Contraindications & Precautions
Important safety information for laser therapy practitioners. Know when NOT to treat and when to exercise additional caution.
Cold laser therapy should never be used over a known or suspected cancer or tumor without oncologist approval, directly into the eyes, on patients receiving immune suppression therapy, over a fetus, over bacterial infections, over pacemakers or implanted electronics, on epilepsy patients, or over medical ports. Additional caution is warranted with children, fever, photosensitivity, light-sensitive medications, sensitive or sunburned skin, coagulation disorders, and tattoos. Metal implants, pins, plates, and plastics are not contraindicated and are safe to treat.
These contraindications have been extracted from professional literature and manufacturer manuals. This is not a comprehensive list: the decision to perform laser therapy is ultimately up to a primary care physician. There may be other contraindications not listed here.
Absolute Contraindications
Do NOT treat in these situations:
Cancer or Tumors
NEVER treat a known or suspected cancer or tumor without approval from an oncologist or primary physician. There is potential that the laser could stimulate cells and promote growth.
Direct Eye Exposure
NEVER look directly into a laser with the naked eye. If the laser is powerful enough, it can cause permanent heat damage to the retina and blindness.
Immune Suppression Therapy
Do NOT treat patients on immune suppression therapy. The light may boost the immune system, which could interfere with their treatment protocol.
Pregnancy (Fetus)
Do NOT treat a fetus. It is not worth the risk given the lack of safety data for developing babies.
Bacterial Infections
Do NOT treat directly over a bacterial infection. The stimulation could potentially spread or worsen the infection.
Internal Electronics
Do NOT treat directly over pacemakers, cochlear implants, or any internal electronic devices. The laser energy could potentially interfere with device function.
Epilepsy
Do NOT treat patients with epilepsy, especially with a pulsing laser. The pulsing light could potentially trigger a seizure.
Medical Ports
Do NOT treat a port. The laser may stimulate cells in a way that could block the port.
Precautions & Warnings
In addition to the absolute contraindications above, these conditions require special care. There is no evidence that damage has been caused by cold lasers in these situations, but it is better to be conservative.
Children & Sensitive Adults
Be careful treating children and sensitive adults. Start with a smaller dosage for the first treatment and monitor response carefully.
Fever
Avoid treating someone with a fever. Wait until the fever has resolved before beginning or resuming treatment.
Photosensitivity & Light-Sensitive Medications
Avoid treating or significantly reduce dosage for patients who may be photosensitive or taking light-sensitive drugs including:
- Thyroid medications
- Retin-A
- Tetracycline
- St. John's Wort
Sensitive Skin
Avoid treating people with sensitive skin, or start with lower dosages and monitor for reactions.
Sunburn or Recent Sun Exposure
Avoid treating any area with sunburn or recent high sun exposure (including tanning booths). The laser can increase reaction in these areas and worsen the sunburn.
Pain or Unusual Reactions
Suspend therapy immediately if the patient is feeling pain from treatment or has any unusual reactions to the therapy.
Coagulation Disorders
Avoid treating anyone with a coagulation disorder. Lasers can increase blood flow, which could result in unexpected consequences for these patients.
Tattoos & Dark Marks
Be careful treating areas with tattoos or other dark marks. Dark ink can absorb all the energy and create a hot spot that might burn the skin. (This is how laser tattoo removal works.)
Areas with Evolving Guidance
The following are listed on some manufacturers' contraindication lists, but there is conflicting information and ongoing research in these areas. Always consult current literature and professional guidance.
Brain Treatment
Some lists say do not treat the brain. However, significant research is being done on laser therapy for brain-related conditions. Dr. Hamblin, author of The Handbook of PhotoMedicine, advocates for using lasers for brain applications. Specialized clinics exist for treating TBI with laser therapy.
Diabetes
Some lists say do not treat someone with diabetes. However, many clinics specialize in treating diabetic neuropathy using lasers to directly address numb and painful areas. Multiple studies show positive results for this application.
Thyroid Gland
Some guidance says avoid using the laser over the thyroid gland. However, some practitioners treat the thyroid specifically to support production. Research exists showing positive results.
Before/During Pregnancy
Standard guidance says avoid treatment before or during pregnancy. Some European practitioners have explored laser use for fertility support, though this is not FDA cleared and should be approached with extreme caution.
NOT Contraindicated
Metal, Pins, Plates & Plastics are Safe to Treat
The following are NOT contraindicated for laser therapy:
- Metal implants
- Surgical pins
- Metal plates
- Plastic implants
- Fabric inserts
These materials do not interact with laser therapy in ways that would cause harm. You can safely treat over these areas.
Quick Reference
Never Treat
- Cancer/tumors (without oncologist approval)
- Eyes (direct exposure)
- Immune-suppressed patients
- Fetus
- Bacterial infections (directly)
- Pacemakers/implanted electronics
- Epilepsy patients
- Medical ports
Use Caution
- Children/sensitive adults
- Patients with fever
- Photosensitive patients
- Light-sensitive medications
- Sensitive skin
- Sunburned areas
- Coagulation disorders
- Tattoos/dark marks
Safe to Treat
- Metal implants
- Surgical pins
- Metal plates
- Plastic implants
- Fabric inserts
Contraindications FAQ
When should cold laser therapy never be used?
Never treat a known or suspected cancer or tumor without oncologist approval, look directly into the laser, treat patients on immune suppression therapy, treat a fetus, treat directly over a bacterial infection, treat over pacemakers or implanted electronics, treat epilepsy patients, or treat a medical port.
Can you use a cold laser over cancer or a tumor?
No. Never treat a known or suspected cancer or tumor without approval from an oncologist or primary physician, because the laser could stimulate cells and promote growth.
Is cold laser therapy safe during pregnancy?
Do not treat a fetus, as there is a lack of safety data for developing babies. Standard guidance is to avoid treatment before or during pregnancy.
Can you treat over metal implants, pins, or plates?
Yes. Metal implants, surgical pins, metal plates, plastic implants, and fabric inserts are not contraindicated and are safe to treat, because these materials do not interact with laser therapy in ways that would cause harm.
What conditions require extra caution with cold laser therapy?
Use caution with children and sensitive adults, patients with a fever, photosensitive patients or those on light-sensitive medications, sensitive or sunburned skin, coagulation disorders, and areas with tattoos or dark marks.
Why avoid treating over tattoos or dark marks?
Dark ink can absorb all the energy and create a hot spot that might burn the skin. This is the same principle behind laser tattoo removal.
Can cold lasers be used on patients with pacemakers?
No. Do not treat directly over pacemakers, cochlear implants, or any internal electronic devices, because the laser energy could interfere with device function.
Questions about specific situations?
If you have questions about treating a specific patient or condition, we're happy to share what guidance exists in the literature.