Laser Therapy Treatment for Fibromyalgia

Sam Freestone, Alyssa Morley and Elizabeth Osantowski

Student Physical Therapists
Central Michigan University
Introduction

Fibromyalgia (FM) is a widespread musculoskeletal pain disorder. It is the most common

musculoskeletal disorder in the U.S., affecting 5 million adult Americans. It causes fatigue,

sleep, memory, and mood issues. Symptoms include constant, dull achy pain that lasts for at least

3 months, fatigue or lack of sleep, and difficulty in cognitive concentration. FM may coexist with

other disorders such as IBS, migraines, painful bladder syndrome, or temporomandibular

disorders (TMD). There is no specific cause of FM, but genetics, infections, and trauma are

believed to contribute. Women and those with a family history of FM are at increased risk for

FM. The diagnosis of FM is often one of exclusion and has no singular course of treatment, but

often a combination of physical therapy, drug therapy, and other courses of treatment are utilized

for management of the disorder.1

For this literature review, the focus is directed on using low-level laser therapy (LLLT) as

a form of treatment for patients with FM. LLLT is found to stimulate tissue repair on tender

points and improve overall quality of life in patients with the disorder by reducing the number

and severity of tender points and increasing tissue healing and blood flow. The purpose of this

literature review is to examine five journal articles for the effectiveness of LLLT as a treatment

for FM.

Treatment of Fibromyalgia Syndrome with low-level laser therapy

This study examined the effects of LLLT on a 19 year old, Hispanic female to treat her

general pain and fatigue due to FM. At her initial evaluation, there were 14-18 hypersensitive

areas found using the American College of Rheumatology Fibromyalgia sensitivity chart. The

patient took two questionnaires to determine the impact of FM on her daily life and to monitor

treatment outcome. The patient scored 82 on the Fibromyalgia Impact Questionnaire (FIQ) and
20 on the Subjective Activity of Daily Living (SADL) subscale. The average person with FM

scores around 50 while a severely affected person will score around 70 on the FIQ scale.2

LLLT treatment was administered twice per week for 2 weeks. The patient was not

involved in any other form of modalities. Each session started with the patient identifying areas

of sensitivity. Before and after each treatment, the patient rated level of pain on a scale of 1-10.

For treatment, the intervention provided was “an MR4 device (Multi Radiance Medical, Solon,

OH), with the super-pulsed laser shower transducer that incorporates six 50W laser diodes (905

nm) and four 25W infrared diodes (660nm). All treatments were administered with utilization of

a sweep protocol (5-1000 Hz) for a 2-minute duration over each of the identified sensitivity

points.”2

After 2 weeks of treatment (4 visits), the total number of sensitive points decreased from

14 to 6. The 0-10 visual analog pain scale showed a decrease from 6/10 to 2/10. The FIQ score

decreased from 82 to 23 and the SADL score decreased from 20 to 5. The patient was unable to

attend therapy sessions for the next two weeks. As a result, the patient experienced an increase in

symptoms and pain without feeling activities of daily living were impacted. The results of this

study suggests that LLLT administered to each tender point will increase the total amount of

energy absorbed by the tissues. Furthermore, it is suggested that LLLT is a suitable treatment to

reduce pain and increase function in FM patients, but further research should be conducted to

investigate the optimal parameters for the best outcome.2

Low-level laser therapy to treat fibromyalgia

This study examined the effects of LLLT to relieve pain and other symptoms of FM. This

study used a placebo-controlled, randomized clinical trial on 20 patients with FM and no other

serious health conditions. The two groups were: a placebo group consisting of 9 females and 1
male (mean age 43.4 years) that received a sham laser exposure (0W) and the LLLT treatment

group of 10 females (mean age 39.4 years). Before and after each treatment session, the patient

was assessed for number of tender points and rated their level of pain using the McGill Pain

Questionnaire and visual analog scale. Additionally, the FIQ was used to evaluate the impact of

FM on each subject's quality of life.3

The type of machine used was an aluminum/gallium/arsenide (GaAlAs) diode laser

(Ibramed, model Laserpulse, code 000689, serial number 1320). Treatment was administered at

670 nm with 20 mW to reduce local inflammation and aid in tissue repair. The therapist

administered 4 J/cm2 using a beam to a focal spot area of 0.035 cm2 for 7 seconds per tender

point. All 18 FM tender point were irradiated at 4 locations around each tender point, which were

separated by 1 cm. The total treatment area was 1cm2 per point with the laser angled at 90°. Both

groups received treatments 3 times a week over 4 weeks for a total of 12 treatments. Overall,

each patient whom was exposed 72 times to LLLT, totaling 504 seconds and 0.57 W/cm2 on

each tender point.3

The number of tender points in the placebo group decreased from 11.8 to 10.4 post-

treatment and in the LLLT group from 11.6 to 7.3 post-treatment. Overall, the LLLT treatment

group had significantly improved in all criteria of the FIQ after treatment, whereas the placebo

group only had improvements in physical impairment and pain. This study found that all the FIQ

criteria were improved amongst both groups except for three areas including feel good, difficult

to work, and rested. In the LLLT group, the McGill Pain Questionnaire showed a decrease in

pain from 45 to 32.1 post-treatment while the placebo group showed a decrease from 47.5 to

42.6 post-treatment. The McGill pain scores were significantly decreased in the LLLT compared

to the placebo group. Additionally, the visual analog scale showed a decrease in the LLLT group
from 6.58 to 4.06 and in the placebo group from 5.81 to 5.34. The results from this study suggest

that LLLT may provide relief of symptoms, decrease pain, and improve quality of life in patients

with FM.3

Effects of class IV laser therapy on Fibromyalgia impact and function in women with

Fibromyalgia

In this investigation, a rheumatologist evaluated potential subjects by assessing 18 trigger

points; each assessed a score from 0 to 3, with 0 being no pain and 3 being a physical withdrawal

from contact for a baseline score out of 54. To be considered for the study, the subject had to

present pain in 11 of the 18 possible trigger points, and then complete the FIQ to assess the

impact FM has on their quality of life. Then, subjects completed CS-PFP, which required

subjects to complete activities of daily living, such as carrying groceries, climbing stairs, and 7

others. Two groups were formed, an experimental and control group, by random selection. The

experimental group received laser treatment, while the sham group received no laser treatment.

To keep participants blind to which group they were in, there was a tube attached to the laser and

a normal tube for the experimental group, both of which provided warm air to the treatment area

to prevent determination by the subject of which treatment they were receiving.4

Treatment was administered twice a week, for a total of 8 sessions over 4 weeks. The

researchers provided treatment for a total 7 minutes, 1 minute for the 7 selected treatment trigger

points across the spine. Parameters for the laser (LCT-1000 (LiteCure LLC, Newark, DE) solid-

state GaAlAs laser) were a continuous-wave treatment with two wavelengths, 810 nm and 980

nm for 20% and 80% of the treatment time respectively with an intensity of 10.63 J/cm2. The

dual wavelengths allowed for treatment of individuals of differing skin tone, as the different

wavelengths are absorbed by each one. A grid pattern was followed to keep the laser head
moving to prevent treatment areas from getting too warm or causing burns. The same pattern was

provided to the control group using only warm air.4

For the 32 women who finished the trial and attended all of the treatment sessions, there

was a significant decrease in pain. One of the most notable differences was in upper body

flexibility; the treatment group improved by 9.9% while the control group had no change. In

most other categories, both groups improved in function or quality of life, but laser treatment

showed a significant improvement while the control group did not. One theory was that the heat

provided from the warm air assisted in promoting muscle relaxation by increasing blood flow to

the area, treating the trigger points minimally even without using laser.4

Overall, this study suggests that the use of a Class IV laser can be effective in treating

those suffering from FM by decreasing pain and increasing daily functional abilities. More

research is needed to explore the various intensity settings and treatment times available to

adequately narrow down the optimal parameters for laser therapy for FM. There is no research as

to the longevity of treatment effects, how frequently the treatment needs to be provided, or if

intermittent laser treatments are sufficient to maintain these improvements.4

Efficacy of Low Powered Laser Therapy in Fibromyalgia: A single-blind, Placebo-

controlled Trial

While low energy lasers have wide use in the treatment of musculoskeletal disorders,

there is little research supporting the efficacy of their use. However, a randomized, single-blind,

placebo controlled study utilizing 40 female patients with FM examined the efficacy of

LLLT. 40 subjects with FM were split into two groups of 20, one of which would receive LLLT,

while the other group would receive a placebo. To be considered eligible for the trial, the

subjects needed to present with a minimum of 11 of 18 tender points associated with FM. Tender
points were examined using a 4kg digital pressure device on the occiput, trapezius, low cervical,

supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter and knee areas of the

body, on either the left or right sides of the body.5

Patients were treated for 3 minutes at each tender point, once daily for 2 weeks,

excluding weekends. Laser treatments used a Gallium Arsenide laser and consisted of an average

power of 11.2mW (20 W max power per pulse, 904 nm, 204 ns max pulse duration and a 2.8

kHz frequency) with an energy density of 2 J/cm2. No laser was emitted for the placebo

treatment. Both groups were examined with a Likert scale (0=no, 1=mild, 2=moderate, 3=severe,

4=extreme) for post treatment pain, muscle spasms, fatigue, morning stiffness, number of tender

points, and sleep disturbances. There was no significant difference between the two groups prior

to the administration of the treatment, however there was a significant improvement in pain,

muscle spasms and number of tender points among the subjects that received LLLT than the

placebo group. For the laser group, pain improved from 3.09 to 1.27, muscle spasm from 2.27 to

0.81, and number of tender points from 13.18 to 6.63. These results suggest that LLLT is an

effective modality for the treatment of pain, tender points, and muscle spasms in individuals with

FM.5

Laser therapy and occlusal stabilization splint for temporomandibular disorders in

patients with Fibromyalgia Syndrome: a randomized, clinical trial

One aspect of FM includes TMDs, which is often an extension of the musculoskeletal

effects of FM spreading into the upper neck and head region. In the treatment of TMD, there is

no one particular treatment used over others. Some involve relaxation techniques, physiotherapy

to train the muscles of mastication, and occlusal splints. In this study, the researchers compared

the use of laser therapy to a proven and effective treatment for TMD, the occlusal splint. An
occlusal splint is a an oral orthotic device, similar to a mouth guard, to prevent TMD problems

and facilitate relaxation of the jaw muscles. Effectiveness of an occlusal splint was reviewed, and

“numerous studies, when taken as a whole, suggest only a modest indication that they are

useful.”6

The study was conducted with 58 subjects who all had TMD and FM. The participants

were sorted randomly into the two groups, while ensuring both groups had the same

representation of different drug therapies for FM. The LLLT parameters were 80W for peak

power, utilizing a pulse-repetition rate of 1.5 Hz and an average power of 50 mW. Treatment

was focused on tender points identified during selection of participants and were scored for

tenderness during the baseline collection of data. Each tender point was treated for 2 minutes per

session, and received a dose of 3 J/cm2. Tender spots were clustered in the joint capsule of the

temporomandibular joint, the muscles of mastication (masseter and pterygoid), the

sternocleidomastoid, the splenius capitis muscle, and the trapezius. Treatment was provided once

a week, over the course of 12 weeks. For the occlusal splint group, the subjects were required to

wear the splint for a total of 8 hours a night, every day during the 12-week period.7

The results were similar for both interventions by providing some alleviation of pain and

tenderness over the entire temporomandibular region. Both interventions reduced joint sounds of

the mouth and decreased the number of tender points. The visual analog scale decreased 44% in

laser treatment and 65% in the splint group. The occlusal splint improved overall sleep quality

while the laser had no impact. The occlusal splint improved all aspects of mouth opening, which

improves function of the joint as well as patients’ everyday life. In comparison between the two

therapies, occlusal splints proved to be more effective in decreasing pain, jaw movement, and

sleep quality. An occlusal splint is easily accessible, in comparison to laser therapy, and can be
used daily by the patient. In the case of TMD treatment in patients with FM, the occlusal splint is

more effective and easier for patients to receive treatment. Although LLLT is effective, it cannot

be recommended over occlusal splinting using the techniques utilized in this study.7

Conclusion

After review of the literature, it can be concluded that LLLT is an effective modality in

the reduction of pain and tender points, and the improvement in functional quality of life of FM

patients. Of the studies reviewed, only the study comparing the effectiveness of LLLT and

occlusal splints for the treatment of TMD’s disputed the efficacy of LLLT. While LLLT was still

able to relieve TMD related tender points and improve mouth functions, the occlusal splint was

more effective than the LLLT. The remaining articles reviewed found that LLLT was an

effective treatment for the reduction of pain, and tender points, however, these articles did not

compare LLLT to other modalities. Therefore, LLLT does provide significant relief from

symptoms for FM patients, but it cannot be concluded that LLLT is the most effective modality

in the treatment of FM.

 References

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conditions/fibromyalgia/symptoms-causes/syc-20354780. Published August 11, 2017.
Accessed November 3, 2017.
2. Moore J, Demchak T. Treatment of Fibromyalgia Syndrome With Low-Level Laser
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fibromyalgia impact and function in women with Fibromyalgia. The Journal of
Alternative and Complementary Medicine. 2013;19(5):445-452.
DOI:10.1089/acm.2011.0398.
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Therapy in Fibromyalgia: A Single-blind, Placebo-controlled Trial. Lasers in Medical
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https://www.agd.org/docs/default-source/self-instruction-
(gendent)/gendent_ma17_crout.pdf. Accessed November 5, 2017
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Aguilar-Ferrándiz ME, Castro-Sánchez AM. Laser therapy and occlusal stabilization
splint for temporomandibular disorders in patients with Fibromyalgia Syndrome: a
randomized, clinical trial. Alternative Therapies in Health & Medicine. 2016;22(5):23-
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