Peripheral Neuropathy

Non-Drug Options for Nerve Pain: How MLS Laser and Shockwave Therapy Can Help Peripheral Neuropathy

Peripheral neuropathy – the burning, tingling, numbness, and shooting pain that comes from damage to the nerves outside the brain and spinal cord – is one of the most stubborn conditions we treat. It can stem from diabetes, autoimmune disease, chemotherapy, radiation, physical trauma, or nerve compression, and it often responds poorly to the medications typically prescribed for it. Gabapentin, pregabalin, duloxetine, and similar drugs help some patients, but many are left with only partial relief and a list of side effects like drowsiness, dizziness, weight gain, and cognitive fog.

That gap is exactly why interest has grown in regenerative, non-pharmacologic modalities – treatments that aim to calm the nerve, improve its blood supply, and support its repair rather than simply masking the pain signal. Two of the most promising are MLS® laser therapy (photobiomodulation) and extracorporeal shockwave therapy (ESWT), in both its radial and focused forms.

Below, we explain how each works, what the research shows, and where they fit for the more difficult categories of nerve injury, including chemotherapy-induced and radiation-induced peripheral neuropathy.

What Is Peripheral Neuropathy, and Why Is It So Hard to Treat?

Peripheral nerves are living tissue. They need a steady oxygen and nutrient supply from tiny blood vessels (the vasa nervorum), a healthy support network of Schwann cells to maintain their insulating myelin, and a low-inflammation environment to function. When any of those break down, the nerve misfires: pain that isn’t warranted, numbness where there should be sensation, and weakness or balance problems.

The trouble with pills is that they act on the symptom – the pain signal – without addressing the underlying nerve environment. MLS laser and shockwave therapy are attractive precisely because their proposed mechanisms target that environment: circulation, inflammation, and the nerve’s own repair machinery.

MLS Laser Therapy (Photobiomodulation)

How it works

MLS stands for Multiwave Locked System, a patented, FDA-cleared Class IV laser technology developed by ASA Laser. Unlike single-wavelength lasers, MLS synchronizes two infrared wavelengths in a single pulse:

• 808 nm (continuous emission) — targets inflammation and swelling (anti-inflammatory and anti-edemic effects), in part by improving local blood flow and lymphatic drainage. This wavelength also falls near a secondary absorption peak of cytochrome c oxidase, the mitochondrial enzyme that drives ATP (cellular energy) production.
• 905 nm (pulsed/superpulsed emission) — targets pain (analgesic effect) by dampening pain signaling at the nerve level and reaching deeper tissue without generating heat.

The manufacturer’s premise, supported by laboratory and clinical work, is that combining and synchronizing these two emissions produces a synergistic effect greater than either wavelength alone, while keeping the safety profile closer to a low-level laser than a conventional high-power Class IV device. In practical terms, this is a light-based treatment that aims to reduce inflammation, improve circulation, and support nerve cell metabolism and repair.

What the research shows

Diabetic peripheral neuropathy. A randomized, placebo-controlled trial by Yosifova and colleagues (published in the Journal of IMAB, 2023) treated 69 patients with type 2 diabetes and painful diabetic neuropathy using an MLS (M6 robotic laser) protocol of 9 sessions over 3 weeks. The MLS group saw neuropathic pain fall by roughly 63%, compared with about 13% in the placebo group, and the benefit largely persisted at follow-up (a ~56% reduction versus a slight increase in the placebo arm). The study also reported improvements in vibration, touch, and temperature sensitivity. Separately, a double-masked, sham-controlled trial of deep-tissue laser therapy in older adults with painful diabetic neuropathy found significant reductions in pain and improvements in quality of life.

General and painful peripheral neuropathy. Across multiple randomized and sham-controlled studies, photobiomodulation has repeatedly outperformed placebo for neuropathic pain, with a strong safety record and essentially no serious adverse events.

What a session is like

MLS treatment is non-invasive, drug-free, and painless. Patients typically feel a gentle warmth. Sessions are short — often around 10 minutes — with no downtime, so patients return to normal activity immediately. A course of several sessions is standard, and many patients begin noticing changes within the first few treatments.

Extracorporeal Shockwave Therapy (Radial and Focused)

How it works

Shockwave therapy delivers acoustic pressure waves into tissue. There are two main types, and a well-equipped practice uses them for different purposes:

• Radial shockwave (rESWT): lower-intensity, less penetrating waves that disperse from the applicator tip. Excellent for broader, more superficial areas — for example, treating the plantar surface of the feet and lower legs in stocking-glove neuropathy.
• Focused shockwave (fESWT): higher-energy waves concentrated at a specific depth. Better for reaching deeper, more precisely targeted structures, including nerves and nerve compression points.

The mechanisms relevant to nerve health are where this gets interesting. Research — largely from animal models and mechanistic studies — indicates that low-intensity shockwave therapy:

• Stimulates neovascularization (new blood vessel formation), partly by upregulating VEGF, improving oxygen and nutrient delivery to nerve tissue.
• Activates Schwann cells, the cells responsible for myelinating and nutritionally supporting axons — a central player in peripheral nerve repair.
• Increases neurotrophic factors (such as BDNF) that promote axon regrowth and myelination.
• Reduces inflammatory markers like IL-1β and IL-6 in damaged nerve tissue.

A 2024 systematic review and meta-analysis in Frontiers in Neurology examined ESWT’s effect on nerve conduction and found supportive evidence for its role in peripheral nerve recovery, alongside its long-established use in musculoskeletal medicine.

What the research shows

Shockwave’s strongest clinical evidence in the nerve space comes from entrapment neuropathies. For carpal tunnel syndrome, a prospective, randomized, single-blind, placebo-controlled trial found that a three-session radial shockwave protocol produced significant, durable improvement in symptom scores (Boston Carpal Tunnel Questionnaire) out to at least 14 weeks, with a cumulative benefit from repeated sessions and larger gains in moderate cases. Shockwave is also well validated for a range of painful musculoskeletal conditions that frequently coexist with neuropathy.

What a session is like

Patients are positioned comfortably while the clinician applies the shockwave applicator to the affected areas — typically the feet, ankles, and lower legs for lower-limb neuropathy. Most describe the sensation as a gentle tapping or pulsing. No anesthesia is required, and there is no recovery downtime.

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

CIPN deserves special attention because it is common, disabling, and notoriously undertreated. It affects a large share of patients treated with taxanes (paclitaxel, docetaxel), platinum agents (cisplatin, oxaliplatin), vinca alkaloids, and bortezomib — with incidence estimates as high as 68% in the first month after certain regimens, and 30–40% of patients left with chronic symptoms long after treatment ends. Symptoms typically appear in a stocking-glove pattern: numbness, tingling, burning pain, and temperature sensitivity in the hands and feet. Beyond the discomfort, CIPN raises fall risk, disrupts sleep, and can force dose reductions or early discontinuation of life-saving chemotherapy.

The critical clinical problem: there are no FDA-approved treatments to prevent or cure CIPN. Duloxetine is the only agent with meaningful supporting evidence for painful CIPN in oncology guidelines, and its benefit is modest. This is exactly the vacuum that light- and acoustic-based therapies are being studied to fill.

The photobiomodulation evidence for CIPN

This is where laser therapy has some of its most encouraging data:

• Argenta et al. (2017), a randomized, double-blinded, sham-controlled, cross-over trial of 70 patients with CIPN, found that photobiomodulation produced a significant reduction in neuropathy symptoms (modified Total Neuropathy Score) while sham treatment did not. The authors concluded photobiomodulation is an effective, low-toxicity treatment for CIPN.
• Teng et al. (2022), a randomized phase II sham-controlled trial published in Supportive Care in Cancer, evaluated laser photobiomodulation in cancer survivors with established CIPN persisting at least 3 months after chemotherapy.
• The NEUROLASER trial (2022) examined photobiomodulation for the prevention of CIPN in breast cancer patients undergoing chemotherapy and reported promising results, with better preserved quality of life and function in the treated group.
• The NEUROLIGHT trial specifically used the Class IV MLS® M6 laser to study photobiomodulation for CIPN management — one of the clearest examples of MLS being investigated in this exact population.

Taken together, the CIPN literature suggests photobiomodulation can meaningfully reduce symptom severity and, potentially, help protect nerves during treatment, with an excellent safety profile and no reported serious adverse events in these studies.

Where shockwave fits for CIPN

Shockwave therapy for CIPN is at an earlier, more exploratory stage. Its documented ability to activate Schwann cells, boost nerve blood supply, and reduce neuroinflammation makes it a mechanistically logical candidate, and it is being discussed in the rehabilitation literature as an adjunct, often to reduce pain enough that patients can participate in the exercise and rehabilitation that also help CIPN. Robust randomized trials specific to CIPN are still needed.

Radiation-Induced Peripheral Neuropathy (RIPN)

Radiation-induced peripheral neuropathy, most often seen as radiation-induced brachial plexopathy (RIBP) after treatment for breast, lung, or head-and-neck cancers or lymphoma, is rarer than CIPN (incidence roughly 1–3% depending on technique and dose, generally above 50–55 Gy) but can be progressive and severe. Its underlying mechanism is different: radiation causes microvascular damage and progressive fibrosis around the nerve, leading to ischemia (loss of blood supply), demyelination, and axonal injury, often years after the original treatment.

We want to be straightforward here: treatment options for RIPN are limited across the board, and the evidence for laser and shockwave specifically is thin. Major reviews note that despite decades of progress in nerve surgery, no clearly effective intervention reliably halts RIBP’s progression, and management is largely aimed at controlling pain and preserving function.

That said, the mechanistic targets of these therapies line up with what drives RIPN:

• Because RIPN is fundamentally a problem of microvascular damage and fibrosis, therapies that promote neovascularization and improve local blood flow (shockwave) and that reduce inflammation and support cellular energy metabolism (MLS laser) are biologically rational candidates for symptom relief and tissue support.
• Shockwave’s well-documented anti-fibrotic and pro-angiogenic effects in other tissues are a particularly interesting fit given that radiation-induced fibrosis is the core culprit.

Why We Often Combine Modalities

MLS laser and shockwave therapy work through different but complementary mechanisms. Laser excels at calming inflammation and quieting pain signaling at the cellular level; shockwave excels at stimulating circulation and the nerve’s structural repair processes. Used together and alongside optimal medical management of the underlying cause (blood sugar control in diabetes, coordination with oncology in cancer survivors), physical therapy, and appropriate medications form part of a multimodal approach designed to treat the nerve, not just the pain.

Both share the qualities that make them appealing for people who are tired of medication side effects:

• Non-invasive: no needles, no surgery
• Drug-free: no systemic side effects, no sedation
• Well-tolerated: minimal to no discomfort, no downtime
• Strong safety profile: serious adverse events are rare to nonexistent in the published trials

The Bottom Line

Peripheral neuropathy is a frustrating condition, and no single treatment works for everyone. What we can say, grounded in the current evidence, is this:

• For diabetic and general painful neuropathy, photobiomodulation (including MLS laser) has solid randomized-trial support for reducing pain and improving sensation.
• For chemotherapy-induced neuropathy, where there are essentially no approved treatments, photobiomodulation has some of the most encouraging clinical data available – with MLS lasers featured in the research – and shockwave is a mechanistically promising adjunct.
• For radiation-induced neuropathy, where all options are limited, these therapies are reasonable, safe, symptom-focused additions rather than proven cures.
• For entrapment neuropathies like carpal tunnel, shockwave has good randomized evidence.

If you’re living with nerve pain, numbness, or tingling, especially if medications haven’t given you the relief you need, we’d welcome the chance to evaluate your specific situation and discuss whether MLS laser, radial or focused shockwave therapy, or a combination might help.

This article is for educational purposes and does not constitute medical advice. Peripheral neuropathy has many causes, some of them serious, and treatment should always be individualized.

 

Selected References

• Yosifova L, Vladeva E, Siderova M. Effects of MLS-Laser on neuropathic pain in diabetic sensomotor neuropathy. Journal of IMAB. 2023;29(3):5079–5084.
• Argenta PA, et al. The effect of photobiomodulation on chemotherapy-induced peripheral neuropathy: A randomized, sham-controlled clinical trial. Gynecologic Oncology. 2017;144(1):159–166.
• Teng C, et al. Evaluating laser photobiomodulation for chemotherapy-induced peripheral neuropathy: a randomised phase II trial. Supportive Care in Cancer. 2022;31(1):52.
• NEUROLASER trial — The use of photobiomodulation therapy for the prevention of chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled pilot trial. (ClinicalTrials.gov NCT03391271)
• NEUROLIGHT trial — Evaluating the efficacy of photobiomodulation therapy in the management of chemotherapy-induced peripheral neuropathy: a pilot trial (using the Class IV MLS® M6 laser). Lasers in Medical Science. 2026.
• Wu Y-T, et al. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial. Journal of Orthopaedic Research. 2016;34(6):977–984.
• Effect of extracorporeal shock wave therapy on nerve conduction: a systematic review and meta-analysis. Frontiers in Neurology. 2024.
• Molecular Mechanism of Action of Low-Intensity Extracorporeal Shockwave Therapy for Regenerating Peripheral Nerves. (Schwann cell activation, neurotrophic factors, VEGF).
• Gu B, et al. Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, and Treatment Options. Journal of Hand Surgery Global Online. 2025.
• Loprinzi CL, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. Journal of Clinical Oncology. 2020;38:3325–3348.