Cold Laser Therapy for Joint Pain: What the Evidence Shows

Key Takeaways

• Cold laser therapy (LLLT) uses low-intensity light to potentially reduce pain and inflammation
• Research shows modest benefits for knee osteoarthritis and some other conditions
• The treatment is painless and has virtually no side effects
• Results are inconsistent—helps some patients but not others
• Not typically covered by insurance
• Best used as part of a comprehensive treatment plan, not as sole therapy

Cold laser therapy—also known as low-level laser therapy (LLLT) or photobiomodulation—has gained attention as a non-invasive option for joint pain. But does shining light on your joints actually help?

This guide examines what we know about cold laser therapy for arthritis and joint conditions.

What Is Cold Laser Therapy?

The Basics

Cold laser therapy uses specific wavelengths of light to potentially:

• Reduce inflammation
• Decrease pain
• Promote tissue healing
• Improve cellular function

Unlike surgical lasers that cut tissue, cold lasers don’t produce heat and don’t damage tissue—hence “cold” laser.

How It’s Different from Other Light Therapies

Cold laser vs. hot laser:

• Cold laser: Non-thermal, doesn’t cut or burn
• Surgical laser: High-powered, cuts tissue

Cold laser vs. infrared heat:

• Cold laser: Specific wavelengths, low power
• Infrared heat lamps: Broad spectrum, primarily heating effect

The Science (Simplified)

The theory behind cold laser:

1. Light photons penetrate skin and tissues
2. Photons are absorbed by cellular components (especially mitochondria)
3. This stimulates cellular energy production (ATP)
4. Enhanced cellular function promotes healing and reduces inflammation

What Does Research Show?

For Knee Osteoarthritis

Evidence summary:

• Multiple studies show modest pain reduction
• Benefits may last several weeks after treatment
• Better results with appropriate wavelength and dosing
• Not all studies show benefit—technique matters

Cochrane Review findings:

• LLLT can provide short-term relief for knee OA
• Effect sizes are small to moderate
• Optimal treatment parameters not fully established

For Neck Pain

Evidence summary:

• Some positive studies for chronic neck pain
• May reduce pain and improve function
• Evidence quality is moderate

For Rheumatoid Arthritis

Evidence summary:

• Fewer studies available
• Some show reduced morning stiffness
• May help with hand pain and function
• More research needed

For Other Conditions

Tennis elbow:

• Mixed results
• Some studies positive, others not

Temporomandibular (TMJ) disorders:

• Promising results in some studies
• May reduce pain and improve function

Honest Assessment of Evidence

Strengths:

• Multiple studies show benefit for knee OA
• Excellent safety profile
• Non-invasive and painless

Weaknesses:

• Results inconsistent across studies
• Treatment parameters vary widely
• Hard to compare studies
• Effect sizes often small
• Placebo effect difficult to eliminate

The Treatment Experience

What to Expect

Before treatment:

• No special preparation needed
• Wear comfortable clothing
• Remove jewelry from treatment area

During treatment:

• Probe or pad placed on or near the skin
• Treatment area exposed to laser light
• You typically feel nothing or slight warmth
• Sessions last 5-20 minutes
• Multiple treatment points usually addressed

After treatment:

• No downtime
• Resume normal activities immediately
• Some report immediate improvement
• Others notice gradual change over sessions

Treatment Course

Typical protocol:

• 2-3 sessions per week
• 4-12 sessions total
• Reassess after initial course
• May need maintenance sessions

Treatment Settings

Wavelength:

• Typically 600-1000 nanometers
• Different wavelengths penetrate different depths

Power:

• Low-level lasers: 5-500 milliwatts
• Higher-power devices available (Class IV)

Dose:

• Measured in joules
• Optimal dosing still being determined

Types of Devices

Professional Devices

Class III lasers:

• Lower power (up to 500 mW)
• Traditional “cold laser”
• Require multiple treatments
• Most studied type

Class IV lasers:

• Higher power (over 500 mW)
• Deeper penetration claimed
• Faster treatment times
• Less research specifically

Home Devices

Over-the-counter devices:

• Available without prescription
• Much lower power than professional devices
• Limited evidence for effectiveness
• FDA-cleared for temporary pain relief

Considerations:

• May not deliver adequate dose
• Quality varies greatly
• Significantly less powerful than professional units

Safety and Side Effects

Excellent Safety Profile

Cold laser therapy is considered very safe:

• Non-invasive
• No tissue damage
• No ionizing radiation
• No known long-term effects

Rare Side Effects

• Temporary increase in pain (uncommon)
• Mild tingling sensation
• Fatigue after treatment

Precautions

Avoid use on or near:

• Eyes (direct exposure)
• Pregnant abdomen
• Cancer sites
• Active infections
• Over growth plates in children

Discuss with doctor if you have:

• Photosensitivity conditions
• Taking photosensitizing medications
• History of cancer in treatment area

Finding Treatment

Who Provides Cold Laser Therapy?

• Chiropractors (most common)
• Physical therapists
• Sports medicine physicians
• Pain management specialists
• Some orthopedists

Questions to Ask

1. What type of laser do you use?
2. What wavelength and dose settings?
3. How many treatments do you typically recommend?
4. What results have your patients experienced?
5. What is the cost per session and total?

What to Look For

Good indicators:

• Uses specific, documented protocols
• Can explain the treatment clearly
• Realistic about expected outcomes
• Tracks patient results
• Combines with other evidence-based treatments

Concerns:

• Promises dramatic results
• Recommends extensive sessions upfront
• Uses vague descriptions
• Won’t discuss limitations

Cost and Insurance

Typical Costs

• Per session: $30-$100
• Treatment course: $200-$800
• Home devices: $50-$500+

Insurance Coverage

• Generally NOT covered by most insurance
• Some exceptions exist
• Workers’ compensation may cover
• HSA/FSA may be usable

Cost-Effectiveness Considerations

• Lower cost per session than many treatments
• Multiple sessions required
• Consider total cost of full course
• Compare to alternatives

Combining with Other Treatments

Works Well With

• Physical therapy exercises
• Manual therapy
• Heat and ice
• Topical treatments
• Oral medications

May Enhance

• Exercise programs
• Joint mobility work
• Other physical modalities

Not a Replacement For

• Proper diagnosis
• Exercise program
• Weight management (if applicable)
• Standard medical care

Who Might Benefit?

Potentially Good Candidates

• Mild to moderate osteoarthritis
• Chronic joint or muscle pain
• Looking for non-invasive options
• Want to minimize medications
• Can afford out-of-pocket cost
• Have realistic expectations

Probably Not Ideal For

• Severe, end-stage arthritis
• Acute injuries requiring other treatment
• Those expecting dramatic results
• Budget constraints (insurance won’t cover)
• Those unwilling to try multiple sessions

Home Laser Devices

FDA-Cleared Devices

Several home laser/LED devices are FDA-cleared for:

• Temporary relief of minor pain
• Muscle relaxation
• Increased local blood circulation

Reality Check

Compared to professional devices:

• Much lower power
• Less evidence for effectiveness
• May help modestly
• Lower cost but lower intensity

If considering:

• Check for FDA clearance
• Read reviews critically
• Understand limitations
• Consider professional treatment first

Frequently Asked Questions

Does cold laser therapy hurt?

No. You typically feel nothing, or perhaps a slight warmth. There’s no cutting, burning, or significant sensation. This makes it appropriate for people who are sensitive or anxious about other treatments.

How many sessions will I need?

Typically 6-12 sessions over 2-4 weeks for an initial course. Some people notice improvement within a few sessions, while others need the full course. Maintenance sessions may be recommended.

Can I use cold laser therapy along with my other treatments?

Yes. Cold laser is often used alongside exercise, manual therapy, and medications. It doesn’t interact with drugs or interfere with other treatments. Discuss with your provider to integrate it appropriately.

Why isn’t cold laser therapy more mainstream?

Despite positive studies, inconsistent results and challenges in standardizing treatment have limited acceptance. Insurance coverage remains rare. It’s used more widely in sports medicine and chiropractic settings than traditional medical practices.

Is the home device as good as professional treatment?

Generally no. Home devices use lower power and may not deliver adequate therapeutic doses. They might provide modest benefit for some people, but professional treatment offers more controlled, higher-intensity therapy.

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Exploring treatment options? Learn about TENS units for joint pain or read about physical therapy approaches.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only. Cold laser therapy should be considered as part of a comprehensive treatment plan. Discuss options with your healthcare provider.