been commissioned and paid for by the very same companies who manufacture the devices, and some may have had a prearranged conclusion of efficacy that needed to be proven, regardless of how this goal was achieved. In essence, the objectivity of these studies is highly suspect, since the financial motivations for gain are obvious. In the few objective studies that we have read, most research points towards laser therapies as being mildly effective for pain relief, enough to grant FDA approval for particular indicated conditions. However, this efficacy is rated as being nearly identical to purposeful placebo treatment, as is so common with many of the back pain treatments in use today.
On the subject of FDA approval, most device manufacturers wear this stamp as an endorsement and a highly effective marketing badge of honor. However, patients are reminded that the FDA also has approved the very same drugs and medical devices that kill hundreds of thousands of people each year and injure millions more. This should not exactly be a ringing endorsement to any logical mind.
On the plus side, currently there are few known risks associated with laser therapy. Who knows how the future may change in this regard, but this goes for any relatively new medical treatment. Laser therapy for back pain is noninvasive, nonpharmaceutical and much less hazardous than many other popular care regimens. These are all excellent criteria to be sure. However, patient treatment outcomes are greatly mixed, with some patients citing almost miraculous results, while many others cite more realistic conservatively positive, but mostly temporary, pain relief enjoyed. Many other patients cite no benefits from treatment, while a tiny minority claims escalated pain or other negative effects. Overall, most patients fall close to the neutral line, with a slight tendency towards modest positive benefit. Given the placebo response offered by a positive bedside manner and a convincing sales pitch, once again, this is not a ringing endorsement to most objective minds.
We know that this article comes off a bit negative regarding the use of laser technologies for treating pain. This critique is justified even if you eliminate all the case-specific evidence against laser treatment and simply view it in the same manner by which all other examples of symptomatic treatment should be evaluated. Symptom-based care is substandard medicine, while curative care is always preferred. Additionally, symptom-based care is well known and documented to primarily benefit the care provider financially, and the patient, secondarily, if at all.
However, laser therapy is still certainly something to investigate compared to other more popular forms of back pain care. It seems safe and hopefully with be proven to be so with the passage of time. It is non-pharmaceutical and nonsurgical which are both excellent attributes to be sure. It is also affordable, even if not covered by insurance plans. Best of all, many providers offer a free session to determine if the therapy is right for the patient’s specific needs. Therefore, there is little risk in trying it out for yourself.
As always, we feel the responsibility of our position greatly and hate to simply jump on the laser therapy bandwagon without more evidence of its true effectiveness. However, even if the treatments works by placebo effect alone, this is not a bad thing, since it does seem to work and does so without any seemingly significant risks. We would love to hear your experience using laser therapy for back pain on our forum.