A Structured Clinical Decision-Making Methodology for Parameter Prescription in Photobiomodulation Therapy: The SMAP-PBM Framework

A Structured Clinical Decision-Making Methodology for Parameter Prescription in Photobiomodulation Therapy: The SMAP-PBM Framework | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Structured Clinical Decision-Making Methodology for Parameter Prescription in Photobiomodulation Therapy: The SMAP-PBM Framework ADRIANA SCHAPOCHNIK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9191871/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Photobiomodulation therapy (PBM) is increasingly used across medical and rehabilitation fields; however, parameter prescription remains inconsistent and frequently protocol-based. The absence of a structured clinical reasoning model integrating biological targets, tissue optics, and dosimetry contributes to heterogeneous clinical outcomes and limited reproducibility. This article proposes a translational therapeutic decision-making methodology and introduces the SMAP-PBM framework (System for Mapping and Analysis of Parameters in Photobiomodulation). The model organizes PBM prescription into sequential analytical phases and independent classification domains linking pathophysiology to optical and dosimetric selection. The framework establishes a hierarchical reasoning pathway in which parameter definition becomes a consequence of tissue identification and therapeutic mechanism rather than device selection or protocol replication. The SMAP-PBM approach provides a teachable and reproducible model for PBM prescription and may assist clinical standardization, professional training, and the design of controlled trials. Prospective clinical validation is required. photobiomodulation therapy dosimetry light-tissue interaction therapeutic planning clinical reasoning laser therapy Figures Figure 1 1. Introduction Photobiomodulation therapy (PBM) refers to the therapeutic use of non-thermal light sources, typically within the red (600–700 nm) and near-infrared (780–1100 nm) spectral ranges, aimed at modulating biological processes. Its application has expanded consistently across medicine, dentistry, physiotherapy, speech-language pathology, and nursing, with potential for progressive incorporation into other healthcare fields. [ 1 ]. Experimental evidence demonstrates that PBM acts primarily through photon absorption by mitochondrial chromophores, especially cytochrome c oxidase, leading to increased ATP production, nitric oxide photodissociation, modulation of reactive oxygen species, and activation of transcription pathways related to tissue repair and inflammation control [ 2 , 3 , 4 ]. Despite advances in mechanistic understanding, clinical PBM application remains inconsistent. Many clinicians rely on pre-established protocols, wavelength tables, or device-specific recommendations. However, PBM is not a single-parameter therapy but a multi-variable biological intervention in which wavelength, fluence, and irradiation geometry interact with tissue optical properties [ 5 , 6 , 7 , 8 ]. A fundamental problem in PBM practice is that parameter selection frequently begins with the device rather than the biological target. Consequently, identical irradiation parameters are often applied to different tissues and mechanisms, which may explain variability observed in clinical trials and systematic reviews [ 9 , 10 , 11 ]. To address this gap, this article proposes a structured therapeutic decision-making methodology and introduces the SMAP-PBM framework. 2. Methods A conceptual translational framework was developed by integrating principles of photobiology, tissue optics, and clinical therapeutic reasoning. The model was constructed based on analysis of established PBM mechanisms, optical penetration characteristics, and clinical treatment-planning logic used in medical decision-making. [ 12 ]. 3. Photobiological and Optical Foundations Cytochrome c oxidase functions as a photoacceptor within red and near-infrared wavelengths. Photon absorption increases mitochondrial membrane potential and oxidative phosphorylation, elevating ATP availability and modulating cellular signaling pathways [ 2 , 4 ]. PBM follows a biphasic dose response: insufficient photon delivery produces no biological effect, whereas excessive energy may inhibit cellular response [ 13 ]. 4. SMAP-PBM Framework The SMAP-PBM operationalizes clinical reasoning into sequential analytical phases and independent classification domains. (Tabela 1) Table 1 SMAP-PBM Framework: Structured Clinical Decision-Making Phases Phase Domain Description Phase 1 Clinical Condition Identification Characterization of the clinical presentation, including diagnosis, symptom behavior, functional limitation, and chronicity. Phase 2 Biological Target Definition Identification of the primary tissue involved: epithelium, muscle, tendon/ligament, peripheral nerve, joint structures, glandular tissue, or central nervous system. Phase 3 Predominant Biological Mechanism Determination of the main therapeutic objective: inflammatory modulation, nociceptive modulation, tissue repair, neuromodulation, muscle performance enhancement, or edema control. Phase 4 Optical Requirement Definition of tissue depth and optical classification: ≤5 mm (Superficial); 5–20 mm (Intermediate); >20 mm (Deep). This phase guides wavelength selection. Phase 5 Parameter Configuration Determination of irradiation parameters based on prior phases: wavelength, power, irradiation time, energy per point, emission mode, and application technique. Outcome Therapeutic Outcome Integration of all phases leading to biologically guided parameter selection and targeted photobiomodulation. 5. Clinical Application Example: Temporomandibular Disorders (TMD) Temporomandibular disorders involve muscles, joint structures, and neural components and have been widely studied in PBM with heterogeneous results. Myogenous TMD Clinical identification: muscular pain during mastication. Biological target: masseter and temporalis muscle fibers. Mechanism: inflammatory modulation and metabolic recovery. Optical requirement: intermediate depth (~ 10–15 mm). Implication: near-infrared wavelengths provide more effective photon delivery than superficial red wavelengths. Parameters therefore become a consequence of tissue mapping rather than protocol replication. 6. Discussion The SMAP-PBM framework shifts PBM prescription from protocol replication to biologically guided reasoning. PBM clinical trials frequently apply identical irradiation parameters to heterogeneous pathologies. 7. Limitations This article presents a conceptual and translational methodology. Clinical validation is required. 8. Conclusion The SMAP-PBM framework introduces a structured therapeutic decision-making methodology integrating biological targets, tissue optics, and dosimetry. Abbreviations PBM Photobiomodulation Therapy SMAP PBM–System for Mapping and Analysis of Parameters in Photobiomodulation ATP Adenosine Triphosphate TMD Temporomandibular Disorders Declarations Funding This research received no external funding. Ethics Approval Not applicable. This study does not involve human participants or animal experimentation. Author Contribution The author confirms sole responsibility for the following: conceptualization, methodology, investigation, data curation, formal analysis, writing – original draft, writing – review & editing, and supervision. References Arany PR (2016) Photobiomodulation therapy: from basic science to clinical translation. J Dent Res 95(9):977–984. https://doi.org/10.1177/0022034516651445 Karu TI (2010) Mitochondrial signaling in mammalian cells activated by red and near-infrared radiation. Photochem Photobiol 86(2):345–351. https://doi.org/10.1111/j.1751-1097.2009.00687.x Hamblin MR (2017) Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys 4(3):337–361. https://doi.org/10.3934/biophy.2017.3.337 de Freitas LF, Hamblin MR (2016) Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron 22(3):7000417. https://doi.org/10.1109/JSTQE.2016.2561201 Hamblin MR (2016) Photobiomodulation or low-level laser therapy. J Biophotonics 9(11–12):1122–1124. https://doi.org/10.1002/jbio.201670113 Jacques SL (2013) Optical properties of biological tissues: a review. Phys Med Biol 58(11):R37–R61. https://doi.org/10.1088/0031-9155/58/11/R37 Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40(2):516–533. https://doi.org/10.1007/s10439-011-0454-7 Ash C, Dubec M, Donne K, Bashford T (2017) Effect of wavelength and beam width on penetration in light-tissue interaction. Lasers Med Sci 32(8):1909–1918. https://doi.org/10.1007/s10103-017-2317-4 Anders JJ, Lanzafame RJ, Arany PR (2014) Low-level light/laser therapy versus photobiomodulation therapy. Photomed Laser Surg 32(4):183–184. https://doi.org/10.1089/pho.2014.9848 Jacques SL (2013) Optical properties of biological tissues: a review. Phys Med Biol 58(11):R37–R61. https://doi.org/10.1088/0031-9155/58/11/R37 Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD (2010) Low level laser treatment of tendinopathy: a systematic review. Phys Ther Sport 11(1):54–65. https://doi.org/10.1016/j.ptsp.2009.10.002 World Association for Laser Therapy (WALT) Recommended treatment doses for low level laser therapy. Available at: https://waltpbm.org Huang YY, Chen AC, Carroll JD, Hamblin MR (2009) Biphasic dose response in low level light therapy. Dose Response 7(4):358–383. https://doi.org/10.2203/dose-response.09-027.Hamblin Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 May, 2026 Reviews received at journal 29 Apr, 2026 Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 12 Apr, 2026 Editor assigned by journal 12 Apr, 2026 Submission checks completed at journal 10 Apr, 2026 First submitted to journal 22 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9191871","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":624294495,"identity":"211f339a-4827-4edb-9325-224026cd472e","order_by":0,"name":"ADRIANA SCHAPOCHNIK","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABHklEQVRIiWNgGAWjYFCCBIYDYFoCTB5gYONhBglIyJCihS0BxOXBp4UBRQsDD48BiIVTC3977sMDP3fY2fPPbn724EPNnTw+njOfX92oseBhYD98dAMWLRJnnhsc7D2TnDjjzjFzwxnHnhWz8fZus845BnQYT1raDWzW3EhjOMDbxpxgIJFgJs3bcDixjZ93m3EOG1CLBI8ZNi3yQC0H/7bV2xtIpH+DauF5ZpzzD7cWA6CWw7xthxk3SORAbeHtYX6c24Zbi+GZZwyHZduOJ864kVMO9AtQC88xM+bcPgkeNhx+kTuexvzxbVu1Pf+M9G3AEDucOL8n+fHnnG91cvzsh49h9T4SYIMzJFC4xGhh/kCE6lEwCkbBKBg5AAAyG2fARbAvOwAAAABJRU5ErkJggg==","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":true,"prefix":"","firstName":"ADRIANA","middleName":"","lastName":"SCHAPOCHNIK","suffix":""}],"badges":[],"createdAt":"2026-03-22 14:23:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9191871/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9191871/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107319605,"identity":"41da0759-42be-4ead-9d31-4e93d2318e75","added_by":"auto","created_at":"2026-04-20 10:17:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1344028,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSMAP-FBM Clinical Classification Framework\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9191871/v1/d864158e2a391022198c4883.png"},{"id":107484982,"identity":"6d6c5292-1509-4243-be00-d63d068363f1","added_by":"auto","created_at":"2026-04-22 02:33:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1222364,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9191871/v1/a39890ec-033b-4ed6-bbb4-5ce350f0c288.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Structured Clinical Decision-Making Methodology for Parameter Prescription in Photobiomodulation Therapy: The SMAP-PBM Framework","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePhotobiomodulation therapy (PBM) refers to the therapeutic use of non-thermal light sources, typically within the red (600\u0026ndash;700 nm) and near-infrared (780\u0026ndash;1100 nm) spectral ranges, aimed at modulating biological processes. Its application has expanded consistently across medicine, dentistry, physiotherapy, speech-language pathology, and nursing, with potential for progressive incorporation into other healthcare fields. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExperimental evidence demonstrates that PBM acts primarily through photon absorption by mitochondrial chromophores, especially cytochrome c oxidase, leading to increased ATP production, nitric oxide photodissociation, modulation of reactive oxygen species, and activation of transcription pathways related to tissue repair and inflammation control [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite advances in mechanistic understanding, clinical PBM application remains inconsistent. Many clinicians rely on pre-established protocols, wavelength tables, or device-specific recommendations. However, PBM is not a single-parameter therapy but a multi-variable biological intervention in which wavelength, fluence, and irradiation geometry interact with tissue optical properties [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA fundamental problem in PBM practice is that parameter selection frequently begins with the device rather than the biological target. Consequently, identical irradiation parameters are often applied to different tissues and mechanisms, which may explain variability observed in clinical trials and systematic reviews [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address this gap, this article proposes a structured therapeutic decision-making methodology and introduces the SMAP-PBM framework.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eA conceptual translational framework was developed by integrating principles of photobiology, tissue optics, and clinical therapeutic reasoning. The model was constructed based on analysis of established PBM mechanisms, optical penetration characteristics, and clinical treatment-planning logic used in medical decision-making. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e"},{"header":"3. Photobiological and Optical Foundations","content":"\u003cp\u003eCytochrome c oxidase functions as a photoacceptor within red and near-infrared wavelengths. Photon absorption increases mitochondrial membrane potential and oxidative phosphorylation, elevating ATP availability and modulating cellular signaling pathways [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePBM follows a biphasic dose response: insufficient photon delivery produces no biological effect, whereas excessive energy may inhibit cellular response [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e"},{"header":"4. SMAP-PBM Framework","content":"\u003cp\u003eThe SMAP-PBM operationalizes clinical reasoning into sequential analytical phases and independent classification domains. (Tabela 1)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSMAP-PBM Framework: Structured Clinical Decision-Making Phases\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical Condition Identification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCharacterization of the clinical presentation, including diagnosis, symptom behavior, functional limitation, and chronicity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiological Target Definition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIdentification of the primary tissue involved: epithelium, muscle, tendon/ligament, peripheral nerve, joint structures, glandular tissue, or central nervous system.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredominant Biological Mechanism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDetermination of the main therapeutic objective: inflammatory modulation, nociceptive modulation, tissue repair, neuromodulation, muscle performance enhancement, or edema control.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOptical Requirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDefinition of tissue depth and optical classification: \u0026le;5 mm (Superficial); 5\u0026ndash;20 mm (Intermediate); \u0026gt;20 mm (Deep). This phase guides wavelength selection.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParameter Configuration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDetermination of irradiation parameters based on prior phases: wavelength, power, irradiation time, energy per point, emission mode, and application technique.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTherapeutic Outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegration of all phases leading to biologically guided parameter selection and targeted photobiomodulation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"5. Clinical Application Example: Temporomandibular Disorders (TMD)","content":"\u003cp\u003eTemporomandibular disorders involve muscles, joint structures, and neural components and have been widely studied in PBM with heterogeneous results.\u003c/p\u003e \u003cp\u003eMyogenous TMD\u003c/p\u003e \u003cp\u003eClinical identification: muscular pain during mastication.\u003c/p\u003e \u003cp\u003eBiological target: masseter and temporalis muscle fibers.\u003c/p\u003e \u003cp\u003eMechanism: inflammatory modulation and metabolic recovery.\u003c/p\u003e \u003cp\u003eOptical requirement: intermediate depth (~\u0026thinsp;10\u0026ndash;15 mm).\u003c/p\u003e \u003cp\u003eImplication: near-infrared wavelengths provide more effective photon delivery than superficial red wavelengths.\u003c/p\u003e \u003cp\u003eParameters therefore become a consequence of tissue mapping rather than protocol replication.\u003c/p\u003e"},{"header":"6. Discussion","content":"\u003cp\u003eThe SMAP-PBM framework shifts PBM prescription from protocol replication to biologically guided reasoning. PBM clinical trials frequently apply identical irradiation parameters to heterogeneous pathologies.\u003c/p\u003e"},{"header":"7. Limitations","content":"\u003cp\u003eThis article presents a conceptual and translational methodology. Clinical validation is required.\u003c/p\u003e"},{"header":"8. Conclusion","content":"\u003cp\u003eThe SMAP-PBM framework introduces a structured therapeutic decision-making methodology integrating biological targets, tissue optics, and dosimetry.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhotobiomodulation Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSMAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePBM\u0026ndash;System for Mapping and Analysis of Parameters in Photobiomodulation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eATP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdenosine Triphosphate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTemporomandibular Disorders\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e \u003cp\u003eEthics Approval\u003c/p\u003e \u003cp\u003eNot applicable. This study does not involve human participants or animal experimentation.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe author confirms sole responsibility for the following: conceptualization, methodology, investigation, data curation, formal analysis, writing \u0026ndash; original draft, writing \u0026ndash; review \u0026amp; editing, and supervision.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArany PR (2016) Photobiomodulation therapy: from basic science to clinical translation. J Dent Res 95(9):977\u0026ndash;984. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0022034516651445\u003c/span\u003e\u003cspan address=\"10.1177/0022034516651445\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaru TI (2010) Mitochondrial signaling in mammalian cells activated by red and near-infrared radiation. Photochem Photobiol 86(2):345\u0026ndash;351. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1751-1097.2009.00687.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1751-1097.2009.00687.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamblin MR (2017) Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. 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Phys Ther Sport 11(1):54\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ptsp.2009.10.002\u003c/span\u003e\u003cspan address=\"10.1016/j.ptsp.2009.10.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Association for Laser Therapy (WALT) Recommended treatment doses for low level laser therapy. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://waltpbm.org\u003c/span\u003e\u003cspan address=\"https://waltpbm.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang YY, Chen AC, Carroll JD, Hamblin MR (2009) Biphasic dose response in low level light therapy. Dose Response 7(4):358\u0026ndash;383. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2203/dose-response.09-027.Hamblin\u003c/span\u003e\u003cspan address=\"10.2203/dose-response.09-027.Hamblin\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"photobiomodulation therapy, dosimetry, light-tissue interaction, therapeutic planning, clinical reasoning, laser therapy","lastPublishedDoi":"10.21203/rs.3.rs-9191871/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9191871/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePhotobiomodulation therapy (PBM) is increasingly used across medical and rehabilitation fields; however, parameter prescription remains inconsistent and frequently protocol-based. The absence of a structured clinical reasoning model integrating biological targets, tissue optics, and dosimetry contributes to heterogeneous clinical outcomes and limited reproducibility.\u003c/p\u003e \u003cp\u003eThis article proposes a translational therapeutic decision-making methodology and introduces the SMAP-PBM framework (System for Mapping and Analysis of Parameters in Photobiomodulation). The model organizes PBM prescription into sequential analytical phases and independent classification domains linking pathophysiology to optical and dosimetric selection.\u003c/p\u003e \u003cp\u003eThe framework establishes a hierarchical reasoning pathway in which parameter definition becomes a consequence of tissue identification and therapeutic mechanism rather than device selection or protocol replication.\u003c/p\u003e \u003cp\u003eThe SMAP-PBM approach provides a teachable and reproducible model for PBM prescription and may assist clinical standardization, professional training, and the design of controlled trials. Prospective clinical validation is required.\u003c/p\u003e","manuscriptTitle":"A Structured Clinical Decision-Making Methodology for Parameter Prescription in Photobiomodulation Therapy: The SMAP-PBM Framework","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 10:17:52","doi":"10.21203/rs.3.rs-9191871/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T01:51:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T15:14:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T09:13:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233238782128904905795391297418862642763","date":"2026-04-28T14:28:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T07:14:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335321858888375611081017609245199128847","date":"2026-04-20T06:58:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32843489773356802007095150669020016071","date":"2026-04-13T16:56:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T02:53:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T02:52:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T11:27:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Lasers in Medical Science","date":"2026-03-22T14:18:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3190d4c3-442f-4b8f-b63c-9c508e15700d","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T01:51:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T15:14:06+00:00","index":65,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T09:13:12+00:00","index":64,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T23:53:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 10:17:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9191871","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9191871","identity":"rs-9191871","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}