A Laser, A Red Light, and An Astronaut Walk Into A Doctor’s Office…
⌚️ read time: 6 minutes
What if I told you we could use laser technology to melt away all your pain? No drugs, no therapy, no surgeries required.
Spoiler alert: the technology is not that good. But there’s some interesting stuff worth understanding about this device.
If you do nothing more before you click away, watch the video below, especially if you’re a parent. My wife and I laughed about it for days.
While I don’t have experience using red light, lasers, or any other form of photobiomodulation (say that ten times fast), I am increasingly asked about it by my patients and now by YOU as my readers.
So I did a little dive into the literature and am here to share with you what I learned over the last few weeks. Sound good?
Let’s do it.
So, is it red light or laser therapy?
Red light therapy is a form of light treatment known as photobiomodulation. Other common or trendy terms you may hear include low-level laser therapy, photonic stimulation, or cold laser therapy.
Side note: true lasers are used in some areas of medicine and can be extremely powerful — often to the point of causing painful and temporarily disfiguring side effects. But when you hear ‘laser therapy’ advertised, chances are they mean red light or low-level laser therapy.
The theory behind this treatment is that certain low levels of light in the proper wavelength (ie, red wavelengths) will ‘stimulate’ cells or tissue. Proponents of the technology will say these cells are ‘stimulated’ to heal faster than they otherwise would naturally.
While the actual way this works is not completely understood, the evidence we have seems to indicate that the light works on a tiny little component within cells known as the mitochondria (how much high school biology do you remember?) to increase the amount of energy (ie, ATP) the cell produces, as well as improve signaling within the cell.
So presumably, with more energy and better communication, the cell can work ‘better.’
🚀 NASA did a lot of the early work. And who doesn’t love space?
I was surprised and intrigued by the history here.
In the 1980s, NASA was studying LED technology to try to grow plants in space. Because, why not?
To be most efficient, they were using only red light and blue light, as these wavelengths are known to be the best for photosynthesis.
But the scientists conducting these experiments noticed that various scratches or wounds on their hands were healing faster than expected while working under the red light all day.
So naturally, NASA took an interest in helping their astronauts heal — and the military took notice.
These organizations developed specific probes that would emit various wavelengths of light with different depths of penetration into the body’s tissues. Once they developed a device called the WARP 10, they began experimenting with red light therapy to help their constituents heal from all sorts of skin wounds and musculoskeletal injuries.
Reports are that it “produced more than a 40 percent greater improvement in musculoskeletal injuries and a 50 percent faster healing time for lacerations, compared to control groups.”
My skeptical brain would love to know how they defined “40% improvement in musculoskeletal injuries,” as that is rather vague and sounds subject to interpretation. Unfortunately, I was unable to locate the study itself to read through how it was actually performed.
It’s probably locked up at Area 51 or something.
With this spark, NASA and associated commercial companies worked closely to develop increasingly effective handheld devices that could apply ‘just the right amount’ of red light stimulation to healing tissues.
And the rest is history…
Then it was time for science, medicine, and commerce to have a turn
I have to be honest. The scientific literature on red light therapy since its NASA days is a total mess. Somehow we went from space-age healing devices to somewhat terrifying sleep masks (see video below if you haven’t seen these things).
Let me try to explain why.
Early reports of the technology, including the previous work by NASA, seem to pretty clearly show that holding the correct device over a healing wound will lead to faster healing than controls or those treated with placebo light. This is particularly true in wounds that otherwise struggle to heal, including non-healing diabetic ulcers.
But the crux of this whole issue is in the language I used above. The ‘correct’ device.
When administering this therapy, there are multiple factors that can be manipulated to produce a desired result. This includes the power of the light, the wavelength of the light, whether it’s pulsed, and various other factors that affect how deep the energy penetrates into different tissues.
Well, there has been a complete lack of standardization of these multiple factors among scientific studies over the last decade or so.
Some papers treat skin wrinkles, while others treat neck pain. Some use a handheld pulsed device, while others place patients in a room with red lights on the wall. Not to mention the differences in length of treatments (5 minutes vs 15 minutes?), number of treatments (patients completed 10 treatments or 50 treatments), and spacing of treatments (come back weekly or do this three times a day).
Some of this variation feels akin to studying whether a femur fracture heals better after surgery to repair the break versus just lying in an operating room for an hour or so. The differences in these studies border on the absurd.
Add in the power of the placebo effect, and everything gets fuzzy — fast.
How far have we strayed from the NASA days?
While debates like this should come down to science, it just isn’t there yet. I expect it will come, but it’s going to take time. So in many ways, this comes down to how you interpret preliminary studies, risk tolerance, and cost.
I think it’s perfectly reasonable in some scenarios to take the ‘where there’s smoke, there’s fire’ approach. It is pretty clear that in the case of poorly healing skin wounds, the appropriate red light therapy applied directly to the healing area does help.
But now you have to decide how far you’re willing to take that signal.
Would a NASA-backed device also help heal the bursitis in your hip that’s right below the skin level? Maybe.
How about the arthritis pain in the bones and cartilage of your hip, perhaps as deep as 6 inches under the skin? Maybe??
Now how about standing in a ‘red light therapy’ room for 10 minutes at one of these IV hydration/cryotherapy/rejuvenation spas to ‘improve your mood and energy’? Mmmm, now I’m starting to wonder.
Or what about buying a ‘red light mask for your wrinkles’ off Amazon for $69.99? You see where I’m going here.
Spa Red Light Therapy
Source: Restore Hyper Wellness
NASA WARP 75 Device
Source: Medical Design Briefs
One good thing that seems clear across these studies is the relative safety of red light. While no intervention is zero risk (there are reports of burns, eye injuries, and skin injuries), this one seems to be fairly low risk if used properly.
The one risk I see glossed over all the time is the risk to your wallet.
I routinely have patients come to my office who are annoyed that their insurance requires a $30 copay to see me. And trust me, I get it! The healthcare insurance industry is a mess.
And yet, a single session to stand in a red-light therapy room for 10 minutes can cost $75-$150!! Not to mention that many repeat this several times a week for months on end. And absolutely none of this is covered by insurance. It’s straight cash.
So it’s all relative.
Should I try red light therapy?
If you are considering red light therapy, here’s what I would do.
I would get really clear about why you’re pursuing the treatment (wound healing vs deep bone pain), who would administer the treatment (a trained specialist vs standing in a room in a spa), and how it would be administered (evidence-backed device vs red light bulbs from Amazon).
It also very much should matter how much you hurt, what else you’ve tried, what your condition prevents you from doing, and what your budget is. Then it’s just weighing the good and the bad for YOU. The balance of all these factors will be different for each individual.
Takeaways:
The real-world effectiveness of red light therapy remains unclear due to a lack of standardization across current available studies
Red light therapy does show reasonable promise for treating poorly-healing skin wounds
Before embarking on red light therapy, consider the specific condition you are treating, the type of device, who is administering the treatment, and the potential financial risk
I know that this may feel as clear as mud. And you know what? It sort of is.
As much as I’d like to give you a concrete answer, it just isn’t there. This has been one of the hardest things about my medical career - getting used to the discomfort of ambiguity. Even in a field like medicine, there are very few absolutes. And the evidence is always evolving.
This is either the curse or the beauty of the profession, depending on how you look at it.
I hope this empowers you with some of the history and data around where all the laser hype has come from so that you can make the best decision for you. Because at the end of the day, what more could we ask for?
