{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:49:10Z","timestamp":1792406950628,"version":"4.4.0"},"reference-count":175,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Integr. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Low-level laser therapy (LLLT; \u2264 0.5 W) is guideline-recommended in the United States for shallow-tissue oral mucositis and other superficial pathologies but has generally failed in trials for deeper tissue conditions due to limited penetration and subtherapeutic dosing. By contrast, Class IV high-intensity laser therapy (HILT; \u2265 0.5\u201380 W), typically at \u223c100-fold higher power, has proven successful for many of these deeper tissue indications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched PubMed, Google Scholar, and the Cochrane Database for Class IV HILT trials published from 2018 to April 2026, classifying interventions as effective when they showed large effect sizes (Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      &amp;gt; 0.8).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across 105 included studies (\n                      <jats:italic>n<\/jats:italic>\n                      = 2,710 HILT;\n                      <jats:italic>n<\/jats:italic>\n                      = 2,925 controls), no serious adverse events were reported. HILT reduced pain in all randomized trials of knee (\n                      <jats:italic>k<\/jats:italic>\n                      = 27), spine\/neuromuscular (\n                      <jats:italic>k<\/jats:italic>\n                      = 20), shoulder\/arm (\n                      <jats:italic>k<\/jats:italic>\n                      = 20), and wounds (\n                      <jats:italic>k<\/jats:italic>\n                      = 2), with &amp;gt; 90% showing large effect sizes. Additional benefits were observed in disorders of the feet (\n                      <jats:italic>k<\/jats:italic>\n                      = 13), hand\/wrist (\n                      <jats:italic>k<\/jats:italic>\n                      = 8), face\/jaw (\n                      <jats:italic>k<\/jats:italic>\n                      = 7), osteoporosis (\n                      <jats:italic>k<\/jats:italic>\n                      = 2), endometriosis, coronary artery disease, cognitive impairment, fibromyalgia, COVID-19, and obesity. HILT yielded durable analgesia, with large VAS pain reductions at end of treatment, &amp;lt; 3-month, and \u2265 3-month follow-ups (SMD -0.98, -1.18, and -1.01;\n                      <jats:italic>k<\/jats:italic>\n                      = 50, 19, and 21, respectively). Functional outcomes improved consistently, including range of motion (92%;\n                      <jats:italic>k<\/jats:italic>\n                      = 26), functional performance (84%;\n                      <jats:italic>k<\/jats:italic>\n                      = 57), and quality of life (85%;\n                      <jats:italic>k<\/jats:italic>\n                      = 25). Structural and physiological changes were observed, including increased knee cartilage thickness, reduced rotator cuff tear size, weight loss, and improved nerve conduction. Comparative trials showed HILT produced greater pain reduction than LLLT in 13\/13 studies, all with large effect sizes. Mean HILT power was 9.3 W (median 10.0; range 0.5\u201330), and mean power density was 19.5 W\/cm\n                      <jats:sup>2<\/jats:sup>\n                      (median 10; range 0.1\u201352.5).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Class IV high-intensity laser therapy appears effective and safe for durable pain reduction across deep-tissue musculoskeletal pathologies, supporting its recognition in clinical practice and coverage by payers as a valuable therapeutic option. Further multicenter trials are needed to refine treatment protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251021772<\/jats:ext-link>\n                      , identifier CRD420251021772.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnint.2026.1914223","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:03:51Z","timestamp":1789394631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The importance of power in photobiomodulation: a systematic review and meta-analysis of high-intensity laser therapy"],"prefix":"10.3389","volume":"20","author":[{"given":"William Todd","family":"Penberthy","sequence":"first","affiliation":[{"name":"Personalized Health Research Services, LLC","place":["Winter Park, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Vorwaller","sequence":"additional","affiliation":[{"name":"Aspen Lasers, LLC","place":["Lindon, UT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1089\/photob.2022.0116","article-title":"Obesity indices and ventilatory function responses to high-level laser therapy in subjects with abdominal obesity.","volume":"41","author":"Abdelaal","year":"2023","journal-title":"Photobiomodul. 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