Low-level laser therapy has been studied in musculoskeletal pain for over thirty years. The evidence is genuinely mixed, and which studies you read determines what you conclude. Here is a fair summary.
Where it holds up best: chronic low back pain
The American College of Physicians’ 2017 clinical practice guideline on low back pain names low-level laser therapy among the non-pharmacologic options clinicians and patients may select for chronic low back pain. That’s meaningful — it’s a major guideline body naming the therapy.
The qualifier belongs with it. Low-level laser therapy sits in the guideline’s low-quality evidence grouping, and it appears only for chronic pain, not acute or subacute.
The counterweight is important too. In 2021, a prospectively registered placebo-controlled trial of 148 patients found photobiomodulation was no better than placebo for chronic non-specific low back pain — pain difference 0.01 points, disability difference −0.63, neither remotely significant. The authors included prominent researchers from within the photobiomodulation field, which makes a null result from them harder to dismiss.
An older Cochrane review found short-term pain relief but no effect on disability, and concluded there were insufficient data to draw firm conclusions.
Where it’s contested: neck pain
A 2009 Lancet meta-analysis of 16 trials reported substantial benefit. Independent appraisal by the UK’s Centre for Reviews and Dissemination flagged extreme statistical heterogeneity (I² of 89–93% on the main pain and disability analyses) and considerable variation in how the trials were conducted.
A separate 2013 meta-analysis found a statistically significant improvement that was below the threshold of minimal clinically important difference — meaning the effect, while real in the statistics, may not be large enough for a patient to notice. Its authors called the evidence inconclusive.
Where a guideline says don’t: knee osteoarthritis
This is the one people should know about.
The UK’s National Institute for Health and Care Excellence, in guideline NG226 (2022), recommendation 1.3.9, states:
“Do not offer any of the following electrotherapy treatments to people with osteoarthritis because there is insufficient evidence of benefit: … laser therapy …”
Two credible meta-analyses reach opposite conclusions on knee osteoarthritis — one in 2015 finding no significant effect and concluding the evidence does not support the effectiveness, one in 2019 finding meaningful pain reduction. The American College of Rheumatology and OARSI guidelines don’t address laser therapy at all.
We think patients considering this for knee arthritis deserve to know a national guideline body has examined it and recommended against it.
Tendinopathy: dose appears to matter
Meta-analyses of shoulder tendinopathy and tennis elbow report pain benefit, with a consistent pattern — trials using inadequate laser doses were uniformly negative. For Achilles tendinopathy, a GRADE-rated review of four trials and 119 participants concluded the results are insufficient to support routine use of laser therapy.
One disclosable limitation: a large share of the positive meta-analyses across knee, neck, shoulder and elbow come from an overlapping group of researchers who are also central to the professional association that publishes the dose recommendations those same reviews use to define their favorable subgroups. That’s worth knowing when weighing the literature.
The consistent finding across all of it
Safety. Across these reviews and trials, surface laser therapy produced no serious adverse events. Whatever else is uncertain, that part is well supported — for light applied to the skin. It does not automatically extend to intravenous delivery, which is a different procedure with its own risks. We go through that in a separate article on intravenous laser therapy.
If you want to know how we use this at Venturis, and what we will and won’t claim for it, that’s on our photodynamic and laser therapy page.
References
-
Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. doi:10.7326/M16-2367
-
Guimarães LS, Costa LDCM, Araujo AC, et al. Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Pain. 2021;162(6):1612–1620. doi:10.1097/j.pain.0000000000002189. PMID: 33449509
-
Yousefi-Nooraie R, Schonstein E, Heidari K, et al. Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev. CD005107. doi:10.1002/14651858.CD005107.pub2
-
Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain. Lancet. 2009;374(9705):1897–1908. PMID: 19913903
-
Kadhim-Saleh A, Maganti H, Ghert M, Singh S, Farrokhyar F. Is low-level laser therapy in relieving neck pain effective? Rheumatol Int. 2013;33(10):2493–2501. PMID: 23579335
-
National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022.
-
Huang Z, Chen J, Ma J, Shen B, Pei F, Kraus VB. Effectiveness of low-level laser therapy in patients with knee osteoarthritis. Osteoarthritis Cartilage. 2015;23(9):1437–1444. doi:10.1016/j.joca.2015.04.005. PMID: 25914044
-
Stausholm MB, Naterstad IF, Joensen J, et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis. BMJ Open. 2019;9(10):e031142. doi:10.1136/bmjopen-2019-031142. PMID: 31662383
-
Martimbianco ALC, Ferreira RES, Latorraca COC, et al. Photobiomodulation with low-level laser therapy for treating Achilles tendinopathy. Clin Rehabil. 2020;34(6):713–722. doi:10.1177/0269215520912820. PMID: 32204620
Reviewed by Dr. Alvin Philipose, B.S., B.S., DC, ICCP, Venturis Clinic, Oklahoma City, Oklahoma. Last reviewed: August 2026.
Important information: Low-level laser therapy and photobiomodulation are not approved by the U.S. Food and Drug Administration for the treatment, cure, mitigation or prevention of the conditions discussed in this article. Nothing here is a claim of efficacy, and no outcome is promised or implied. Individual results vary. This article is educational and does not constitute medical advice, diagnosis or treatment.